1 Equality Impact Assessment Tool: Policy, Strategy and Plans (Please follow the EQIA guidance in completing this form) 1. Name of Strategy, Policy or Plan Renfrewshire Community Mental Health Team Operational Policy and Standing Operating Procedures. Please tick box to indicate if this is: Current Policy, Strategy or Plan New Policy, Strategy or Plan 2. Brief Description Purpose of the policy; Changes and outcomes; services or activities affected The Community Mental Health Team (CMHT) forms part of an integrated whole system approach to mental health services. The service is delivered in conjunction with Primary Care CMHT, Intensive Home Treatment Team (IHTT), Out of Hours (OOH) Services, In-patient Services and Network Employability Service. The purpose of the CMHT service is to provide accessible, timely, safe, equitable and consistent care to match the assessed need of those service users considered to have a psychiatric disorder or mental illness with complex needs. The Operational Policy and Standing Operating Procedures set out the procedures, processes and standards that will ensure staff within the Community Mental Health Teams plan, deliver and evaluate what they do and provide assessment, interventions, support and risk management that is person centred. 3 Lead Reviewer Linda Spence Lead Nurse Support to Joint Community Services Manager
4. Please list all participants in carrying out this EQIA: Lindsay Jack Health Improvement Senior (Mental Health and Addictions). Jim Clocherty Service Manager, Community Mental Health Service Janice Naven Nurse Team Leader RCMHT Rona Slevin Senior Social Worker RCMHT Roberta Roberton Nurse Team Leader Paisley CMHT John Gray Senior Social Worker Paisley CMHT (Bank) Jackie Jackson Senior Social Worker Paisley CMHT Yvonne McFarlane Medical Records/Administration Manager Scot Little CPN (Acting Nurse Team Leader) RCMHT 2
3 5. Impact Assessment A Does the policy explicitly promote equality of opportunity and anti-discrimination and refer to legislative and policy drivers in relation to Equality The introduction states that the ethos and practice of the service is underpinned by the principles of: The Mental Health (Care and Treatment) (Scotland) Act 2003 The Equality Act 2010 The 10 Essential Shared Capabilities Adults with Incapacity (Scotland) Act 2000 The service model aims to meet the commitments and targets described in key strategic drivers for modernising Mental Health and Social Care services in Scotland as outlined in: Delivering for Mental Health, Scottish Executive (2006) Admission to Adult Mental Health Inpatient Services, Best Practice Statement, NHS Quality Improvement Scotland (2009) Mental Health Service Development Framework (2012) NHS Greater Glasgow and Clyde Mental Health Services: Case for Change & Framework for Mental Health Services (2012) (work in progress) Mental Health Strategy Scotland (2012) 2020 Vision for Health and Social Care 21 st Century Social Work Review Public Bodies (Joint Working) Bill West of Scotland Adult Support and Protection (ASP) Guidance and Procedures
4 B What is known about the issues for people with protected characteristics in relation to the services or activities affected by the policy? All The Renfrewshire Community Mental Health Services are aware that their collection of data in relation to the protected characteristics can be improved. We will ensure monitoring arrangements are put in place to in order to establish the protected characteristics of those referred to the services and those currently being treated within the services. This will allow us to establish if the needs of those service users are being met, identify any barriers to accessing the services and assess the impact the Policy and SOPs has on them. We will develop plans to engage with service users to ensure the needs of those with protected characteristics are represented. We will develop a Service Users leaflet in line with NHSGGC s Accessible Information Policy. Source Sex Studies have shown that women are significantly more likely than men to have a common mental health problem. Scotland s Mental Health: Adults 2012 55% of those referred to the CMHT are female, 45% are male. More males (18%) do not attend allocated appointments than females (15%). DNA rates for Paisley CMHT appear to be higher than Renfrewshire CMHT (19% vs. 13%). Females: 18% vs. 12%. Males: 21% vs. 14%. The Consultant Psychologist and Nurse Team Leader are currently exploring this difference and will develop a plan to address it. PIMS Data Warehouse (2013)
5 Gender Reassignment Where possible same sex staff are allocated if an appropriate request is made. This support can be accomodated by care provided across the Renfrewshire CMHT Service. Venue and times for assessment and care can be agreed depending on individual needs to consider other responsibilities such as carer/child care needs. Same sex interpreters are requested if required. All staff are aware of GBV Policy. All staff have attended Basic Awareness of Domestic Abuse training. 2/3 of staff have attended Sensitive Routine Enquiry training. CHMT assessment form now includes a prompt re domestic abuse. Staff are aware of the Transgender Policy and act accordingly ensuring transgender people using or visiting services can do so without fear of prejudice, discrimination or harassment. We will ensure the policy is circulated to staff for reference. Race 77% of those referred to the CMHT identify themselves as White Scottish; 0.3% as White Polish; 0.2% as African; 0.2% as Indian (Scottish or British); 0.2% as African; 0.1% as Pakistani (Scottish or British); 0.1% as from another Asian Background. PIMS Data Warehouse 2013 Interpreting Services are used when required; these are accessible by both Health and Social Work staff. Patient information is requested in alternative formats as required. The NHS Corporate Inequalities Team is used to provide translations. Racial incidents are dealt with through appropriate channels. We will develop a plan to identify how cultural needs are accommodated across the service.
6 Disability Not all venues are DDA compliant. Alternative arrangements can be made as required this can include home visits or appointments offered at GP surgeries or other community venues. Alternative arrangements will also be made if patients have difficulty accessing the venue because of its location or cost of travel. Patient information is requested in alternative formats e.g. Braille as required. Information on Community Mental Health Services is in Mental Health Directory. Patients with mild learning disabilities are managed within the CMHT with advice from the Renfrewshire Learning Disability Service (RLDS). Patients with moderate to severe learning disabilities are managed by the RLDS with an allocated CHMT worker. Staff signpost to other services including local counselling, pain clinic, disability resource centre, Scottish Mental Health Service for Deaf People. Text messaging service for appointments is available. Induction Loop System is available for hearing impaired clients. Sign interpreter is available through interpreting services. We will explore how disability is impacted by the policy and develop a plan to address any issues that may arise. Sexual Orientation All staff are aware of the Civil Partnership Act. Research carried out in 2008 into the health of lesbian and bisexual women found that 20% of lesbian and bisexual women deliberately harmed themselves in the previous year compared to 0.4% of the general population. 5% had attempted to take their own life. Prescription for change: Lesbian and Bisexual Women s Health Check
7 (2008) 3% of gay men and 7% of bisexual men in Scotland have attempted to take their own life in the last year. Gay and Bisexual Men s Health Survey Scotland (2011) UK Government estimates that 5-7% of the population are identified as LGB. The sexual orientation of service users is not routinely collected in Addiction or Mental Health Services. Office of National Statistics Religion and Belief The majority of Renfrewshire s population (69.42%) describe themselves as Christian; 23.82% have no religion; 1.04% are non-christian. Currently the religious beliefs of service users is not routinely collected in Addiction or Mental Health Services. Renfrewshire Census 2001 Appointment times can be arranged to accommodate prayers, services etc. NHSGGC Spiritual Care Manual is available for staff to refer to for guidance. This will be circulated to all staff. Age Renfrewshire s Child and Adolescent Mental Health Service (CAMHS) work with young people under the age of 18. At 18 the young people are supported into the Community Mental Health Service if required. Movement from CAMHS to CMHT could be improved; there is a working group in progress looking at the transition of care between services this group includes service user and advocacy in it s membership.
8 Pregnancy and Maternity It is agreed that individuals who are under 70 years will receive their initial assessment in adult psychiatry, and those aged 70 years or older will receive their initial assessment in Older Adults Mental Health Services. Once a functional assessment is carried out their care and treatment will be carried out by the most appropriate area of the service. Older Adults services will assess and manage all patients with cognitive impairment related to organic changes, since they have the most appropriate expertise. Known service users over 70 years old remain in the Community Mental Health Service if there is no change to their presentation. If their presentation changes and they require the support of the Older Adults Mental Health Service a transfer to that service will be facilitated. These graduate transitions between services are defined in functional, rather than chronological, terms and give consideration to individual service user needs; transfer is agreed between Consultant Psychiatrists and there is an agreed process in place to facilitate this. Transfer of older adults is between consultants. Agreed process in place. Child protection is a priority for staff. All staff have been trained in child protection. Staff routinely ask and record if there are children in the house, their name and their date of birth. Data on the age of service users is currently collected by the Community Mental Health Service and will be analysed to monitor trends in referrals and attendance. We will explore the development of a pathway for transfer of service users from CAMHS to the CMHT and from the CMHT to the Older Adults Mental Health Service. Pregnant service users access the local Special Needs In Pregnancy Service (SNIPS) CMHT s have link nurses associated with this service. Staff link with health visitors and GPs during pregnancy and maternity.
9 Medications are adjusted as required. Staff link with the Perinatal Mental Health Services for inpatient admissions and also clinical support when required. Breastfeeding is accommodated as and when required. We will ensure SNIPS are fully briefed on the Policy and SOPs. Marriage and Civil Partnership 45.61% of Renfrewshire Residents are married. No information exists on Civil Partnerships. Renfrewshire Census 2001 All staff are aware of the Civil Partnership Act. Information on marriage and civil partnership is not routinely collected by services. This will be explored. We will circulate the Civil Partnership Act to staff for reference. Social and Economic Status Other marginalised groups (homeless, addictions, 65.97% of Renfrewshire residents are economically active. Staff will facilitate travel passes for those who are eligible. A dedicated point of contact has been identified within the service through whom all correspondence and updates on Financial Inclusion and Welfare Reform changes are distributed to staff. The social and economic status of service users is unknown. Analysis of postcode data of service users will be explored in order to monitor trends in referrals, non attendance and attendance to service. CMHT staff will link in with other agancies as appropriate, including Network Services, Advice Works, RAMH Financial Literacy Service and Carers Centre. HOMELESSNESS Renfrewshire Census 2001
10 asylum seekers/refugees, travellers, exoffenders Homeless pathway is in final stages. Will enable access to the CMHT without GP and provides clear support for Housing and Homeless Staff. ADDICTIONS Mental Health and Addictions Interface Protocol is in place. This protocol sets out procedures and guided responses that will ensure staff in Renfrewshire s Tier 3 and 4 Addiction and Specialist Secondary Mental Health Services provide treatment, support, planning and risk management that is person centred. Addiction services provide appropriate interventions for mild to moderate mental health issues and Mental Health services provide appropriate interventions for mild to moderate substance misuse problems. Guidance is provided as to when and how referrals to the specialist service should be made. ASYLUM SEEKERS/REFUGEES NHS and Social Work staff access/use interpreting services as necessary. Patient information is requested in alternative formats as required. The NHS Corporate Inequalities Team is used to provide translations. Staff signpost to support groups within the area. TRAVELLING COMMUNITY 0.1% of those referred to the CMHT identify themselves as White Gypsy/Traveller. The CMHT Homelessness Pathway will support access to mental health services for the Travelling Community. EX- SERVICE PERSONNEL
11 When servicemen and women leave the armed forces, their healthcare is the responsibility of the NHS. All veterans are entitled to priority access to NHS hospital care for any condition as long as it's related to their service, regardless of whether or not they receive a war pension. Staff have access to support services with Erskine Hospital. If any mental health problems are related to a patient s military career staff will joint work with Combat Stress and Erskine Hospital. vi) PRISONERS AND EX-OFFENDERS Current prisoners are treated within the Forensic Mental Health Service. CMHT staff liaise as necessary with Scottish Prison Health Staff on conviction and in preparation for release from prison. Service users with a past history of offending behaviour will be treated by the CMHT history of serious offending behaviour will be discussed with Forensic Services and care formulated as necessary. C Do you expect the policy to have any positive impact on people with protected characteristics? General Highly Likely Probable Possible The Policy and SOPs outline how service users can access the CMHT and outlines the standards that can be expected from the service.
12 Sex Men and women will be treated equally under the terms of the policy. Appointment times can be offered to fit round child care commitments. Monitoring arrangements will ensure a robust checking process is in place to measure improvements in attendance for both sexes. Gender Reassignment There is no evidence that the Policy and SOPs will have a positive effect on the protected characteristic of gender re-assignment. However, transgender people will benefit from the improved standards of care outlined. Race Disability Information relevant to the care of the service user will be translated as required. The CMHT Service Users leaflet will be translated as required. Service users will continue to be communicated to in a format
13 appropriate to their additional support needs. Alternative arrangements for appointments e.g. home visits will remain in place. Sexual Orientation Religion and Belief There is no evidence the protocol will have an impact due to the protected characteristic of sexual orientation. However, those who identify as LGB will benefit from the improved standards of care outlined. There is no evidence the protocol will have an impact due to the protected characteristic of religion and belief. However, service users will benefit from the improved standards of care outlined. Service users will be able to decline an appointment offered if it conflicts with a specific religious festival or specific reserved period of observance.
14 Age Marriage and Civil Partnership Pregnancy and Maternity Social and Economic Status The transition between services is clearly outlined in the Policy. Pathways will be developed to support transitions. There is no evidence the Policy and SOPs will have an impact due to the protected characteristic of marriage and civil partnership. However, service users will benefit from the improved standards of care outlined. There is no evidence that the Policy and SOPs will have an impact on the protected characteristic of pregnancy and maternity. However, service users will benefit from the improved standards of care outlined. We will ensure the Renfrewshire SNIPS team are briefed on the Policy and SOPs. There is no evidence the policy will have an impact due to the protected characteristic of social and economic status. However service users, regardless of their social and economic status, will benefit from the improved standards of care outlined.
15 Other marginalised groups (homeless, addictions, asylum seekers/refug ees, travellers, ex-offenders Service users who are homeless will benefit from improved access to the CMHT. Those with mild to moderate addiction problems will remain under the care of the CMHT. D Do you expect the policy to have any negative impact on people with protected characteristics? General Highly Likely Probable Possible Staff may have limited understanding
16 of the protected characteristics. We will ensure all staff have completed NHSGGC or Renfrewshire Council Equality and Diversity training. We will develop a plan to assess how each of the protected characteristics are affected by the protocol and address any negative issues identified. This will include monitoring patient experiences. Sex Gender Reassignment Race Appointment times may not be suitable due to child care, work commitments etc. Alternative appointments can be made to accommodate this. There is no identified negative effect due to the protected characteristic of gender reassignment. Staff may have a limited understanding of the protected characteristic. We will ensure the NHSGGC Transgender Policy is circulated to staff for reference. There is no identified negative effect due to the protected characteristic of race. A language barrier may prevent some
17 patients from fully understanding the Policy and SOPs. We will ensure the Patient Information Leaflet is translated as requested. Disability Sexual Orientation Religion and Belief There is no identified negative effect due to the protected characteristic of disability. This will be monitored and any issues addressed. There is no identified negative effect due to the protected characteristic of sexual orientation. There is no identified negative effect due to the protected characteristic of religion and belief. The NHSGGC Spiritual Care Manual will be made available to staff to refer to. Age Marriage and Civil Partnership The interfaces between CAMHS and the CMHT and the CMHT and Older Adults Services will be explored and improved. There is no identified negative effect due to the protected characteristic of marriage and civil partnership. The Civil Partnership Act will be circulated to staff.
18 Pregnancy and Maternity Social and Economic Status Other marginalised groups (homeless, addictions, asylum seekers/refugees, travellers, exoffenders Staff in the Special Needs in Pregnancy Service (SNIPS) may not be fully aware of the CMHT Policy and SOPs. We will arrange for SNIPS staff to be briefed. There is no identified negative effect due to the protected characteristic of social and economic status. Service users will access support for travel if required and home visits will be offered if required. Service users currently receiving support with travel expenses will continue to do so for any additional appointments required.
19 E Actions to be taken E1 Changes to policy Responsibility and Timescale E2 action to compensate for identified negative impact Explore central recording of gender re-assignment, sexual orientation, faith, disability; sexual orientation; religion and belief; pregnancy and maternity; marriage and civil partnership; socio-economic status; other marginalised groups (homelessness, addiction, asylum seekers/refugees, travellers, exoffenders). Explore the difference in DNA rate between the Paisley and West Renfrewshire CMHTs and develop a plan to address this. Linda Spence December 2014. Consultant Psychologist/ Janice Naven December 2014. Explore implementation, monitoring and recording of Sensitive Routine Enquiry of domestic abuse and childhood sexual abuse within the Community Mental Health Service. Jim Clocherty, Linda Spence, Susan Clocherty December 2014
20 Explore delivery of Sensitive Routine Enquiry of domestic abuse and childhood sexual abuse training to remaining relevant members of staff. Ensure new staff and students attend Basic Awareness of Domestic Abuse training. Circulate NHSGGC Transgender Policy to staff. Develop a plan to explore how cultural needs are addressed within the service. Explore how disability is impacted by the policy and develop a plan to address any issues that may arise. Circulate NHSGGC Spiritual Care Manual to all staff. Explore development of a pathway for transfer of service users from CAHMS to the CMHT. Explore the development of a pathway for transfer of service users from the CMHT to the Older Adults Mental Health Service. Ensure the Renfrewshire SNIPs team are briefed on the Policy and SOPs. Jim Clocherty, Linda Spence, Susan Clocherty December 2014. Team Leaders Ongoing Linda Spence July 2014. Linda Spence December 2014. Linda Spence December 2014. Linda Spence July 2014 Linda Spence December 2014. Linda Spence December 2014. Linda Spence December 2014
21 The Civil Partnership Act will be circulated to staff for reference. Develop a plan to monitor postcode data to monitor trends in referrals, non attendance and attendance to service. Ensure service user experience is monitored regularly. Re-design service leaflet in line with Accessible Information Policy. Linda Spence July 2014 Linda Spence December 2014. Team Leaders Ongoing. Linda Spence and Lindsay Jack December 2014 E3 Further monitoring potential positive or negative impact Establish a process for monitoring and reporting the protected characteristics of service users. Linda Spence 6 months from submission E4 Further information required Begin EQIA of CMHT. Linda Spence 6 months from submission
22 6. Review: Review date for policy / strategy / plan and any planned EQIA of services To be confirmed once agreed. Lead Reviewer: Sign Off: Name: Job Title Signature Date: Please email copy of the completed EQIA form to EQIA1@ggc.scot.nhs.uk Or send hard copy to: Corporate Inequalities Team, NHS Greater Glasgow and Clyde, JB Russell House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH