Community Impact Assessment
For a summary of this Community Impact Assessment, click here
Title of Community Impact Assessment (CIA): Mental Health Floating Support
Directorate: Community Health and Social Care
Date of assessment: March 2014
Names and roles of people carrying out the community impact assessment. (Please identify
Lead Officer):
Janice Lowndes
Summary of Community Impact Assessment
How did you approach the CIA and what did you find?
The CIA was completed using evidence based information on mental health support. This
information was combined with the information gathered through consultation and engagement
processes with staff, service users, family, carers and other services to inform the CIA. The
information in the CIA has been used to review the original budget proposal and inform a new
service model, which enables the reduction in the level of community support and achieve the
budget saving.
What are the main areas requiring further attention?
Establishing the ‘step down’ support for service users through the Pathway to Independence
Model.
Developing the new criteria for the reduced service.
Summary of recommendations for improvement
 Implement revised model in light of consultation and engagement process
 Continue to provide a reduced but targeted level of support to service users with highest
level of need
 Redesign of the new role combined accommodation and community support
 Embed the step down process
Section A – What are you impact assessing?
(Indicate with an “x” which applies):A decision to review or change a service
A strategy
A policy or procedure
A function, service or project
x
Are you impact assessing something that is?:New
Existing
Being reviewed
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Being reviewed as a result of budget constraints
x
Describe the area you are impact assessing and, where appropriate, the changes you are
proposing?
This CIA focuses on the Salford City Council Mental Health Floating Support Service.
The Mental Health Floating Support Service provides a diverse and flexible advice/ support to
people living in their own homes (tenants or home owners), to ensure that individuals can
successfully maintain current and future accommodation. When support is no longer required by
the service user, they are discharged from the service, if support is required beyond 6 months this
is commissioned by Greater Manchester West Mental Health Services from care providers. The
Mental Health Floating Support Service helps the people discharged from acute mental health
services to become more independent, enabling them to live independently at home when with out
support it would be difficult to do so. The service provides initial intervention to meet a range of
desired outcomes related to independent living for people with mental health problems.
The Mental Health Floating Support will be removed in the proposed change by removing the
community care worker posts. This proposal will mean that a community based service will no
longer be provided. Initial feedback from staff, mental health services and service users through
the service user consultation has raised concerns about the removal of this support, stating that
service users are unlikely to access support from communities, family and friends without a least
some initial help in the first few weeks of discharge from acute services.
The proposal therefore reflects these initial concerns and a reconfiguration of accommodation
support team and realignment of the Salford Clinical Commissioning Group funding will be
implemented, which will ensure that some one to one support is provided in community settings
alongside support in the intermediate support hub (Hollybank). This will be a reduced service,
which will be provide support for service users with highest level of need determined through the
referral process in Greater Manchester West Mental Health Services.
The proposed new service will be remodelled in a way that clearly places it on a recovery pathway
from acute and specialist provision through to ordinary accommodation supported by a reduced
community support service. The service will be accessible to people who are experiencing crisis to
avoid admission into inpatient provision. The levels of support and type of accommodation will be
determined though individual care plans and guided by the Care Co-ordinators in Greater
Manchester West Mental Health Services.
This proposal will continue to support the delivery of a number of key priorities including reducing
hospital admissions and length of stay, levels of homelessness, incidents of crime and antisocial
behaviour, reduction in worklessness, and incidents of physical and mental ill health.
This change will impact on service areas as below:
 Mental Health Floating Support: a new service model was put in place during 2014, which
included merging the service with the accommodation service under a single management
structure. The service has 18wte posts; the proposal will remove these posts funded by the
council. The remaining investment allocated by the Clinical Commissioning Group will be
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used to provide support in the community for people with high level of support needs
discharged from acute services.
 Victoria Crescent: Victoria Crescent will be retained and there will be no change in service.
o Hollybank: Improvements in Hollybank have been approved; this will be developed as the
intermediate support hub where support will be provided to people leaving acute services in
the accommodation and in the community. The redevelopment work will start in July 2014.
Hollybank staffing model will provide a more effective element of the recovery pathway in
mental health services. A reassessment of the length of stay has been completed for
accommodation at Hollybank; ensuring an appropriate length of time for clients to stay in the
accommodation is in place to encourage a focus on recovery. Victoria Crescent service will
continue to be supported from Hollybank.
Section B – Is a Community Impact Assessment required (Screening)?
Consider what you are impact assessing and mark “x” for all the statement(s) below which apply
Service or policy that people use or which apply to people (this could include staff)
Discretion is exercised or there is potential for people to experience different outcomes. For example,
planning applications and whether applications are approved or not
Concerns at local, regional or national level of discrimination/ inequalities
Major change, such as closure, reduction, removal or transfer
Community, regeneration and planning strategies, organisational or directorate partnership strategies/
plans
Employment policy – where discretion is not exercised
Employment policy – where discretion is exercised. For example, recruitment or disciplinary process
If none of the areas above apply to your proposals, you will not be required to undertake a full CIA.
Please summarise below why a full CIA is not required and send this form to your directorate
equality link officer. If you have identified one or more of the above areas, you should conduct a full
CIA and complete this form.
Equality Areas
Indicate with an “x” which equality areas are likely to be affected, positively or negatively, by the
proposals
Age
x
Religion and/ or belief
Disability
x
Sexual Identity
Gender (including pregnancy and maternity)
x
People on a low income (socio-econom
Gender reassignment
Race
Other (please state below) (For examp
offenders)
x
If any of the equality areas above have been identified as being likely to be affected by the
proposals, you will be required to undertake a CIA. You will need only to consider those areas
which you have indicated are likely to be affected by the proposals.
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Section C – Monitoring information
C1 Do you currently
monitor by the following
protected characteristics
or equality areas?
Age
Disability
Yes
(Y) or
No (N)
Gender (including
pregnancy and maternity)
Gender Reassignment
Race
Religion and/or belief
Sexual Identity
People on a low income
(socio-economic
inequality)
Other (please state) (For
example carers, ex
offenders)
Y
Y
Y
N
Y
Y
Y
Y
If no, please explain why and/ or detail in the
action plan at Section E how you will prioritise the
gathering of this equality monitoring data.
All users of the service have mental health
problems and consequently all would be classed
as disabled
This is not collected for the client group
This is a provider service, service users are
referred into the service via Greater Manchester
West Mental Health Services. Access to the
service is determined by need of the patient
through a formal assessment process.
Section C Consultation
C2 Are you intending to carry out consultation on your proposals? Yes
If “yes”, please give details of your consultation exercise and results below
Public consultation ran for 12 weeks from 3rd March 2014. The views and opinions expressed by
people using the service and their carers will help to influence the model of service delivery. A
letter explaining the consultation process was sent to all the service users in March 2014. Access
to the consultation document was via the Salford Council website. Service user groups were
encouraged to complete the consultation feedback through the group leaders. Service staff
encouraged and supported service users to complete the questionnaire.
Staff engagement began on 3rd March at the start of the staff briefings. The staff consultation will
commence with Mental Health Floating Support staff and Accommodation Support staff following
the end of the service user consultation.
Monthly staff engagement sessions were held and staff invited to make suggestions for the refocus
of the service. Briefing and updates on service user consultation were given. Staff ideas were
collected and ideas shared. Staff were invited to share ideas either in the sessions or via email or
discussion with service managers or through the arranged drop on sessions.
Service engagement and consultation processes were with Greater Manchester West Mental
Health Service who has responsibility for referral in to the service and the Salford Clinical
Commissioning Group who provide funding for community based support. These sessions
commenced in April 2014 and will inform the service change.
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Section C Analysis
C3 What
An assessment of the service users supported by the Mental Health Floating Support
information staff was completed by the Care Co-ordinators and service users who have been in the
has been
service for more than the allocated 6 months of support who have been discharged or an
analysed to alternative package of care provided where appropriate.
inform the
content of
this CIA?
What were
the
findings?
Some of the service users have been re-assessed by the social care team where the
service user has been in receipt of care allocated via the Fair Access to Care Services
moderate level for social care.
Consultation results
Please
include
details of,
for
example,
service or
employee
monitoring
information,
consultation
findings,
any
national or
local
research,
customer
feedback,
inspection
reports, and
any other
information
which will
inform your
CIA.
Please
specify
whether
this was
existing
information
or was
specifically
in relation
to this
equality
analysis
and CIA
process
The council received 1,832 responses to the overall consultation, of which 1,058 (57%) referred
to the Mental Health Floating Support proposals. 258 (24%) of the responses were in agreement
with the proposal.
Do you agree that it is fair to stop funding this service and instead provide information
and advice about how people can find support for themselves?
Of all those who responded about Mental Health Floating Support, 24% (258) either strongly
agreed or agreed that it is fair to stop funding this service and instead provide information and
advice about how people can find support for themselves. The proportions were similar for users
(9%, 10), carers (12%, 3) and family and friends (14%, 5), confirming that overall there was a
majority of respondents who disagreed or strongly disagreed that it is fair.
Those who identified themselves as disabled people agreed virtually equally with those who
identified themselves as not disabled, with 24% (107) of all disabled respondents supporting it,
compared to 26% (83) of non-disabled respondents. Whilst there was similarity between
disabled and non-disabled users of the service, 10% (5) compared to 15% (4), this was not the
case between family and friends of users of the service. The family and friends of non-disabled
users agreed more with the proposal 24% (4) than the family and friends of disabled users 6%
(1). There were no carers of disabled people who use this service who supported the proposal,
but 14% (2) carers of non-disabled people who use the service did.
Agreement was generally the same amongst those aged 25-44 (20%, 27) and 45-64 (22%, 55)
compared to those aged over 65 (30%, 106). It was lowest amongst those aged 25-44 who were
users (8%, 2), carers of users (11%, 1) or family of friends of users (8%, 1). It was highest
amongst those aged over 65 who were users (26%, 4) or family of friends of users (40%, 2). No
carers of users responded in support.
The proportions of men and women who strongly agreed and agreed that it is fair were virtually
equal at 26% (71) and 25% (122). There are no exceptions between users (men 8%, 3 – women
11%, 5), carers of users (men 17%, 1 – women 7%, 1) or family and friends of users (men 15%,
2 – women 12%, 2) by gender.
Approximately 66% (462) of respondents indicated that they had a religious belief. Of these 18%
(123) strongly agreed and agreed that it is fair, which is slightly less than those who indicated
that they had no religious belief (24%, 56). The majority of those who disclosed their religion
(93%) were Christian. 28% (132) agreed that it was fair, with a similar proportion of those with
Jewish faith (25%, 2), other (21%, 4) and Muslims (19%, 3).
Only three quarters of respondents revealed their ethnic heritage, and of those who did 93%
(717) were White British, 26% (190) of whom strongly agreed or agreed with the proposal,
compared to only 3% (22) of the much smaller number of people who identified themselves as
White Irish, of which 14% (3) supported the proposal. 2% (12) people identified themselves as
mixed heritage and 33% (4) supported the proposal.
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Many respondents did not disclose their sexual identity (40%, 394). Of the 24% (242) who
strongly agreed or agreed that it is fair to stop funding this service and instead provide
information and advice about how people can find support for themselves, 62% (151) were
heterosexual/ straight, 3% (7) gay men and 2% (6) bisexual.
Q13. If you have received this service (Mental Health Floating Support), could the
support you received following discharge from hospital be provided by …
Getting more help from family
Getting more help from friends and neighbours
Information and advice about things to do
More involvement in social or community groups
Other (combined variations on the above options)
Other (please specify)
Total
Respondents to
this question
51
23%
12
6%
36
17%
49
22%
57
26%
13
6%
218
100%
N.B. - these figures include responses only if Q12 (Mental Health
Floating Support), was answered.
Of the 218 responses, the remainder being ‘not answered’, the single most common
sources of similar support from elsewhere in the future was ‘from family’ at 23% and
‘more involvement in social or community groups’ at 22%.
Comments
Many people said that support should continue as people with Mental Health issues
were vulnerable and they needed professional help. Not everyone has friends or family
to help, but even if this is so, they do not have the specialist knowledge required or
cannot cope with supporting their friend or relative. In some cases friends or family can
make someone’s condition worse. Several people said that the proposal would not be
cost effective as it would increase the need for other services. Other comments
mentioned that people with mental health problems are unlikely to seek out or follow up
information and advice, so this alone will not help, what they need is a support worker.
Respondents felt that removing the service would lead to isolation and ill health. Two
stakeholders commented that if this service were not available, landlords would be
unwilling to let to people with mental health issues and this would lead to them spending
longer in temporary accommodation, then tenancy failure, increased homelessness,
evictions and offending.
The table below summarises respondents’ comments:
Comment
Support should be continued for the most vulnerable with level
dependent upon circumstances
If help/ support is not provided the cost will be greater in the longterm (false economy - early intervention prevents - reduce pressure
on other services)
This service is specialised and support cannot be got from
elsewhere
Family/ friends are not able to help/ offer support
There is nowhere else for people to get support & they are unlikely
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Number
45
41
40
24
16
to seek support by themselves
There are other organisations that can help (better signposting/
referral required)
I have worked and paid taxes so am entitled to this service
Pay for service from other sources, e.g. reduce number of Assistant
Mayors & reduce service duplication
This service tops-up what family/ friends do and contribute
It is not affordable to continue given low numbers of users & there
are relatively few users so impact will be minimal
4
3
2
1
1
Below are examples of the comments received:
“In my experience of working in the city for 20 years with vulnerable residents, I do not
feel that the people who use this service would always be able to source information for
themselves as the range of services they need to access to remain in the community are
becoming more fragmented and complex. This puts their ability to remain in the
community at risk. Families are often under a great deal of pressure and this is likely to
increase their caring responsibilities which will affect their well being.”
“It is contradictory in essence - how can someone with mental health issues access
support for themselves - typical M/H issues depressive illness/
anxiety/agoraphobia/schizophrenia - They may say they will access support themselves
when signposted - but in reality they are highly unlikely to access this support due to the
nature of the M/H conditions they have.”
“Mental health is a specialist field and should be left to the professionals.”
“Mental Health services are scant at best already. I have often found service users who
have slipped through the gaps, and their condition has got much worse. Not only does
this mean a great personal cost to the patient and those close to them, but often costs
more to deal with crisis and more severe mental health problems in the future. We
should be thinking more about preventative services.”
There are approximately 150 service users supported in the service. Support is
provided for a maximum of six months, although there are a number of people in the
service that have exceeded six months and are currently in the process of review by the
Care Co-ordinators in Greater Manchester West Mental Health Service.
Below is a table of the wards where service users live.
NUMBER
Swinton
Worsley
Eccles
Little Hulton
Irlam
Cadishead
Ordsall&Langworthy
Higher Broughton
Total
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%AGE
14
8
28
6
7
6
13
2
84
17%
10%
33%
7%
8%
7%
15%
2%
100%
Below is a table of the service users by gender.
Area
Swinton
Worsley
Eccles
Lt
Hulton
Irlam
Cadishead
Ordsall
Langworthy
Higher
Broughton
Total
Male
% Male
Female
%
Female
9
19%
5
14%
5
11%
3
8%
12
26%
16
43%
4
9%
2
5%
3
6%
4
11%
4
9%
2
5%
8
17%
5
14%
2
4%
0
0
47
100%
37
100%
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Section D – Potential impacts and how these will be addressed
Could your proposals have a
Yes (Y)
differential impact relating to age
equality
Are your proposals
discriminatory on the grounds of
age?
Will people within certain age
ranges not be getting the
outcome they need?
Will people within certain age
ranges be disadvantaged as a
result of your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Will the proposals mean that
people within certain age ranges
will experience positive
Y
outcomes?
Highlight any positive impacts
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
N
Starting Today – Background Paper 3: Mental Health and Inequalities
Mental health and inequalities
Authors: Isabella Goldie, Julie Dowds, Chris O’Sullivan, Mental Health Foundation
There is a strong body of evidence that living in poverty brings with it poorer mental
health, and that the stresses of living in poverty increases the risk of developing
mental health problems. In addition that living with a mental health problem brings
with it increased social disadvantage, such as higher levels of unemployment.
Across the UK, we experience mental health inequities, these are inequalities in
relation to mental health status that can be described as ‘morally or ethically’ unfair
or unjust (Whitehead, 1990).
These inequities are often experienced by the same people and accumulate over a
lifetime, placing older people who experience poverty at increased risk of poor
mental health and of developing mental health problems.
In keeping with recent developments across mental health services, where
services were not defined on the basis of age, the new service will continue to work
with all adults with functional mental health problems regardless of age.
All people accessing the service will continue to have an individual support plan
which will ensure that the outcomes identified are personal and positive. Each
service users’ support plan will define the desired outcomes for them and support
will be provided to meet the following additional outcomes:

Personal outcomes, as identified by the Service User, are achieved.

Service users are engaged and committed to achieving the goals in their
support plan;
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Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
Y

Service users maintain their tenancies and/ or make positive move on into
independent accommodation;

Service users do not return to an accommodation based support service due
to difficulties in managing independently;

Service users are encouraged and supervised in developing their daily living
and independent living skills;

Service users can identify college courses and job opportunities to match
their skills and abilities;

Service users have an understanding of what is considered unreasonable or
anti-social behaviour and take responsibility for the behaviour of family,
friends and visitors;

Service users are involved in managing their support, which includes
partaking in assessment and support plan reviews and where appropriate
being supported to access the personalisation pathway to meet ongoing and
future care and support needs

Service users are encouraged to exercise their right to representation and
complaints procedures;

Service users’ physical, mental, and emotional well-being is safeguarded and
promoted;

Service users engagement with treatment interventions is improved and
sustained;

Service users maintain contact with neighbours, other individuals and
agencies in accordance with their support plan;

Service users are supported to reduce social isolation.
A key role of the service will be to support people in their local community and
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relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
potential to foster good relations
Could your proposals have a
differential impact relating to
disability equality
Are your proposals
discriminatory on the grounds of
disability?
Will people with disabilities not
be getting the outcome they
need?
Will people with disabilities be
disadvantaged as a result of
your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Will the proposals mean that
people with disabilities will
experience positive outcomes?
Highlight any positive impacts
enhance their engagement in their locality. This will be supported through the use
of the Pathway to Independence and access to community support, helping people
to widen their engagement with the community in which they live.
Yes (Y)
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
N
Not everyone that experiences discrimination encounters socio-economic
inequalities although very many do, with large numbers of people with mental
health problems unemployed and poverty a very real experience for many older
people (Age Concern and Mental Health Foundation, 2006).
People with disabilities and long term health conditions have the additional
disadvantage associated with their health conditions, such as pain, unpredictability
and the impact of long term use of medications. All of this can serve to limit their
lives and therefore their ability to access opportunities that can work to protect
mental health, such as employment and social support.
Y
The proposed service is targeted specifically at people with mental health
problems.
All people accessing the service will continue to have an individual support plan
which will ensure that the outcomes identified are personal and positive. Each
service users’ support plan will define the desired outcomes for them.
Support is provided to meet the following additional outcomes:

Personal outcomes, as identified by the Service User, are achieved.

Service users are engaged and committed to achieving the goals in their
support plan;

Service users maintain their tenancies and/ or make positive move on into
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independent accommodation;

Service users do not return to an accommodation based support service due
to difficulties in managing independently;

Service users are encouraged and supervised in developing their daily living
and independent living skills;

Service users can identify college courses and job opportunities to match
their skills and abilities;

Service users have an understanding of what is considered unreasonable or
anti-social behaviour and take responsibility for the behaviour of family,
friends and visitors;

Service users are involved in managing their support, which includes
partaking in assessment and support plan reviews and where appropriate
being supported to access the personalisation pathway to meet ongoing and
future care and support needs

Service users are encouraged to exercise their right to representation and
complaints procedures;

Service users’ physical, mental, and emotional well-being is safeguarded and
promoted;

Service users engagement with treatment interventions is improved and
sustained;

Service users maintain contact with neighbours, other individuals and
agencies in accordance with their support plan;

Service users are supported to reduce social isolation.
A key role of the service will be to support people in Hollybank and in the
community to enhance their engagement in their locality. The redesign of these
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Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
potential to foster good relations
Y
Could your proposals have a
Yes (Y)
differential impact relating to
gender equality (this includes
pregnancy and maternity)
Are your proposals
discriminatory on the grounds of
gender?
Will men or women, boys or girls
not be getting the outcome they
need?
Will men or women, boys or girls
be disadvantaged as a result of
your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Will the proposals mean that
men or women, boys or girls will
experience positive outcomes?
Highlight any positive impacts
Y
services will have an emphasis on ensuring that services are personalised, flexible
and maximise individual’s capacity for recovery and independence. This will in turn
help people to widen their engagement with the community in which they live.
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
N
In 2007, NHS Health Scotland and the National Resource Centre for Ethnic
Minority Health (NRCEMH) produced a report focused on the 6 equality and
diversity strands of: Gender; Age; Disability; Sexual Orientation – LGBT; Race and
Ethnicity; Spirituality.
The report took as its starting point the argument that the factors that can
undermine mental health or promote well-being are not randomly distributed but
reflect social divisions of class and socio-economic status, aspects of social identity
such as age, gender race or ethnicity, sexual orientation, disability (including the
experience of mental health problems), religion and belief.
The report made the point that it is not being a woman, or being black or gay, per
se that cause mental distress, but the fact that some aspects of social identity can
expose people to discrimination, stigma and prejudice.
The experience of discrimination and prejudice can undermine mental health and
well-being directly through exposure to, for example, harassment, and indirectly
through the experience of poverty, deprivation, exclusion and inequality with which
they are associated (NHS Health Scotland, 2007).
The growing diversity in the UK brings a range of opportunities but will also
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challenge the way services operate. Currently there is a distance to travel to
achieve equity in service provision for the settled Black and minority ethnic
communities and new patterns of migration will expose the shortfalls further. For
example one study found that as many as 57% of Refugee and asylum seeking
women were above the cut off point for Post Traumatic Stress Disorder (LSHTM &
SRC, 2009).
The service will not discriminate on the basis of gender and will be open to all
adults who fit the eligibility criteria.
All people accessing the service will continue to have an individual support plan
which will ensure that the outcomes identified are personal and positive. Each
service users’ support plan will define the desired outcomes for them in line with
the Supporting People National Outcomes Framework. The Service Provider will
ensure that support is provided to meet the following additional outcomes:

Personal outcomes, as identified by the Service User, are achieved.

Service users are engaged and committed to achieving the goals in their
support plan;

Service users maintain their tenancies and/ or make positive move on into
independent accommodation;

Service users do not return to an accommodation based support service due
to difficulties in managing independently;

Service users are encouraged and supervised in developing their daily living
and independent living skills;

Service users can identify college courses and job opportunities to match
their skills and abilities;

Service users have an understanding of what is considered unreasonable or
anti-social behaviour and take responsibility for the behaviour of family,
friends and visitors;
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Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
potential to foster good relations

Service users are involved in managing their support, which includes
partaking in assessment and support plan reviews and where appropriate
being supported to access the personalisation pathway to meet ongoing and
future care and support needs

Service users are encouraged to exercise their right to representation and
complaints procedures;

Service users’ physical, mental, and emotional well-being is safeguarded and
promoted;

Service users engagement with treatment interventions is improved and
sustained;

Service users maintain contact with neighbours, other individuals and
agencies in accordance with their support plan;

Service users are supported to reduce social isolation.
Y
A key role of the service will be to support people in their local community and
enhance their engagement in their locality. The redesign of these services will have
an emphasis on ensuring that services are personalised and flexible and support
and maximise individual’s capacity for recovery and independence. This will in turn
which will help people to widen their engagement with the community in which they
live.
Could your proposals have a differential
impact relating to equality for people
planning, undergoing or who have
undergone gender reassignment?
Are your proposals discriminatory for
people planning, undergoing or who
have undergone gender reassignment?
Will people planning, undergoing or who
Yes (Y)
No (N)
Explain impact(s) and what evidence or data exists to support your
analysis?
N
Starting Today – Background Paper 3: Mental Health and Inequalities
Mental health and inequalities
Authors: Isabella Goldie, Julie Dowds, Chris O’Sullivan, Mental Health
Foundation
15/30
have undergone gender reassignment
not be getting the outcome they need?
Will people planning, undergoing or who
have undergone gender reassignment
be disadvantaged as a result of your
proposals?
If the impact is negative, how will it be
reduced or eliminated?
Will the proposals mean that people
planning, undergoing or who have
undergone gender reassignment will
experience positive outcomes?
Highlight any positive impacts
This report made the point that it is not being a woman, or being black or
gay, per se that cause mental distress, but the fact that some aspects of
social identity can expose people to discrimination, stigma and prejudice.
The experience of discrimination and prejudice can undermine mental
health and well-being directly through exposure to, for example,
harassment, and indirectly through the experience of poverty, deprivation,
exclusion and inequality with which they are associated (NHS Health
Scotland, 2007).
Y
The service will not discriminate on the basis of gender and will be open to
all adults who fit the eligibility criteria.
Since the service is a one to one service this will be based entirely around
achieving the positive outcomes that the individual has identified. Each
service users’ support plan will define the desired outcomes for them in line
with the Supporting People National Outcomes Framework. The Service
Provider will ensure that support is provided to meet the following additional
outcomes:

Personal outcomes, as identified by the Service User, are achieved.

Service users are engaged and committed to achieving the goals in
their support plan;

Service users maintain their tenancies and/ or make positive move on
into independent accommodation;

Service users do not return to an accommodation based support
service due to difficulties in managing independently;

Service users are encouraged and supervised in developing their
daily living and independent living skills;

Service users can identify college courses and job opportunities to
match their skills and abilities;
16/30
Are the proposals likely to impact on
community cohesion?
Is there potential to enhance
relationships between people who share
a protected characteristic and those who
do not?
Identify areas where there is potential to
foster good relations
Y

Service users have an understanding of what is considered
unreasonable or anti-social behaviour and take responsibility for the
behaviour of family, friends and visitors;

Service users are involved in managing their support, which includes
partaking in assessment and support plan reviews and where
appropriate being supported to access the personalisation pathway to
meet ongoing and future care and support needs

Service users are encouraged to exercise their right to representation
and complaints procedures;

Service users’ physical, mental, and emotional well-being is
safeguarded and promoted;

Service users engagement with treatment interventions is improved
and sustained;

Service users maintain contact with neighbours, other individuals and
agencies in accordance with their support plan;

Service users are supported to reduce social isolation.
A key role of the service will be to support people in their local community
and enhance their engagement in their locality. The redesign of these
services will have an emphasis on ensuring that services are personalized,
flexible and maximise individual’s capacity for recovery and independence.
This will in turn which will help people to widen their engagement with the
community in which they live.
17/30
Could your proposals have a
differential impact relating to
race equality
Are your proposals
discriminatory on the grounds of
race?
Will people within certain racial
groups not be getting the
outcome they need?
Will people within certain racial
groups be disadvantaged as a
result of your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Yes (Y)
Will the proposals mean that
people within certain racial
groups will experience positive
outcomes?
Highlight any positive impacts
Y
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
N
Starting Today – Background Paper 3: Mental Health and Inequalities
Mental health and inequalities
Authors: Isabella Goldie, Julie Dowds, Chris O’Sullivan, Mental Health Foundation
Many problems associated with relative deprivation are more prevalent in more
unequal societies. A review of the evidence suggested that this may be true of
morbidity and mortality, obesity, teenage birth rates, mental illness, homicide, low
trust, low social capital, hostility, racism, poor educational performance among
school children, the proportion of the population imprisoned, drug overdose
mortality and low social mobility (Wilkinson & Pickett, 2007). Arguably these are all
part of the same pattern of social problems in which mental illness is a (large)
player.
When discussing inequality it is important to reflect on groups of people who
experience discrimination, and although are also highly represented within lower
socio-economic groups, also encounter additional social injuries. Clear examples of
this are people from minority ethnic communities, refugees and asylum seekers,
older people and people with disabilities, including mental health problems and
learning disabilities.
The service will not discriminate on the basis of race and will be open to all adults
who fit the eligibility criteria.
All people accessing the service will continue to have an individual support plan
which will ensure that the outcomes identified are personal and positive. Each
service users’ support plan will define the desired outcomes for them in line with
the Supporting People National Outcomes Framework. The service will ensure that
support is provided to meet the following additional outcomes:

Personal outcomes, as identified by the Service User, are achieved.

Service users are engaged and committed to achieving the goals in their
18/30
support plan;
Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
Y

Service users maintain their tenancies and/ or make positive move on into
independent accommodation;

Service users do not return to an accommodation based support service due
to difficulties in managing independently;

Service users are encouraged and supervised in developing their daily living
and independent living skills;

Service users can identify college courses and job opportunities to match
their skills and abilities;

Service users have an understanding of what is considered unreasonable or
anti-social behaviour and take responsibility for the behaviour of family,
friends and visitors;

Service users are involved in managing their support, which includes
partaking in assessment and support plan reviews and where appropriate
being supported to access the personalisation pathway to meet ongoing and
future care and support needs

Service users are encouraged to exercise their right to representation and
complaints procedures;

Service users’ physical, mental, and emotional well-being is safeguarded and
promoted;

Service users engagement with treatment interventions is improved and
sustained;

Service users maintain contact with neighbours, other individuals and
agencies in accordance with their support plan;

Service users are supported to reduce social isolation.
19/30
potential to foster good relations
A key role of the service will be to support people in their local community and
enhance their engagement in their locality. The redesign of these services will have
an emphasis on ensuring that services are personalized, flexible and maximise
individual’s capacity for recovery and independence. This will in turn which will help
people to widen their engagement with the community in which they live.
Could your proposals have a
differential impact relating to
religion or belief equality
Are your proposals discriminatory
on the grounds of religion or belief?
Will people of certain religions or
who have particular beliefs not be
getting the outcome they need?
Will people of certain religions or
who have particular beliefs be
disadvantaged as a result of your
proposals?
If the impact is negative, how will it
be reduced or eliminated?
Will the proposals mean that
people of certain religions or who
have particular beliefs will
experience positive outcomes?
Highlight any positive impacts
Yes (Y)
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
N
The service will not discriminate on the basis of religion or belief and will be open to
all adults who fit the eligibility criteria.
All people accessing the service will continue to have an individual support plan
which will ensure that the outcomes identified are personal and positive. Each
service users’ support plan will define the desired outcomes for them in line with
the Supporting People National Outcomes Framework. The service will ensure that
support is provided to meet the following additional outcomes:
Y

Personal outcomes, as identified by the Service User, are achieved.

Service users are engaged and committed to achieving the goals in their
support plan;

Service users maintain their tenancies and/ or make positive move on into
independent accommodation;

Service users do not return to an accommodation based support service due
to difficulties in managing independently;

Service users are encouraged and supervised in developing their daily living
and independent living skills;

Service users can identify college courses and job opportunities to match
20/30
their skills and abilities;
Are the proposals likely to impact
on community cohesion?
Is there potential to enhance
relationships between people who
share a protected characteristic
and those who do not?
Identify areas where there is
potential to foster good relations
Y

Service users have an understanding of what is considered unreasonable or
anti-social behaviour and take responsibility for the behaviour of family,
friends and visitors;

Service users are involved in managing their support, which includes
partaking in assessment and support plan reviews and where appropriate
being supported to access the personalisation pathway to meet ongoing and
future care and support needs

Service users are encouraged to exercise their right to representation and
complaints procedures;

Service users’ physical, mental, and emotional well-being is safeguarded and
promoted;

Service users engagement with treatment interventions is improved and
sustained;

Service users maintain contact with neighbours, other individuals and
agencies in accordance with their support plan;

Service users are supported to reduce social isolation.
A key role of the service will be to support people in their local community and
enhance their engagement in their locality. The redesign of these services will have
an emphasis on ensuring that services are personalized flexible and maximise
individual’s capacity for recovery and independence. This will in turn which will help
people to widen their engagement with the community in which they live.
21/30
Could your proposals have a
differential impact relating to
sexual identity equality
Are your proposals
discriminatory on the grounds of
sexual identity?
Will gay, lesbian and/or bisexual people not be getting the
outcome they need?
Will gay, lesbian and/or bisexual people be disadvantaged
as a result of your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Yes (Y)
Will the proposals mean that
gay, lesbian and/or bi-sexual
people will experience positive
outcomes?
Highlight any positive impacts
Y
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
N
Mental health issues within lesbian, gay and bisexual (LGB) communities, DoH,
2007, Briefings for Health and Social Care staff.
Although the majority of LGB people do not experience poor mental health,
research suggests that some LGB people are at higher risk of mental disorder,
suicidal behaviour and substance misuse. Evidence indicates that the increased
risk of mental disorder in LGB people is linked to experiences of discrimination.
LGB people are more likely to report both daily and lifetime discrimination than
heterosexual people.
Gay men and bisexual people are significantly more likely to say that they have
been fired unfairly from their job because of discrimination.
Lesbians are more likely to have experienced verbal and physical intimidation than
heterosexual women.
Discrimination has been shown to be linked to an increase in deliberate self-harm
in LGB people.
LGB people demonstrate higher rates of anxiety and depression than
heterosexuals; lesbians and bisexual women may be at more risk of substance
dependency than other women.
Access to mental health services
Lesbians, gay men and bisexual people use mental health services more
frequently than their heterosexual counterparts. Despite higher usage, LGB people
report mixed experiences of services:
One-third of gay men, a quarter of bisexual men and over 40% of lesbians reported
negative or mixed reactions from mental health professionals when they disclosed
22/30
their sexual orientation.
One in five lesbians and gay men and a third of bisexual men stated that a mental
health professional made a causal link between their sexual orientation and their
mental health problem.
Lesbians reported not being confident about accessing mental health services.
LGB people reported problems in their encounters with mental health
professionals ranging from lack of empathy about sexual orientation to
incidents of homophobia.
There are acknowledged difficulties for mental health professionals in getting the
balance right. In some of the accounts reported, the mental health professional was
regarded as insensitive if they placed too much emphasis on sexual orientation in
the clinical setting, while others were regarded as insensitive if they ignored it.
The service will not discriminate on the basis of religion or belief and will be open to
all adults who fit the eligibility criteria
All people accessing the service will continue to have an individual support plan
which will ensure that the outcomes identified are personal and positive. Each
service users’ support plan will define the desired outcomes for them in line with
the Supporting People National Outcomes Framework. The service will ensure that
support is provided to meet the following additional outcomes:
Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
Y

Personal outcomes, as identified by the Service User, are achieved.

Service users are engaged and committed to achieving the goals in their
support plan;

Service users maintain their tenancies and/ or make positive move on into
independent accommodation;

Service users do not return to an accommodation based support service due
to difficulties in managing independently;
23/30
not?
Identify areas where there is
potential to foster good relations

Service users are encouraged and supervised in developing their daily living
and independent living skills;

Service users can identify college courses and job opportunities to match
their skills and abilities;

Service users have an understanding of what is considered unreasonable or
anti-social behaviour and take responsibility for the behaviour of family,
friends and visitors;

Service users are involved in managing their support, which includes
partaking in assessment and support plan reviews and where appropriate
being supported to access the personalisation pathway to meet ongoing and
future care and support needs

Service users are encouraged to exercise their right to representation and
complaints procedures;

Service users’ physical, mental, and emotional well-being is safeguarded and
promoted;

Service users engagement with treatment interventions is improved and
sustained;

Service users maintain contact with neighbours, other individuals and
agencies in accordance with their support plan;

Service users are supported to reduce social isolation.
A key role of the service will be to support people in their local community and
enhance their engagement in their locality. The redesign of these services will have
an emphasis on ensuring that services are personalized, flexible and maximise
individual’s capacity for recovery and independence. This will in turn which will help
people to widen their engagement with the community in which they live.
24/30
Could your proposals have a
differential impact on socio
economic equality (people on a
low income)?
Are your proposals
discriminatory on the grounds of
socio economic inequality?
Will people on a low income not
be getting the outcome they
need?
Will people on a low income be
disadvantaged as a result of
your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Will the proposals mean that
people on a low income will
experience positive outcomes?
Highlight any positive impacts
Yes (Y)
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
N
Adverse mental health outcomes are 2 to 2.5 times higher among those
experiencing greatest social disadvantage compared to those experiencing least
disadvantage (Kessler et al., 1994; Macran et al., 1996; Gilbert & Allan, 1998;
Murali & Oyebode, 2004).
In addition those living with disability or a mental health problem remain at highest
risk of poverty (Parckar, 2008). Socio-economic pressures such as poverty and low
levels of education are recognised risks to mental health for individuals and
communities. The greater the gap between the rich and the poor, the greater
differences are observed in health.
Y
Many problems associated with relative deprivation are more prevalent in more
unequal societies. A review of the evidence suggested that this may be true of
morbidity and mortality, obesity, teenage birth rates, mental illness, homicide, low
trust, low social capital, hostility, racism, poor educational performance among
school children, the proportion of the population imprisoned, drug overdose
mortality and low social mobility (Wilkinson & Pickett, 2007). Arguably these are all
part of the same pattern of social problems in which mental illness is a (large)
player.
When discussing inequality it is important to reflect on groups of people who
experience discrimination, and although are also highly represented within lower
socio-economic groups, also encounter additional social injuries. Clear examples of
this are people from minority ethnic communities, refugees and asylum seekers,
older people and people with disabilities, including mental health problems and
learning disabilities.
The service will not discriminate on the basis of socio economic inequality and will
be open to all adults who fit the eligibility criteria.
All people accessing the service will continue to have an individual support plan
which will ensure that the outcomes identified are personal and positive. Each
25/30
service users’ support plan will define the desired outcomes for them in line with
the Supporting People National Outcomes Framework. The service will ensure that
support is provided to meet the following additional outcomes:
Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is

Personal outcomes, as identified by the Service User, are achieved.

Service users are engaged and committed to achieving the goals in their
support plan;

Service users maintain their tenancies and/ or make positive move on into
independent accommodation;

Service users do not return to an accommodation based support service due
to difficulties in managing independently;

Service users are encouraged and supervised in developing their daily living
and independent living skills;

Service users can identify college courses and job opportunities to match
their skills and abilities;

Service users have an understanding of what is considered unreasonable or
anti-social behaviour and take responsibility for the behaviour of family,
friends and visitors;

Service users are involved in managing their support, which includes
partaking in assessment and support plan reviews and where appropriate
being supported to access the personalisation pathway to meet ongoing and
future care and support needs

Service users are encouraged to exercise their right to representation and
complaints procedures;

Service users’ physical, mental, and emotional well-being is safeguarded and
promoted;
Y
26/30
potential to foster good relations

Service users engagement with treatment interventions is improved and
sustained;

Service users maintain contact with neighbours, other individuals and
agencies in accordance with their support plan;

Service users are supported to reduce social isolation.
A key role of the service will be to support people in their local community and
enhance their engagement in their locality. The redesign of these services will have
an emphasis on ensuring that services are personalized, flexible and maximise
individual’s capacity for recovery and independence. This will in turn which will help
people to widen their engagement with the community in which they live.
Could your proposals have a
Yes (Y)
differential impact relating to any
other equality groups, for
example, carers, ex offenders?
Are your proposals
discriminatory in relation to any
other groups?
Will people within any other
groups not be getting the
outcome they need?
Will people within any other
groups be disadvantaged as a
result of your proposals?
If the impact is negative, how
will it be reduced or eliminated?
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
N
The service will not discriminate and will be open to all adults who fit the eligibility
criteria.
We will ensure that any consultation work also captures the views of carers. The
proposal reduces the support provided to people leaving acute mental health
services carers of the service users with high needs will not be impacted negatively
by the changes.
Carers are entitled to access a carer’s assessment to identify any needs that they
may have to support them with their caring roles. Carer’s assessments can identify
support that could be offered to carers to help them to continue caring and (if
eligible) this can be combined with carer’s personal budgets (via personalisation) to
meet their needs. Should individual carers identify that they would benefit from an
assessment; it can be arranged in a timely manner.
Carer’s can also be supported to sign up to the Carer’s Centre where they are able
to access further information and support that may be useful in their role.
27/30
All people accessing the service will continue to have an individual support plan
which will ensure that the outcomes identified are personal and positive. Each
service users’ support plan will define the desired outcomes for them in line with
the Supporting People National Outcomes Framework. The Service Provider will
ensure that support is provided to meet the following additional outcomes:
Will the proposals mean that
people within any other groups
will experience positive
outcomes?
Highlight any positive impacts
Y

Personal outcomes, as identified by the Service User, are achieved.

Service users are engaged and committed to achieving the goals in their
support plan;

Service users maintain their tenancies and/ or make positive move on into
independent accommodation;

Service users do not return to an accommodation based support service due
to difficulties in managing independently;

Service users are encouraged and supervised in developing their daily living
and independent living skills;

Service users can identify college courses and job opportunities to match
their skills and abilities;

Service users have an understanding of what is considered unreasonable or
anti-social behaviour and take responsibility for the behaviour of family,
friends and visitors;

Service users are involved in managing their support, which includes
partaking in assessment and support plan reviews and where appropriate
being supported to access the personalisation pathway to meet ongoing and
future care and support needs

Service users are encouraged to exercise their right to representation and
complaints procedures;

Service users’ physical, mental, and emotional well-being is safeguarded and
28/30
promoted;
Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
potential to foster good relations

Service users engagement with treatment interventions is improved and
sustained;

Service users maintain contact with neighbours, other individuals and
agencies in accordance with their support plan;

Service users are supported to reduce social isolation.
A key role of the service will be to support people in their local community and
enhance their engagement in their locality. The redesign of these services will have
an emphasis on ensuring that services are personalized, flexible and maximise
individual’s capacity for recovery and independence. This will in turn which will help
people to widen their engagement with the community in which they live.
Y
Section E – Action Plan and review
Detail in the plan below, actions that you have identified in your CIA, which will eliminate discrimination, advance equality of opportunity
and/or foster good relations.
If you are unable to eliminate or reduce negative impact on any of the equality areas, you should explain why
Impact (positive or
negative) identified
Proposed action
Person(s)
responsible
Where will action be
monitored? (e.g.,
Directorate Business
Plan, Service Plan,
Equality Action Plan)
Target date
Required outcome
Reduction in the number
of people that can be
supported in the
community due to the
removal of the Mental
Develop criteria for
access to the limited
service
Janice Lowndes
Service plan
July 2014
Criteria identified
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Health Floating Support
team
Restructure of the
accommodation team to
deliver both in
accommodation and in
the community
Restructure of the
service. Redevelop job
description and staffing
rotas. Staff training and
development
Barbara Bond
Service plan
July 2014
Integrated delivery
New service model
Could the changes in any of the above areas have a negative effect on other groups? Explain why and what you will do about this.
No
Name
Senior Manager
Signature
Janice Lowndes
Date
28th May 2014
Lead CIA Officer
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