A community of over 200 experts of all kinds came to hold a conversation with an all star cast of national leaders in community mental health at the Mercure Exeter Rougement Hotel on Thursday and Friday last week. Experts by experience, leaders from the community and voluntary sectors, GPs, pharmacists, social workers, occupational therapists, nurses, psychologists, psychiatrists sat together to talk about how community mental health services might be improved.
The event opened with Dr Mike Hunter from Sheffield, Dr Sri Kalandindi and Dr Rajesh Mohan from London considering how care in locked environments miles from home might be avoided in favour of intensive care and support in local communities. Leaders from policy, Professor Tim Kendall, National Clinical Director and education Dr Kate Lovett Dean Royal College of Psychiatrists described the shortage of professional staff whilst noting that many local organisations were able to offer people and support that could help.
Next Dr Tom Cant from South Devon was joined by a carer to describe and demonstrate Peer Support Open Dialogue, a community approach known to have worked well in Finland and now currently part of a large scale clinical trial in England.
Alongside Tom Cant, Simon Sherbersky engaged the room with ‘tropical rain’ illustrating the power of collective effort.
Andy Bell Deputy CEO from the Centre for Mental Health Equally Well campaign then described the awful general health outcomes and premature mortality for people with severe mental illness, learning disability or personality disorder. Our Chief Executive Melanie Walker MBE signed a commitment for Devon Partnership NHS Trust to be part of the work on closing this gap.
The first day concluded with a panel discussion describing how working with the third sector and bringing organisations together around the needs of the person can really make a difference. Olivia Craig from Plymouth Mind, Julie Haley from Mental Health Matters, Hannah McDonald from One Ilfracombe and Professor Jonathan Burns from Co-Lab joined Dr Andrew Moore to share stories of success.
The second day of the conference opened with Dr Billy Boland, Chair Elect for the Faculty of General Psychiatry at RCPSCYH from Hertfordshire describing morale and recruitment issues for psychiatrists working in community. Dr Alison Battersby from Plymouth then offered an inspiring example of how a whole community approach bringing third sector, primary care and specialist mental health resources together was making a real difference for people.
Next, one of the founding fathers of Community Psychiatry, Professor Tom Burns spoke about the moral and ethical as well as clinical failure of having to send people in their worst moments miles away from family and friends for care that was often sub standard and poorly scrutinised. He advocated for a simpler model of community mental health team that managed its work within local beds and in partnership with primary care and community. Professor Steve Pilling, Director at the National Collaborating Centre for Mental Health and Professor of Psychology at UCL agreed. Care has become fragmented and that was never the intention. Care Program Approach no longer serves the purpose for which it was designed. He too advocated for a return to a simpler more inclusive model for community mental health, this time embedded in community and drawing on third sector and primary care.
Dr Alan Cohen, Clinical Lead for Equally Well and a GP expert in mental health care spoke in some detail about the appalling health outcomes for people with mental illness and learning disability. He advocated strongly for liaison physicians to help psychiatrists tackle the burden of obesity and diabetes often caused by the selection of treatment. He also pointed the way to integrating general practice and mental health care in a single community framework where both kinds of expertise were easily available to people with mental illness co-morbidity.
Dr Nav Chana from London and Clinical Director for National Association of Primary Care continued this theme and described how a Primary Care Home model could care of the health needs of a population of 30-50000 people. He offered examples of where placing the community mental health effort in integrated teams that also case managed health and social care complexities of all kinds made a real difference. Dr Jonathan Cope, former partner in the Beacon Primary Care Home in West Devon and now Associate Medical Director at University Hospitals Plymouth offered a local example and emphasised the key role mental health specialist services have to play in helping build the new framework.
Dr Geraldine Strathdee, National Clinical Mental Health Lead for NHS Digital, moved to describe the importance of good data helping Primary Care Networks to understand the needs of their populations and how digital can help bring agencies closer and help collaborative workings.
Finally, Mark Trewin from NHS England and the Department of Health and Social Care spoke about the key role for social work in helping make the transformation. He spoke of the importance of accommodation, employment and relationships and how local authorities, councils and the third sector could work together to create opportunities for people to have more settled lives around which health care might be delivered.
The conference was a terrific success. It was very well attended on both days and the conversation around the tables and in the breaks was every bit as rich as the offer from the platform speakers. Comment in feedback and on Twitter suggests that some light may have appeared at the end of the tunnel for people working in some of our most hard pressed services. There is a genuine sense of cautious optimism that change can come and a whole community approach to a new community framework for mental health can achieve much better health and life outcomes for people in recovery.
The conference presentations are available here.