Maidstone Borough Council

Maidstone and Tunbridge Wells Joint Health Overview and Scrutiny Sub Committee

Friday 14 September 2012

Achieving excellent care in a mental health crisis

Report of: Overview and Scrutiny officer

1.      Introduction

1.1    The Local Government Act 2000 and the Health and Social Care Act 2001 set out statutory functions for local authorities to review and scrutinise matters that relate to the planning, provision and operation of health services in the area of its local authority.

1.2     In June 2010 The Maidstone and Tunbridge Wells Joint Health Overview and Scrutiny Sub Committee agreed a joint protocol which states: The Committee will perform all National Health Service Overview and Scrutiny functions on behalf of both Boroughs.

2.      Recommendation

2.1     The Committee is recommended to:

o Interview witnesses about the proposed changes outlined in the consultation document to establish the likely effect upon local health services;

o Identify specific issues in the consultation papers that will impact upon both patients and the provision of services in the local area; and

o Collate the evidence from the witnesses and discussion of the

consultation into clear points to be included in the Committee’s response to the consultation. The Committee should seek to make a recommendation in support of one of the three options being proposed.

2.2 Areas of questioning could include but are not limited to:

• The overall effectiveness of the proposals being put forward;
• The public’s confidence and understanding of the services available to them;
• Are the proposals part of a long term objective or are they a short term solution (i.e. the lack of capital funds to improve facilities and services at Medway’s A Block)?;
• The current success of Crisis Resolution and Home Treatment;
• The effect of Maidstone and Tunbridge Wells Crisis Resolution and Home Treatment (CRHT) Teams merging on current proposals;
• Will there be more in depth consultation with patients, carers and organisations in Medway, Sittingbourne and Sheppey as areas where they impact of the proposals could be perceived most negatively?;
• The impact on current services provided at Maidstone and Tunbridge Wells Crisis resolution based a Priority House;
• What savings, if any, are proposed by the current plans?; and
• What investment, if any, is to be made to ensure that CRHT teams and centres of excellence remain robust and responsive to changing need?

3.      Background information 

3.1 On 26 July 2012 the Kent and Medway NHS and Social Care Partnership Trust published a consultation document entitled ‘Achieving excellence in a mental health crisis’ (Appendix A).  It is a review of adult acute mental health service in Kent and Medway and is seeking to improve the service provided for people in a mental health crisis.  The document sets out proposals for the future for consideration.

3.2    The consultation states: ‘Every year, around 3000 of the 1 million men and women in Kent and Medway have a mental health crisis and need treatment urgently. ‘

3.3    In its online booklet, ‘The Mind guide to crisis services,’ the mental health charity Mind describes the type of mental health crisis that requires urgent help as either an already diagnosed severe mental health problem such as schizophrenia, bipolar disorder or severe depressive disorder or a first episode of a diagnosable mental health problem.

3.4    The booklet includes the following examples of mental health crises:

• Suicidal behaviour or intention;
• Panic attacks/extreme anxiety;
• Psychotic episodes (loss of sense of reality, hallucinations, hearing voices) ; and
• Other behaviour that seems out of control or irrational and that is likely to endanger yourself or others.

3.5    The consultation document explains that crisis services have been drastically transformed over the past eight years. Crisis Resolution and Home Treatment (CRHT) services were one of the key elements in the 1999 National Service Framework for mental health. The NHS Plan (2000) made the provision of CRHT services a national priority. The Department of Health’s 2002 Public Service Agreement included targets both for the number of teams and the number of people treated. Prior to this most patients would have been admitted to hospital as an inpatient.

3.6    It is explained that most people are now treated in their own homes by specialist staff from the CRHT teams. Staff are available 24 hours day and can visit three times a day if needed.  This type of treatment is said to offer a better recovery rate, it offers independence and avoids patients becoming institutionalised. 

3.7    In support of its proposals for community cased Crisis Resolution and Home Treatment teams and to demonstrate the success of this method of treatment, the consultation highlights the following finding: “A four year reduction in use of hospital beds by people in a mental health crisis, as a result of successful home treatment.  There are now 160 Kent and Medway beds for people in a mental health crisis but in 2011-12 an average of 144 were occupied.”  It should be noted that of the six teams currently covering Kent and Medway, the Maidstone and Tunbridge Wells ones are merging.

3.8    In terms of acute care, the consultation states that ‘Not everyone in Kent and Medway has access to this’.  There are said to be too few beds in East Kent, more required in East Kent and those currently provided in Medway (A Block) are ‘not up to 21^st Century Standards’.  Since 2000 all new mental health units (Dartford, Maidstone and Canterbury) have been built with single rooms instead of dormitories and preferably with en suite facilities which helps alleviate patient distress and violent incidents. 

3.9    The proposals offer equal access to psychiatric intensive care (PIC) with this being delivered by the outreach team visiting the hospital ward.  Currently there are two PIC Units (PICU) in Kent. These are in Dartford and Canterbury.  “In 2011/12, the outreach team helped West Kent and Medway ward staff prevent a potential 78 PICU admissions, nearly 40 per cent of those referred to the service.  In East Kent, where there is no outreach team, a person who cannot be managed on the ward has to be admitted to the PICU at present.  This is not ideal, as patients can find the move to a different unit disruptive.”

3.10  The Key Proposals for consideration in the consultation document include plans to:

o Strengthen community based crisis resolution and home treatment teams to provide more support to people outside hospital;

o Develop three centres of excellence for people in mental health crisis based in Dartford, Maidstone and Canterbury; and

o The closure of A Block at Medway Maritime Hospital.

4.      Reason for Urgency    

4.1     This meeting has been arranged to enable the Maidstone and Tunbridge Wells Joint Health Overview and Scrutiny Sub Committee to make a response to the consultation, in line with the consultation timetable and deadline.