Report CSD23050

The Board considered a report providing an update on progress to deliver the Bromley Mental Health and Wellbeing Strategy (BMHWS).

The Associate Director of Integrated Commissioning – SEL ICB (Bromley) informed Board Members that the BMHWS (2020-25) was a joint endeavour by both Bromley Council and the NHS South-East London Integrated Care Board (ICB) which set out the joint vision and action plan to support communities and individuals to have good mental health and wellbeing. The Strategy set out an approach in which the Council and NHS would work together with partners to prevent children and adults reaching a crisis point through the provision of a strong prevention and early intervention offer. It also put in place a joint plan for the provision of a number of important services for people with mental health challenges. It was noted that an All-Age strategy was developed in 2019-20 following a significant period of engagement and co-production with people with mental ill-health or who had a history of mental health challenges.

The BMHWS was built around “Five Pillars” – prevention; early intervention; multi-disciplinary approach to treatment; long-term conditions; and recovery and rehabilitation. The overarching vision was to provide excellent mental health and wellbeing services for people in Bromley. It was noted that there had been substantial progress made across each of these five areas, and there was a need to begin work on what would follow the current strategy post-2025.

The Associate Director of Integrated Commissioning – SEL ICB (Bromley) highlighted that the finalisation of the BMHWS had coincided with the COVID-19 pandemic. Whilst it was not possible to see the full picture of the pandemic at that time, in subsequent years, the impact on both individual’s and communities’ mental health and wellbeing had become increasingly clear. One area where the impact of the pandemic had been seen was the mental health and wellbeing of children and young people, with a significant rise in referrals made to Children and Young People’s (CYP) Mental Health and Wellbeing Services from September 2020. Referrals had remained high, which had a huge impact on Children and Adolescent Mental Health Services (CAMHS) waiting times, and there had also been challenges within Adult Mental Health Services. Key achievements that had been delivered in terms of children and young people’s mental health and wellbeing included:

-  the roll-out of three mental health support teams (MHSTs) to Bromley schools. The teams provided “on the ground” support to teachers and pupils dealing with mental health challenges.

-  established the Mental Health Network between Bromley schools and CYP mental health and wellbeing services.

-  expansion of the mentoring programme; establishment of a youth ambassador; roll-out of cutting-down (eating disorder) programme; and new support to children in the Youth Justice System.

-  agreement on a new integrated NHS/voluntary sector Single Point of Access (SPA) and specialist  Eating Disorder Pilot.

In response to a question regarding CAMHS waiting times, the Associate Director of Integrated Commissioning – SEL ICB (Bromley) acknowledged that these were unacceptable, however this was a trend seen across the country, and not just in Bromley. This had been a key focus within CYP mental health and additional funding had been agreed to help reduce waiting times – it was hoped that within a few months the waiting times would be at a more acceptable level. It was noted that, in addition to this, a different approach was needed which worked for schools and partners to ensure that the right support was provided for children and young people. The Board Member suggested that a target for reducing CAMHS waiting times be included in the next plan. The Chairman enquired if there were also difficulties relating to the number of skilled staff required. The Associate Director of Integrated Commissioning – SEL ICB (Bromley) said the amount of money put into mental health had increased significantly, but the biggest challenge related to the lack of psychologists and other skilled staff to appoint to these posts. They were using other roles in a more innovative way – hybrid roles were being developed by partners, which was helping to address the workforce challenges.

A Board Member highlighted that the pandemic had brought huge pressures and changed the way in which providers interacted with the public. It was considered that young adults may be more comfortable in approaching providers using digital methods of communication, such as e-consult or text message, and the risks and benefits of the digital offer could be reflected upon. The Associate Director of Integrated Commissioning – SEL ICB (Bromley) agreed that this would be a positive area to look at and could be considered for a deep dive. During the pandemic, a number of services had moved online – this was positive for some, but not all, and the importance of getting the tailored approach correct was highlighted.

The Associate Director of Integrated Commissioning – SEL ICB (Bromley) advised that key achievements, in terms of prevention and early intervention for adults with mental health and wellbeing challenges, included:

-  the opening of the Bromley Mental Health and Wellbeing Hub – an innovative NHS/voluntary sector partnership between Oxleas NHS Foundation Trust and Bromley Mind, which was a “single point of access” for adults seeking help with mental health and wellbeing challenges.

-  established mental health practitioner roles in GP Practices (Primary Care Networks) – supporting GPs with mental health clients, and delivering physical health checks for people with mental ill health.

-  improved access for Bromley talking therapies, with more people able to access services and better recovery outcomes.

-  improved employment support services rolled-out for people with mental health challenges including the Individual Placement Scheme (IPS) service.

In relation to recovery and long-term conditions for adults with mental health and wellbeing challenges, the following key achievements had been delivered:

-  commencement of a large-scale transformation programme of mental health recovery services, enabling 80+ people to live more independently – taking on tenancies. This had been done through co-production with clients, who had shaped and designed their new service offer.

-  opened a new “step down” services for adults with mental health challenges who were moving into their own homes.

-  established a new joint funding panel across Bromley Council, Oxleas NHS Foundation Trust and the SEL ICB to agree packages in a joined-up way.

-  rolled-out a pilot personal health budget (PHB) service between Bromley Council and the ICB, which included mental health.

The Associate Director of Integrated Commissioning – SEL ICB (Bromley) informed Board Members that there were a number of other strategies within their ‘bookcase’. Joint working had been untaken in relation to the BMHWS, Bromley Learning Disability Strategy and the new Bromley All-Age Autism Strategy (2022-27). There had been increased opportunities for the delivery of the strategies to be aligned, with areas including housing, employment and community treatment reviews (CTRs) managed together.

Board Members were advised that, despite a number of challenges, the BMHWS (2020-25) had been successful and had demonstrated what could be achieved when Bromley Council and the local NHS came together around a shared vision. It was proposed that work to refresh the strategy begin, with the aim of a new plan commencing in 2025/26. It was noted that the Health and Wellbeing Board would provide a key role in overseeing the development of the new strategy.

In response to questions regarding the statement that BAME community groups were over-represented across all types of severe mental health needs, the Associate Director of Integrated Commissioning – SEL ICB (Bromley) advised that a several pieces of outreach work had been undertaken. The youth ambassador worked closely with the communities and schools in Penge and Anerley – due to their own background and life experiences, they were able to reach areas that others could not. It was noted that similar work had also been undertaken in Oxleas adult mental health. The Associate Director of Integrated Commissioning – SEL ICB (Bromley) suggested that this was an area that could be explored further. The Member noted that there may be other aspects, but this appeared to be a lot for the youth ambassador to shoulder, and how this could be included as part of everyone’s roll should be reflected upon. It was recommended that learning should be taken from teams within the Council, third sector organisations and charities. Another Member highlighted that, in relation to prevention, other boroughs undertook a lot of work around Pride Month and Black History Month – increased activity could help communities in the borough to feel more supported, and therefore help reduce the strain of mental health. The Associate Director of Integrated Commissioning – SEL ICB (Bromley) said this was something that could be considered as part of the work to support people from different groups and communities to better manage their own mental health, and they may also consider forming a cross party Task and Finish Group.

In relation to a question on the statistics provided on page 16 of the BMHWS, the Associate Director of Integrated Commissioning – SEL ICB (Bromley) informed Board Members that additional services had been provided, which it was believed were meeting the current needs of the population – however, a new baseline would be provided through the Joint Strategic Needs Assessment (JSNA). Another Member highlighted the reference made in the BMHWS regarding Bromley having the third highest level in London of adults diagnosed with depression and enquired if the reasons for this were known. The Associate Director of Integrated Commissioning – SEL ICB (Bromley) said that Bromley was a borough with a large population and higher CAMHS waiting times were expected in comparison to smaller boroughs. It was noted that the schools in borough were high achieving, which could bring added pressures, and this was something that would be looked at as part of the JSNA.

The Chairman thanked the Associate Director of Integrated Commissioning – SEL ICB (Bromley) for the presentation to the Board and requested that an early timeframe for the revision of the new BMHWS be provided to Board Members following the meeting.

RESOLVED that the progress to deliver the Bromley Mental Health and Wellbeing Strategy (2020-25) be noted.