Agenda item

Members received an update from SLAM (South London and Maudsley NHS Foundation Trust).

 

Attending from SLAM were:

 

1.  Hilary Williams (Service Director)

2.  Dr. Shubalade Smith (Clinical Director)

3.  Ranjeet Kaile (Executive Director of Communications)

 

The representatives from SLAM expressed their condolences regarding the death of Councillor Mary Cooke. Councillor Cooke was part of a small delegation from the Council that had visited the Bethlem Royal Hospital on 18^th November 2021.

 

The Service Director said that the main areas that she wished to focus on were:

 

a)  The continuation of the provision of services during the course of the pandemic.

 

b)  The development and focus on the Trust’s Mental Health Strategy.

 

c)  The activities that took place on the Bethlem Royal Site.

 

d)  The site had now reopened after the pandemic and was being used by local services and the general public.

 

e)  The Bromley Protocol.

 

It was noted that most cases of leave passed without event. When this was not the case, the Trust worked closely with the police and the Ministry of Justice and informed local stakeholders via the Bromley Protocol. During the period of March 2021 to February 2022, there were 10 incidences of a person absconding, with one person being responsible for three of these incidences.

 

Dr Smith informed Members that the Trust had robust risk management procedures:

 

a)  Physical Risk Management

b)  Procedural Risk Management

c)  Trust Policies and Procedures

d)  Relational Security.

 

With respect to relational security, this enabled staff to get to know the patients and to get to know what increased or decreased risk. As far as the Trust was concerned they were not adopting a ‘one size fits all’ policy but worked by formulating individual plans for their patients. 

 

The Director of Communications said that SLAM were keen to work with the Council to challenge the discrimination that was often associated with mental health. It was the case that during periods of isolation or lockdown because of the pandemic, that this isolation could worsen mental health issues. SLAM was keen to work with the Council, schools and other community groups.

 

It was noted that 10 incidents of low risk absconding had been recorded. The Service Director explained that two of these were of a particular type of notified incident and would therefore be subject to an investigation to see what lessons could be learnt. In these cases, the patients did not return to the hospital setting at the correct time. A response was mobilised, the Bromley Protocol was activated, the police were called and the Ministry of Justice was informed. There was no harm caused to the absconder or to any members of the public. Incidences such as these would have a bearing on further decision-making in respect to the patient’s clinical treatment plan.

 

Doctor Smith explained that there were different types of leave, there could be leave in the unit, leave in the grounds (both escorted) and if they conformed to these boundaries, then they could be considered for leave outside of the hospital. If boundaries were breached, then leave was curtailed.

 

A discussion took place regarding the hospital’s Certitude Services and the difference of approach with respect to medium and secure units and treatment.

Members were informed that as well as the medium and secure units there was also:

 

a)  Acute and specialist rehabilitation wards

b)  Wards for older adults

c)  Wards for children

d)  Wards for working age adults

 

It was explained that a Medium Secure Unit was similar to a ‘Category B’ prison. A Medium Secure Unit would have certain specifications with respect to physical security. The Medium Secure Unit at Bethlem therefore had an 18 foot high perimeter fence which was difficult to climb and to escape from. The Low Risk Unit did not have a fence of this nature. There were other differences in that it was harder to obtain leave from a Medium Secure Unit. Those patients in a Medium Secure Unit would be of higher risk because they had committed more serious offenses.

 

With respect to the Certitude Service, it was explained that this was a housing complex which was adjacent to the hospital and was run in conjunction with Certitude Housing. It was a step forward housing unit where patients could go after being treated to meet their housing and support needs. The benefit of this was that it would allow those patients to transition to normal life and at the same time would free up hospital beds within the hospital itself. The housing complex had been developed using some estate that had been left to the Trust. There were 36 self-contained step forward flats in the housing complex. The average stay for a person in the Certitude Housing unit was approximately six weeks.

 

A Member asked what sort of outreach and preventative work was taking place. The SLAM Director of Communications listed some of those:

a)  A package supporting dads that may be struggling with family life and bringing up children.

b)  Packages for schools such as ‘Fantastic Friends’

c)  Working with local football associations.

d)  40 different pilots taking place—one of which was the utilisation of community embedded workers. 

e)  Information regarding the provision of housing services

f)  Analytical data technology was being used to identify ‘mental health hotspots’ where resources could be targeted.

 

Doctor Smith explained the differences between primary and secondary prevention. SLAM had been used to dealing historically with secondary prevention and were resourced for that. This meant that when people came to Bethlem they were already unwell. So there needed to be more of a focus on primary prevention to prevent individuals from suffering from mental health issues in the first place. She explained that research had shown that a mother’s actions like taking drugs could affect the child in the womb and enhance the probability of the child being born with mental health issues. It was understood that substance abuse by young people especially before the age of 19 was very harmful. Childhood adversity was also very harmful for the mental health of young people. It was also understood though, that if you provided the child or young person with the right support they would get better and they would not develop mental health problems further down the line. 

 

It was agreed that the list of projects mentioned by the Director of Communications would be disseminated to Members later, probably with the minutes. 

 

Members were informed that many people with mental health issues could be supported in the community without coming into a hospital setting. Most people that were treated in the hospital setting got well. Even if a person came into hospital in a state of crisis, they were able to leave again in around 30-40 days. Most people being treated in the secure unit were treated successfully between 14-18 months. However, there was a cohort of about 10% who were resistant to treatment and could remain in the hospital setting for 5 years or more. A discussion took place regarding the importance of mental health support outside of the hospital setting by various charities and community support services. One of these was the ‘Be Well’ Hub. An innovative tool that had been introduced was the CAMHS ‘Virtual Waiting Room’. This was an online space that was designed to support young people and parents whilst they were waiting for treatment.

 

A Member noted the excellent work being undertaken by SLAM with respect to various projects and community engagement. Bearing in mind the presentation given by Mr Seal from BYC and the difficulties in knowing how young men could access relevant help and services, it was the general consensus that greater co-ordination and synergy was required so that those young men that needed help could be signposted to the various projects that SLAM were developing. 

 

A discussion took place regarding the number of people that absconded and it was noted that the ratio was actually very small. The reasons for extending leave and any consequences would be assessed on a case by case basis. This meant that the approach to these issues was truly person centred. Some patients were known to have deliberately extended leave as they did not wish to leave the care of the hospital. A discussion took place concerning the living accommodation, communal spaces and various on-site facilities.

 

It was noted that about half of the patients had been referred from prison. They would stay until they got better (normally for about 6 months). Once they got better they would be returned to prison.

 

The Portfolio Holder thanked SLAM for the opportunity to visit Bethlem in 2021 and she recommended a visit to other Members of the Committee. An offer of mental health training for Councillors had been presented and she was keen for this offer to be taken up. 

 

A Member asked about services provided for army veterans. The Service Director responded and said that there was not much in the way of services provided for veterans in the Bromley Borough. However, Bethlem was linked with Kings and there were 4 sites across London that ran Veterans’ programmes.

 

The Chairman mentioned that in one London Borough there was a trial taking place regarding the decriminalising of cannabis. He asked the SLAM representatives what they thought about this. Dr Smith replied that cannabis was not the only drug that was connected with mental health issues, drugs like ecstasy, amphetamines and cocaine were also causes of mental health issues. Cocaine use was associated with the development of psychosis. There had been an experiment in Canada where cannabis had been de-criminalised and SLAM had received reports from colleagues in Canada of more rates of psychosis as a result. There was a greater risk of psychosis because of certain hereditary factors and childhood abuse. The view of SLAM was that cannabis was NOT a benign thing. The right kind of understanding and education was required.

 

The Chairman thanked the SLAM representatives for attending the meeting and said that the Committee looked forward to another on site meeting at Bethlem in due course.

 

RESOLVED that the update from SLAM be noted.