Quite often we’ve found that when people are closer to home their risk factors reduce. They are nearer their social network, their care-givers and local mental health teams. These factors are also significant in improving their mental wellbeing and could reduce the time they need care in hospital,”

Anne Forbes, Dr Jason Fee: South West Regional Secure Services

Community forensic mental health care service pilot

New Care Models for mental health aims to bring patients closer to home and help them maintain a better connection with their families and friends. In the South West, new services were launched in April 2017 for people detained under the Mental Health Act who have severe mental health issues. These services, the South West Regional Secure Services, are part of the New Care Models for mental health, an innovative partnership between the NHS, the independent sector and communities. They focus on improving patients’ mental health and quality of life.

This case study focuses on Devon Partnership NHS Trust, which was selected by NHS England as one of the pilot sites for secure care in the region. The community forensic trial at Devon Partnership began in April 2018 and the NHS trust’s teams are being trained and supported to develop the values, behaviours and skills required to deliver this new service. This activity has involved recruiting to the community mental health teams, working with housing providers and reviewing the cases of people receiving secure care. The pilot will benefit adult patients in Devon and there are two additional teams covering Somerset and Cornwall.

Anne Forbes is the trust’s Programme Director for New Care Models and is responsible for directing the transformation programme on behalf of South West Regional Secure Services. She said: “Through our community forensic mental healthcare service we want to make sure people are safely and appropriately stepped through the levels of secure care. That will enable us to repatriate more people back into the region where they can be cared for closer to home. From the person’s point of view, they will be integrated back into society in a more timely and meaningful way – feel part of it, see their family and friends.”

Those aspirations for the patient recovery and wellbeing are true to the ambitions of the Five Year Forward View for Mental Health, Anne explains, which aims to improve the mental health care pathway through the New Care Models programme. This programme brings patients closer to home so they can better connect with their families and friends and improve interaction with services. It also aims to reduce unnecessary admissions to hospital and out-of-area placements.

Alongside two other community forensic mental health care service trial sites, Devon Partnership NHS Trust is taking part in events, webinars and teleconferences to support teams’ learning, and share good practice. The trust has received an allocation of £1.2 million annually for two years and ongoing evaluation by NHS England will help ensure the service will be sustainable – as from April 2020 the community forensic mental health care service will need to be self-funding. In line with the principles of New Care Models, savings made will be re-invested in developing further community teams, with the aim of providing seven teams across the South West region.

Child and adolescent mental health services (CAMHS)

For medium and low secure mental health services for adults, many more people are receiving specialist care closer to home, in less restrictive environments and for shorter periods through the South West Regional Secure Services NCM pilot. With the support of NHS England, the partnership is now building on this success to develop tier 4 child and adolescent mental health services (CAMHS).

One of the benefits of New Care Models is the opportunity it provides for clinicians and people who have experienced services to work together to design a care pathway based on the needs of the local population. Dr Jason Fee, Clinical Director for South West Regional Secure Services, explained how this was demonstrated by establishing CAMHS inpatient services for Cornwall, Devon, Somerset, Bristol and South Gloucester.

He said: “New services will provide care for children and young people with more complex mental health needs who may require inpatient treatment. Although there has been an increase in CAMHS tier 4 beds nationally, there is a significant under-provision in the South West which the partnership is seeking to rebalance.”

Work has started on the clinical and financial groundwork necessary to identify the true level of need – informed by the number of children and young people with mental health needs treated in A&E, locations of tier 4 beds, and whether other alternatives are appropriate. Once the level of demand is understood, the partnership will work with other providers to ensure its CAMHS services are designed to be as clinically effective and as close to home as possible. The aim is to go live with the CAMHS tier 4 service in mid-2019, subject to approval by the regional partnership board and individual organisations’ boards within the partnership.

Sharing good practice with other organisations

Anne Forbes added: “We believe these examples of the work taking place to transform mental health services illustrate how South West Regional Secure Services has embraced the New Care Models programme.”

Through conferences, networking and visits, all partners are enthusiastic about sharing the good practice and learning they’ve developed, she said. During 2017 and 2018 these have included a symposium presentation at the International Forensic Mental Health Conference in Antwerp, and showcasing our learning and good practice at events organised by the Royal College of Psychiatrists and NHS organisations at a national level.

• South West Regional Secure Service is a partnership of eight providers which launched in April 2017 in wave one of the New Care Models for Tertiary Mental Health programme. Earlier this year the service won the HSJ Value Award for Mental Health. The judges commented the service had presented “a project with a hugely impressive feat of leadership and transforming of productivity, patient and family experience across a large geography in a very complex area of care”. They said the award was deserved recognition of a great deal of work by the team and much improved services for patients.

Further information

Anne Forbes, Programme Director for New Care Models for Devon Partnership NHS Trust. Email: anne.forbes2@nhs.net