Webinar: “Thinking Differently – a ‘first steps’ guide to transforming community mental health care”

Webinar: “Thinking Differently – a ‘first steps’ guide to transforming community mental health care”

well good afternoon and a very warm welcome to today’s webinar which is on the transformation of community mental health care my name is brian dow and as you can see there from that screen i’m the deputy chief executive at rethink mental illness um and it’s my huge privilege to be cheering today and welcoming not only so many of you who’ve joined the call and my apologies that we’ve started a little bit late we’re just waiting on um claire murdoch uh coming along no doubt she has been caught up in something else um but but also i’m in but i’m joining by phone link sorry to interrupt you brian not at all really glad to have you there claire and i thank you very much for that i think it it will more or less feel the same hopefully to um to our attendees although they’ll be deprived your phys but i’m sure we’ll i’m sure we’ll manage because your words will more than compensate for that so thank you claire nice to nice to hear from you um so just uh just to run through the um the hygiene stuff first if i can so we have well about 55 minutes or so i guess um we’re going to hear from our speakers for about 25 minutes uh or so we’re going to start off with clear and then on to kate and then on to mark we’ll see a little bit more about in a second um if you do have any questions do please um send those throughout on our q a function and they will be forwarded through to me by the magic of what’s up and hopefully i’ll get a chance to then convey those to uh to our guests so do those at any point that questions occur i’m sure that you’re all sitting there with them thoughts on your mind at the moment but that would be really welcoming obviously helps the second half of the of the webinar and just to say that if we don’t get to all the questions we are going to find a way to make sure we ask those of our guests and we’ll make a point of following up with those afterwards but i’ll come on to that in due course so back back to the event itself i mean i think it’s it’s impossible really to overstate um the importance of this of this moment in the in the community mental health sector reefing mental illness has has campaigned for for for many decades uh to to establish a level of parity between mental health and physical health and there have been many barriers along the way to making that happen firstly we’ve had public attitudes and the stigma that creates for people um i think it’s reasonable to say that governments of all hues in the past have not really prioritized mental health in the way that perhaps they have prioritized physical health and i think we have to say that uh in times gone by there has been a leadership question has been the drive on this issue but i think now is that is the time that we can right to that historic wrong and we have two things i think very much in our favor the first is that we have that commitment at the top of the nhs which you’ll hear from in a second and i think that’s true also a local level um but that’s now reflecting the the concerns and the desires of the public at large i mean i think survey after survey in the lead up to the i don’t know 246 general elections it feels like we’ve had over the last um few years mental health has come out as a much higher priority for the public so it’s really creeped up the agenda and of course it will be even more so at a moment like this and i think that that commitment we now have at the top of the nhs has translated into uh and claire won’t mind me saying this i don’t think a doggedness to to really fight for our corner uh and at a time when we had an extended period of austerity i know that the the the commitment that has led to record funds which are about to go into the system have not been possible and have not been achieved by other government departments so i think that commitment that doggedness to see that through leaves us in an incredibly good position to have a transformation hopefully about to take effect but that will happen on its own i think equally on the other side of the um on the balance sheet it would be remiss not to mention one of the things which make it far more challenging namely the pandemic that we are all living through just at the point where i suppose we were kind of ready to um amplify that that transformation the system has literally been thrown up in the air and the front line front line as you all know has been redeployed to deal with that crisis that presented itself suddenly out of nowhere but even that said and i’m sure clearly we’ll speak to this i think what the pandemic has demonstrated is the art of the possible and things have happened during the pandemic that we probably did not believe could have happened so i don’t think we should see the pandemic as a as a barrier to making everything happen it’s an additional obstacle for certain but it doesn’t mean that we can’t make that transformation agenda realized so um i think without further ado let’s let’s go through our speakers and and obviously we’ve been joined by claire on the phone claire i think needs no introduction but nonetheless i will say is of course the national director for mental health and i think it’s true to say that we could not have a better friend on this issue at a more important time and claire will speak about um the transformation that she’s trying to make happen with all of you um secondly we’re going to hear from kate hall who will talk about her experience of caring for her father who had a severe mental illness in the community and then finally um we’ll hear from mark yates who’s the director of operations at wrestling mental illness and talk about our experience in working with one of the pilots in somerset who i know we have a number of colleagues on the call and that’s been a really incredibly positive experience for us and informs how we can begin to help other stp years over the coming months so um i’ll hand over to claire claire really fabulous to have you here and let’s let’s let’s um let’s hand over to you brian thank you so much for that and before i just uh go into the presentation may i just ask are the slides that i’m going to speak to on the screen for people don’t worry if they’re not but it’s i can’t see what you all can see or not see we can currently see a picture of you with a with a log of rethink which is a a nice prospect but now we’ve got the slides up on the screen so yeah we can we can see this lovely thank you so we haven’t got many slides thank you so much thank you i just wanted to get that bit of housekeeping out of the way i’m so so sorry that my link isn’t supported on my ipad pro so when i tried to join you um i couldn’t uh back through that route but as you say brian you’ve been spared my face which um i think there are many would think is a blessing um but can i can i just say a huge thank you to to rethink and all of your members and activists campaigners and people who are living with uh serious mental illness or mental health problems who have in you know thousands if not millions of people across the country have really insistently and often at such high personal cost determinedly tried to make policy makers funders uh frontline practitioners people like me aware of things that need to change and i just want to congratulate rethink because i think you’re a superb organisation and you bring together some of the brightest and best people i know from all kinds of backgrounds to make the change possible so thank you hugely and thanks for asking me here today um i just by way of introduction some people know me i’ve worked in mental health services for 37 years now and i can’t believe it is 37 years and recently visited my best friend’s daughter who bought her has bought her first flat um up in free and barnet which used to be the hospital i trained in how times have changed so it’s been a long time and at times it felt like pushing water up a hill trying to get mental health the priority it needs and deserves um but right now it still feels really tough and even that but but so much better i think uh brian you’re right when you say this is a moment in history we cannot waste and we’re getting priority even when the country now is 2 trillion in debt at the moment the commitment to the long term plan the 2.3 billion additional investment in frontline mental health services by 2023 that we have secured as well as people will have noted at the weekend and not before time might i add but nonetheless at the weekend government announced over 400 million to end dormitory provision in this country now so i should think but we are a country that’s 2 trillion in debt in debt and in the grip of a global pandemic and i think it speaks to the importance of this issue mental health and the fact the country needs to do better but that capital announcement has survived if you like when clearly treasury is having to take a long hard look at all it spends its money on our money on currently um so i’m excited about the advances we make but i don’t for one moment want that excitement or feeling of positivity to overshadow the fact that too many people are still spending too much of their time not accessing not only the services that they should access but also the other supports and the other avenues and routes into being contributing members of society i think we’ve come a long way but we’ve much further still to go i think we have the five year forward view for mental health but over the last two years we’ve superseded that by the long term plan now what’s really exciting in the long term plan obviously is that of the 2.3 billion i mentioned earlier nearly a billion of it you can see the little piggy bank on the slide and the 975 million nearly half of it will be invested in community mental health services to pay for in particular the expansion and not just the expansion the improvement and transformation of community services for in the main people aged over 18 years and older and we think that that will enable us to see 370 000 people a year more by 23 24 but we really don’t just want more or more of the same though many thanks to colleagues who’ve done a great job in recent years we want different and better and if we can go to the next slide please and many thanks to my national team colleagues who are working with yourselves and other organizations thinking about how do we get the best bang for our bark in terms of that nearly billion pounds and what really should we be um aiming to deliver by way of transformation and that is why by the way the work that you’ve been doing in somerset and other places as we think looking at how do we bring more people into the model of care so it’s not just the nhs on diagnosis and treatment which is a small part of somebody’s life it’s all of the other organizations and community assets and strengths that sit around our ability to really support people to live their best life possible so we know we want a core model but you can see on this next slide and then a dedicated focus and a big focus in particular on physical health support back into employment ips and we want to keep a big focus on early intervention in psychosis as well so there are some if you like givens that we built into the ask to try and get this money into the service and these are the components that just are not negotiable that you can see on the sides in front of you i suppose a big one in terms of the model of care is that whatever we put into it it must be based in local care networks primary care networks it must be working with third sector organizations schools if we’re talking about children community groups and so on and so forth it has to be to be successful we believe that community mental health services need to be deeply anchored in the local if we can come to the next slide please because i don’t i want to leave time for other speakers and of course questions but we’ve identified 12 early implementer sites so off the long term plan runs for five years and we’re in year two currently if you like the big cmht money uh you can see the pound signs on the next pound sign on the next slide which says that we um particularly now over the next three years from next april onwards the financial years run from april to april in the nhs um there’ll be uh 782 million of that funding will flow in and 120 million of that funding will flow in as of for coming april um and it will be um shepherded by the ics the integrated care systems or stp so just used interchangeably but it’s where clusters and groups of ccgs and providers come together across the bigger footprint than just one borough so this money will be shepherded into the front line by ics’s and icps we’ve already identified 12 early implementer sites in years one and two who are testing all sorts of things um for us so we had 70 million to support the 12 early implementer sites and the sorts of things that they’ve been testing for us are what about a better focus on adult eating disorders what about better talking therapies and other things for people living with psychosis what about the transition that currently can feel so awful between 18 and 25 year olds and how do we do that better as youngsters with mental health problems become young adults and adults and how do we do that better but also and importantly can we test access and waiting time standards wouldn’t it be lovely if people could be seen in cmhts between one and four weeks depending on urgency and if we could really do away with waiting times that are so bad for people’s mental health and we could make the services more responsive so you’ve got to clock up there so we’re trying to pilot various things so that when the bigger money the 782 million comes in for the next three years we’ve got some really clear stairs that we’re giving to the system if we can go on to the next slide and as we do it’s just to note that we want to keep driving these developments even though we’ve got a system under extreme pressure with coved it’s not something we can ignore it is a fact of our lives and certainly in wave one we saw some slowdown of our developmental work as we really focused on keeping our existing client caseloads patient caseloads seen and engaged and supported well we can’t afford to see that interruption in wave 2 and we know colleagues in the north and communities and citizens in the north of the country maybe feel like they never even really left wave one and they’re already in wave two and we’ve heard the news about liverpool so our hearts go out to everybody there what we’re trying to do is make sure that we keep a real drive around this expansion and investment and transformation so i’ve already said a bit about the service model we want as well for and the pilots are looking into this as well this dreaded term personality disorder um is another group of patients or service users that we really feel get a poor deal from services as well at the minute we don’t feel there’s been enough focus on people living with serious mental illnesses and psychosis and this is our opportunity to correct that we definitely want more trauma-informed care and we definitely want to stop mental health rehabilitation units kind of being outside of local areas for residential care far from home and disconnected from local communities and we want our community model to anchor people back locally um and i guess the thing the other thing i want to say on this side i’m not going to take you through all the points but is if if we’re going to see more people but better more appropriately more flexibly more innovatively if we are to move mental health services to place greater value on the totality of people’s lives not just the assessment and treatment piece and that is what we’re determined to do we have to work with other partners and our voluntary sector partners it seems to me are absolutely front and center of how we all be both planning but also delivering changes and improvements in care i also think we need to on staffing if you could go to the next slide and as you move it i’ll just say something about staffing on the last slide my next one is also my last night on staffing we want to bring many more people with lived experience into explicitly working in mental health services more peer support workers uh and more people lived experience into all kinds of roles and i do believe that we will have a more compassionate more flexible service the more we can stay in touch with what’s it really like living with a major mental illness what things really matter how do we really invest in what matters most to people not what matters most to professionals and just finally um i suppose uh that we are absolutely and i’ve said most of this already so i’m not going to talk to it for long we’re absolutely determined to do not more but more and different to do that we need to listen to carers to service users we need to work closely into primary care one of my great wishes is that we stop this referral between primary and secondary care of people who have got a mental health condition that they may be living with for life or for years it seems to me it makes no sense to go oh you’re for primary care or you’re for secondary care we’ve got to stop this and instead of moving the person between primary and secondary which makes little or no sense to them we need to move the resource in around them as their needs change and that resource absolutely needs to include working with voluntary sector partners and people with lived experience i’ve said enough i just want to say thank you for listening to me thank you all of you who’ve campaigned to get us to the point where we’ve got this additional investment and i mean what i say about the different and better not just more so your help and input and questions will be much valued claire thank you so much and we we know that you mean what you say and we profoundly welcome that point about the system revolving around the person rather than the person trying to find his or her way through the system i think that that in a nutshell encapsulates what we really should be trying to do in terms of a longer term i’m also struck by that point the point you made earlier on about the best life possible and um our next speaker kate hall i think it gives a really good example of how while it’s easy to come to conclusion about what isn’t possible if you have a severe and enduring mental illness or the right kind of care and support and the the right kind of model that clear described so eloquently actually you can live a far more meaningful life so kate um let’s hand over to you thank you very much brian um so i am the daughter of a man called clive butterworth and i’m just going to show you his photo because he’s not here but i always think that it helps to be able to see her face this was him on his wedding day back in 2013. and this is just another quick one because i love it it’s him and my little boy when he was a baby and i just think they they look so uncannily similar that i just love that photo so um that’s him um he uh was a wonderful man and he lived with schizoaffective disorder which he was diagnosed with in his early twenties um he despite that was a really shining example of what is possible for people who are living with serious mental illness and we are just desperate to um share his story really as widely as possible and because we hope that it can create a legacy of hope and show that there is a way that people can be um contributing and really valuable members of society and so dad struggled with quite a lot of shame to do with his diagnosis um but he was just fiercely determined to not let him um to not let it hold him back and to not be defined by it um so he had three careers over the course of his lifetime and he started off in marketing um working at uh unilever and vandenberg’s his claim to fame which he was so proud of was launching strawberry hubba bubba which some of you will probably know and he also wrote the line spread straight from the fridge on clover packaging which i think has been taken off now which he was very upset about but anyway um when kind of stress sort of um became too much in that role he retrained and he went into teaching which i’m not sure i would consider to be a less stressful existence but he went to teach secondary school boys and business studies and economics then he went into higher education briefly and before finishing his career as a civil servant and working for the inland revenue in an administrative role um so he yeah he just he kept going and he kept kind of changing as he needed to dependent on what his um capabilities were and managing obviously alongside the illness he was brilliant at maintaining really long and lasting friendships he his oldest friends he’s still in touch with from primary school um and they were a source of great support to him over the years um dad was a single parent to us um for some of his life um my pet my parents divorced when i was nine um but they maintained a really strong and solid friendship which again was a huge support to dad during difficult times and times when he had breakdowns and was hospitalized for periods um but despite all of that he was just such a devoted father and he would be there every other weekend without fail you know unless he was um he was in hospital um and he would take us on trips he would take his you know visiting friends and relatives all over the country he would make our time together as special as possible and he was just completely he took his duties and his parental responsibilities really seriously despite you know obviously having a background of a serious mental illness that that he was also always managing but he was really um careful to try and shield us from that particularly you know when we were so young that we didn’t really you know understand the realities of it um he got remarried in 2013 as i said um after his last really serious breakdown where he was sectioned for several months um back in 2001 um some friends of his that actually his best friend from primary school was was worried about him and they recommended that he joined his local church in aylesbury which he did um and it was hugely important for him actually at that point because he was at a very low ebb and i was going off to university i was worried about how he was going to be and the church just took him in and they gave him it gave him a renewed sense of purpose and when he retired when he was just before he turned 60 he threw himself into church life and he was given roles and responsibilities that gave him helped his self-esteem particularly that had been really damaged after what happened in that um 2001 episode so it was a process of rebuilding and the church um you know was so fundamental in that and we will always be forever grateful to them um he uh through the church he kind of led a very full life um and he did he stayed very active he used to in his younger years played football and cricket and rugby and that then became walking football when his knees gave up um but he used to take i mean he used to take the older you know more elderly members of the church out on day trips he’d take them to appointments for you know doctor’s appointments if they needed to so it really gave him purpose and a sense of value um and actually he so he obviously isn’t here he died unfortunately in january um and that was because of a transition um from olanzapine onto a new drug um that was aiming to prolong his life and protect his physical health because a lanza pin had led to chronic pancreatitis which he was really suffering with and he had such a high pain threshold but nevertheless we knew that he was he was in a lot of pain and it was something that wasn’t getting any better so he took the decision to transition and it was going very well um seemingly for the first few weeks until very suddenly overnight it then was not going well and unfortunately he died um so that’s obviously been something that we’ve been coping with over the last um few months against the backdrop of covet um and in the days after he died he died on the wednesday on sunday we went to church with pam with our stepmom and to support her and obviously they were going to talk about dad at church because he was such a well-known member of the community um and i just took a moment to gaze around and i just looked at really how many people were so obviously in need and that was just really kind of on the outside you know and there’s probably so many more people who were in need on the inside who i couldn’t see but it just struck me that the church was holding those people and providing such a vital role for them um and you know religion aside i’m not a regular churchgoer but i could just see that there was a need that they were fulfilling and i just had the question in my head of where would these people be if they were not in church today um so despite dad’s death we are really determined that his legacy like i said should be one of hope and it should be one of hope and that people living with um severe mental illness and their families that they can be really highly valuable and contributing members of society and it should be expected and that they can have the opportunity and get access to the care that they need to create the life that they want um obviously managing their illness alongside it um they should never be made to feel sidelined they should certainly never be made to feel like they’re facing discrimination and they should live in the hope that that yeah like i said they can they can build um the care that they need so we are really excited um by everything um that we’ve heard from rethink and also um that was reinforced by claire the fact that um you know this new mental health framework is putting the patient like front and center and it’s really important that the patient and and if not the patient then the family around the patient who are there often the next best people to speak to in terms of lived experience they are put front and center and the care is built around them and what their specific needs are and i think that that you know would be a truly different you know to claire’s point around different and better that really would be something different and better um for the future and so it being it’s you know the fact that it could be a joined up approach combining individuals patients with families with experts with community support groups with voluntary organizations like claire mentioned that’s a really exciting prospect and we’re as a family really keen to be part of um making that a reality okay thank you thank you so much for that i just think that was such a really powerful example of the human dimension of of that model that claire talked about all those other factors that kept your dad well yeah being socially connected having a job a sense of purpose that comes with that obviously a level of financial security that you acquire when you’re working staying fit that i mean that is that is the model that we’re looking to to develop in a nutshell so thank you so much for that and actually kind of perfectly almost as if we planned it perfectly set up our next speaker mark cates who’s who’s rethinks director of operations um and mark just going to talk to us a bit about of our experience and working with our colleagues in somerset some of whom i know are on the call today really about how we’ve tried to work with them and other players in that community to to advance that model and to make it reality there as we are very keen to work with other areas to make it reality wherever you happen to have a mental health problem so i’ll hand over to mark thank you brian and and thanks kate for sharing your your story i think and a reminder which we need we needed one of why this work is so important and as i’m sure you’ll be aware in signing up to today’s session wreaking mental illness has developed a guide setting up the first five steps needed to be ready for the transformation funding coming into the system next year and and as a charity is purposes by people living with severe mental illness and campaign for change to provide services and campaign for training we can see what a significant opportunity that the community member health frame represents to change the way we work we develop this guide because we committed to playing our part we want to make the the plans of nhs england a success so it’s um it’s not my job to introduce the guide to you over the over the next few minutes but before i go on to do so i did just want to say a huge thank you at the start to those who’ve been involved in developing the guard with us so um to just name name a few people we want to thank viral at nhs england we want to thank experts by experience keith sue steve and jill and my colleagues and partners in somerset grimsby alongside johnson for funding this work so so thank you to all of you for your your contributions in bringing this guy given fruition and before introducing the guide i just wanted to start with what’s a brief kind of personal reflection and that’s the thing within health and social care we’ve always talked about the concepts or importance of integration that’s you know the joining up of health and social care systems and perhaps even a seamless connection between the statutory sector and the voluntary community service and and an independent sector and you know sitting on the provide defense side of the fence as i do it’s that is something that we’ve always seen as a as a panacea but perhaps kicked around or grumbled about from the sidelines without ever really doing anything about it or feeling that we were able to do anything about it but it feels that the tables have turned somewhat and and the community mental health framework i think invites and perhaps provides the mechanism for the autistic together they’ll be kind of running out of excuses to not think more more differently about how we collectively work in the interests of people who use our services and think of it as the as the permission we probably never needed but we’ve got anyway just just with the avoidance of dull um so there’s perhaps not many reasons left for us not to begin to begin to do this work so that said in introducing the guide i just wanted to outline a couple of initial thoughts to bear in mind in setting out the five steps and that’s firstly well what’s the places and areas from which we’ve learned some of the things featured within the guide their distinct geographies the principles we’ve set up should be universal that help you to find the right solution in your area to provide a way of doing things recognizing the outcomes will look different depending on what your system priorities are what people in your area may need and secondly and and colleagues have referenced this already no doubt feels like a huge amount of work and significant change particularly in the midst of a global pandemic so it’s really important to consider this as just the start of the work and working through the guard over the next few months will not just result in in the job being done you know they did the job being being finished it’s it’s an e3-2 program of work over a month and perhaps years to help the ambitions um to help achieve the ambition which have been set up but moving on to the guide itself then the five steps of a chronic chronological order but there are obvious overlapping implementation which will hopefully be clear as i run through those so starting from the top the first is is very much about identifying the right leaders and having the appropriate governance in place so this is about understanding who in the stp has the right level of authority to get decisions agreed the capacity to dedicate time needed to ensure that this is truly transformational and alongside an understanding of mental illness and on that last point no one person in the stp or any org any organization can really truly have the knowledge and understanding of the complexities around transforming a community mental health model of care so there has to be representatives from the nhs local authorities voluntary sector and certainly representative experts by experience and those representatives have to include those from different those people from different groups across society such as black and other minority ethnic backgrounds and backgrounds on older people with mental illness those individuals really need to be involved at this senior leadership level to make sure that the the change which the organization is striving for is really really impactful and although you may not want to be overly prescriptive at this stage it’s invited to agree ways of working as a leadership group so develop a process for decision making degree in outlier terms of reference at the beginning and on this we have to share more of our own experience in the areas that we’ve been we’ve been working that brings us on neatly to co-production which is the second stage in that in our guide and this is key to what nhs england and nhs improvement will be looking for in the in the pro in their planning process and claire referenced it in her presentation a few seconds ago co-production isn’t quick it’s not easy but it’s vital to ensuring community care in your area is transformed and will actually work for your populations and it has to start somewhere so develop your plan early at the beginning it can develop and build over time and can be carried on concurrently with other other early actions you must ensure that your co-production does go beyond those traditional boundaries again and ensure that those voices of underserved groups are clearly heard that they are able to contribute their thoughts and ideas it must include older people you may face barriers in accessing mental health services and can use their experiences to help overcome these we know from our work in facilitating co-production within stps that getting it right now can save a huge amount of time and money later on down the line we’ve heard it described as the as the deal breaker so the thing that can help get difficult decisions made and signed off if there are disagreements on where funding should go or who should deliver certain services you can always go back to that co-produced model of care to help get decision made and so have a look at our guide and again get in touch if you like more detail how and how to work in partnership with locally thirdly there’s if there’s a range a huge range of support already been provided in your area by different organizations and as as kate alluded to in her presentation some of those aren’t meant for how specific but they play a crucial role in providing some kind of support for people with mental illness it’s really important to map those community assets to further develop your understanding of the range of different services and support networks people living with mental illness choose to access to support their recovery and well-being and within our guide we include an example tool to help with mapping community assets assets as an appendix and so again there’s a there’s a reference point for you within within the guide and i think that then that that brings us on to step four um so step four is really helping and looking at those voluntary and community sector organizations which are really important in designing and delivering a new community model of care we recommend identifying these groups earlier early on and building an alliance the key here is that traditionally the voluntary and community sector organizations and rutherford mental illness are a part of part of that sector we we’re used to competing with one another for contracts and it’s even more pertinent in the face of poverty effective funding levels that actually you know that competitive marketplace is something that we we’re used to doing and being part of but to be successful in transforming community mental health care we need to work together and build on each other’s strengths and then the knowledge of voluntary organizations who between them are able to agree the right right ways of working and leadership alongside different approaches to procurements will help lead your work off in the right direction and again a common theme really is that the ambition of the alliance must look beyond kind of the boundaries of mental health charities and service providers not to include wider community groups and smaller micro or grassroots organizations connecting to individuals from organizations represents diverse communities there’s a really important role for the leadership of the stp being clear on establishing kind of this sense of joint work and wisdom between the volunteering community if the vcs are clear that there is an expectation on them to work together in partnership and not just competitors then it creates that environment in which some of the usual boundaries can begin to be removed by people working in those systems and in those segments and again the principles of co-production are important here if co-production is a central driver of any service model or new development then that can be supported by the alliance and driven by the alliance as they take they were their work their work forward and and finally and and perhaps talking to to players final point really is that no system transformation can be possible if you don’t consider the needs of brilliant people who work across them and in our services as a co-produced model of care begins to form there’ll be some early signs of clear gaps in workforce particularly when you look at health education england’s new roles and then and whilst it’s important enough to jump to assuming what a new amount of care will look like and not and and that we don’t recruit to more roles too early some roles will need to be filled whether it be clear gaps to hit the ground running in some areas as the new money comes into the system from april next year so workforce plan will need to be creative it will need to avoid just moving people around the system and not create gaps in other places but also recognize that we’ll be required for new roles so bringing in you know people with lived experience and peer support workers into the system so in terms of the guide that that they are our first five steps they’re the things we recommend that the stp’s begin to begin to focus on their governance co-production asset mapping alliance building and workforce planning and to reiterate we feel that that’s going to be a big task we know he’s going to be a big task and we’ll get more it will take time to get right but there is support available and funding to support the transformation is on its way so as a final reflection then i just wanted to share our motivation for doing this um the idea is as brian um outlined at the start the idea of transformative care for people with severe mental illness is fundamental to our mission as a charity it’s why we’re founded 50 years ago is why we exist today is why we published our document communities that care to help frame the ambitions of the community mental health framework around the needs of people using services it’s why we worked with colleagues across the system in somerset grimsby and other areas to try and develop the concept prove that change is possible and that the ambitions of the plan are deliverable over time it’s why we’ve developed the guide that we’ve shared today sharing our experiences and learning from colleagues with you to help you deliver on your ambitions for people in your areas and it’s why that’s not kind of the end of the game for us it’s while we’re going to continue to share our experiences we’re going to host for further webinars quite a bit of a deeper guide into some of this work including in somerset um we are going to host a further webinar where we hope to hear from partners such as the local nhs partnerships justin the second step one of the founding members of the alliance which is scheduled to take place on the 4th of november we’re also going to plan a deeper dive on alliance building and co-production you can continue to iterate learn and involve and we’ll share more dates and details on those with you in in due course we’re completely committed to the success of the nhs long-term plan and and the ambitions of the community mental health framework and recognize the key to making the next phase of delivery successful is through what happens on the ground locally in your areas we’ve got a cross-organisational community mental health framework unit working on this so we can help you to you to translate the national drivers into local delivery and then as importantly make sure that we share your local experiences and understanding back into and through the national framework so please consider attending our next webinars and stay in touch we’ll be sharing more details after this event and equally if you want to talk to us some more about tapping into our unit then again please and please don’t hesitate to get in touch with us so um thank you very much i hope you found that uh introduction to the guide useful and i’ll hand back over to back over to brian thank you mark um i’m conscious we’ve got about 170 odd people on the call and a lot of questions have come in so i’m going to try and get through as many as we can in the time that we have left and that means i’ll slightly entreat our guests to um ask his answer as quickly as or at least as a maximum brevity if they possibly can but just to say if we don’t answer your question now as i said we will kind of put those to our guests and we’ll make sure that we follow up uh with you so don’t worry if your question isn’t aired now um i’ll kind of put two if i can firstly to clear um because i feel sort of hanging together really um the first is a relatively straightforward one clear but i’ll do the first and the second um so the 975 million pounds uh someone asks that you talked about being ring fence for community mental health framework implementation well it that’s the question really is that ring fence for the community mental health framework implementation or is it for all the long-term community objectives for example including i act and the second question i made which i think is a very pertinent one uh given everything that’s going on um just a welcome for the commitment of the talk from yourselves and others but how difficult if you can hear this one are you and colleagues finding it to convince treasury at the moment to deliver on those commitments not least because of course as we know that if you like the mental health burden of phrase i’m not very keen to use but the kind of overall level of population mental health is changing dynamically as a result of the pandemic so just a sense that the recent announcements around capital are very welcome but they obviously will not solve in and of themselves um that the problems are whole so those two questions together clear if you wouldn’t mind thank you and can i just before i answer it say kate you made you brought the tear to my eye i love my dad too and yours just sounds like a lovely wonderful man and i wanted to say that um now the money yep um when we talk about the 900 uh etcetera million that’s excluding iact this is for cmht development and virile who got a plug earlier and my national team spend a lot of their time working with regions through to systems to try and shepherd that money through to its intended cause so we’ve got 2.3 billion in total so the other 1.45 billion is for the rest of our long-term plan commitments so yes this really is for community mental health development um which is why it’s such a fantastic opportunity we can’t take our eye off the ball for a moment um in terms of treasury look um on capital there is absolutely no doubt that we are in a really competitive um arena right now and one has to feel a bit sorry for our treasury in our country right now as as they make decisions about what’s most important but myself and my colleagues and i have to say nadine doris our minister has been really good on this one are just going to keep batting really really hard for mental health capital and simon stephens used that phrase himself for chief exec of the nhs so it is hard we can’t take our eye off that ball for a moment we need more new hospitals not just the ending of dormitory provision and we need our share of those for mental health as the capital flows for them but actually and my colleagues on the national team have been working with colleagues across the country actually we also need an investment in the community infrastructure as well um so you’re absolutely right whoever said 400 million is not enough to do it all it absolutely isn’t our ask of treasury is considerably more and um yeah we’ll we’ll we’ll go in an advocate very very hard for that investment thank you claire and mark i’ll direct the next one to you because obviously this is something that we think and other organizations in working in places someone said to me a place is just somewhere but uh working in places have experience of which is really that connection between the local authority and the health trust and person here saying that in this case the local trust refuses to work with all social care and voluntary organizations and that’s a huge issue for people living with for example ptsd and who are at risk of uh suicide so so so mark been what why is is it important do i say that those two different agencies work together hand in hand thanks brian um and obviously it features quite heavily within our guide the importance of that kind of joint working across the stp between um local authority nhs and and and the wider system i think i think there are two reasons that absolutely stand out and first of all both parts of the system are no doubt going to be at some point seeing the same people and working with the same individuals and having having those connections with with them with people living living with mental illness and the fact that actually there are two parts of the system that aren’t talking to each other that makes that makes that more difficult for that those individuals to to navigate those services and i think the other one is that actually means that the investment in the system can can go further and and and be used more efficiently so if um local authority commissioning and and and health health commissioning are talking to each other about their plans for developing servicing that servicing those those areas it just feels obvious that the best way to do this is by thinking collectively about well how do we deliver this in the best ex but for the best experiences of our of our combined population ultimately you you think that those those organizations have have a common goal around delivering better services for people so um you would think that that money and and and income would go further if it was working across across um all of the system and not just not just parts of it and ultimately that drives better outcomes for people who will use services great thank you mark um the next question is really around how to best involve people who are either carers over the lift experience and really that’s kind of sense of not feeling confident about about co-producing there’s also attention about the ambition to move quickly which is incredibly welcome with the desire to get this right so kate i mean from your perspective you know how would you have liked to be involved in shaping that offer for for your dad that best helped him live that that kind of full life that you described so well um i think what would have been key is more well i i guess better access to peer-to-peer support so we didn’t know anyone else with dad’s diagnosis no other sufferers or their families and i think it’s a bit of a you know something we battle with is that we don’t really feel like we understood the half of what dad was going through actually um because we didn’t have anybody else to talk to and to be fair like we because dad seemed to cope so well we didn’t necessarily reach out and try and access these things but i also think it’s it’s a case of making it really obvious to people where they where their point of access is and what all the different options are and yeah creating opportunities for people to link up and share their experiences i think could could have been so beneficial and would have been so beneficial for us great thank you kate um and then i think the last question we’ll have this base for um is around the issue of stigma and again i’ll kind of direct this towards you clear if i can it’s still so prevalent even within mental health services themselves and particularly on personality disorders as you as you indicated so so will there be money for awareness trading on on personality disorders so i think we’re hoping i mean look firstly i think stigma is still such a live issue and um i think it was 1982 or 1983 when an mp stood up in the house for the first time on his maiden speech chris smith and basically he said yes i’m a new mp and i’m gay get over it you know people are different and you know it was it was something like 2012 uh before a uh before mp stood up in the house and said yeah i i suffer from mental health problems or a mental illness and um four did it at that time i thirty years behind and that was a massive step i remember crying on the way home from work about listening to the nine o’clock news uh the mps had stood up and done that very brave of them and when i emailed them at midnight that night both of them had got back to me by six in the morning and i doubt they’d slept at all at the enormity of the step they’d taken but i had huge respect for them and i agree we’ve come a long way it there’s been a brilliant campaign with the royals with celebrities with others coming out we had a celebrity recently coming out talking about his bulimia his eating disorder didn’t we um and so i think we’ve come a long way i completely think that within the system people with um verbal personality disorder are discriminated against which is why um our development of community mental health teams is placing so much emphasis on for trauma-informed care now in order to deliver trauma-informed care actually your service spec who you’re recruiting how you’re training them um the sharing of best practice a whole programme of developments to and certainly the introduction of more and more peer support workers working in services whose job isn’t just to deliver help deliver care but help shape it and help raise awareness within teams i think there are several things that we are doing to try and make sure that we tackle the stigma that can exist both within and without so we’ve come a long way but we’ve got at least as far to go again and with organizations like rethink people are on this call today on this meeting today and many many more um i i feel very optimistic we’ll we will get there but not soon we’ve just got to be indomitable and keep at it because we’re making progress claire thank you so much and i think that seems like almost a perfect place to stop because it’s about that tight rope that we’re trying to walk isn’t it between the ambition that comes from decades of trying to get this right but the reality that we’re in very difficult situation circumstances at the moment but we just have to get started um you know that cliche about every journey starts with the first path well it’s not like none of this has been in place but um i suppose the question is what’s a reasonable place to get to by when and i think hearing what everybody has said my sense is if if if if our ambition is to have that rounded care model that bio psychosocial model or is capable to all those things that make such a difference to your quality of life for everyone no matter where they live perhaps that by april it’s reasonable if if people have identified a leadership team to take it forward have have given some thought to what corporate co-produced framework begins to look like perhaps identified those areas within their stp which can move quickest and be that demonstrate have that demonstrator value identified that voluntary sector alliance that can help build that capacity to to to make sure that the assets are in there in that local place to deliver and have some given some serious consideration what the workforce looks like to to meet that then you’ll be well on the way because it’s a it’s a journey nobody’s expecting that destination to be reached by april the first but it’s a journey to and if you don’t start that road and start down that road in the right manner you must much less likely to get to the destination so final two thoughts and uh really thank you so much to everybody for coming uh as we said it’s the first in the number of webinars and we will be doing one with our colleagues in somerset and i think we have i think the link to that is on the side if you if you want to register for that and we will talk a bit more about our experience there um so all really that remains for me to do i think is to is to thank our three guests claire kate and mark and all of you for joining us i think it’s been a fantastic discussion we will follow up with some of those questions which we haven’t had a chance to answer i’m sure that you will have many more that we can support you with hopefully in the coming coming months and years so do get in touch if you’d like us to to work with you and in the meantime very best of luck for your journey your transformation and for the change that you’re trying to make in your community thank you

Rethink Mental Illness hosted this practical webinar on 13 October to support STPs/ICSs to take the first steps needed to transform community mental health care.

This webinar, chaired by Rethink Mental Illness Deputy Chief Executive Brian Dow, offers expert insights, user perspectives and practical tips based on lessons from pilot sites, such as Somerset, where Rethink Mental Illness is leading a voluntary sector alliance and working closely with Somerset STP to deliver a new model of care.

It is designed to support STPs/ICSs to come together with everyone involved in providing local support for people with severe mental illness, and plan how to realise this vision ahead of the upcoming investment.

Speakers include:
• Claire Murdoch – National Mental Health Director at NHS England and Improvement
• Mark Yates – Director of Operations at Rethink Mental Illness
• Kate, whose father lived with severe mental illness