www.sheffield.gov.uk/scap
Strategic Direction &
Commissioning Priorities
Adult Mental Health
May 2008 – review in progress
Strategic Commissioning and Partnership Section
Strategic Direction & Commissioning Priorities – Adult Mental Health – Document No.005
- Review in Progress -
Document No.: 5
Document Title: Strategic Direction & Commissioning Priorities –
Adult Mental Health
Document Owner: Strategic Commissioning Manager (Mental Health)
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Service Manager
Amendment Record
Formal Reviews
This document will be reviewed annually. The next formal review will take place in April
2009. Completion of each formal review will be recorded below:
Date Of
Formal Review
Reviewer's
Name & Position
01-05-08
Stephen Todd
Approved By
Amendment Record
Date
Amendment
18-10-07 First Issue
01-05-08 Reviewed following feedback
and comments received and
outcome of stakeholder event
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Strategic Direction and Commissioning Priorities
Adult Mental Health
1.0
The Introduction
Service users and carers want mental health services that are responsive and
effective. Commissioners and providers need to offer services people want to
use, that assist them to improve their mental well being, and that support choice
and autonomy in their lives.
The local authority has responsibilities for assessment of need and provision of
social care. These are essential elements of a mental health service, but only
make sense if they are provided as part of an integrated whole system. This
system must work across health and social care and maximise the opportunities
within statutory, independent and third sectors.
This document aims to set out the strategic direction and commissioning priorities
for the delivery of Adults’ Services, Neighbourhoods and Community Care
(formerly Social Services) adult mental health responsibilities to meet these
challenges over the next 5 – 10 years. It is intended to be an indication for
service providers of the commissioning intentions to meet future needs and so
support a responsive and high quality range of services.
It is part of the wider partnership vision for mental health services:
“…to provide mental health services that are user centred, with a focus on
prevention of mental health problems and the promotion of well-being. Our
services will be provided efficiently and effectively on the basis of equality. We
will meet mental health needs in the context of the whole person, being
supportive of carers, linking with partnership services to promote recovery and
social inclusion”
(A Strategy for Adult Mental Health Services in Sheffield 2006-2010- DRAFT –
MHPB/2006)
2.0
Setting the Context
2.1
National Priorities
There are legislative imperatives for health and social care that define the duties
and responsibilities of local authorities. The Commissioning Framework for Adult
Social Services (N&CC) identifies these and the national and local priorities that
set the direction for all service areas within Adults’ Services (N&CC). Our health,
our care, our say (DH 2006) is of particular importance and sets the overall
direction for adult social care. It requires increased choice and control for people
needing services, and a greater emphasis on prevention through promoting
health and emotional well-being. These outcomes set the tone for adult mental
health services over the next 5+ years.
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Mental Health became a national health priority in 1999 with the National Service
Framework (updated 2004). This set national standards, defined service models
for the prevention and treatment of mental illness and put in place a delivery
process with performance indicators and achievement targets. Service models
were supported by an evidence base and include Assertive Outreach, Early
Intervention and Crisis Assessment and Home Treatment Services.
There has been a range of further initiatives that impact upon the provision of
social care and local authority responsibilities. In particular Mental Health and
Social Exclusion (ODPM 2004) highlights the importance social inclusion within
mental health, the effects of stigma and discrimination; the hurdles for accessing
employment, housing, financial services; and the negative impact of mental health
services themselves.
Emphasis on social inclusion across mental health services is positive. It supports
the role of social care in prevention and promoting good mental health, highlights
access to training and employment, and ensures issues of discrimination are
addressed through care planning. It also highlights the fact that mental health is
everyone’s business and needs to be addressed across all aspect of local
authority responsibilities from employment practices to education and
regeneration.
Day services are an important aspect of social care investment. The
Commissioning Guidance for Day Services (DH 2006) lays out the direction for
future services, moving away from the traditional building base towards a
community focus, an emphasis on self help initiatives and support to access
training and employment.
“Delivering Race Equality in Mental Health Care: An Action Plan…” (DH 2005)
puts forward a vision for mental health services that challenges the way services
respond to black and minority ethnic communities (Appendix 1). It outlines action
required across health and social care communities based upon three building
blocks: More Appropriate and Responsive Services; Community Engagement;
Better Information.
The development of integrated mental health services has brought the role of all
professions under scrutiny. Social work practice and social care services have an
important role in the new model of services and skills in the workforce have
extended into new areas e.g. Psycho Social Interventions. The Social Work role
itself is currently subject to review (NIMHE/CSIP). In addition new social care
roles have developed e.g. Carer Support and STR (Support Time Recovery)
workers.
The proposed amendments to the Mental Health Act (1983) remain controversial,
and will bring significant challenges for statutory mental health services,
particularly around home treatment. It includes the introduction of the Approved
Mental Health Practitioner (AMHP) to replace the Approved Social Worker
(ASW). The local authority will maintain the Approval role and the Social Work
profession will continue to play a major part in this service, but will be open to
other health professionals, most obviously community mental health nurses.
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The Care Programme Approach (CPA) provides the structure for assessment and
care planning that cements together the integrated mental health service. It is
aligned with Fair Access to Care requirements for the local authority, and
provides the basis for reporting on performance. A DH review of CPA is currently
underway that is expected to simplify the current Standard and Enhanced Levels
(Due Autumn 2007).
Empowering recovery and self worth through promoting choice is an imperative.
“Our Choices in Mental Health” (CSIP/NIMHE 2006) echoes the general direction
of social care services. It promotes the use of Direct Payments and a move to
individualised budgets. Within mental health the application of these basic
principles highlights further the artificial boundary for the service user and their
carer between health and social care.
Summary
In conclusion the strategic direction for mental health services are identified in the
following objectives:
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Services that promote social inclusion with the community rather than
separation from it and that enable access to training, employment, and
other opportunities
Services that focus on prevention and recovery so that the social and
physical damage of mental ill health is reduced
Services that build self autonomy through placing choice at the heart of the
system – from direct payments to individualised budgets
Effective user and carer involvement
Services accessible for black and ethnic minority communities and that
address cultural difference
Services that meet the challenge of drugs and alcohol misuse and their
relationship with mental health
Key document: The Future of Mental Health: a vision for 2015 (The Sainsbury
Centre for Mental Health, LGA, ADSS and NHS Confederation)
2.2
Local Priorities
Service Model
The Mental Health Partnership Board (MHPB) established the Local Strategy for
Sheffield Adult Mental Health Services in 2003. This set the direction for the
modernisation of local services in line with NSF and including establishing the
new services: Assertive Outreach (SORT), Early Intervention Service (EIS) and
Crisis Resolution (Assessment) and Home Treatment (CAHT).
The service model placed these services at the heart of the treatment and care
system. This was to ensure they would impact on the development of all other
services, rather than being an ‘add on’ e.g. CAHT provides the gate keeping for
inpatient admissions. All these services are now in place, with the last phase of
development for EIS taking place 07-08.
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A Whole Systems Review approach was adopted to supported the involvement of
stakeholders in these changes but two significant areas were not concluded and
remain local priorities:
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The development of a Primary Care focused Mental Health Service
Accessible and cost effective Talking Treatments.
A Strategy for Adult Mental Health Services in Sheffield 2006-10 (Draft) (MHPB
2006) will take services into the next phase of change. It is work in progress, but
will reflect the national priorities (see 2.1) and a model of service will be built upon
a Stepped Care and Recovery approach.
A Stepped Care approach provides effective advice, support and treatment in the
most appropriate and accessible settings. It requires primary care to manage
common mental health problems effectively, ensuring only the more severe or
complex needs access secondary care. In return skills currently in secondary
care need to be accessible to primary care. A service focused on recovery
maximises self-autonomy and minimises the damage mental ill health can cause.
Shifting Resources to the Community
Sheffield Primary Care Trust (PCT) is required to achieve financial balance and
has a Financial Recovery Plan in place. This will have a significant impact on
secondary care services over the next 2 years including a reduction in inpatient
beds, and nursing staff in day services and community mental health teams.
What it does provide is an opportunity to consider how resources can support a
move from traditional institutional care, towards a community-based model with a
stepped care approach.
Day services are an important element of the social care services in Sheffield.
They are a valuable resource for improving the inclusion of people with mental
health problems into the communities where they live and playing a vital role in
supporting self-autonomy and self-help. These challenges require a new direction
for these resources that challenges the traditional building-based model.
Improving Services for Black and Minority Ethnic Communities
Delivering the race equality framework for mental health is a key priority and
Sheffield is part of the South Yorkshire Focused Implementation Site (SYFIS) to
develop and share good practice. The PCT NSF target to establish Community
Development Worker posts is one opportunity to find innovative ways of
challenging and changing services. But there continues to be a large task for all
services to ensure the diverse range of communities in the city are properly
served.
Registered Residential and Nursing Care
A Review of services has identified that the traditional models of residential care
do not meet the needs of younger people in contact with mental health services.
More flexible models of support are required to ensure present and future needs
are met.
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Choice and Self Directed Support
Across all areas of service the role of service users and carers to inform and
influence development and change must be central. They have a vital role in
ensuring service providers deliver high quality and responsive services. A
commitment to placing control with the service user through Total Transformation
to Self Directed Support is a significant local priority that will radically change the
relationship between the user and provider of services.
Summary
In conclusion the local priorities build upon the national but include:
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Primary Care focused Mental Health Service.
Accessible and cost effective Talking Treatments.
Shifting resources to community based services
A new vision for day services
Accessible and appropriate services for black and minority ethnic
communities
Flexible accommodation and support
Improving choice and self autonomy through Self Directed Support
3.0
Assessing the Need
3.1
Prevalence of Mental Illness
In general terms we can expect the population of Sheffield, 16–64 years, to have
the following levels of mental illness:

61,000 people experiencing neurotic disorder (32,000 of these having a
mixed picture of anxiety and depression)
 9,500 experiencing a depressive episode
 4,000 with an obsessive-compulsive disorder (OCD)
 1,800 with probable psychosis
 16,000 with a personality disorder
(source: Mental Illness in Sheffield – a population health needs assessment –
draft Jan 2007. PCT from ONS 2000 based upon work of Metzer 1995 on
psychiatric morbidity)
This information does not easily translate into detailed need for social care
services, however the relationship to other factors does indicate how services
must be targeted to provide both support and prevention.
There is an important relationship between mental health and physical health. A
person with schizophrenia can expect to live for ten years less than someone
without, because of physical health problems they experience. Smoking-related
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diseases are twice as high among people with schizophrenia and people with
severe mental health problems are at higher risk of cardiovascular disease and
three times more likely to be dependent on alcohol.
(Mental Health and Social Inclusion, OPDM, 2004)
The Sheffield Health and Illness Prevention Survey (SHAIPS) in 2000 included
information on depression. In 16–64 age group:

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6.9% reported symptoms suggestive of depression, equating to 25,000
people across the city
12.5% reported borderline depression equating to 46,000 people.
It found little variation between men and women, but did confirm a high
correlation between levels of depression and deprivation across the city. The
highest rates were found in the wards of Castle, Firth Park, Manor, and Park.
However the pattern of usage of both primary or secondary care services is
inconsistent. It does not always reflect the demands expected and raises the
question of whether services are targeted effectively across the geographical
communities, for example the relatively level of referrals to sector community
mental health teams from areas of high deprivation. (Mental Illness in Sheffield
– A population health needs assessment – January 2007)
Nationally there is a correlation between unemployment and admission to
psychiatric hospital that is also borne out locally. Mental health has the lowest
proportion of employment of any disability group (24%) and the Yorkshire and
Humber region is below the national average for the percentage of adults of
working age who have a mental health problem and are in employment.
(Indications of Public Health – Mental Health APHO – 2007).
There is a high correlation between levels of depression and suicide. Reducing
suicide by 20% for 2010 is a Health of the Nation (1999) target and a suicide
audit has been undertaken annually in Sheffield since 2001. The audit includes all
ages and numbers are low so caution is required when identifying trends, but it
indicates:
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Average of 32 suicides per year. This is below the national average
4 times more men commit suicide than women. This is higher than the
national average
 80% had recorded mental health problem and 25% had contact with
mental health services in the week prior to death
 Black and minority ethnic community numbers are small but compared to
the general Sheffield population – Asian/Asian British is 3 times lower than
you would expect and Black/Black British two times greater
(Source: Sheffield Suicide Audit 2001-2004, April 2006, Sheffield PCT)
The prevalence of a diagnosis of Schizophrenia is about the same for men and
women, but the average age of onset for men is 18 years old, and for women 25
years. Early diagnosis and intervention has been demonstrated as effective in
minimising the damage the disruption can cause. (The Fundamental Facts – MHF
2007)
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For black and minority ethnic communities the key issues are around how mental
ill-health is dealt with. People from African Caribbean and Black African
communities are less likely to be referred to mental health services by a GP. They
are more likely to be given medication and high doses of medication at that, and
less likely to be offered psychotherapy, counselling and other non-medical
interventions. (The Fundamental Facts – MHF 2007).
In Sheffield 10.8% of the population are from black and minority ethnic
communities (2001 Census), with four neighbourhoods where over half the
citizens are from black and minority ethnic communities. In addition there is a
great diversity of new populations arriving in the city as asylum seekers and
refugees. Unemployment rates as well as experience of long-term limiting illness
are generally higher for black and minority ethnic communities. (Sheffield City
Council 2001 Census Topic Reports – Ethnic Origin; Sheffield City Council
Community Profiling, 2006)
Key Issues:
 Relationship between unemployment and mental health
 Relationship between physical and mental health
 High correlation of mental health problems with areas of deprivation and yet this does not
reflect the pattern of usage for primary and secondary care service.

Early diagnosis and support to minimise long term damage
 Effective services for the black and minority ethnic communities of Sheffield
 Impact on mental health of alcohol and drug misuse
3.2
Service Demand
The Care Programme Approach (CPA) provides the basis for assessment, care
planning and review. At enhanced level (ECPA) this should include all people with
a serious mental illness. In February 2007 there were 1393 people on ECPA.
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58% men and 42% women
54% between ages of 30 and 49 years
23% from black and minority ethnic communities
The overall number of people registered on ECPA has been reasonably
consistent over recent years, although we can project that it should be nearer
2000 if it is to be consistent with ONS data. This position may be a result of
people with serious illness being managed effectively in primary care as well as
people who do not want to engage with statutory services.
The geographical pattern of ECPA does not reflect the pattern of deprivation.
There are some areas of high deprivation with a high rate of people on ECPA e.g.
Burngreave, but others e.g. Southey Green that are more in line with affluent
areas of the city. This pattern is mirrored when looking at formal admissions
(using Sections of the Mental Health Act) to inpatient services, but not when
considering admissions overall. There is some indication that this variance
reflects areas with the highest proportions of people from black and minority
ethnic communities (Burngreave, Darnall and Sharrow). It certainly confirms the
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need to ensure resources are targeted effectively. (Mental Illness in Sheffield –
A population health needs assessment – Jan. 2007)
The experience of black and minority ethnic communities is most starkly
demonstrated by inpatient admissions and formal detentions (Mental Health Act
1983) where people from some black and minority ethnic communities are up to
two times more likely to be admitted to inpatient services and up to five times
more likely for this to be under a Mental Health Act section (Black/Black British).
For Asian communities (Asian/Asian British) admission rates reflect the
population average, but up to two times more likely to be under a Mental Health
Act section. (Ref: Admissions and Detentions data 2004-2005 – J. Walsh) This
imbalance reflects the national picture as demonstrated in the Count me in
national annual inpatient census (ref Mental Health Act Commission)
Since 2000 Sheffield has received a significant number of refugees and asylum
seekers, primarily as part of the asylum seeker dispersal scheme. This has been
to established Sheffield communities e.g. Somali, but also new communities to
the city. There were about 1400 asylum seekers in August 2006, although
numbers are now declining, however there are estimated to be a further 1000
people who have been unsuccessful in their applications and are now destitute
(ASSIST estimate).
Because of the trauma experienced by people fleeing persecution and conflict, as
well as the cultural disorientation of locating into a completely different social
environment, mental distress and mental illness are a part of this experience.
Research into mental health issues for these communities in Sheffield (DH 2005)
highlighted practical barriers to accessing services as a basic problem and then
simplistic solutions that either over-medicalised a problem, or do not recognise it.
This is on top of the lack of support to meet specialist needs e.g. post-traumatic
stress disorder.
In line with the national trend, a significant change in the characteristics of the
client group over recent years has been the increase in people requiring services
who have a mental illness and misuse street drugs and/or alcohol (dual
diagnosis). It has an impact across all areas of the service from inpatient to
community support.
National research suggests that between 22% and 44% of inpatients have a
problematic use of street drugs or alcohol, up to half being dependent on them. In
high secure settings between 60% and 80% have a history of substance misuse
prior to admission. (From Dual Diagnosis in mental health inpatient and day
hospital settings. DH 2006). This is matched in community services where one
study has shown that 44% of people using services of Community Mental Health
Teams are reporting problematic drug or alcohol use (Rethink – Living with
Severe Mental Health and Substance abuse Problems – 2004 From The
Fundamental Facts – MHF 2007).
This has meant that additional skills are required within the workforce as well as a
change in how providers respond to the behaviours related to substance misuse
including more aggressive reactions and related chaotic lifestyles. Historically
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mental health services have evolved separately from substance misuse services
and a separate commissioning framework and performance regime for drug
misuse through the Drug Action Teams has emphasised this.
Key Issues:
 Changing services to become more accessible for black and minority ethnic communities
 Ensuring resources are targeted at areas of greatest need

Meeting the needs of people with mental health and substance misuse problems
3.3
Service User and Carer Feedback
Service users and carers were involved in the Whole Systems Review process to
introduce the new NSF services and there has generally been a positive welcome
to these services: Assertive Outreach, Early Intervention and Crisis Assessment
and Treatment.
Through the Service User and Carer Council within SCT there has been greater
opportunity for the involvement of people with the detail of the organisation and
the services it provides. In addition service users and carers have a number of
places on the Mental Health Partnership Board. Through these arrangements
concerns are raised, most recently about the reduction in investment in mental
health services as part of the PCT Financial Recovery plans for 2006-07 and
beyond. In general, there remains a view among service users and carers that
their opinions continue to have limited impact on decision making.
At the level of receiving services there remain some persistent concerns.
Complaints across the adult mental health service in SCT indicate that the main
areas of concern are about the clinical care people receive and the attitude of
staff people experience.
The Health Care Commission Patient Survey for service users within mental
health services is a national exercise undertaken annually. The 2006 survey
identified a range of concerns for Sheffield that impact on social care services
including:
- Staff attitude. Continue to ensure people are treated with respect
- Access to out of hours services
- Access to the care coordinator
- Involvement in the development of the care plan and having a copy
- Day service support including access to information about support groups,
advice on benefits, help to find training and employment
The need for responsive services in a crisis and outside normal hours is also
highlighted in consultation about Supporting People services.
The views of carers are regularly sought through the Standard 6 (Carers) group
and consultation events (Dec 2006 & June 2007). The range of concerns
includes:
- The attitude of mental health professionals to carers – recognition of the
carer and their role
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Access to information about mental health and mental health services
Improvement in assessment of carer needs, including a plan for when the
carers are unable to continue to provide support
Key Issues:
 Service user and carer involvement in strategy and service change
 Being treated with respect
 Responsive services in a crisis
 Involvement in care planning
 Effective day services
 Improving information about mental health and services
3.4
Future Trends
The challenge for mental health services is to minimise the development and
impact of serious mental health. It has been shown that there is a relationship
between areas of mental ill-health and deprivation as well as with physical health,
social isolation and family breakdown. The cause and effect relationship is a
complex one, but all these aspects are affected by socio-economic factors way
beyond the influence of mental health services.
However, there are some areas where we can be more certain about future
needs. We can project that the number of people currently on ECPA in Sheffield
is an under representation for people with a serious mental illness and that will
continue to increase to around 2000.
In terms of overall population changes it is the age structures of different ethnic
groups in Sheffield that is of particular significance. This varies considerably, but
in general these communities have a younger profile than the average and as
such will continue to increase proportionately to the overall population. As such
services will need to ensure they can meet the needs of an increasingly diverse
population.
The prevalence of people with both mental ill-health and misuse of either drugs or
alcohol has been increasing and affecting the nature of service provision. We can
anticipate that this trend will continue and the longer-term impact on physical and
mental health of persistant use of drugs and alcohol will become apparent.
Impact of the new Services
We should expect the new NSF services to have an impact on future demand and
the type of support services required. They should minimise the damage mental ill
health can cause by ensuring appropriate treatment at the earliest opportunity.
The objective of the EIS is to reduce the duration of untreated psychosis (DUP) to
an average of 3 months and a maximum for an individual of 6 months. In
Sheffield the median is below 3 months but only less than 6 months for 34% of
clients (Sheffield EIS Annual Report June 2006). The age of average onset is 21
years with 38% in higher education.
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Reducing the DUP will minimise the damage psychosis causes to health, selfrespect and social relations. It will therefore help people to sustain personal
relationships, education, training and employment opportunities. It is difficult to
project the medium to long-term impact of these changes, but it should reduce the
level of demand for longer-term treatment and support services currently provided
across mental health.
The Crisis Assessment and Home Treatment service has undertaken a gatekeeping role for inpatient services and provided alternative models of treatment at
home. This has already had an impact on inpatient admissions and a reduction in
acute inpatient beds is planned. What is less known is the impact this has on
community based services although we can project an increased demand for
more short-term care and community support services that are flexible and
provide a rapid response.
Traditional models of social care services currently provided are not meeting the
needs of younger people with more complex needs and dual diagnosis. Models of
registered care provide the levels of support needed, but not the flexibility and
self-determination required. At the same time there is a group within traditional
adult services, e.g. registered care, whose needs will change as they get older
and more physically frail.
EIS focuses on young people from the age of 14 years with an untreated
psychosis and is well researched. What is less well known is whether there are
other groups of young people who move on to long term contact with mental
health services, but who with the early intervention of appropriate support and
direction, the damage mental ill health can cause to their social relationships and
opportunities can be minimised.
Key Issues:
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3.5
Developing services to support and sustain social relationships, education and training
and employment opportunities
Responsive services meeting the needs of black and minority ethnic communities
Models of support and care that are flexible and responsive in a crisis
Identifying the needs of younger people to minimise the long-term damage of mental illhealth
Summary
In conclusion the priority areas to improve the understanding of need and
development of effective services includes:
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Services targeted at areas of deprivation
Accessible and responsive services for the range of diverse communities
Targeting prevention at high risk groups
Improved understanding of the relationship between mental ill-health and
substance misuse and the services required
The needs of young people who do not have untreated psychosis, but are
at risk of long term mental ill-health
Services that can respond flexibly and rapidly
Effective day services and support to access training and employment
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
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Improved service user and carer involvement in support planning,
development and change
Services that treat service users and carers with respect
4.0
Analysis of the present
4.1
Strategic Development
The Mental Health Partnership Board (MHPB) provides the focus for establishing
the overall strategic direction for adult mental health services. The last shared
vision was established in 2003 and led to the introduction of the new NSF
services. The purpose of the 2003 strategy has largely been fulfilled and a new
shared strategic direction required that takes account of the national and local
priorities.
The MHPB also provides the means to coordinate joint working across health and
social care partnership. It includes statutory and voluntary sectors, service users
and carers. It is charged with providing direction and leadership for adult mental
health services. Its function includes those of the Local Implementation Team for
the NSF.
The Mental Health Partnership Network (MHPN) is an active forum for the
voluntary sector. It nominates to places on the MHPB and provides the basis for
working with this sector to develop and change services. The main focus for
service user and carer involvement in planning and development has been
through the Sheffield Care Trust Council. This will no longer operate from
December 2007 and the way service users and carers are involved in the
governance arrangements of SCT will need to change to reflect SCT becoming a
Foundation Trust.
There are service user and carer places on the MHPB and a remuneration
scheme is in place to support this. In addition the Standard 6 group involves
carers specifically in carer issues and priorities. The MHPB does provide a useful
forum for sharing partnership issues, but not for key decision taking and
ownership. Changes in PCT arrangements, the development of Foundation Trust
and financial recovery have tested its ability.
Key Issues:
 Establish the new strategic direction for mental health services
 Review MHPB to identify its future purpose and membership
4.2
Commissioning for Services
The PCT and Sheffield City Council (SCC) are the main commissioners of adult
mental health services in Sheffield and commission core statutory services from
SCT. However, there are separate contractual arrangements in place and we can
expect Practice Based Commissioning, the development of Payment by Results,
and the development of SCT into a Foundation Trust will alter the current
commissioning relationships.
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A joint commissioning approach between SCC and the PCT has been in place for
services within the third sector. It includes joint contracts with third sector
providers as well as a joint approach to annual service planning.
Supporting People (SP) is now a significant commissioning partner. It provides
specialist tenancy support services in mental health (2007-08 £2.15m) as well as
generic services for vulnerable people (2007-08 £2.06m). With the development
of SP a boundary between tenancy support and social care has been highlighted
and yet is artificial for the service user.
Key Issues:

Joint Commissioning or services with the PCT/Practice Based Commissioning
 Joint Commissioning of services with Supporting People
4.3
Service Partnership
SCC adult mental health functions are provided by SCT through a Partnership
Agreement - Section 31 (Health Act 1999) for the provision of integrated services.
Established in 2001, it was revised in 2003 to set up a health and social care
trust. SCT is applying for Foundation Trust status in 2007.
The integrated service includes:
- Assessment and care planning services. This is the social work service
and social workers are currently seconded because of their ASW
status.
- Provider services: day provision, short-term care, and community
support. The staff in these services were transferred to SCT in 2003
- Care Purchasing. Budget accountability is with SCT to purchase
packages of care (registered & nursing care, home & community
support)
To obtain Foundation Trust status, SCT must demonstrate financial viability. A
change in status will affect in the governance arrangements for the integrated
service and a revised Partnership Agreement (Section 31) will need to reflect this.
The third sector plays a significant role in the provision of mental health services.
SCC and the PCT commission and support a wide range of services from
community support & day provision to advocacy & advice. These services are
purchased through partnership contracts and the total investment in 06/07 was
£2.7m including the SCC contribution of £1.5m (67%). However, the ability of the
sector to access a wide range of other sources of investment is critical. The
sector includes local, regional and national providers and some strategic partners
work across a different client groups.
In addition there is a range of self-help and user-led initiatives. These range from
day service and activity based initiatives to condition focused support networks. A
small grants arrangement is in place targeted at this area of provision.
Individual packages of care are purchased for the following range of services:

Nursing and Residential Care
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
Supported Living

Home Care
These are purchased from private and third sector providers and registered with
CSCI. This registration does not apply to Supported Living services. Providers of
Home Care and Supported Living services are identified through a tendering
process for preferred providers.
Direct Payments brings the purchase of some of these services closer to the
service user. It is available for people within mental health to purchase social care
support services identified within their care plan. The uptake has been limited with
the number of service users receiving direct payments in 2006-07 at 13. Self
Directed Support including the self-assessment and allocation of a budget, will
further challenge the traditional models for commissioning.
Key Issues:
 Impact of Foundation Trust on Partnership Arrangements
 Impact on commissioning arrangements of Self Directed Support
4.4
The Structure of Investment
In 2006/07 the overall investment in adult mental health by the PCT and SCC was
£56m. Per head of population this is above the regional average, but below the
national and similar areas.
Area
Sheffield
South Yorkshire
Cluster
of
similar areas
England
Adult Weighted
Investment per
head
£153
£150
£169
£156
(Mental Health Strategies – Autumn 2006 - Financial Mapping)
The SCC investment in social care in 2007/08 is £10.2m (£7.4m net), this does
not include Supporting People investment. When the net figure is compared with
other cities it indicates that Sheffield is below the average.
2007/2008
Planned investment in Adult Mental Health Services
Sheffield
£17.45 per head
Average for audit group of similar £19.79
cities per head
Average fpr core cities group
£24.81 per head
(CIPFA)
Some caution has to be taken with financial comparison as there are often
differences of interpretation across local authorities and LITs, but there is a
general indication that Sheffield does invest a lower per capita amount in mental
health services.
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External grants provide a significant contribution to overall funding for SCC. They
are expected to be phased out from 08-09: Mental Health Grant (2007-08:
£1.62m ) and Carers Grant (2007-08: Mental Health allocation: £0.14m – 6.5% of
SCC allocation).
The current structure of SCC investment in adult mental health is as follows:
Assessment Services including Social Work Services - 33%
Care Purchasing (Individual Care Packages)
- 34%
Day and Community Support (Block Purchasing)
- 34%
The purchasing of social care support is split 50:50 between spot purchasing
individual packages of care from preferred providers (Care Purchasing) and block
purchasing services (Day and Community Support).
The individually purchased services (Care Purchasing) are provided from private
sector and third sector providers only. The block purchased services are split
between direct provision provided by SCT (60%) and contracted services from
external providers in the third sector (40%).
Care Purchasing includes the use of Direct Payments for the purchasing of Fair
Access to Care services. This is currently a small element of the purchasing (11 –
15 packages for mental health). It is primarily used for the purchase of home care
and supported living services.
All services have a duty to be responsive to the needs of black and minority
ethnic communities, in addition 4% of the investment is specifically for services
dedicated to these communities, including the Transcultural team (SCT) and
contracted arrangements with community providers.
An annual allocation of capital (Mental Health Supported Capital) is available to
support the NSF and related priorities, in particular Social Inclusion.
Key Issues:
 Level of mental health investment relative to other service areas
 Structure of purchasing social care and support
4.5
Current Services and the Market
4.5.1 Assessment and Care Management Services
The boundaries between health and social care are of little interest to service
users and their carers. CPA provides the framework for holding together both the
treatment and support needs through its processes of assessment, care planning,
monitoring and review. Eligibility for the personal social care services SCC is
responsible for is determined by Fair Access to Care Services (FACS). This
currently operates at Substantial and Critical levels of need and is largely aligned
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with enhanced CPA to ensure an integrated approach across health and social
care.
Social workers and community mental health nurses undertake the main Care
Coordination role within the CPA arrangements. This remains a crucial role and
includes the assessment of carer needs. The CPA care plan provides the focus
for identifying the health and social care services required to support a person’s
care.
Approved Social Work
It is a legal duty of the local authority to ensure there is an adequate number of
Approved Social Workers (ASW) to operate under the Mental Health Act (1983).
The current number of registered ASWs is 51 (March 2007). This is in line with
the national average of 1 per 10,000 population (ASW survey 2006, ADSS). The
introduction of the Approved Mental Health Practitioner will extend the range of
professions able to undertake this role.
4.5.2 Social Care Support Services
Range of Services
. The range of social care services currently available is structured as follows:








Registered Care and Nursing Care
Supported Living Services
Home care
Day services
Short-term and respite care including Adult Family Placements
Carer Support
Advocacy, Advice and Information
Access to Training and Employment
4.5.3 Registered Care and Nursing Care
The registered care and nursing home provision for adult mental health in
Sheffield is small. There are 122 registered care beds and 25 nursing. Other
specialist providers are used when required. 60% of beds are provided from the
independent sector and 40% from the voluntary sector. There are no directly
provided services. These resources are vital and across the 8 provides there is in
theory some variation and choice.
Review and monitoring of registered and nursing care provision continues to
indicate no spare capacity within the market provision. The closure of one care
home (2006) has compounded this and when vacancies arise they are soon filled.
The lack of spare capacity obviously limits the notion of choice. This needs to be
set against a three year trend where the number of people in acute inpatient beds
waiting for registered or nursing care has go down from an average of 1.7 (2005)
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to 0.4 (2007) waiting at any one time. This does not take account of people in
rehabilitation services or in the community awaiting placements, but is an
indicator of the changing demands for this type of care.
However, there are a small number of high cost placements with specialist
independent sector providers, either within or out of the city, who meet particular
needs e.g. Huntingdons Disease. Because the level of demand for these services
is low, the costs cannot always be reconciled back to the level of service provide.
These specialist units often offer care and nursing across client groups. In August
2007 11 (9%) high cost placements in residential and nursing required 22% of the
available budget.
Move on to more independent living from registered care and nursing services
has been limited. Indeed the profile of these services indicates over 70% are 45
years old and above and 64% are men (2006). A more proactive approach to
reviewing placements has now been adopted to address this. Some services
remain the home of people placed in the community following the closure of the
long stay psychiatric hospital (Middlewood). Consequently they are working with
an aging population and needing to respond to the changing needs of residents
as they get older and more physically frail.
But this is also an indicator that these services are not able to provide the right
balance of independence and support for younger people with complex needs
including people with drugs/alcohol problems as well as mental ill health. In
comparison to the low and reducing number of people in acute inpatient beds
waiting for registered care, the number assessed as waiting for supported
accommodation has fluctuated between an average of 1.8 and 4.9 people waiting
at any one time. This form of accommodation provides the capacity for both
support and independence.
Key Issues:
 Ensuring the cost of placements provides best value
 Flexible alternatives for people with complex needs
 Meeting the needs of the aging registered care population
4.5.4 Supported Living Services
Supported Living Services provide support to enable people to live as
independently as possible in their own home. This overlaps with services
commissioned by Supporting People to provide tenancy related support.
The Community Support Service is a city-wide service providing supported living.
It is block purchased from 3 different providers including SCT (N) and two third
sector providers (SW & SE). 290 to 320 placements are available and referrals
from community mental health teams fluctuate at around 30 - 40 a month.
Services therefore generally operate to capacity. Additional preferred providers
have been identified so that services can be purchased on an individual basis to
provide additional capacity and to meet a range of needs. There is variation in
unit costs and quality of provision across the providers.
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Due to the ability of this range of services we can expect the need for additional
capacity and the provision of specific needs to continue to develop.
The introduction of Supporting People (SP) as a new commissioning framework
has largely been a positive development for adult mental health, consolidating
and coordinating supported accommodation and floating support. This provision
is based largely on the pattern of services available at the inception of SP,
however it did support a significant increase in tenancy support resources for
vulnerable people that people with mental health problems access.
SP commissions 198 supported accommodation and 106 floating support
placements for adults with mental health problems. In addition there are a large
number (510) of generic placements providing a lower level of support for
vulnerable adults to which people with mental health problems also have access.
These services are provided largely within the third sector.
The SP Strategic Review and Commissioning Plan for mental health (2006)
identifies a below average expenditure per head on services in Sheffield as
compared with similar cities. In addition it highlights:


The need for medium to long-term floating support, unrestricted by the
current 2 year guideline
A gap in provision for people complex needs
Mental health service users need equality in access to general housing and other
support schemes for which they are eligible e.g. Extra Care Housing. However,
there is a group of hard to house people, often with mental health and/or
substance misuse problems, who have not been successful in a range of
placements because of difficult behaviour that has impacted on neighbours etc..
A Complex Cases panel has now been established to improve joint working
between housing and mental health services.
Key Issues
 Best value and capacity of community support and supported living services
 Jointly commissioning community support services with SP
 Improving access to general housing
 Provision for the most difficult to place
 Maintaining preferred provider resources
4.5.5 Home Care
There is less demand for home care support within adult mental health than for
supported living. Service are available through purchasing individual packages of
care from identified preferred providers. Further work is required to analyse the
information currently available.
Key Issues
 Analysis of information available
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
Maintaining preferred provider resources
4.5.6 Day Services
Day services have traditionally been a significant element of social care services
within mental health. There is currently an integrated health and social care
service that is city-wide (four sectors) provided by SCT as part of the Partnership
Agreement. In addition complementary services are provided by the third sector.
The integrated health and social care services now focus upon support for
recovery and improved social inclusion through helping people access support
networks and community resources away from the traditional building based
services. Evidence about these shows that:
- 53% of service users are women (2006). This is a significant change
from the tradition service model attended mainly by men.
- 47% of service users are on Enhanced CPA. This compares poorly with
a target of 80% and indicates a drift away from meeting the needs of
the main priority group.
There are a small number providers of day services within the voluntary sector
providing complementary services, particularly drop-in support. These services
are used by a wider group of vulnerable people including those with mental health
problems who do not wish to attend statutory day services. A review undertaken
in 1999 indicated that providers at that time wanted to continue to provide
complementary services rather than take on services then provided by the
statutory sector.
The approach to day services includes support for self-help and user-led
initiatives. These are supported through small grants via Grant Aid and a range of
groups have developed from support groups based on specific difficulties e.g.
survivors of depression to social support activities.
Key Issues
 Day services that support recovery and social inclusion
 Services focusing on people wifh greatest need due to mental ill –health (ECPA)
4.5.7 Carer Support
The services to support carers of people with a mental illness provide a range of
provision from carer breaks to advice and training. These services are
commissioned from third sector providers, including organisations that provide
support to particular black and minority ethnic communities and particular areas
of need (Young Carers and Eating Disorders). These services support XXX(JT)
carers, although the information currently available does not enable us to identify
how well these services are targeted to ensure the best outcomes for people
providing substantial care.
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We can expect that awareness of the needs of carers will continue to develop and
services will need to adjust and change accordingly. There is currently
inadequate information available on the person the carer supports so that we can
develop a greater understanding of ensuring services are targeted effectively but
also focussing on prevention where this is most effective.
Assessment of carer needs is undertaken by community mental health team staff
in SCT. The monitoring information has indicated an overall improvement year on
year to the following position:
-
93% of carers offered an assessment
-
61% receiving an assessment and care plan
(SCT Quarterly Governance Report – Year End 2006-07)
However, there are concerns within the Carer Support Services that this does not
adequately present the view of carers, where the process of accessing an
assessment is not as helpful as the information indicates.
Key Issues
 Targeting services at the greatest need and most effective prevention
 Improving access to the carer assessment
4.5.8 Advocacy, Advice and Information
Specialist mental health advocacy and advice services are in place. The
advocacy service deals on average with 32 new people a quarter. 60% of these
(Q1 07-08) were self-referrals and the areas of concern are fairly evenly balanced
between community and inpatient services. 16.5% of clients have been from
black and minority ethnic communities indicating that it is an accessible service
and feedback from people who use the service is very positive. The service
currently meets the demand for its services, although it has highlighted the lack of
an advocacy service for older adults.
The advocacy service for the Mental Capacity Act is provided on a South
Yorkshire basis and has only been in place since 2007 and so its impact has not
yet been assessed. The new development will be the advocacy requirements
within the amended Mental Health Act (1983)
Specialist advice services are available and additional methods of outreach have
been explored e.g. the piloting of an information kiosk within services. These
services play a vital role in providing advice on benefits, housing and employment
as well as specialist legal advice and support. A specialist service improves
accessibility for services users and complements generic advice services. The
promotion of social inclusion has highlighted the importance of advice services
and the potential for development.
The availability of information about services for service users and carers has
focused on the development of a database accessible on the internet, and the
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periodic updating of a booklet – The Smooth Guide to Adult Mental Health
Services in Sheffield which has always been well received. A review of these
functions (2007) has indicated there is significant duplication, scope for improving
the quality and range of information available, and scope for using more
accessible formats.
Key Issues
 Service requirements to meet advocacy duties within amended Mental Health Act

Establish new models for the provision of information to service users and carers
4.5.9 Access to Training and Employment
Taking account of the employment circumstances and needs are a requirement
within the CPA assessment and care planning arrangements and support to
access training and employment is provided through the community mental health
teams and day services. In addition there is a small network of providers within
the third sector and SCT (User Employment Scheme) to support people to get
back into a pattern of work and to find and maintain employment.
SCC itself is an important employer in the city and its own employment practices
provide an opportunity to be an exemplar “Mindful Employer”. This is work in
progress.
Initiatives have also been taken to improve access to IT facilities and skills within
day services and the third sector. However, we know the importance of
employment in successful recovery and this will continue to be an area where
there is a need for improved coordination and development of new initiatives in
partnership with other agencies.
Key Issues
 Improving access to Training and Employment
4.5.10 Other Social Inclusion Priorities
Health Promotion and Tackling Stigma
The responsibilities for mental health promotion and tackling stigma runs across
the span of SCC responsibilities and services, from education in school to
tackling inequalities across the city. To this end mental health is identified as a
priority within the Sheffield First Inclusive and Cosmopolitan City partnership.
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World Mental Health Day provides an important focus for activities promoting
mental health awareness across the mental health partnership.
The ability to get out and about is an important part of improving people’s
recovery. South Yorkshire Passenger Transport Executive operate an effective
mobility pass scheme to provide access to bus travel for people eligible because
of disabilities caused by their mental illness.
In addition Sheffield is part of the Yorkshire and Humber “Altogether Better”, a
lottery funded scheme from October 2007. This includes a range of initiatives to
promote positive mental health including Mental Health First Aid to train people in
communities or at work to improve awareness and support for people
experiencing mental health problems.
4.6
Summary
In conclusion the priority areas within the current provision of services includes:













Strategic direction confirmed for mental health services across the
partnership including Board arrangements
Effective joint commissioning with PCT/Practice Based Commissioning
Self Direct Support introduced into the commissioning and purchasing
arrangements
Structure of social care investment that meets future priorities
Residential and Nursing Care Placements that meet high levels of need at
best value
Accommodation with flexible support arrangements to meet the needs of
people with complex needs
Jointly commissioned community support services with Supporting People
Maintaining a range of providers of supported living and home care
services to ensure choice and to meet the needs of particular communities,
including an improved understanding of home care
Day Services focused on social inclusion and recovery
Carer support services targeted to meet needs most effectively
New approaches to provision of information for service users and carers
Requirements of the revised Mental Health Act in place
Improved access to Training and Employment
5.0
The Discussion and the Design
5.1
Choice and Self Directed Support
The major challenge and opportunity for the provision of social care services over
the next 1 - 5 years is the development of models of care that enable self-directed
support to be a viable reality. A model built on the basic principle of choice
requires a range of options of services that not only offer the support required, but
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also in a way that people want to receive it. In addition it provides a challenge to
ensure this is done in such a way that there is a viable business for providers.
The block purchasing of services from providers allows for economies of scale
and to improve value for money. It also gives more security to providers to
establish a viable business. On the other hand purchasing services on an
individual or ‘spot’ basis from preferred providers, will give service users greater
choice. A process of identifying preferred providers ensures the commitment to
quality but places greater risk with the provider and will affect value for money.
The commissioning challenge for self-directed support is to establish the right mix
of services in a way that supports a stable provider market.
Increasing choice and the move to self-directed support will challenge the current
structure of investment. The 50:50 split between spot and block purchasing of
services and the significant level of block purchasing from SCT will need to be
reassessed to ensure it can provide flexibility and choice, but within a stable
provider market.
5.2
Model of Service
The model of service for the health and social care partnership requires a shift
away from institutional based services towards services that promote social
inclusion rather than social difference. It should reduce a dependence on
secondary care services where this is not helpful for a person’s well-being and
recovery. The care pathway continues to be key to make sure services meet
individual needs and the stepped care model should make sure responses are
proportionate.
The development of a mental health service delivered within a primary care
setting is vital for these changes. It provides the opportunity for and effective
stepped care model with and increase in support and treatment options available
through primary care. These changes need to ensure social care assessment and
support resources available through Adult Services are focused on those with the
greatest level of need, in line with the FACS criteria. To achieve this, a primary
care focused service will need to establish its connections to housing,
employment and training, and social care support networks through a range of
means rather than expecting it is the role of the social worker. It makes no sense
to refer less complex cases to specialist services simply because of non-medical
needs.
The other key services providing access points to secondary care are the Early
Intervention Services and Crisis Resolution and Home Treatment. They both
have a role in diverting people from a career within mental health services where
this is appropriate and minimising the potential damage mental illness can cause
to social relationships and personal opportunities.
Crisis Resolution and Home Treatment has already had an impact on reducing
inpatient admissions and length of stays, minimising the potential impact of
institutional care and supporting people to remain within their home and
community networks. These changes need to be supported by responsive
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community based services from supported living to short-term or respite care.
Services flexible enough to provide rapid support in a crisis. But it also highlights
the importance of effective carer support arrangements and the need for support
networks that help people maintain their social relations, accommodation and
employment and training opportunities.
5.3
Understanding the future pattern of need
The Early Intervention Service is expected to have a significant impact on the
future nature and demand for mental health services because it is targeting young
people with a psychosis and working with them to minimise the damage the
mental illness might cause on social relationships, education and employment
opportunities. An area less well researched is whether there are other identifiable
factors psychosis that effect whether a young person later needs specialist
mental health services that would be minimised if picked up upon early.
The relationship between certain mental illness and deprivation is established and
yet does not necessarily reflect the distribution pattern of resources. Further
understanding of the patterns of use of primary and secondary mental health
across the different geographical communities in the city is required to ensure
resources are allocated in the most targeted and effective manner.
The role of employment and training is also a crucial factor in effecting future
needs. The correlation between mental illness and unemployment itself highlights
the importance of training and employment. This is both support for people with
mental health problems to access training and employment, and also an
improved understanding of mental well-being within employment practice.
In addition the impact of mental health on physical well-being is significant and
indicates the importance of close working between social care and the public
health agenda.
5.4
Day Services – A vision for future
The day services have moved on from the provision of traditional, building based
day care and embraced some of the elements of a service that promotes the
social inclusion of its service users. This has included supporting use of
community-based resources and accessing training and support. However, a
consequence of this has been to drift away from providing services for people
with the highest levels of need.
The Commissioning Guidance for Day Services continues to present a dilemma
of meeting the needs of people with highest levels of need as well as providing
services that are much less dependent of a day centre. A new vision for day
services is required to embrace this challenge. Services need to support self-help
and social networks, help people access community resources, training and
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employment, but at the same time ensure support is available for people with the
most difficult recovery journey.
5.5
Information
There is great scope to improve approaches to information. This includes
information about services, information about mental health including self-help
materials. Neighbourhoods and Community Care have a role in supporting and
facilitating initiatives that improve access to information for service users and
carers, and particularly black and minority ethnic communities.
5.6
Nursing Care and Registered Care
5.6.1 Capacity
The lack of capacity within the market place impacts upon user choice. However
the general trend does not indicate the need for anything other than minimal
additional capacity. Instead the main issue is that the style of a registered care
services no longer meets the needs of younger people in contact with specialist
mental health services. Providers are limited by the risks they are able or
prepared to take and by the tenancy law they need to adhere to. In addition the
policy direction is away from more institutional forms of care.
Other models need to be found to provide accommodation with high levels of
support within a supportive environment. The support needs to be flexible and
provide residents the opportunity to develop the skills to manage more
independently when they are able to do so.
5.6.2 Specialist Needs
Placements for the small group of people with a very high level of need, often
specialist e.g. Eating Disorder or a degenerative condition such as Huntingdons
Disease are often made in conjunction with Health through Continuing Health
Care Guidance. The current range of providers for these services is limited and
often out of Sheffield, consequently the price of placements is high and can relate
to market circumstances rather than the level of need and quality of care
provided. There is scope for closer purchasing arrangements with both Health
partners and across the region.
5.6.3 Aging Population
The current population in nursing and care homes is an aging one. The desire to
ensure people continue to live in the place they know and ensuring their changing
physical needs are met is a challenge, particularly when the number of care beds
available within the sector is small.
5.7
Community Support and Supported Living
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5.7.1 Flexible and Responsive
The Community Support and Supported Living Services need to be very flexible
and responsive to support hospital discharge, prevent admission and provide
maintenance support. They have a crucial role to play in supporting the CRHT
and EIS services and this is a role that will continue to develop. They are also
suited to focusing on particular needs e.g. for people from black and minority
ethnic communities. The range of services provided and the available capacity
needs to keep under review.
The services are provided by a range of organisations from statutory, third sector
and independent. Placements are purchased through both individual contracts
through preferred providers and through block purchased arrangements. This
range of approaches provides a good basis to assess the provision of best value.
The future model for purchasing these services are also likely to be affected by
the development of Self Directed Support.
5.7.2 Supporting People
The development of SP as commissioners of tenancy related support services
has highlighted the artificial distinction between this and social care support
commissioned by Community Care (Adult Services). In addition the SP model of
a 2 year floating support service is difficult to apply in mental health because of
the way needs fluctuate. People may not need continuous support, but will need
to access these services quickly if their mental health deteriorates. A joint
commissioning approach can ensure these distinctions are not a barrier to the
provision of a seamless service for the users and the monitoring and
management of is efficiently undertaken.
5.8
Supported Accommodation and Housing
5.8.1 Supported Accommodation for people with complex needs – see 5.6.1
5.8.2 Chaotic Lifestyles
In some circumstances the chaotic behaviour of people with mental health
problems who have support needs has led to exclusion from services providing
supported accommodation and yet independent living also remains problematic
because of anti-social behaviours. This group is a priority for Housing Solutions
as well as mental health services. A Complex Cases Panel has been established
across housing and mental health services that will be able to inform further
priorities.
5.9
Carers services
The importance of information and communication with carers cannot be
overestimated if we are to ensure carers remain involved and supported.
The Carers Grant was introduced in 2000 and the commissioning of support
services for carers remains an area that needs to be reviewed and improved.
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This is particularly so as services continue to develop that focus on treating and
supporting people at home and minimising the time spent in more institutionalised
settings.
5.10
Accessible and appropriate services for black and minority ethnic
communities
Effective care pathways for black and minority ethnic
advice, support and treatment at an early stage remains
mental health services. The high representation of
communities on inpatient services reflects the national
indictment of services.
communities to access
a challenge for Sheffield
people from particular
picture, but remains an
Primary Care Mental Health Services have a vital role to play as well as the other
services through which people access specialist treatment and support including
A&E, EIS and CRHT.
As well as tackling institutionalised behaviour and a need to understanding the
care pathways more effectively, it highlights the importance for support services
in the community that are flexible to meet the range of different needs. This is a
complex challenge across the wide spectrum of communities in Sheffield, and
one to be faced by all service providers. The shift towards self directed support
provides an opportunity to establish models of service that can be tailored to
individual cultural and religious circumstances.
As well as ensuring services respond appropriately, an important task is a focus
on mental health awareness and prevention. This includes access to appropriate
information about conditions, services and support. The appointment of
Community Development Workers within the Primary Care Trust as part of the
Delivering Race Equality targets have an important role to play to support this
improvement.
5.11
Social Work Profession
It is recognised that the social worker continues to play a fundamental role in
mental health services, particularly the Care Coordination role within ECPA and
its traditional focus on social relations and the community. However, there are a
number of particular challenges.
Integration with health services has provided new opportunities for skill
development but it has also brought significant challenges such as providing
consistent professional and managerial support. It is an uphill task for the social
care profession to establish itself within an organisation that has a predominant
health service culture. The development of Sheffield Care Trust into a Foundation
Trust will not make this any easier.
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The development of a service model that adopts a stepped care approach
highlights the importance of primary mental health services. This raises the
question of where the valuable social worker asset best fits. Social inclusion is the
responsibility of all professions, but for the social work resource to be focused
only on people with the greatest needs (FACS) limits the important role it can play
in prevention.
The introduction of the Approved Mental Health Practitioner in the amended
Mental Health Act potentially dilutes one of the pillars of the social work function,
the Approved Social Work role. But it also provides the opportunity to
demonstrate its strengths along side health professions. Most significantly it
opens up options about the employment arrangements for social workers
highlighting whether the current arrangement of secondment to SCT remains the
most judicious.
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Appendix 1
The vision for Delivering Race Equality in Mental Health Services

Less fear of mental health services among BME communities and services
users

Increased satisfaction with services

A reduction in the rate of admission of people from BME communities to
psychiatric inpatient units

A reduction in the disproportionate rates of compulsory detention of BME
services users in inpatient units

Fewer violent incidents that are secondary to inadequate treatment of
mental illness

A reduction in the use of seclusion in BME groups

The prevention of deaths in mental health services following physical
intervention

More BME service users reaching self-reported states of recovery

A reduction in the ethnic disparities found in prison populations

A more balanced range of effective therapies, such as peer support
services and psychotherapeutic and counselling treatments, as well as
pharmacological interventions that are culturally appropriate and effective

A more active role for BME communities and BME service users in the
training of professionals, in the development of mental health, policy, and
in the planning and provision of services

A workforce and organisation capable of delivering appropriate and
responsive mental health services for BME communities
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Commissioning Intentions
This is a working document – subject to development and change
How
What
Strategic Direction and Service Model
Establish Strategic Direction for mental health services across the health and
social care partnership
Establish service model / care pathways
Revise Partnership Arrangements:

Commissioning
Effective joint commissioning with PCT/ Practice Based Commissioners
(PBC)

Effective service user and carer involvement in planning and
development

Service Provision
Identify impact and opportunities of Foundation Trust
Establish Primary Care Mental Health Service and Recovery and
Rehabilitation Service
- Ensure social care priorities and best use of social work resources
- Ensure social inclusion is integral to the service model
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When
Comments
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Improving Needs Information and Analysis
Improved understanding of the mental health needs of young people at risk
of long-term mental ill-health
Improved gathering and analysis of need and service use information
Improved understanding of relationship between mental ill-health and
substance misuse – future impact on services
Resource Allocation
Resources effectively targeted
 high risk groups
 areas of deprivation
 effective prevention
Choice and Self Directed Support
Establish balanced purchasing model: spot-purchasing vs. block purchasing
contracts
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Daytime activities, training and Employment
Identify and implement model for modernised day services to meet DH
Commissioning Priorities (less dependence on building based services)
Increase availability and connections to employment and training
Promotion of Self Help and User-Led services
Nursing Care and Registered Care
Coordinated approach to ensure best value for nursing and specialist registered
care placements to support high levels of need
Needs of an aging population
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Community Support, Supported Living,
Provision of best value community support services
Additional capacity in conjunction with Supported People – meeting specialist
needs.
Tenancy support and social care support services integrated at the point of delivery
for the service user
Additional Supported Living providers to meet specialist needs including black and
minority ethnic communities
Supported Accommodation and Housing
Additional supported accommodation to meet needs of people with complex needs
(dual diagnosis etc)
Specific support for people with a history of being unable to maintain tenancy etc.
Social Work Services
Revised Mental Health Act - Approved Mental Health Practitioner
Improving integration within Foundation Trust
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Carers Services
Partnership Contracts in place for carer support services (Carers Grant) from April
2008
Information and Advocacy for Users and Carers
IMCA service – South Yorkshire
Improved access to information on services and conditions
Improving information for BME communities (FIS)
Improved information for carers
Revised Mental Health Act – Advocacy
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Black and Minority Ethnic Communities
Delivering Race Equality Framework
Prevention/Promotion
SCC – Good Practice Employer
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