Download Primary Care Mental Health Programme

Key Learning Points
Chris O’Sullivan
Policy and Development Manager
[email protected]
Key Programmes of Work
• Primary Care Mental Health Programme
• Peer Support and Long Term Conditions
Programme
• Mainstreaming Mental Health
Programme
Primary Care Mental Health
Programme
Training and capacity building with
primary care staff on mental health in long
term conditions management, and with
staff delivering Keep Well health checks
Long Term Conditions
Management
• Developed as part of ‘Living Better’ programme
• SG funded initiative working with 5 CHP and 10 GP
practices across Scotland to address mental health
and wellbeing in people with long term conditions.
• In 4 CHP sites the focus is on diabetes and/or CHD
and in 1 CHP site Chronic Obstructive Pulmonary
Disease (COPD).
• Patient workshops, leading to development of staff
training based on discussing MH in LTC
management
Final report at http://bit.ly/12ktXxK
Key Questions (PHQ-2)
• During the last month, have you often been
bothered by feeling down, depressed or
hopeless?
• During the last month, have you often been
bothered by little interest or pleasure in doing
things?
Anticipatory Care Training
• Keep Well Health checks for 45-65 year
olds from deprived areas
• Delivered by a range of staff
• Covers a range of health risks and
screening
• Includes mental health, in different ways
in different health boards
• A challenge, because caseness can be
very high
• General session of social determinants
of mental health, including both formal
and informal aspects of MH
• Discussion of risk and protective factors
in their practice
• Bridging from existing skills to mental
health
• Discussion on suicide and highlight
specific trainings
• Delivered across Scotland
Peer Support for Long Term
Conditions
Amy Woodhouse, Senior Researcher
“It’s a matter of coming to terms with things all
the time, finding alternatives and luckily I’ve
got interests and hobbies... But it’s something
that I’ve had to work out myself, and I don’t
think it’s been easy for me...or my partner for
that matter.” (Male with CHD)
• Evidence of Need (2008-2011)
– Living Better Project (2008-2011) – focus groups and
survey with 700 people with CHD, Diabetes or COPD.
Participants reported: fear of the future, social isolation,
low mood, anxiety, lack of confidence, financial
concerns. Participants would like access to peer
support to help with MH impact of LTC
– Peer Support Feasibility Study (2011) found access to
peer support was patchy and peer services often lacked
‘credibility’
• Impact and Model of Change (2012)
– Networking events, guidance and local development
support
– Development and delivery of two new training courses
– Training participants showed increased levels of
knowledge and understanding of peer support and links
between mental and physical health
Mainstreaming Mental Health
Training and capacity building with local
authority and health board staff to connect
their job roles to mental health and
recovery outcomes.
“It was really useful to have a day set aside to pull
together this stuff. Some of it I knew, but I hadn’t had the
chance to sit and connect the dots before”
• Evidence of Need
– Local Govt obligations under MH Legislation, and policy
initiatives.
– Originally commissioned by Glasgow City Council. Recommissioned by GCC, then by NHS Ayrshire and Arran and
now Highland Council
– Focus group research with service users and scoping phase with
managers in local government/health to choose areas of focus.
• Impact and Model of Change
– Work with ‘non-traditional’ departments like environmental health
to broaden MH message.
– Statistically significant improvements in awareness.
– Implementation of action plans.
– Discussion of risk and protective factors for suicide, and
signposted to local suicide prevention training.
Seminar
Structure and
Content
To increase
understanding of
determinants of
mental health and
mental ill-health
To connect services
and activities in the
department to
mental health and
recovery objectives
To collect good
practice, and
identify actions on
a departmental and
council level
Learning Points
• Mental Health Awareness
– Expectations of mental illness awareness
• Trojan Horse
– Appreciation of MH role, but some indications for
mental illness training (e.g. SMHFA/
ASIST/Something else)
• Gatekeepers and Pioneers
– Gatekeepers – staff who could assist people with
mental health problems/poor MH to access services.
– Pioneers – staff who come into contact with people
who might not otherwise contact health or council
services for help.
• Enforcements Roles
– Ensuring decisions made and communicated to
minimise MH consequences on those affected, and
solve problems for communities.
• The Third Space
– Coined by Glasgow Life, describing council services
as the ‘third space’, i.e. not school/work or home,
important for decompressing and relaxing
• Mentally Healthy Workplace
– Though not specifically in the training, most
sessions included HR staff, and discussed mental
health at work in that department
Resilience key throughout the life
Later Life
course
•
•
•
•
Young People
• Schools and Education
• Youth Services
• Addressing youth
unemployment
• Intergenerational Activities
• Supporting vulnerable groups
Active Ageing
Social Care
Intergenerational Activities
Independent Living
Adults of Working Age
Early Years
•
•
•
•
•
•
Parenting Support
Family learning
Nursery provision
Housing
Greenspace
Child protection
• Public Sector Employee
wellbeing
• Employability
• Complexity and Chaotic Lives
• Independent Living
• Homelessness
• Crisis Support
• Family Support
• Opportunities for personal
development
-Housing -Green space -Protection of Vulnerable People -Environmental Health
Connecting Role and Outcomes to
MH is Key
Finding and assessing impact of
mental health in the context of
challenges faced in job role
Protecting and developing
individual or community mental
health through job related
activities
youth unemployment
anti-social behaviour
reduced budgets and service redesign
youth work
environmental health
education
housing
planning
Comparison of participants’ attitudes towards
mental health improvement pre and post-workshop
(Ayrshire)
95
100
90
98
95
87
90
80
80
70
62
60
45
50
40
30
20
10
0
Mental health promotion is I consider myself aware of I understand the factors that I am confident in my ability
relevant to my everyday
the importance of mental influence mental health and to develop activities or
job***
health to overall health and
wellbeing***
services which contribute to
well-being***
improving public mental
health***
Pre-workshop
Post-workshop
* p < .05; ** p < .01; *** p < .001
So…
Public policy at national and local level
has sought to mainstream mental health
and inequality messages in Scotland, but
these messages still need to be anchored
at practice level
People who live in areas of deprivation
are subject to multiple, overlapping risk
factors for poor mental health and suicide.
This complexity is a challenge for
statutory services and for community
organisations alike.
Men access community resources in
relation to employability, physical ill health
and welfare advice more often than they
do in relation to emotional concerns or
addictions.
This can mean that emotional difficulties
spring up in other contexts, and first
contact is critical
Existing suicide prevention training can be
difficult to access as the time commitment
of two days plus can be hard to arrange
cover to attend.
In addition these courses do not cover
complexity and deprivation, nor on the
needs of men as a particular risk group.
It can be an easy assumption for those
working on mental health that community
organisations are more aware of the role
mental health in wider health, poverty and
complexity than they actually are.