Filling the gaps
Claire Cunliffe reports on progress on pilot projects on supporting people with co-occuring substance misuse and mental health issues
In MARCH 2013 four pilots were initiated across South wales to develop services for people living with co-occurring substance misuse and mental health issues. this is commonly referred to as ‘dual diagnosis’.
The need for these pilots was identified following a piece of work undertaken by Cymorth Cymru and Public Health Wales in February 2012 which found that service provision for this client group was patchy and in some areas non-existent. It was found that clients were often passed ‘from pillar to post’ between substance misuse and mental health services, ‘falling through the gaps’ in service provision.
As a result of these findings a conference was held by Cymorth Cymru and the Homelessness & Supporting People Network in January 2013 to learn from best practice elsewhere and identify potential pilot areas.
Bridgend, Western Bay, Newport and Cwm Taf were subsequently successful in bidding to host a pilot project. The projects had no direct funding, instead expertise was made available in the form of two consultants to provide a facilitative and evaluative role. As part of this work, it was also agreed a training package would be developed to ensure all staff working with this client group were fully trained and accredited. This article will look at the outcome of the Kerrigan (Bridgend) and Cwm Taf pilots.
KERRIGAN (BRIDGEND) PILOT
This project was developed as a collaborative commitment between housing departments, supporting people, children and young persons’ services, adult care services, mental health services and community safety. It was intended to support key outcomes identified within the Welsh government strategy together for mental Health – a Strategy for mental Health and Wellbeing in Wales.
Initially the project aimed to deliver six units of high level supported accommodation plus one emergency access bed provided by Gwalia. However, at the time of writing, this single unit model had yet to be commissioned, with floating support being provided as an interim alternative.
Nonetheless, the project has still
succeeded in producing some key, meaningful outcomes for service users through early intervention and engagement.
The consultant (JMB Health Consultancy) helped to achieve these outcomes through: supporting the project in demonstrating positive outcomes for both service users and key stakeholders, identifying potential barriers, and ultimately making recommendations to support improvement.
The project has the potential to provide a long-term focus on health awareness and the impact upon lifestyle and choices. Indeed, overall it has started to address the overall aims and plan for collaborative working with the potential to:
• Reduce inequalities for vulnerable groups with mental health needs, ensuring equitable access and provision of mental health services.
• Ensure that public services work together to provide an integrated approach.
• Ensure substance misuse co-occurring with mental health problems is managed effectively and remains a key focus.
• Reduce homelessness and helping people with mental health problems sustain tenancies.
It is acknowledged through a report completed by JMB Health Consultancy that Kerrigan is a ‘positive work in progress’, with clear recommendations for supported continuation of the original proposals. To obtain a copy of this report once it is made available, please contact Claire Cunliffe at claire.cunliffe@swansea.gov.uk
E LEARNING PACKAGE
As part of the Dual Diagnosis pilot, the Homelessness and Supporting People Network, with the assistance of the Public Health Wales Older People, Vulnerable Groups and Inequalities Team, has modified and re-hosted a robust Dual Diagnosis e-Learning package originally developed by PROGRESS and Coventry University. The e-learning package is an online resource suitable for the full spectrum of professionals within the social care, healthcare and criminal justice setting. The online course consists of four interactive modules, including case studies and video footage, ending in a self-assessment section.
Embedded in the Welsh version of the course are key NHS and Welsh Government documents and policies to aid and compliment the users overall learning experience.
The English version of this course is currently available at dualdiagnosis.co.uk and it is hoped the Welsh version will be available on the PROGRESS and NHS Wales website by April.
NORTH WALES NETWORK
It has been recognised that the pilots involved have all been centred in South Wales. It is the intention that the learning from these pilots will be shared with North Wales authorities to ensure the whole of Wales is included in this valuable piece of work. It is also hoped that the two consultants, Julie Butterworth and Ann Gorry, will help to establish a North Wales Network which will ensure all relevant sectors and professionals are working together to provide high quality support to this client group.
CWM TAF PILOT
The Cwm Taf bid stemmed from recognition that meeting the needs of people with co-occurring substance misuse and mental health problems
is a challenge for partners in both the statutory and voluntary sector services. It was acknowledged by staff working with this client group that no single body or sector is able to meet the needs of people with co-occurring problems. Instead, a co-ordinated approach is required with effective partnership working between health professionals in both primary and secondary care, local authorities, the third sector and the independent sector. Most importantly services user and carers must be at the heart of decision making and care planning; in control of their treatment journey as far as possible.
Whilst individual organisations in the area had previously produced their own procedures for the treatment of patients, this approach had limitations and often led to a fragmented service. As a result, partners were committed to a multi-agency, multi- disciplinary approach. The pilot therefore aimed to produce a coordinated approach to assessment and intervention which involved a range of partners. To deliver this approach the pilot sought to develop a set of joint working protocols which aim to achieve:
• Optimum opportunities for recovery.
• Improved care through adopting a more holistic approach to assessing and addressing service users’ needs.
• Improved access to appropriate treatment and support.
• A reduction in the harm caused by substance misuse.
• Increased stability in the individuals’ mental health.
• Ease of access to services, which includes clear coordination from one key worker to another.
• Services best suited to client needs and, if additional services are involved (which is usually the case), coordinated with as little disruption to the service user as possible.
• Avoidance of duplication in the assessment process and subsequent interventions wherever possible of mental health and substance misuse services.
• Emphasis on a preventative and recovery model in which services work closely together to provide the best and safest possible care for the service user, their carers and families.
To date, the independent consultant has met with the key players who put forward the original pilot proposal to tease out the key product to be produced. A small working group has been developed with stakeholders, which has benefited from very good support and attendance.
A workshop was organised and delivered at the end of 2013 that brought together representatives from a wide range of statutory and voluntary sector organisations. This workshop focussed on the themes of management of risk, joint working and communication and training. It was felt to be a very positive event by attendees and was extremely useful in gathering information from key stakeholders.
Work is now progressing on developing the document. This will take time as it is imperative that all partners are fully engaged at every stage of the process, and that a robust governance structure is in place to ensure that the agreement continues to develop and be monitored to ensure the desired service improvement.
With thanks to Ann Gorry and Julie Butterworth for their invaluable contribution in the development of this work. for any further information on the pilots, the prospective north Wales network or this work in general please contact claire cunliffe at claire.cunliffe@swansea.gov.uk