Examples of what we are doing across the Northern England Clinical Networks footprint February 2017

Implementing the Five Year Forward View for Mental Health Examples of what we are doing across the Northern England Clinical Networks footprint February 2017

Contents The Role of the Clinical Networks... 3 Case studies from the Northern England Clinical Networks footprint - Examples of excellence... 4 70,000 more children will access evidence based mental health care interventions... 4 Intensive home treatment will be available in every part of England as an alternative to hospital... 8 No acute hospitals without all-age mental health liaison services, and at least 50% are meeting the Core 24 service standard... 9 At least 30,000 more women each year can access evidence-based specialist perinatal mental health care... 10 10% reduction in suicide and all areas to have multi-agency suicide prevention plans in place by 2017... 11 Increase access to evidence-based psychological therapies to reach 25% of need, helping 600,000 more people per year... 13 The number of people with severe mental illness (SMI) who can access evidence based Individual Placement Support (IPS) will have doubled... 16 280,000 people with SMI will have access to evidence-based physical health checks and interventions... 18 60% people experiencing a first episode of psychosis will access NICE concordant care within two weeks 27 Inappropriate out of area placements (OAPs) will have been eliminated for adult acute mental health care 29 New models of care for tertiary mental health will deliver quality care close to home, reduced in-patient spend and increased community provision... 31 There will be the right number of CAMHS T4 beds in the right place reducing the number of inappropriate out of area placements... 32 There will be 100% access to liaison and diversion services in secure and detained settings... 34 A Dementia Case Study 36 Contact... 37 Page 2 of 37

The Five Year Forward View for Mental Health The Role of Clinical Networks The document Implementing the Five Year Forward View for Mental Health identifies the Clinical Networks as an integral part of the support available in local areas to achieve the aims of the plan. This funding in part supports the continued provision of clinical networks for mental health in all regions of England. The 12 existing mental health clinical networks provide clinical leadership and engagement and deliver bespoke improvement programmes to CCGs and providers along the pathway, across health, social care and the third sector, to deliver sustainable improvement on outcomes for individuals, aligned to mental health priorities and programmes. The networks will link with HEE local area teams to support workforce planning and development to meet the workforce targets required to improve access. The Northern England Clinical Networks combine the experience of clinicians, the input of patients, and the organisational vision of NHS staff, to work in partnership with those who use, provide and commission health services to make improvements in outcomes and reduce variation across the region. The Mental Health Clinical Network is proud to share in this document some examples of excellence from across our region illustrating how we are improving care and achieving the targets set out in the 2020/21 Billion for a Million. We compiled it specifically for today and would stress it provides only a glimpse of the fantastic work that is taking place across Northern England. Page 3 of 37

Case studies from the Northern England Clinical Networks Examples of excellence from across the geography Objective: 70,000 more children will access evidence based mental health care interventions By 2020/21, there will be a significant expansion in access to high quality mental health care for children and young people. At least 70,000 additional children and young people each year will receive evidence-based treatment representing an increase in access to NHS-funded community services to meet the needs of at least 35% of those with diagnosable mental health conditions. South Tyneside Lifecycle Primary Care Mental Health Service Project Summary: South Tyneside Lifecycle Primary Care Mental Health Service offers a variety of group based intervention programmes for a wide variety of common mental health difficulties. All our groups are evidenced based programmes. Those offered to adults include Take Control of Anxiety; Take Control of Depression, Take Control of Stress and Managing Long-term Conditions - these use a cognitive behavioural therapy approach. We facilitate the Incredible Years Parenting Programme (Webster-Stratton) for parents and carers to assist them in developing positive behaviour management strategies for children under 10 years who display challenging behaviour. In addition, the service offers the FRIENDS Programme which is an intervention specific for childhood anxiety. The FRIENDS programme uses group based cognitive behavioural approach to help children to understand the influence of worrying, to learn about and practice coping skills with the support of peers. Individual Case Study Tom aged 10 years was referred to the Lifecycle Service by his GP after his mum reported experiencing increasing difficulties managing Tom s behaviour and described Tom as becoming very angry towards others in the home, not sleeping very well, and struggling with his emotions. Tom was accepted for assessment by the service and within 5 days Tom and his mother met with a Primary Mental Health Worker to discuss their needs. The assessment highlighted that Tom was struggling with anxiety and he was subsequently provided with an individual programme of low intensity cognitive behavioural therapy which lasted over 8 weeks. Tom s mum received individual therapy from the team linked with her low mood following the breakdown of her 7 year relationship. In addition Tom s mother was offered an education session to learn about anxiety to help her understand his worries, how this impacted upon his behaviour and how parent and school could work to support Tom to regulate his emotions in more positive ways. Tom developed his own coping plan which he shared with his parent and school teacher to help them understand how best to support him. Dr James Gordon, Clinical Director, Mental Health and Learning Disability, South Tyneside CCG james.gordon1@nhs.net Page 4 of 37

Takeover Day and #free2bme project Project Summary: Takeover Day and #free2bme project work allowed us to find out what young people felt were the barriers to achieving positive mental health, and how we might support them to achieve this. Coping techniques about stress, anxiety and self-esteem were delivered, followed by consultation sessions; allowing us to gain young people s feedback on what we need to develop and what format this should be presented in. This consultation has been vital in providing young people with the opportunity to discuss an emotive subject; it also allows us to ensure services for young people are partially designed by young people. Young people s consultation carried during 2015 revealed that many young people were unsure how to access services and were uncertain what that provision entailed. An overwhelming majority of those involved in consultations felt that they didn t have enough awareness and knowledge of practical self-help strategies; the general consensus was that there was still a lot of mental health stigma that needed to be addressed. Group discussions highlighted that waiting lists are thought to be too long and limited number of sessions prevents opportunities to establish trust. Services aren t always easy to get to for those living in rural areas and travelling for long periods of time can create more anxiety for the young person. School Health Advisors (referred to by young people as the School Nurse) were thought to not be as visible to young people and this can be a missed opportunity for support. Some young people felt that the GP s interaction is sometimes unhelpful, repetitive (due to not being allocated a specific GP) and stressful. Many young people had negative views about the way their GP communicated with them and some felt unable to ask for help. Our role was to address and tackle some of these issues. Health Improvement, Northumberland Adolescent Service and mental health professionals worked together with groups of young people to see if we could create some really useful resources, with young person appropriate language. The aim of these resources is to teach young people how to cope with difficult emotions or how to manage when experiencing challenging times. The resources look at: low mood, anxiety, stress, self-harm and also anger. The draft version of each resource has received such positive feedback from young people s participation groups that the next steps are to work with a local artist to ensure the information is engaging to young people and utilises digital technology. Tracy Cole, Health Improvement Practitioner Specialist, Northumbria Healthcare NHS Foundation Trust Tracy.Cole@nhct.nhs.uk Paul Kirkpatrick, Participation & Programmes Manager, Northumbria County Council Paul.Kirkpatrick@northumberland.gov.uk Page 5 of 37

Resilience Building in Cumbria schools Project Summary: Our multi-agency Emotional Wellbeing and Mental Health Partnership has oversight of Cumbria s Whole System approach to supporting the emotional and mental wellbeing of children and young people, and the implementation of the Cumbria Transformation Plan. It is chaired by an Executive Head Teacher who is also the chair of the Cumbria Alliance of System Leaders in Schools. We have prioritised supporting schools to develop whole school approaches to mental wellbeing for the last five years. Upskilling a whole community - Millom s Good Enough Start initiative. The importance of a good understanding of how attachment relationships impact upon mental wellbeing and emotional resilience is being led by schools in the Millom locality to work with local services to develop and integrate attachment friendly service delivery. Building on the principles of an integrated care community 10 schools (2 Secondary) have partnered with public health nurses, health visitor, midwives, the local Action for Children led children s centre, the Council and community groups. The aim is to upskill everyone in terms of attachment informed practice and promote resilience to impact long term on the health of the community and prevent mental health problems from becoming serious. Family Learning Family Resilience ( Bouncebackability ) As part of our Phase II HeadStart project (2014 2016) and as a result of feedback from parents our County Council Community Learning and Skills Service developed a course on Emotional Resilience for parents and carers aimed at those families with pupils in Year 6 about to move up to Secondary School. Consultation groups were established with parent and carer volunteers in two Primary Schools. They developed the key areas to include, a ten hour timeframe (to be delivered in two-hour sessions) and a toolkit for parents, carers and children to jointly produce. All aspects of the course are underpinned by the Boing Boing Resilience Framework (Hart and Blincow with Thomas 2007) www.boingboing.org.uk. The courses were then piloted by five Primary Schools. Mindfulness in Schools in Cumbria - In January 2015 we started introducing Mindfulness into our schools in Cumbria as part of the Head Start project. A GP-led Steering Group including Head Teachers, a Public Health consultant, Head Start Manager, Educational Psychologist, young people, a PhD student and Mindfulness trainers. Learning was captured throughout the implementation and future sustainability incorporated. Teachers at 5 secondary schools and 25 primary schools completed a Mindfulness Based Stress Reduction (MBSR) course and learnt to deal with their own stress and experienced how Mindfulness could help them personally. Teachers had to develop their own regular Mindfulness practice over 6 months and then went on to train in how to teach Mindfulness to young people. We then worked with schools to introduce the courses across an entire year group within the national curriculum. The entire year 9 in a secondary school did a.b Mindfulness course and the whole of year 6 did a Paws b Mindfulness course. By the end of the course young people have a greater understanding of the neuroscience behind stress, anxiety and low mood and also have 'Toolkit' of practices they can use to prevent mental health problems developing. In total in 1 year, 900 pupils completed a Mindfulness course. For 2017 we are concentrating on embedding Mindfulness in the participating schools and working closely with a PhD student from Leeds University looking at Implementation. Our experience is the educational setting is the perfect place to introduce Mindfulness to young people and we continue to learn how to implement in a sustainable way. With encouragement 900 pupils will experience a Mindfulness course this year. We will then involve other schools. Anne Sheppard, Strategic Manager Emotional Wellbeing and Mental Health Services, Cumbria County Council anne.sheppard@cumbria.gov.uk Lindsey Ormesher, Resilience and Wellbeing/5-19 Healthy Child Programme Officer, Cumbria County Council lindsey.ormesher@cumbria.gov.uk Page 6 of 37

Speak Up Silent Voices - Northumberland Project Summary: During Summer of 2016, 195 young people from Northumberland took part in the National Citizen Service. For the Social Action element of this programme over 150 of the participants were involved in campaigns promoting mental health services for young people. The young people worked with professionals and organisations within the mental health arena to produce information materials, workshops, digital resources, videos and fundraising campaigns. Young people produced 'young people friendly' resources differing entirely from the information and resources produced for them by adults. Speak Up Silent Voices was one such campaign involving 10 young people. Mental health was identified by the young people as a major issue in their lives that they wanted to have an impact on. Many of the participants had or were experiencing mental health issues in their lives and there was a real overwhelming feeling amongst them that the subject should be at the core of their social action projects. The main resources that the young people researched were produced by adults and so the young people decided to address the gap. The key stakeholders were the young people themselves although they were quick to get the support / advice of the organisations that are there to provide support to young people suffering mental health issues. Schools requested full access to all of the resources produced as did the Police and fire services, NHS, GP's, Sure Start Centres and Social Workers amongst others. The resources were also extremely well received by Northumberland Safeguarding Children's Board who shared them on their website and with several other Local Authority areas. An evaluation of these projects has been carried out which has shown the projects to have many benefits, for the young people who took part, for their communities and for young people suffering from mental health issues. The projects received such a positive reception across the board that the Speak Up Silent Voices group were asked by the cross party sexual exploitation committee to develop similar resources. They did, and have been invited to launch the resources nationally at a National Safeguarding conference in London later this year when they will also meet with Professor Jay and the National Inquiry into Historical Child Sexual Abuse Team to discuss how young people can be a valuable preventative resource themselves. The resources continue to be distributed to young people in Northumberland. Other Local Authorities and NHS have asked permission to use the resources (e.g. Rotherham) and are welcome to do so as long as the young people are credited with their production. The young people continue to be involved in Social Action activity and have been entered into regional and national awards for their contributions. http://www.northumberland.gov.uk/northumberlandcountycouncil/media/child-families/safeguarding/speak- Up-Silent-Voices-Leaflet.pdf John Smith, Northumberland Youth Service Manager, Northumberland County Council john.smith01@northumberland.gov.uk Page 7 of 37

Objective: Intensive home treatment will be available in every part of England as an alternative to hospital By 2020/21, all areas will provide crisis resolution and home treatment teams (CRHTTs) that are resourced to operate in line with recognised best practice delivering a 24/7community-based crisis response and intensive home treatment as an alternative to acute in-patient admissions. Crisis Resolution Home Treatment in NTW Project Summary: Newcastle was one of the early adopters of the home based treatment model as defined by John Hoult and later the NSF Policy Implementation Guidance and has a large crisis team serving a population of 480,000. It was hospital doctor team of the year in 2002 for this work. It has been accredited by Home Treatment Accreditation Scheme (HTAS) from RCPsych for 4 years now. It remains an integral part of the acute psychiatric pathway providing home based treatment as an alternative to hospital admission. In another part of the NTW Trust, Sunderland has developed a single point of access for all callers and a policy of no bouncing where all call are directed to a point of help, which has been received extremely positively by patients and referrers alike. This model is being rolled out around the Trust. A robust bed management system allows easy access to beds when needed. All CRHTTs in the trust take self-referral and referral of patients not known to services and operate 24 hours a day. They have an MDT and high fidelity to the original model and that described by the CORE study (Johnson et al 2016) as being the most likely to divert patients from hospital admission. Street triage is available for all CRHTTs, working alongside them, and they integrate well - this has reduced the number of 136 assessments drastically. Some teams see older people and people with LD and are supported by experts in these fields to provide care but there is not a true universal CRHTT for all ages and abilities functioning as the adult teams do. Dr Mary-Jane Tacchi, Consultant Psychiatrist, NTW Trust mary-jane.tacchi@ntw.nhs.uk Page 8 of 37

Objective: No acute hospitals without all-age mental health liaison services, and at least 50% are meeting the Core 24 service standard By 2020/21, all acute hospitals will have liaison teams in place in emergency departments and inpatient wards, with at least half providing this on a 24/7 basis in line with the Core 24 standard. Sunderland Psychiatric Liaison Team providing a Core 24 service Project Summary: In January 2013 the Sunderland Psychiatric Liaison Team extended their working hours to cover Sunderland Royal Hospital 24 hours a day 7 days a week. The service offers a rapid response within an hour to Accident and Emergency, and to the wider hospital a routine response within 24 hours. Feedback for the service is continually positive from service users and our Acute Trust peers. Nurse led innovations include Chronic Obstructive Pulmonary Disease brief intervention clinic delivering a four-fold reduction in admission rates, a stroke pilot delivering a service to 41% of patients with a previously unmet need, and significant training in common mental health problems. Other patients who present with a medically unexplained component are seen in outpatient clinics and receive psychological interventions and psychoeducation that supports them to move forward with their lives. The nursing team are supported to develop their skills utilising the Liaison Nurse Competency Framework as a measurement reviewed annually. Of paramount importance is the improved patient experience and satisfaction in seeing the right practitioner with the right skills at the right time and then being directed to the right on-going care. Additionally I have noted less adverse clinical incidents being reported through the ED relating to patients with mental health needs and I doubt very much that this is a coincidence. Dr Cath Motwani, Associate Specialist, A&E, SRH. Whole Person Care An evaluation of an integrated COPD pathway The aim was to evaluate the effectiveness of a Chronic Obstructive Pulmonary Disease outpatient clinic in reducing the burden on a general hospital. Referrals to the clinic were made by mental health nurses, specialist COPD nurses and inpatient ward staff. Each patient underwent psychiatric assessment and then was reviewed in clinic or at home. Interventions included psycho-education, solution focused and CBT-based psychotherapy delivered by Band 3 support workers and Band 6 or 7 nurses. Medication was utilised as appropriate under the supervision of a Consultant Psychiatrist. Symptoms were measured using validated scales (CORE-10; PHQ-9; GAD-7) at the beginning and end of treatment. ED attendance, inpatient admission rates and total occupied bed days for the 12 months prior and during 12 months post treatment was also recorded. Results demonstrated that using a psychiatric approach in treating co-morbid anxiety/depression for persons with COPD was able to reduce burden on a general hospital. This was shown by a reduction in the number of presentations to the emergency department, inpatient admissions and total bed days. In the modern economic climate it would be valuable to calculate the cost saving for the hospital. Psychiatric treatment also resulted in a reduction in depression and anxiety levels within this population. The outpatient COPD clinic continues to evolve with interventions being delivered increasingly by band 3 support workers. There was also a shift to delivering therapy more frequently within patients homes. Outcomes should be re-evaluated in 12 months time to evaluate impact on efficacy. Kate Chartres, Nurse Consultant, NTW Trust katherine.chartres@ntw.nhs.uk Page 9 of 37

Objective: At least 30,000 more women each year can access evidence-based specialist perinatal mental health care By 2020/21, there will be increased access to specialist perinatal mental health support in all areas in England, in the community or in-patient mother and baby units, allowing at least an additional 30,000 women each year to receive evidence-based treatment, closer to home, when they need it. Northern England Perinatal Mental Health Network Project Summary: The Perinatal Mental Health Network was established in 2015 and has already made significant progress towards increasing access to specialist services across the region. Achievements so far include: The development of a service specification for secondary Perinatal Community Mental Health Teams approved by both Maternity and Mental Health Networks and circulated to CCG leads A regional care pathway for Perinatal Mental Health A service evaluation report has been completed to gather information from midwives and health visitors regarding training in perinatal mental health, pathways, processes of care and experience of referral to mental health services and feedback from secondary services A task and finish group focusing on collaborative commissioning was formed with the support of Public Health to assess and prioritise service commissioning. A report was published in February 2016 and circulated via the Specialised Commissioning Oversight Group Establishment of a presence on the Clinical Networks website as a means of disseminating project updates and providing links to national guidance and other resources Established links with patient organisations such as the Happy Mums Foundation in Cumbria and Raindrops to Rainbows in Teesside. We were delighted that Northumberland, Tyne & Wear NHS Foundation Trust were successful in their bid to the Perinatal Community Service Development Fund to expand the existing specialist CMHT across 4 more CCG areas. This will provide care to an additional 221 women in 2017-18 and 474 women in 2018-19. The Perinatal Network has also been working with North Cumbria and Durham & Darlington to support the development of their bids for Wave 2 of the Development Fund. Rachel Tomlin, Network Delivery Lead, Northern England Clinical Networks racheltomlin@nhs.net (Clinical Lead: Dr Andrew Cairns, Consultant Perinatal Psychiatrist, NTW Trust) Page 10 of 37

Objective: 10% reduction in suicide and all areas to have multi-agency suicide prevention plans in place by 2017 By 2020/21, the Five Year Forward View for Mental Health set the ambition that the number of people taking their own lives will be reduced by 10% nationally compared to 2016/17 levels. To support this, by 2017 all CCGs will fully contribute to the development and delivery of local multiagency suicide prevention plans, together with their local partners. North East Community Mental Health resilience through football project Project Summary: The project aims to use football fan culture as a medium though which to encourage men to talk about their problems and develop improved mental health and greater emotional resilience, thus preventing further ill-health and reducing the risk of suicide. To include: The development of local community boot rooms providing a venue and space for men to meet socially and provide mutual support An information campaign to raise awareness and recognition of distress, reduce mental health stigma, promote behavioural change in seeking help Actions/impacts to date include: Pump priming finance award via PHE to North East Mental Health Development Unit (NEMHDU) to project lead Regional multi agency project group established including: NEMHDU; Middlesbrough, Sunderland and Newcastle football foundation clubs; Teesside, Sunderland and Newcastle Universities; 12 Local authority Public Health Teams; 3 rd sector mental health services; PHE Project plan developed and agreed Middlesbrough and Redcar successful pilot site Team Talk targeting men who have become unemployed due to closure of SSI steel works. Pilot evaluation report was produced by Newcastle University. Poster presentation at national PHE conference Dave Belshaw, Chief Executive, North of England Mental Health Development Unit dave.belshaw@nemhdu.org.uk or Paul Johnson paul.johnson@nemhdu.org.uk Working with Julie Daneshyar, Health Improvement Manager, Health and Wellbeing Team, Public Health England (North East) julie.daneshyar@phe.gov.uk Page 11 of 37

Respond: Multi-agency mental health simulation training Project Summary: Respond is a unique multi-agency simulation training package for professionals involved in mental health crisis care. By increasing collaboration and knowledge, it equips staff to respond quickly and appropriately to improve patient experience. The Crisis Care Concordat has brought together relevant agencies with a shared commitment to improve the system, so that people in mental health crisis get the support they need whatever the circumstances and whichever service they turn to first. Respond training models the collaborative behaviour that is essential to an effective and joined-up crisis response. Designed with active involvement of experts by experience, this immersive training method helps the learner to experience as closely as possible the emotions and the style of thinking of someone in a stressful situation. Agencies in the North East developed Respond after recognising that experiential training is the most effective way to gain the skills to handle crisis situations effectively, with the full range of relevant agencies learning together. The training can be delivered in a variety of ways, recreating incidents in a vivid and realistic way in a classroom environment or a designated simulation suite. We are at the start of developing and piloting a scenario for the Perinatal Mental Health Network. Respond was developed through the Northern England Clinical Networks, and is supported by organisations including Northumberland, Tyne & Wear NHS Foundation Trust; North East Urgent and Emergency Care Network; Fulfilling Lives; Tees, Esk and Wear Valley NHS Foundation Trust; Northumbria Police; North East Ambulance Service; and Newcastle City Council. Dr Mary-Jane Tacchi, Consultant Psychiatrist, NTW Trust mary-jane.tacchi@ntw.nhs.uk Page 12 of 37

Objective: Increase access to evidence-based psychological therapies to reach 25% of need, helping 600,000 more people per year By 2020/21, there will be increased access to psychological therapies, so that at least 25% of people (or 1.5 million) with common mental health conditions access services each year. The majority of new services will be integrated with physical healthcare. Sunderland Psychological Wellbeing Service Increasing access for clients with long term health conditions and common mental health problems Project Summary: Sunderland Psychological Wellbeing Service is an integrated Improving Access to Psychological Therapies Service (IAPT). IAPT services nationally are required to increase access for clients who are experiencing a comorbid long term health condition and common mental health problem. Additionally in 2014 Sunderland Psychological Wellbeing Service received a local commissioning request to increase access for this specific client group and funding to support the process. The service delivered IAPT and Mental Health Awareness sessions to local physical health teams to increase their understanding of how depression and anxiety may present in clients. In return the physical health teams provided training to therapists within Sunderland Psychological Wellbeing Service which gave further insight into how therapy may need to be adapted to meet the needs of this client group. A working group of Psychological Wellbeing Practitioners agreed that the service would build on the successful portfolio of psycho-educational classes already offered and develop a bespoke psychoeducational class. Forging new referral pathways with physical health services has resulted in an integrated way of working with a range of specialist health services, including stroke, dermatology, COPD and cardiology. Open lines of communication and referral pathways between mental and physical health services, coupled with a stronger understanding of the roles and remits of each service results in patients receiving a seamless and more informed experience of care and treatment. Since the pathway work started in 2014 the percentage of clients accessing the service with comorbid LTHC and CMHP has increased from 33% to 46%. It also offers clients with comorbid LTHC and CMHPs a more focused and specialised package of care. Toby Sweet, Chief Executive, Sunderland Counselling Service toby@sunderlandcounselling.org.uk Working with Northumberland, Tyne and Wear NHS Foundation Trust and Washington Mind Page 13 of 37

Waiting List Outcome Initiative - North Tyneside Talking Therapies Project Summary: This case study looks at the work of the Mental Health Intensive Support Team (IST), NHS England with an NHS IAPT Provider: North Tyneside. The use of an interim pathway designed to clear waits in order to implement new and sustainable pathways is discussed. The case study is connected to a Waiting List Initiative inviting bids to clear waits within IAPT services. Following a visit by IST, funding was agreed with the provider. The North Tyneside Talking Therapies Service had inherited large waiting lists as a result of a re-tendering process. In order to clear waits to get to a sustainable position understood by using capacity and demand modelling, the service needed to do something innovative as business as usual would not clear waits. A waiting list initiative based on an interim six session focussed CBT Model with therapists seeing 25 patients per week to clear the High Intensity waiting list was agreed. Methodology The service combined two separate Step 3 waiting lists with patients waiting for CBT Therapy. Waiting list validation: Mental Health Practitioners and Senior Therapists reviewed all cases based on information given at referral, assessment and identified problem descriptors. Patients who presented with trauma and OCD were ruled out as it was felt that these two presentations would not benefit or recover within a 6 session therapy model. Of the total 511 cases waiting; 459 were identified as appropriate for the waiting list initiative. A waiting list initiative label was placed on identified patients electronic record held on IAPTus (patient management system). Eight whole time equivalent therapists were recruited using recruitment agencies and a further two service employees working additional hours were also recruited to work on the interim pathway offering a 6 session therapy model to work through the combined list of identified cases. Each wte therapist held a caseload of 25 patients seen on a weekly basis. All service employed staff were informed when removing patients from the waiting list to select the patients who had not been identified. This enabled therapists to offer patients presenting with OCD or Trauma a course of treatment as necessary to achieve maximum recovery results. Waiting List Initiative or interim pathway patients were also offered a 6 month subscription to The Big White Wall ; this is a guided support selection of structured online programmes. Members can subscribe to a course on managing anxiety, or managing depression. Members take a Minimum Data Set before they can access each week s session content. The service developed a strict DNA and Cancellation policy which included a Therapy Contract specifically for use within the initiative and therapists discussed the importance of attendance at initial treatment sessions. Both clinician and patient signed the contract of understanding regarding this. Conclusion The waiting list initiative was successful in reducing the waiting list in both size and length of wait. Page 14 of 37

Although recovery was below the national target of 50%, the high number of declined treatments (patients who were contacted and offered a course of therapy and stated they no longer wished to be seen) and dropped out (patients who failed to engage for their full course of therapy) had a negative impact on achieving this recovery target. However, it is important to note that the reliable improvement rate was higher than the nationally set target and national average rate of 60%. This reflects that although patients may not have met the IAPT definition of caseness, they showed a high level of reliable improvement. The aim of the Waiting List Initiative was to create an interim pathway to clear waiting lists. The service was successful in this but they reported additional gains including a change to the culture of the service. Where therapists had been very kind but not effective, the new pathway with clear boundaries was beneficial to both patients and clinicians. Whilst initially resisted by staff, a return to a pure IAPT model improved clinical outcomes and staff morale. The service has increased its recovery by 10 per cent and the commissioner has plans to use the methodology with the step 4 waiting lists. Clearing backlogs and waiting lists is difficult and many services fail despite additional funding. Using an interim pathway, bespoke to individual services, is one way of addressing this problem. IST can provide support with this and demonstrate how to use the methodology. This case is an example of IST working with provider/commissioner to support a waiting list initiative to successfully reduce waits and, in this case, improve services for patients and staff. Claire Studholme, Service Manager, North Tyneside Talking Therapies, Northumbria Healthcare NHS Foundation Trust claire.studholme@northumbria-healthcare.nhs.uk Gail Richardson, Senior Manager, Northumbria Healthcare NHS Foundation Trust Carole Hirst, Intensive Support Manager, NHS England Page 15 of 37

Objective: The number of people with severe mental illness (SMI) who can access evidence based Individual Placement Support (IPS) will have doubled By 2020/21, adult community mental health services will provide timely access to evidence-based, person-centred care, which is focused on recovery and integrated with primary and social care and other sectors. This will deliver a doubling in access to IPS, enabling people with severe mental illness to find and retain employment. Embedding IPS within the Early Intervention in Psychosis team Project Summary: As part of a preventative and treatment programme that addresses employment related needs, an Employment Advisor following the model of Individual Placement and Support (IPS) was recruited as part of a 12 month pilot initiative within the Newcastle Early Intervention and Psychosis (EIP) team. This service works with young people aged 14 35 who experience an episode of psychosis. Research has shown that if someone receives support and treatment quickly, then they are less likely to have further episodes of psychosis. The employment support offered is recovery focussed and aims to facilitate and encourage hope for the future and optimism for our service users. The model chosen for this project is the Individual Placement and Supported Employment Model. However, given that the vocational goals of individuals with a recent onset of psychosis often involve completion of schooling and/or job related training rather than only competitive employment, I felt it was appropriate that the principles of Individual Placement and Support were extended to include supported education. This extension involved an evaluation of the most appropriate goal for individual participants with follow-along support that included work with further educational establishments, assistance with course planning as well as typical supported employment activities. I devised a leaflet for care co-ordinators to hand out to potential clients in the first instance, which outlines the available support. It was agreed that I would take any referral from the care co-ordinators, even if they were deemed not yet job ready ; the rationale is that I would be able to plant the seed, instilling hope for their future that as further into the recovery, they would be able to consider paid employment and /or training. The approach is person-centred and client led at a pace to suit the client. I engage with clients primarily through 1-2-1 visits, but also liaise via text and email. I undertake a caseload review on a weekly basis and will utilise quiet periods by sending out the re-engagement letter that I have devised; these letters are only issued to those clients who may be well enough to re-engage after having a further discussion with the care co-ordinator. A high proportion of my work is supporting the care co-ordinators between visits offering assistance upon benefit advice, appeals processes, etc. I also visit employers on a speculative basis, usually for a half day per week to source possible work experience placements and/or paid employment. I have also visited local charities, jobcentres and colleges to introduce myself and forge some links within the Newcastle area. Wherever possible, I try to establish a single point of contact for future enquiries. To date, I have received 32 referrals, not including 8 who reside in North Tyneside. The caseload number fluctuates, but usually stays around a dozen. This is a very manageable number and there is capacity to increase that without having to sacrifice any time spent with each client. My findings to date are that some clients remain stable and progress well, whilst others may disengage for a period of time due to relapse; however, they do tend to re-engage and all clients appear to benefit from support relating to direction and focus for education and/or training. In addition, I have compiled client and care co-ordinator evaluation forms to measure the efficacy of the role and areas of development as an ongoing process. Page 16 of 37

It is fair to say that with the nature of the client group and the associated risk of relapse, we would not expect to see much by way of improvement in six months; it is hoped that the job role is permitted to further evolve and prove to be an integral part of the recovery focussed treatment plan. My vision includes further emphasis upon the younger cohort of service users, paying particular attention to those who have missed a great deal of schooling. I have already made tentative enquiries with the child psychologist and she has given me some clients who will be ready hopefully by the turn of the year. Lynn Orr, IPS Employment Services (EIP Team), NTW Trust lynn.orr@ntw.nhs.uk Converge: Education for Recovery Project Summary: Converge North East is an exciting new partnership which takes a successful model delivered by York St John University and partners, for the past 8 years, and puts a local Newcastle Gateshead slant to it. Its purpose is to deliver campus based educational opportunities to people aged 18 and over that use mental health services. Converge is designed to meet a 'convergence of needs' across different public sector partners and the model relies on assets provided in kind. In this way people using mental health services get access to good quality educational facilities and teaching resources, and in return the university is able to improve its offer to students by providing increased vocational experience and community connection. The emphasis is on an educational model with academic staff supporting graduate and postgraduate students to act as course tutors and buddies to Converge students. The focus in York initially included creative and performance arts, but has subsequently expanded into psychology, sports, life coaching and business start-up. Following a formal launch in October and a taster day in November 2016, we are in the process of designing a Theatre Studies course to start at Northumbria University in February 2017. The project is being led by a multiagency Steering Group and it will be evaluated (by peer researchers and postgraduate students supported by academic staff) in order to produce a business case for a sustainable model that can be rolled out more widely in the future. The Converge approach has been running very successfully in York for eight years and it is based on the following key principles: 1. Courses take place in a university or college environment. 2. Participants are enrolled as students. 3. University students are involved in course delivery and support. 4. Converge students can become mentors or tutors. 5. A focus on subject knowledge not on mental health. Dr Heather Robson, Faculty Associate Pro Vice-Chancellor (Strategic Planning & Engagement) h.robson@northumbria.ac.uk Steve Nash, Chairperson, Mental Health Voluntary Sector Advisory Group steve.nash@volsag.org Collaboration between Northumbria University, York St John University, Newcastle Gateshead Clinical Commissioning Group, and local mental health services Page 17 of 37

Objective: 280,000 people with SMI will have access to evidence-based physical health checks and interventions By 2020/21, there will be a reduction in premature mortality of people living with SMI, and 280,000 more people having their physical health needs met by increasing early detection and expanding access to evidence-based physical care assessment and intervention each year. Going Smokefree Project Summary: People who use mental health services have an average life expectancy which is 12 years lower than the adult population. The majority of this is caused by lifestyle factors, especially smoking. Working alongside Public Health England, the Clinical Network brought partners together to establish a Healthy Lifestyles steering group in July 2014. The aim of the first project for the group was to reduce the health inequalities experienced by those with severe mental health conditions, by eliminating tobacco use across the North East`s two Mental Health Trust estates (Tees, Esk and Wear Valleys and Northumberland, Tyne and Wear NHS Foundation Trusts). This built upon NICE guidance (PH48), which set out recommendations for reducing smoking amongst mental health service users. Both Trusts successfully went fully smokefree on No Smoking Day, March 2016, following a co-ordinated approach involving early engagement with service users and carers, facilitated by North East Together. The group worked with Local Authority Commissioners of Stop Smoking Services to adapt the existing referral pathway from MH Trust setting back into the community. We are now evaluating the impact of going smokefree in the mental health trusts. Taking a regional, partnership approach to smokefree estates across NHS MH Trusts has been shown to be effective. Coordinating resource and expertise has overcome some of the barriers faced by organisations and localities working in isolation. Suzanne Thompson, Network Manager, Northern England Clinical Networks suzannethompson2@nhs.net Smoking Cessation and Nicotine Management Project Project Summary: The project recently had a NICE Shared Learning published demonstrating innovative ways to support smokers requiring nicotine management in a mental health organisation. NICE Shared Learning Case Study Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) provide mental health, learning disability and eating disorder services in County Durham, Darlington, Tees Valley, York and most of North Yorkshire. The Trust ambition to go smokefree followed publication of the NICE Guidance PH48: Smoking cessation in secondary care: acute, maternity and mental health services and involved introduction of a Trust wide smokefree policy. The objectives of the smokefree policy are to protect the health of mental health service users whilst promoting a healthy working environment and accessible smoking cessation support for staff. The Trust looked for innovative ways to support smoking cessation whilst implementing the NICE guidance, one of these being the offer of free e-cigarettes on admission to hospital for service users requiring nicotine management. Page 18 of 37

The main aim of the project was to support the reduction in years lost by going completely smokefree Trustwide in all buildings and grounds by the provision of dedicated nicotine management and smoking cessation support to service users. Key project objectives identified by the Nicotine Management and Smoking Cessation Group included: All buildings and grounds to become smokefree To support the reduction in service users and staff smoking rates To reduce second-hand smoke exposure To improve the health of both service users and staff To increase staff knowledge related to smoking and its effects on health To review all smoking cessation/nicotine management aids To review and update the current smokefree policy To have service users and carers to support the project To develop information leaflets for service users, carers and staff To develop detailed communication plans To challenge myths and provide latest evidence to support smoking cessation in mental health services Context An internal review against the NICE PH48 Guidance was conducted in 2015 and demonstrated the need for a project to support guidance implementation. A Project Lead was identified and following the set-up of a dedicated Nicotine Management and Smoking Cessation Steering Group, smaller sub groups were then identified to support the delivery of the NICE Guidance recommendations which would allow the Trust to go smokefree. This smokefree ambition was based on NICE Guidance PH48 which sets out a series of recommendations for reducing smoking amongst service users, carers and staff. Service users and carers were offered the opportunity to support the sub group work and became regular attendees to support the implementation of the policy. The Smokefree Policy was updated and renamed as the Nicotine Management policy and various information leaflets were developed following Trustwide consultation to support the smokefree agenda. Communication was key throughout the 12-18 month preparation phase and the communications team developed a robust communications plan to support the agenda. Staff were offered the opportunity to complete varying levels of training to support the smokefree agenda and over 1500 staff completed the National Centre for Smoking Cessation and Training (NCSCT) Very Brief Advice (VBA) training online. A further 187 staff trained to NCSCT Level 2 practitioner standards which then enabled them to carry out comprehensive assessments for service users on admission to hospital. Clinicians, staff and patients were offered the best evidence available to give them the confidence to support smokers requiring nicotine management and the Trust were keen to look at innovative ways to support patients including reviewing all current e-cigarette options. Benefits realised: reduction in service user and staff exposure to second hand smoke reduction in number of staff smoking (FFT results 10% to 8%) increased staff time available to support service users immediate access to nicotine therapies on admission access to free disposable e-cigarettes potential for reduction in medications dosages i.e. clozapine potential for reduction in side effects following reduction in medication dosages Page 19 of 37

increase in ward based activities to support rehabilitation regular clinical audits to assess smoking rates across all trust sites policy developed and implemented, along with leaflets and pharmacy guidance (co-produced with service users and carers). Methods A key element of the NICE Guidance PH48 was to identify senior level board support to lead on the implementation of the guidance. This was undertaken early in the process to ensure clear direction and was a crucial part of the project. NICE Guidance PH48 is clear on the steps required to go fully smokefree, including early identification of smokers on admission (or before), rapid access to NRT/support, Trust leadership, trained staff, communications, etc. We also drew on the experiences of other Trusts Nationally that had gone smokefree in particular accessing support from staff at the South London and Maudsley NHS Trust. Work then commenced to: Identify funding to support the project and fund the identified increase in pharmacy costs for nicotine replacement products, inclusive of the option for varenicline and bupropion Identify service users and carers wishing to support the project Link with commissioners to support the project Update the current Smokefree Policy Develop a detailed communications plan Develop the training programme and start the delivery of training to staff inclusive of behavioural support Identify any alternative nicotine delivery devices and identify funding to support a free supply to service users who smoke on admission The updated Nicotine Management Policy now encourages access to NRT within 30 minutes of admission and offers the option for all models of e-cigarettes to be considered should a service user decline NRT in the first instance. The Trust`s policy around smokefree sites is more actively enforced, and staff are encouraged to remove any tobacco products brought onto site and only offer for return to service users on final discharge. Changes were needed in terms of Trust culture both amongst the Trust Board to renew and enforce the existing policy, but also from all staff to support this. Both staff and service users who smoke needed behavioural support and access to alternative nicotine products to help them abstain from smoking on-site. Some of the challenges in the change process were with staff attitudes, training provision, access and supply of e-cigarettes and service user anxieties regarding the change and how to alleviate these anxieties. To address the identified concerns we held regular staff meetings, increased training provision and identified smokefree champions, developed an e-cigarette pathway for supply and issue and held a service user conference to allow further discussion. Results and evaluation The Trust has successfully implemented the policy, supporting many service users with nicotine management during their inpatient stay also achieving a 2% decrease in the number of staff smoking identified in the 'friends and family test' in June 2016. Page 20 of 37