Mental Health Strategy 2024-2027

Foreword

Physical and mental health care have traditionally been delivered separately. While investment and improvements in mental health services is welcome, physical, and mental health services will only truly be equal when we stop viewing physical and mental health as distinct.

Services need to be built around all of people’s needs and not determined by professional or interest groups. There is increasing recognition of the importance of integrating services across health and social care.

Many of the people attending acute hospital emergency departments with physical health needs may also have mental health needs. These people are in a vulnerable position and need to be treated with compassion and dignity. This must be in a way that makes them feel safe and upholds their human rights.

Mental health service improvement is a national priority, particularly focusing on crisis care, perinatal mental health, children, and young people, avoiding inappropriate out of area admissions, ending inappropriate use of police intervention, better access to psychological therapies and parity of esteem (giving equal value to mental and physical health).

As a Trust which has been accredited as a Veteran Aware organisation by the Veterans Covenant Healthcare Alliance (VCHA), meeting the needs of this community will be an area of focus.

Building on the NHS (National Health Service) Mandate, NHS England has published the Five Year Forward View and the NHS Long Term Plan.

The long-term plan builds on the mental health five year forward view and National Partnership Agreement for the Right Care, Right Person (RCRP) approach, which is designed to ensure that people of all ages, who have health and/or social care needs, are responded to by the right person, with the right skills, training, and experience to best meet their needs.

The RCRP approach is focused on the interface between policing and mental health services and sets out a collective national commitment from the Home Office, Department of Health and Social Care, the National Police Chiefs’ Council, Association of Police and Crime Commissioners, and NHS England to work to end the inappropriate and avoidable involvement of police in responding to incidents involving people with mental health needs.

New and integrated models of primary and community mental health care will give 370,000 adults and older adults with severe mental illnesses greater choice and control over their care and support them to live well in their communities by 2023/24.

There will also be a new Mental Health Safety Improvement Programme, with a focus on suicide prevention.

By 2023/24, NHS 111 will be the single, universal point of access for people experiencing mental health crisis.

There will also be an increase in alternative forms of provision for those in crisis, including non-medical alternatives to A&E (Accident & Emergency) and alternatives to inpatient admission in acute mental health pathways. Families and staff who are bereaved by suicide will also have access to post crisis support.

By 2023/24, the wider health service will introduce mental health transport vehicles, introduce mental health nurses in ambulance control rooms and build mental health competency of ambulance staff to ensure that ambulance staff are trained and equipped to respond effectively to people experiencing a crisis.

Many patients at The South Tees NHS Foundation Trust have mental health needs which need addressing, alongside their physical health needs if we are to achieve high quality care and good clinical outcomes.

South Tees provides a number of services for people who are particularly vulnerable or present an elevated risk.

People with a mental health problem or a learning disability tend to experience poorer physical health and die younger than other people.

They also experience ignorance, prejudice and discrimination which may result in their health needs being misdiagnosed or missed altogether.

There are examples of good practice in the promotion, prevention, and intervention of mental health needs across South Tees, but as a trust we have organisational development needs to support the learning and improvement of mental health care which include training, practice development, communication, and commissioning.

Our strategy brings all of this together, alongside the physical health needs of our patients, so they receive the best care and treatment.

Dr Hilary Lloyd, Chief Nurse

Dr Michael Stewart, Chief Medical Officer

January 2024.

Our Mission, Vision, Values and Behaviours

The safety and wellbeing of our patients and staff, underpinned by the quality of the care we provide, is at the heart of our mission.

Our Mission

Safety and Quality First
As a clinically led organisation, the safety and wellbeing of our patients and staff, underpinned by the quality of the care we provide, is at the heart of our mission. It is what matters most to people who use our services.

Alongside our influence on wider determinants of health, this is our core organising principle.

Our Vision

Empowering our Clinicians
We will continue to empower our clinicians to take the decisions about how we manage our resources and deliver safe, quality care across our hospitals and services for children, adults, families, and our communities.

In doing so, we will deliver the highest standards of patient-centred healthcare to communities in the Northeast of England, North Yorkshire and beyond.

Our Values and Behaviour

Respectful
I listen to others without judgement. I promote equality and diversity and treat others as I wish to be treated.

By holding myself and others to account I demonstrate my professionalism and integrity to my colleagues.

Supportive
I acknowledge the contribution of my colleagues. I support my colleagues and our trainees to develop themselves to deliver the best possible care to our patients and families. Being part of a team requires me to be honest, available, and ready to help others and myself.

Caring
I show kindness and empathy to others through the delivery of individual and high-quality care to our patients, families, and my colleagues.

Introduction and Context

The development of our Mental Health Strategy for 2024 – 2027 has been informed by several strategies and directives.

These pieces of guidance include:

• A literature review including national guidance, legislation, and regulation – particularly the Five Year Forward View for Mental Health – NICE and good practice evidence and the Long-Term Plan, CQC (Care Quality Commission) guidance about providing mental health care in an Acute Hospital setting and Royal College Guidance.
• A review of what our staff, service users and carers have said about what is important to them following several engagement events which were carried out between February and October 2023.
• Key public health messages about mental health experiences and our local population.
• The expertise and knowledge of our local mental health providers.
• Our vision and values as an organisation and other underpinning strategies and priorities including those for Safety, Quality and Dementia.

Engagement

Our strategy has been developed with patients, families, and carers at the centre of our discussions.

People with lived experience of mental ill health, those with both physical and mental ill health, together with people who have had hospital care, community services, or cared for relatives in receipt of care have joined focus group, one-to-one interviews, and completed a survey to share their experiences.

We have also met with colleagues working within mental health trusts, health care providers, carers organisations, our staff, and volunteers, who all shared their stories and ideas for improvement.

We have attended conferences and workshops to explore best practice and followed up with experts for advice on our emerging strategy for critique.

Our strategy has also been reviewed alongside academic literature, practice, and policy guidance.

We concluded through this engagement that our implementation needs to:

• Keep patients, families, and carers in mind always.

• Share learning and highlight achievements.

• Be curious and open to doing things differently.

• Resist our defensiveness when things do not go so well, to enable growth.

• Identify and address the impact of inequality.

Why Mental Health is Important…

Having a trust wide mental health strategy will help

• To ensure we are continually reflecting on all aspects of patient care and their journey through services.
• Increase awareness to the moments in a patients’ care that are potentially challenging, worrisome or of concern for them.
• Staff become mental health literate, noticing where they can intervene to comfort and support patients, families, and carers.
• The trust to be a leader in evidenced based holistic care, in keeping with statutory guidance, policy and best practice.
• Create new partnerships with mental health trusts, mental health providers and communities to support care pathways for patients with physical and mental health needs.
• Through agreed care pathways, we will increase opportunities for our trust to work in partnership with local mental health providers to support our patients’ with either their new or ongoing needs.

What is Mental Health?

Mental health refers to an individual’s emotional, psychological, and social wellbeing. Mental health as a state of wellbeing supports people to identify, cope with and manage daily stressors.

Mental health helps to enhance personal resilience and enables people to overcome or find a way through life’s regular challenges.

The way we think, feel, behave, and respond to experiences can alter our mental health. Mental health needs can arise in response to life events, where stress, uncertainty, vulnerability, or trauma can increase anxious feelings, or contribute to a change in mood or impact our ability to relate to others.

Mental health needs can be fleeting, they are unique to the individual, they can change and adapt in response to new experiences.

Where mental health becomes mental ill health, for example, longer term, persistent, diagnoseable difficulties like depression, anxiety, trauma, personality or psychotic disorders, psychological interventions may be required.

Mental health difficulties are reported to impact 1 in 4 people with the number of people seeking support for mental ill health is increasing, particularly amongst LGTBQ+ people, black and minority ethic people, and young women where experiences of discriminations are prevalent.

Additionally, key risk groups include those impacted by homelessness, substance use or who are involved in the criminal justice system.

They are also less likely to access mental health support, which may contribute to more entrenched difficulties.

People who experience social and economic disadvantage, social isolation or experiencing physical ill health have an increased likelihood of reporting symptoms of mental ill health.

Mental health and physical health

Also known as Parity of Esteem

Throughout our conversations we have heard multiple examples of how mental health, mental health needs and mental ill health can be present, amplified and altered during periods of physical ill health.

This applied to all areas of trust intervention, including recipients of inpatient elective and emergency care, care in the community and care at home.

We have identified the ways services can unintentionally contribute to altering and creating negative experiences of mental health.

We have also heard examples where care and compassion have been so well entwined that the patient, family, and carers have been contained, nurtured, and supported to thrive. Our patients have concluded that to help improve the provision and understanding of mental health care we should commit to the following goals.

Developing our understanding of what we need to do

The key findings from our work with service user’s, staff, the literature reviews, and feedback to surveys were:

• Ask patients about their mental health experiences to better understand their needs, alongside their physical health needs.
• Ask our patients, with compassion about their current or previous experience of trauma or abuse. And consider how we can support them with these experiences.
• Communicate clearly, succinctly, and be jargon free.
• If using medical words, acronyms, or professional language, make sure to explain what this means, and check patients have understood.
• At appointments, staff should ensure they know the persons story, can identify why the patient is with us, can talk about treatments, options and follow up care, and importantly give space for patient questions.
• Staff, through training to recognise our patient’s mental health inducing experiences and work towards reducing their impact.
• Identify and promote a resource directory that staff and patients can access to better understand mental health needs and the local services available to support these needs.
• Be assured that our care offers the least restrictive approach and there is robust oversight of any restraint or deprivations of liberty.
• Have mental health informed staff in all services. Always act compassionately.

Getting the basics right – also known as the Fundamentals of Care

The fundamental standards define the basic standards of safety and quality that should always be met, and which should never fall beyond for every patient. More specifically, one of these standards says that care and treatment must be appropriate and reflect service users’ needs and preferences.

At South Tees, this means giving equal priority to our patients physical and mental health needs, through a range of evidence based clinical assessment and pathways.

The effectiveness of these can be shown through Audit and Clinical Effectiveness measures, as well as our South Tees Accreditation for Quality of Care (STAQC) programme. This has been developed by the trust to enable a comprehensive assessment of the quality of care provided to patients by each clinical area.

It aims to drive safety, quality and provides continuous improvement in patient outcomes and satisfaction.

Our Strategic Intentions

To address the issues raised from the local surveys, staff and service user feedback and national publications the following strategic intentions have been developed. These will incorporate an appreciative inquiry approach to promote best practice and wellbeing.

• Patient involvement group:
  We will host a quarterly staff and patient forum to share progress of our mental health journey. We will prioritise opportunity to hear from those with lived experience to help shape and support our journey to change.
• Mental health strategic group:
  We will form a mental health strategic group to provide oversight and governance of our mental health focused work. Membership will also be extended to partner organisations and service users with lived experience of both physical and mental health needs.
• Annual audit and action plan:
  We will undertake and annual audit across each collaborative, chaired by the triumvirate leadership team. This will enable us to identify the ways by which mental health informed care is enacted and support the trust in recognising areas for development. This will also be incorporated into the trust’s STAQC programme.
• Learning and improving on mental health:
  We will add mental health awareness sessions for all staff during their induction to the trust. We will develop a mental health training programme which includes class-based workshops and e learning packages. This will help enhance our knowledge, skill, and values in delivering effective patient care. We will identify which training is most relevant through our annual collaborative audit, doing this will ensure the training is targeted, specific, meaningful, and impactful.
  As the trust moves to the new patient safety incident response framework (PSIRF), we will identify opportunities for improvement and learning in line with updated duty of candour guidance which recognises the equity of psychological and physical harm.
• Mental health practice and documentation:
  We will evaluate and refresh our trust wide patient focused documentation, risk assessments and signposting information to better support patient pathways and onward referral.
• A focus on suicide prevention:
  We will identify a range of resources, training, and support for staff to ensure we are doing all we can to learn about and prevent suicide while patients are in our care.
• A commitment to partnership working:
  We will, through our strategic group identify how to support mental health providers to identify best practice in meeting the physical health needs of people who are mental health inpatients, whilst also drawing on the expertise of our local mental health providers to support patients who have mental health needs who are in our care.

Expected Outcomes

It is anticipated that our journey towards integrated mental and physical health care as set out within this document will result in the following outcomes:

• A holistic understanding of patients’ needs which supports care delivery, clinical interventions, and discharge planning.
• Increased opportunities to attend to mental health needs, alongside physical health needs, signposting to additional services where needed.
• Enhanced organisational safety, risk management and governance processors, to support patient care.
• Clearer objectives and key performance indicators which demonstrate our commitment to and compliance with statutory responsibilities.
• Increased collaboration across health, social care, voluntary and community services.
• Enhance and promote mental health self-help for patients.
• Joined up services and pathways between physical health and mental health providers.

Our mental health strategy is underpinned by our mental health improvement plan which sets out the details behind each of our planned outcomes, including timescales, key milestones and deliverables which will be reported through our quality assurance governance structure.

Our Commitment

Our focus is to develop, improve, learn from, and enhance the provision of mental health care for our patients, alongside their physical health needs.

We are committed to acting compassionately, taking the time patients require so that we can understand their individual needs and plan their care accordingly. We will identify and continue to build our knowledge, skills, and values so that we can be sure we are a safe, effective, caring, responsive and well led organisation.