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1 Public Document Pack Please note that the following documents were published separately from the main agenda for this meeting of the Community Leadership Scrutiny Committee to be held on Tuesday, 26th January 2016 at 6.00 pm in Committee Room 1, City Hall. 4. Verbal Overview by Tony McGinty representing Public Health and Clinical Commissioning Group (Pages 3-8)

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3 Item No. 4 Questions for Community Leadership Scrutiny Committee 26 January 2016 City Centre Environment Alcohol misuse, Substance misuse and Mental Health The purpose of this meeting is to explore and understand the current service provision available for hard to reach individuals in the city in relation to alcohol and substance misuse and mental health. 1. What service provision is there currently available for alcohol, substance misuse and mental health? Substance Misuse Treatment Services Lincolnshire currently has two providers (DART and Addaction) delivering a drug and alcohol recovery service for adults and a further contract (Young Addaction) that offers treatment to young people. All services deal with a full range of substances and can provide anything from brief interventions through to residential detoxification and rehabilitation. Services have bases within Lincoln, Boston and Grantham but work from many other sites across the county to ensure full coverage is achieved. All substance misuse services work with dual diagnosis clients and seek treatment pathways in partnership with mental health services where appropriate. There are currently 2786 adults and 127 young people receiving treatment across Lincolnshire. Of these adults: 1656 are opiate users 206 non-opiate drug users 722 use alcohol 202 use alcohol and non-opiate drugs Housing Related Support Services Mental Health Crisis Houses: Public Health contract manage a Crisis House service on behalf of the CCGs who fund it. This was recommissioned in 2015 and contracts run from 1 July 2015 to 30 June 2018 with a potential extension of 2 years built into the contract. The purpose is to provide an alternative and supporting environment for adults in emotional and/or psychological distress due to the onset of, or existing, mental illness whose ordinary place of residence may contain elements that are over-stressing or simply not conducive to recovery at the time of crisis. The service works to the recovery approach which is a personal individual process of overcoming the negative impact of a mental health episode. This is delivered via two Crisis Houses, one in Boston which provides 5 rooms and one in Lincoln which also provides 5 rooms. Stays in the Houses are limited to 7 days. However these can be extended to 10 days in exceptional circumstances on the of both the provider and mental health representative. 3

4 All referrals are made via the Crisis Resolution and Home Treatment Team (CRHT). Access to the service will be based on need and accessible between the hours of 8am and 10pm, 7 days a week, to provide an alternative to hospital admission. Between September and November 2015 there were 56 people that stayed in the Crisis Houses in Lincolnshire. Generalist Housing Related Support Services: Public Health commissioned a package of housing related support across Lincolnshire. This was recommissioned in 2015 and contracts run from 1 July 2015 to 30 June 2018 with a potential extension of 2 years built into the contract. These services include emergency (short-term, maximum 3 months) and nonemergency (longer-term, maximum 6 months) accommodation. There is provision in every district of the county from various providers. There is also a countywide 'floating' support service to prevent people becoming homeless by supporting them to remain in their existing accommodation and a rough sleeper outreach service. All of these services can support people with Mental Health needs where they have a housing related support need. Focussing on those service users with an identified mental health need between 1 July 15 and 30 November 2015 there were 50 service users referred into services, 32 of which were/are in services, an additional 7 have been accepted for support and are awaiting placement and 11 have declined a service. Overall, the services have accepted and supported 78% of those referred with a mental health need. Mental Health Services Adult mental health services are commissioned on behalf of the CCGs by South West Lincolnshire CCG. Children and young people's mental health services are jointly commissioned by South West Lincolnshire CCG and the County Council. Both are provided by Lincolnshire Partnership NHS Foundation Trust. 2. What work is being done by services to engage with hard to reach individuals? Substance Misuse Treatment Services Information on all services is available in multiple languages and specific pieces or targeted intervention can be undertaken where identified issues have been raised. Providers positively target difficult to reach groups and utilise peer mentors and volunteers from those groups to break down barriers. Once in treatment, translation services are available and individual circumstances can be taken into account when developing recovery plans and care packages. These may include the use of chaperones or peer mentors to offer support and reassurance to those accessing treatment, as well as employing staff who speak multiple languages or come from difficult to reach groups. 4

5 Housing Related Support Services Mental Health Crisis Houses: Information on services is available in multiple languages and support can be tailored where there are particular issues. Since the referral route is through the Crisis Resolution and Home Treatment Team (CRHT), that team would inform the Crisis House staff of any considerations that need to be made based on their longer term involvement with the client. Generalist Housing Related Support Services: Information on services is available in multiple languages and support can be tailored where there are particular issues. Referrals into these services come from numerous different agencies such as District Councils, drug/alcohol treatment services, criminal justice, Shelter, Lincolnshire Partnership NHS Foundation Trust who also operate their own equality and diversity policies. Lincolnshire also has a countywide homeless strategy which discusses many issues including how to engage with 'hard to reach' individuals - thus a strategic countywide approach is in place which deals with these issues. By the nature of the client groups supported, many of our services are identifying and supporting 'hard to reach' groups, e.g. people with low level mental health needs, exoffenders, people suffering domestic abuse and people who are risk of or experiencing homelessness. Mental Health Prevention of Suicide: Hard to reach groups are engaged through a high level, multi-agency steering group in Lincolnshire for the prevention of suicides. HealthWatch, Chaplaincy services and voluntary organisations are members of this group. 3. When hard to reach individuals are engaged how effective is the treatment and what performance indicators do you have available to support this? Substance Misuse Treatment Services Substance misuse treatment services are monitored through the National Drug Treatment Monitoring System (NDTMS). This system produces reports each quarter that includes the Diagnostic Outcomes Monitoring Executive Summary and the Partnership Activity Report. Neither of these reports specifically monitors hard to reach groups but do monitor outcomes progress through treatment and exits for all groups. The ethnic background of those in treatment is included and from that it is possible to compare numbers against the local data below. 5

6 From the 2011 census the 'Non-White' population of Lincolnshire was 2.4% compared with our current 3.5% in treatment, also the 'White Other' population was 4% from the census - this group make up 4.5% of the treatment population. From this data it would suggest that treatment services are having success gaining access to ethnic groups that may be hard to reach but there are no field monitored for other groups such as Lesbian, Gay, Bisexual, Transexual (LGBT) or Men who have Sex with Men (MSM) Housing Related Support Services Mental Health Crisis Houses: Crisis Houses are monitored on a quarterly basis in contract management meetings. At present the reports do not specifically monitor hard to reach groups although this data is collected. Generalist Housing Related Support Services: As part of their package of support, providers work towards a set of standard outcomes, the following of which focus specifically on enriching the lives of 'hard to reach' individuals in and out of service. Advice, advocacy and liaison Support to develop social skills/behaviour management Help in gaining and establishing access to other services Help in establishing social contacts and activities Help in gaining access to local community organisations Culture-specific counselling/emotional support Liaison and advocacy support from the same ethnic group Signposting to culture specific legal services Signposting to culture specific health/treatment services These are collected and measured by providers when individuals enter service, when they exit and at monthly intervals. As such this provides a picture of the individual's journey and what the support has helped them achieve. Public Health are in the process of analysing this data to determine success rates. However current evidence suggests that the above outcomes are very positive and barriers for 'hard to reach' groups are being overcome regularly. Mental Health Services Prevention of Suicide: The multi-agency initiative for the prevention of suicide is very much in its infancy therefore we have no measured outcomes at this point. 6

7 4. What impact will the recommissioning of services have on these hard to reach individuals? Substance Misuse Treatment Services All treatment services are currently out to tender. New specifications are outcome focussed and include the following monitoring categories: 1. Freedom from dependence on drugs or alcohol 2. Improvement in mental and physical well-being 3. Prevention of drug and alcohol related deaths and blood borne viruses 4. A reduction in crime and re-offending 5. Sustained employment 6. The ability to access and sustain suitable accommodation 7. Improved relationships with family members, partners and friend 8. Improved capacity to be an effective caring parent These outcome areas include targets such as increasing the number of dual diagnosis clients who are simultaneously engaged in substance misuse and mental health treatment. There are no specific targets linked to vulnerable groups but treatment services are expected to work with all groups within the county. Sitting alongside the treatment service will be a new recovery service for Lincolnshire. This contract will wrap around the treatment service and offer support to anyone seeking, or in recovery from, alcohol or drug use. This service will develop peer groups across the county including within specific communities or hard to reach groups. The recovery community will have a focus on re-integration and a meaningful use of time. It will promote wellbeing and signpost to treatment or other services as appropriate. The recovery service is a new concept for Lincolnshire and has the options to develop a very bespoke package of support across the county that will benefit the entire population, including hard to reach groups. Housing Related Support Services Mental Health Crisis Houses: These services have recently been recommissioned and consideration was given to hard to reach individuals. The core eligibility is around the client's mental health and their need for that support in a period of crisis. However through ongoing discussions with colleagues at CCG level we are ensuring that the Crisis Resolution and Home Treatment Team (CRHT) don't put up barriers to the service and encourage 'hard to reach' clients to access services. Generalist Housing Related Support Services: These services were also recently recommissioned and consideration was given to hard to reach individuals. For these services the focus was ensuring that it was available 7

8 consistently for both accommodation based services and those available in individuals' homes. By taking away the label of 'offender' or 'mental health' we have opened up our services so that individuals can access services across the whole county without having to fit into a category. This consistency is something that has been welcomed by referrers and providers alike. 8

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