Young people transitioning into adult mental health services in Torbay will increase over the next 5 years.
This is due to:
- Higher rate of looked after children
- Higher levels of hospital admissions for self-harm and injuries.
- 1 in 5 children have a special educational need
- Higher levels of long-term health or disability
- Higher proportions living in poverty.
The cost of Adult Under-65 Mental Health has increased by £1.1m (nearly 45%) over the last five years, with a current forecast spend of £3.6M for year 2020/21. The challenge will be to do more with the budget we have, as levels of demand are set to increase, especially following COVID 19 and the predicted impact of bereavement, social isolation, debt, unemployment and homelessness.
What we can do differently
In Torbay too many under 65 adults with mental health needs are living in residential care. For adults in contact with secondary mental health services, only 45% are living independently with or without support, compared to the 58% England average.
Supported living not only costs less than residential care but increases self-determination, control and citizenship, which are the basis of recovery for people who have felt disempowered either by their mental health or the system itself (DOH 2016). Therefore cutting our residential placements by a third would not only benefit individuals but also generate savings (about £200 per person per week, about £135K per year for 13 people).
We need to make sure that fewer people experience deteriorating mental health, and that there is earlier, accessible support in their community, so there’s support at the right time, and right place. We think this will also help to reduce admissions to hospital under the Mental Health Act
A new Community Mental Health Framework is being developed across Devon, and Torbay Council is also investing in the CVSE to develop a peer support network and ‘places of welcome’ across the Bay, where people who are concerned about their mental wellbeing can meet others and get information about what support is available. This will include access to group sessions on coping with loss, anxiety, depression and OCD, to promote wellbeing, understanding and validation of lived experience. There will also be access to advice about benefits, housing and finances (the social determinants of ill health).
- The Torbay GP register data shows Torbay has over 16,300 adults with depression, 1800 adults with Schizophrenia, bipolar disorder, other psychoses, or on lithium therapy.
- PANSI prevalence data shows 24,000 working age adults have a mental health problem in 2020, and that this isn’t predicted to rise much by 2024.
- Using residential care for younger adults is prevalent (over 55%) and Torbay is a significant outlier in this area compared to its CIPFA neighbours.
- This presents a demand for longer-term support that is closer to home, promotes independence and self-care, and requires social care, NHS and CVS resources to be better integrated around the individual.
Inputs and resources
- Increase review team - 2 x staff costs
- Develop dynamic SL framework & essential tech infrastructure.
- Training of care co-ordinators/ SWs on CA re-assessments
- Cost employment support project Cost of MH Peer Support Project - VCSE
- Cost of Outcome star licences for Residential and SL providers
- Engagement with providers and service users
- Cost of venues, facilitators, refreshments.
- Commissioner time to analyse data.
Activities - what we will do
- Review all U65 mental health people in residential care and identify who could move into supported living.
- Procure more mental health supported living providers.
- Practice change – reviews are re-assessments and placements in residential care are recovery focussed
- Commission mental health/LD employment support for employers and individuals.
- Ensure the mental health panel process challenges residential care placements
- Commission VCSE peer support scheme
- Engagement with residential care providers on market development
Outputs - what is delivered
Market development:
- Mental health residential care providers supported to reduce beds by 20 and altering the focus towards rehabilitation and recovery
- Expansion of specialist mental health supported living provision – 30 units including supported living plus and self-contained
- Overdue reviews/ re-assessments of people in residential care - reduced by 80% (currently over 100 in 2020).
- ASC weekly costs reduce as average supported living costs £200 pp/pw less than residential care.
- Greater VCSE and community resources, places of welcome and earlier, accessible local intervention.
Outcomes - what needs to change
- More people under 65 with mental health issues are supported to live as independently as possible - ASCOF 1H - Torbay currently 45%, c.f. SW region 56%.
- The number of people under 65, with MH issues in residential settings, who do not have complex needs, is halved.
- More MH residential care is recovery and rehabilitation-focused and the average length of stay in residential care is reduced by 25%.
- Fewer people have deteriorating mental wellbeing and more people know where to access support locally (right time, right place)
- DTOC waiting times reduced by 20%.
- The number of adults supported on journey back into paid employment is doubled – ASCOF 1F, Torbay currently 3% c.f. SW region 11%
- Fewer people are admitted to hospital under MHA - Reduction in s117 costs
Process benefits and system change
- Improved coordination of services.
- Increased efficiency and value for money.
- Increased skills, capacity and knowledge to better support people with mental health issues.
- Availability of wider range of service provision
- Increased evidence base for what works