Improving Mental Health
Introduction
1. Kim Crowe – Executive Director of
Service Development and Delivery
2. Mersey Care NHS Trust
3. Service User and Carer involvement
4. Contribution to improving patient safety
5. An example of service user involvement
6. Evaluation of service user and carer
involvement
1. Kim Crowe – Executive Director of Service
Development and Delivery
2. Mersey Care NHS Trust
3. Service user and carer involvement
4. Contribution to improving patient safety
5. An example of service user involvement
6. Evaluation of service user and carer
involvement
2. Mersey Care NHS Trust
• Specialist provider of Mental Health, Learning Disability
and Addiction services to Merseyside in North West
England.
(weighted population of 1.4m)
• Medium secure service to Merseyside and Cheshire
(weighted population size of 2.9 m)
• One of 3 providers of High Secure Mental Health
Services in England covering North West England and
Wales.
(weighted population size of 6.9 m)
Demographics and Demand
•
Some of the most deprived communities in the UK
•
Higher than average unemployment rates
•
Total population remains unchanged but proportion of Older People
increasing
•
Higher than average incidence of drug abuse and excessive alcohol
consumption
•
Demand for learning disability services forecast to increase over the next
10 years
Mersey Care Vision and Strategy
Vision
• To be recognised as a leading organisation in the provision of Adult
Mental Health, Learning Disability and Substance Misuse care that
has at its heart health and well-being.
Strategy
• To improve the quality and increase the value of services
• To enhance partnership arrangements to deliver a better range of
integrated services.
• To consolidate, develop and expand the range of services provided.
• To become a better organisation by building on involvement with
stakeholders and strengthening governance.
Services Provided By Mersey Care
•
Inpatient and community based services for
- Adult and older peoples mental health
- Addictions – drugs and alcohol services
- Learning disabilities
- Brain injury
- Medium secure services
•
Inpatient High Secure service
•
•
•
•
710 Inpatient Beds
4,300 Staff
35 Sites
Budget for 2011-12 £189m
www.merseycare.nhs.uk
1. Kim Crowe – Executive Director of Service
Development and Delivery
2. Mersey Care NHS Trust
3. Service user and carer involvement
4. Contribution to improving patient safety
5. An example of service user involvement
6. Evaluation of service user and carer
involvement
3. Service User and Carer
Involvement
• Mersey Care established 2001
• Consultation process included service
user and carer views
• Recruitment to Board level posts of new
organisation included service users and
carers.
• Service User and Carer Forum established
• Involving Service Users and Carers Policy
Current Examples of Service User
Involvement
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Trust Board
All Committees of the Board
Annual appraisal for Directors and Consultant Pyschiatrists
Policy Formation e.g. Adverse Incidents, Suicide strategy
Recruitment - Mersey Care - 2825 Mersey Care posts recruited to
since 2003
Universities – recruitment and training programmes.
Training - induction and equality/human rights training
Service development
Incident reviews
Evaluations – SURE Group
Governance Checks for Clinical Business Units
Environmental Inspections
Mersey Care NHS Trust
Governance Structure
Making it Happen
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•
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Data base of service users and carers
Access to training opportunities
Work experience
Volunteer Policy
Payment for contribution £12 per hour
(14 euros)
1. Kim Crowe – Executive Director of Service
Development and Delivery
2. Mersey Care NHS Trust
3. Service user and carer involvement
4. Contribution to improving patient safety
5. An example of service user involvement
6. Evaluation of service user and carer
involvement
4. Contribution To Improving Patient
Safety
• Performance Framework – quality and safety informed
by:
-
National Policy
-
Clinical Quality Commission - inspections
-
Local Contract for services - core payment and
quality premium
-
Quality Account – locally determined priorities
Performance Framework
Quality Account Local Priorities
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Improve the care pathway
Improve patient environment
Improve stakeholder engagement
Reduce top 5 incidents and complaints
– Incidents – violence and aggression, falls
and self harm
– Complaints – care and treatment, staff
attitude
Director of Patient Safety
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Incidents
Violence and Aggression
Complaints
Legal Claims
Safety Culture
Service users involved in all of the above
1. Kim Crowe – Executive Director of Service
Development and Delivery
2. Mersey Care NHS Trust
3. Service user and carer involvement
4. Contribution to improving patient safety
5. An example of service user involvement
6. Evaluation of service user and carer
involvement
5. An Example of Service User
Involvement in Brain Injury Services
• Service User & Carer Away day in April
2010:
– The need for a facility for service users and
carers to drop in, meet, exchange information
and provide peer support.
– The increased use and involvement of service
users and carers in the development and
delivery of Brain Injury Rehabilitation
Services.
Achievements to date …
A chance to learn
from others and
share
experiences
Forum for
ideas
Confidence
booster
Makes you feel
relaxed –stops your
worries and helps
you help yourself
Helps to discuss
different
approaches to life
Opportunity to
talk to
professionals and
change services
What we have achieved so far…
•
Personal:
– Brought people together
– Better understand myself and others with brain
injuries
– Boosted confidence and people skills
• Group:
– Raised awareness of brain injuries
– Developed signposting ideas
– Act as a Service User & Carer Forum
– Linked up community and inpatient services
– Service user and Carer committee to action and take
forward the issues highlighted at the drop in centre
The Future
• Improve Service User involvement:
– Act as service users representatives/consultants in all areas of
the service
– To have a voice to shape the future of the Brain Injury
Rehabilitation Centre
– Volunteer opportunities:
• Sports Programmes – swimming, fitness
• Mentoring/buddy programme on the ward
• Group co-facilitators on education and ward programmes
• Service User and Carer Led drop-in centre
1. Kim Crowe – Executive Director of Service
Development and Delivery
2. Mersey Care NHS Trust
3. Service user and carer involvement
4. Contribution to improving patient safety
5. An example of service user involvement
6. Evaluation of service user and carer
involvement
6. An Evaluation of Service User &
Carer Involvement in Mersey Care
NHS Trust
SURE comprises a small group of
Service Users & Carers who have
been trained to undertake audit,
research and service evaluations…
Why Become Involved?
What were your reasons for becoming involved in Mersey
Care?
70
60
63
64
51
50
40
30
20
22
19
13
10
0
To give
To change I wanted
Because
Expenses
something
and
something payment is
are
back
improve meaningful offered reimbursed
services
to do
Other
Has getting involved in Mersey Care made a difference
for you as a person? A negative
No difference
5%
Some positive
difference
41%
difference
1%
A lot of positive
difference
53%
It has helped me regain my sense of
purpose in life and a lot of my dignity
following my breakdown.
To have something important to get up
for in the morning became my
motivation to live and carry on. I hate
to think where I might otherwise have
been.
Made me feel useful
again. As if I have the
ability to think and
contribute.
Improved self-esteem and
confidence. Feeling valued
which resulted in improved
self-respect and respect from
family and friends. Being able
to 'treat' family with payment,
as felt they’d earned it!
I enjoy working with
fellow service users,
with carers and with
Mersey Care staff. I
really feel listened to.
Being involved with MCT has
changed my life. It has given
me the opportunity to try and
help the way service users
are treated and to help
change bad practices.
My input is true, honest and
if my experience can help
others not do the pain I went
through over the past 27
years, then so be it. I just
want to be me.
Helped me to meet other
carers whose
sons/daughters have been
sectioned and been in
hospital for long periods.
Meetings have acted as a
support group and
friendships have formed.
Being involved with Mersey
Care has transformed my
life, from being in a position
where I thought I had no
place in life to a position of
respect and responsibility.
Mental Health and Recovery
Has being involved in Mersey Care had any impact upon
your mental health recovery and well being (service
users)?
Don't know
7%
No
15%
Yes
78%
When I was at my most ill, I had no
confidence, sense of purpose or
motivation. Now I am out and about
and involved in all sorts of
meaningful activities and it is like I
have a new lease of life! The day I
met Lindsey changed the course of
my life forever and I shall always be
grateful for this. Thank you.
I always thought I was a bit
thick. I never went to school on
a regular basis. Mersey Care
has given me back my self
worth and confidence. I know I
will always have a mental
illness but at least now I have a
voice and I am valued.
For many years I thought
of myself as a non-person,
existing not living. On
being involved with Mersey
Care I have found I have
something to offer. Life,
once more, has purpose.
Overcame agoraphobia by
being involved and having
to face people. Made me
push myself when due to
be on a pre-arranged
interview panel
(recruitment and selection).
I am involved in groups
and activities I probably
would not have been
involved in. Apart from
certain physical activities, I
don't think I have a limit.
Getting involved with
other service users and
carers and staff has
allowed me to use
skills I have.
Involvement with Mersey
Care has given me a sense
of purpose, greater
confidence and most
importantly, the opportunity
to mix with others and feel
valued and respected as
an equal.
Has being involved in Mersey Care had any impact upon
your mental health and well being (carers)?
Don't know
0%
No
21%
Yes
79%
What difference (if any) has getting involved in Mersey
Care made for you?
70
70
60
50
40
30
20
10
0
60
59
36
46
22
17
Involved In Care
Do you feel service users & carers are more involved in
their care and treatment than they were 3 years ago?
Don't know
28%
No
11%
Yes
61%
Changes Seen
I feel service users and
carer’s have largely earned
the respect of Trust
managers and they are much
more accepted as part and
parcel of the way things are
done in Mersey Care.
Every month there's
something new to get
involved in. If you wish!
I feel a bit more confident with
others and have also, at all
the events, been made to feel
welcome (especially by the
Director, Ms Lindsey Dyer - a
lovely and competent
woman).
More emphasis on
human rights.
I think that the fact that
Mersey Care involves service
users and carer’s has made a
big difference especially in
treatment on the wards and
around the Trust. We are now
seen as people.
Less shortlisting this
year. Only had one.
The other one got
cancelled.
Improved attitudes of staff to
service users, i.e. seen as
individuals. Positive effects of
Reader in Residence and
Everton Projects. Seeing how
much effort and care that staff
put into their work.
Has involving service users/carers in Mersey Care made
a difference for you as a person?
No difference
4%
A negative
difference
0%
Some positive
difference
28%
A lot of positive
difference
68%
Difference service user & carer involvement has made
70
56
61
60
50
40
30
30
20
10
0
Attitude
Practice
Other area
Changes To Attitude
Increases my
confidence in MCT
as a whole due to the
importance of service
user/carer
involvement.
Working with service users and
carers has had such a positive
change in my attitude. Would like
to think I was always
caring/compassionate but in this
role it has heightened my
sensitivity to the needs of others
and inspired me to constantly
assess my values and opinions.
It provides both a
grounding and focus as to
the purpose of the service
we provide, and enables
challenge and constructive
discussion to occur which
might not ordinarily
flourish.
Become much
more explicit that
involvement is a
human rights
issue.
Makes the service
focus at all times
on what's at the
heart of our service
- the people.
Made me
focus on
what the job
is all about.
Try to involve service users
from older people’s services
- not on database but have
a big group of people with
dementia and carers who
have been involved in
service redesign in
Liverpool CBU.
I hope that I always
appreciated the qualities and
potential contribution of people
using services, but this
continues to be reinforced by
the capabilities and generosity
that is shown by people I work
with in Mersey Care.
Changes To Practice
I am more
empathic as a
person.
Made me think a lot
more about how I
communicate with
service users.
I think I have perhaps
moved away from a
slightly 'protective'
approach to people,
which risked patronising
and underestimating
them.
More clearly linking
involvement of
service users/carers
to a human right
based approach to
healthcare.
There is no doubt that the
comments and actions of
service users and carers
are currently helping
shape future working
practices.
Service users now play an
integral role in core business
discussion, especially with
any changes, and
involvement on a day to day
basis ensures that decisions
are better informed.
It has resulted in me
thinking what additional
information I can
provide for hospital
inpatients during their
stay.
Changes Seen
It is now expected that there will
be service user and carer
involvement - whereas before it
was not initially on the table. I
feel now that it's not looked at as
'something to remember' but it's
now always on the agenda with
everything else.
Increased feelings of
empowerment and
confidence in service
users. This leads to
increased job
satisfaction for staff
involved.
I believe it really helps
address staffs' negative
attitudes. Allows service
users to be seen in a
more positive light and
builds their confidence. Having service user involvement
Bravo.
I have seen service users
within the development of the
giving their own
clinical business unit has
presentations at
ensured the direction of the
conferences, meetings
CBU is measured, and balances
and events(instead of
the strategic direction to meet
professionals speaking
service user needs along with
for them).I think it has done a lot
the challenge of value for
money.
to promote the
Service user’s expression of
concept of recovery
empowerment, having
when staff see living
meaningful roles. Reduced
examples in front of
anxiety amongst staff about
them.
Improved
meaningfully engaging service
reception area.
users in Trust business. More
Improved service
positive attitude amongst staff
user information.
re involvement.
Conclusions
• Involving Service Users and Carers improves care
delivery.
• Culture change takes time.
• Benefits are worth the investment