Minutes:
(1) Representatives from the Patient and Public Involvement Fora and others were invited to ask questions and highlight issues in relation to mental health services. The Committee heard from Mrs Epps and Mrs Witherden (PPIF representatives), Mr Wanstall (East Kent Mental Health Carers’ Forum), Mr Wright (Sevenoaks RETHINK Support Group), Ms Leonard (Sevenoaks MIND), Ms Chesher (Maidstone MIND) and Ms Morland. A number of points were made, including the following:-
(a) In relation to the out-of-hours services for emergencies that fell short of the level of crisis needed to trigger CRHT intervention, these services were not felt to be adequate. Professionals should be available to attend if needed. It was extremely difficult in many cases to get a mentally ill person to attend A&E. It was necessary for the services when required to come to the client.
(b) An assurance was given by NHS colleagues that out-of-hours services would be made as accessible as possible, through all the various pathways that existed.
(c) A comparison was drawn between the way that the Health Service responded to a mental health crisis situation compared to a physical emergency. It was started that someone with, for example, a heart attack on a Saturday evening would be in hospital within a short period of time being cared for – whereas if somebody had a psychotic episode, the route to hospital was difficult and convoluted, and it could often take days to get appropriate care.
(d) There was a perception amongst carers that when a person was psychologically ill, it was often necessary for them to hit “rock bottom” before any help was available and that services tended to be reactive rather than proactive. Often the carer’s experience of getting a loved one into hospital was fraught with problems, whatever the route they took. The existence of nine separate pathways into hospital was not necessarily a good thing – a “one-stop shop” approach would actually be more effective, it was suggested.
(e) The view was expressed that front-line community mental health services were not operating as they should be and that they were not performing to very high standards; but it was hoped that this would improve.
(f) Reference was made to the issue of young carers caring for mentally ill relatives and the importance of these carers being assisted and supported by social care services. Mr Mills referred to the strategy for young carers “Invisible People”. He stated that the Children’s Trust would be working to make sure there was good awareness in schools of pupils who were young carers. The Trust would also make sure that, when somebody was identified with mental health problems, the children in the wider extended family who provided support got an assessment if necessary.
(g) The importance of talking therapies was emphasised and an apparent lack of provision in the Medway area was mentioned.
(h) The health and safety implications of lone ambulance staff attending a call-out relating to a person with mental health issues were raised.
(i) In relation to the role of CRHT services, NHS colleagues stated that these services were fundamentally about avoiding hospitalisation. There was a lot of confusion amongst carers and service users about the role of the CRHT and the assistance they were able to provide in crisis situations.
(j) It was stated to be important that the rights of carer and service-user representatives should be recognised.
(k) Responding to a question about bed numbers, Mr Millar said that the Partnership Trust had 46 wards in total and promised to make available to the Committee a full beds schedule.
(l) A PPIF representative raised the issue of adverse consequences for carers if they criticised services.
(m) The often long and drawn-out process of trying to get someone with severe mental health problems “sectioned” was highlighted. A multiplicity of agencies were involved and they needed to work together to achieve a quick, speedy and satisfactory outcome. One of the issues was that the police in these situations would only attend when they had resources available. It was important that colleagues in the Health Service engaged with the police and ambulance service to ensure that adequate assistance was given by the police when it was required.
(n) Ms Kavanagh confirmed that, at the South East Coastal Ambulance Trust meeting on 21 January 2008, the availability of appropriate transport for mental health service users was to be raised.
(o) The issue of inconsistency in the provision of Care Plans was raised.
(2) The Overview, Scrutiny and Localism Manager invited PPIF colleagues to share with Health Overview and Scrutiny Members their submissions to the Healthcare Commission for the Annual Health Check. He thought the Committee would find this extremely helpful.
(3) The Chairman thanked Health Service colleagues and the representatives of PPIF and Mental Health support organisations for attending.