The fact that people with depression die up to 10 years earlier than the average life expectancy, and people with schizophrenia up to 15 years earlier, is shocking. But the reality of life for people suffering with severe mental health problems was really brought home by spending a week with the children and adolescent mental health services at the South London and Maudsley NHS Foundation Trust (SLaM).
SLaM provides inpatient care for about 5,300 people each year and treats more than 45,000 patients in the community across Lambeth, Southwark, Lewisham and Croydon. They provide some very specialist services and offer the widest range of mental health services in the UK.
We spent time on the inpatient wards in Bethlem, attended parenting groups and observed community clinics. We saw services delivered in a wide range of settings and met lots of staff, children and their families during the week. We both gained a lot from the connecting experience but wanted to share three of the key policy questions we came away with:
• How to integrate health services with other support in the community and ensure young people’s life goals are met?
• How to redesign services based on the journey of care experienced by users rather than just clinical pathways and protocols?
• How to overcome fragmented commissioning and ensure the incentives are to deliver the best outcomes at the lowest cost?
Meeting the needs of young people with mental health problems
Firstly, we were reminded that the needs and priorities of young people with mental health problems are not likely to be met just by health services. They need advice and help to access education and training, housing and benefits advice, support for their families and parents and help to access social activities and meet other young people. The onsite school for children and young people who are inpatients at SLaM was an amazing testament to the commitment by the teaching staff to provide for each child’s educational needs. There was a great display of a recent visit to the top of the Shard and they were in the midst of making props for their end of year show. We also spent time with a team who are piloting and evaluating a supported discharge programme. We heard about wonderful examples of how young people were being helped to reengage through horse riding and outdoor activities, and to take up training opportunities enabling them to get into work.
Becoming more patient centred
Secondly, we saw how difficult it is for parents to navigate the system. For example, despite one of the community clinics being collocated with other children’s health services, there was no ability for direct referral, no single receptionist able to book in for all appointments needed. This meant that one mother was going to have to go back to the GP for her prescription and get her child another GP appointment to secure a referral to see another specialist. There is a commitment at SLaM to measure what is important to patients with widespread use of patient reported outcome measures and the use of systems to record and track patient defined goals. These hold out an exciting prospect for care to become more patient centred.
Difficulties around commissioning care
Thirdly, we heard how the way care is commissioned sometimes makes it difficult to meet the patient’s need in the best way. Mental health services are commissioned by local authorities, CCGs and by NHS England. Initiatives such as the supported discharge programme and outreach services were working hard to ensure that patients are actively managed and helped to transition back into the community or into a hospital nearer to home. But, the pressure on beds generally and the availability of secure beds means some patients are being admitted some distance away from their families.
A deeper understanding of commonly discussed issues
Spending a week in one part of an organisation gave deeper insights than it would ever be possible to get as a day visitor. It generated new insights as well as giving deeper understanding of some commonly discussed issues. Other civil servants spent time in other specialties during the week and we were able to share our experiences and insights at the end, not only with each other, but also with the trust executives. We were all incredibly impressed with the dedication and compassionate attitude of staff to the people they care for and their determination to improve the lives of these children and young people.