Sheffield EPIC Enhancing Pathways into Care. What about Sheffield? The start of ethnic diversity in the UK

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1 The start of ethnic diversity in the UK Sheffield EPIC Enhancing Pathways into Care Sustainable partnership working between the mainstream and voluntary sectors Dr Simon Mullins, Consultant Psychiatrist Sheffield Crisis Service What about Sheffield? The Empire Windrush from the Caribbean in 1948 Migration to Sheffield since 1951 Birthplaces of Sheffield residents 2001, outside the British Isles Pakistan Jamaica India Gender imbalances: in % of Pakistan-born were male 59% of Jamaica-born were male 56% of India-born were male First major migrant stream was from Jamaica Pakistan only becomes a major source in the 1960s. N. America 7 S. America 1 Source: 2001 Census results E. Europe 3 W. Europe 8 Middle N. Africa 1 East 6 Far East 6 S. Asia 19 (2%) W. / C. Africa 1 S. / E. Africa 6 Per thousand residents. Oceania 1 The top 10 birthplaces outside the UK, Sheffield residents, 2001 From immigration to ethnic communities Per thousand population Pakistan Jamaica Ireland India Germany Somalia Bangladesh Malaysia China Hong Kong Certain locally-important source countries are hidden within the data. Yemenis are included as Other Middle East Source: 2001 Census results Born British 480,000 Pakistan 6,800 Caribbean 2400 Ireland 2000 India Census data Stating ethnicity 458,000 15, Ethnicity Rate 89.2% 3.1% 1% 0.7% 0.6% 1

2 Ethnic composition, Sheffield residents 2001 not declaring themselves to be White British Spatial distributions Pakistanis by ethnicity Bangladeshi Mixed White / Asian Chinese Other Asian Others Pakistani Fir Vale Darnall Tinsley Indian African Irish Mixed White / Caribbean Caribbean White not British or Irish Sharrow Source: 2001 Population census Deprivation according to ethnicity So what should we do about these inequalities in Sheffield? The Vision of Partnership Working Why build this Relationship? Voluntary Sector Mainstream Sector Patchy cultural awareness in mainstream mental health services Mistrust of mainstream mental health by BME communities Avoidance leads to more likelihood of access in crisis Pakistani Muslim Centre Sheffield Crisis Service More likely to admit BME service user to hospital More likely to detain BME service user under MHA 2

3 References Count Me In, Healthcare Commission (2005) Ethnic variations in pathways to and use of specialist mental health services in the UK (systematic review), Kamaldeep Bhui, MRCPsych and Stephen Stansfeld, FRCPsych The British Journal of Psychiatry (2003) 182: Pakistani Muslim Centre PMC was established in 1984 Irshad Akbar (Chief Executive Officer) Through our collaborative work with a number of mainstream providers that include Jobcentre plus, Sheffield Action Team, Sheffield City Council, NHS Primary Care Trust, South Yorkshire Police and many more, PMC is seen as the "Scaffolding that supports, nurtures and articulates the needs of the Muslim communities in Sheffield". PMC, Woodbourn Road, Sheffield, S9 3LQ info@pmcuk.org Opportunities provided by PMC Functions; weddings Training; language, IT, further education Activities; gym, arts and craft Healthy lifestyle promotion Sukhoon Clinic; women's mental wellbeing Organised shopping trips Immigration support; passports, visa Translation support Children's needs; education support, play scheme Sheffield Crisis Service 2 Crisis Assessment Home Treatment (CAHT) teams Effectiveness of Home Treatment Local sample of 123 Home Treatment clients in 2005 (20% BME) Roles and responsibilities Crisis Hub during out of hours period (ASW s/medics/nurses) Gate keeping of acute admissions Home Treatment as an alternative to admission Facilitation of Early Discharge to shorten stays in hospital BME group had higher HoNOS and BPRS scores on admission to Home Treatment BME group in Home Treatment showed greater improvements Results are statistically significant HoNOS BPRS White British BME Mean difference of outcome measure between admission and discharge 3

4 Sheffield s EPIC Journey November 2005 Department of Health award 4 sites for Delivering Race Equality pilot projects; Sheffield, Manchester, Birmingham, Easington Sheffield vision of partnership working between Crisis Service and Pakistani Muslim Centre (Rashna Hackett nurse consultant) Dr Kwame McKenzie and Professor Kamaldeep Bhui lead quarterly meeting between 4 pilot sites January 2006 Organisational Leadership gives backing to project from the start (Irshad Akbar, CEO of PMC and John Ramsden, Chief nurse of Sheffield Care Trust) Steering group with support of South Yorkshire FIS manager (Sarwar Khan) sets scope of project with 12 aims 12 wide reaching initial goals of Sheffield EPIC A decrease in compulsory detention for the Pakistani community Decreased in Inpatient care for the Pakistani community Increase in early discharge rates (this is to be defined as the average length of stay) for the Pakistani community Appropriate percentages of Pakistani people accessing secondary care in non emergency community mental health services (consider the local data in the relevant areas and compare the percentage in contact with statutory services). Explorative data regarding the subjective views of PMC users with regards to stigma, suspicion, mistrust, capacity, interpreting/translation. The development of advocacy services and representation in Care Trust Council. A focus on economic circumstances of service users within the Pakistani Muslim Centre i.e. signposting etc. An improvement in existing collaboration between Sheffield Care Trust and the Pakistani Muslim Centre. An improvement in the limited knowledge of the CAHT team on matters of Race and culture in mental health. An increase in the assessments of social care needs of service users from PMC who also use secondary mental health services. An increase in the facilitation of respite care for both service users from the Pakistani community and their carers. The emergence of pathways of care that are timely and appropriate for the Pakistani community i.e. Early Intervention Services, Psychological Services. Sheffield s EPIC Journey January 2006 Crisis service psychologist (Jo Nicholson) integrates audit and develops a tool to assess cultural competencies of the crisis service care pathway February 2006 Launch of pilot at PMC with community involvement Initial positive experience of a few Home Treatment Clients gaining access to PMC April 2006 Initial Experience of partnership working could be more systematic and more coordinated Sheffield s EPIC journey May 2006 EPIC Steering group leadership gains SCT funding for a Community Development Worker at PMC, 20 hours a week July 2006 Delays in appointed CDW (Nayla Mahmood) starting; partnership with crisis service requires coordination of worker within PMC August 2006 Developments occur in other services such as referrals from the Early Intervention Teams to PMC and a cultural checklist introduced into wards Sheffield s EPIC journey September 2006 Decision to have a smaller clinical working group with additional project lead within service (Simon Mullins, consultant psychiatrist) to augment community collaboration of nurse consultant Define roles and responsibilities of EPIC clinical group Roles and Responsibilities Cross disciplinary project leads; consultant psychiatrist and nurse consultant Audit Information lead; team psychologist Nursing champions in teams to promote project within clinical service and develop a care plan to help coordinate and standardise our interventions (Sue Bently, Liz Miller) STR champions in teams to accompany service users and support them whilst at the PMC initially (Gareth Pritchard, Lucie Green) Administrative support (Clare Devine) Team manager (Sharon ward) to provide managerial support 4

5 Sheffield s EPIC Journey Refocus from broad EPIC goals to implement specific pathway interventions that impact on the patients journey in acute care. Pakistani client referred to CAHT in Crisis HOME TREATMENT PMC INPATIENT CARE Sheffield s EPIC journey October-January 2006 Nayla Mahmood starts work as Link worker for the project Team psychologist mentors and supervises Nayla to develop specific roles and responsibilities of the new role January 2007 Gender issues emerge as important for Pakistani men. A male service user volunteer (Matloop) is recruited to work alongside Nayla The partnership link worker Role The partnership link worker role Aims and objections Improve awareness of cultural needs of Pakistanis in acute care mainstream staff Work alongside mainstream staff to facilitate pathway interventions Provide advocacy for Pakistanis in acute care Develop competencies in mental health within staff group at PMC and more appropriate support services Delivery of Pathway Interventions Develop leaflet/ Prayer scroll for use in signposting Pakistanis to PMC at times of crisis Collaboration with staff and in preventing admission at assessment through Home Treatment Weekly visit to Acute wards to identify and facilitate Early Discharge to Home Treatment for Pakistani Inpatients Weekly visit to Inpatient Units and Crisis Service to identify and facilitate referral to PMC for aftercare The partnership Link Worker role Practicalities of role Requires support from leadership of each sector Requires a structured and systematic approach Requires flexibility in setting; Home visits Requires working closely with the family and carers Requires collaborative relationship with key mainstream staff Requires sensitivity to gender issues Quantitative data being collected on effectiveness of 3 pathways e.g. Preliminary results for period Oct 06-Jan Pakistani Inpatients identified by link worker 8/16 accessed link worker for advocacy 4/16 accessed PMC 2/16 accessed Home Treatment via early discharge 5

6 Sustainability Sustainability Describe what we did Write up EPIC journey with lessons learned along the way Describe good practice Write up blueprint protocol for partnership working between voluntary and mainstream services Provide evidence for good practice Write up audit findings including quantitative impact of pathway interventions on acute care use and qualitative impact on service user/carer experience Important roles on each side of partnership need to be maintained Voluntary sector link worker Mainstream worker to coordinate delivery of protocol and offer ongoing supervision Good will and the energy of a pilot project only takes you so far Funding of key roles Transferability Contacts Simon.mullins@sct.nhs.uk Rashnahackett@sct.nhs.uk Initial fruitful discussions with Sheffield Afro Caribbean Mental Health Association (SACHMA) with aim to replicate partnership protocol 6