Project Description

In March 2013, four pilot areas were initiated across South Wales to develop services for people suffering with co-occurring substance misuse and mental health issues.

The need for these pilots was identified following a piece of work undertaken by Cymorth and Public Health Wales in February 2012 which found that service provision for this client was patchy and in some areas non existent. It was found that clients were often passed from pillar to post between substance misuse and mental health services, ‘falling through the gaps’ in service provision.

As a result of these findings JMB Health Consultancy Ltd was asked to facilitate a conference hosted by Cymorth and the Homelessness & Supporting People Network in January 2013 to take this issue forward and support potential pilot areas.

The following areas were subsequently successful in bidding to host a pilot project: Bridgend, Western Bay, Newport and Cwm Taf. These projects had no direct funding, rather more expertise were made available by JMB Health Consultancy Ltd to provide a facilitative and evaluative role. This following are some of the outcomes of the Kerrigan (Bridgend) pilot and the Cwm Taf pilot.

Kerrigan (Bridgend) pilot

This project was developed as a collaborative commitment by Housing departments, Supporting People, Children and Young Persons’ Services, Adult Care Services, Mental Health Services and Community Safety. It was intended to support key outcomes identified within the Welsh Government strategy Together for Mental Health – A Strategy for Mental Health and Wellbeing in Wales.
Initially the project aimed to provide 6 units of high level supported accommodation plus one emergency access bed provided by Gwalia. However, it should be noted that at time of writing, this single unit model had yet to be commissioned, with floating support being provided as an interim alternative. This was noted to be in relation to the various problems encountered in the procurement of a property.

Nonetheless, the project has still succeeded in producing some key meaningful outcomes for service users through early intervention and engagement.
The consultant (JMB Health Consultancy) helped to achieve these outcomes through: supporting the project in demonstrating positive outcomes for both service users and key stakeholders, identifying potential barriers and ultimately making recommendations to support improvement.
The project has the potential to provide a long term focus on health awareness and the impact upon lifestyle and choices. Indeed, overall the Kerrigan project has started to address the overall aims and plan for collaborative working with the potential of:

• Reducing inequalities for vulnerable groups with mental health needs, ensuring equitable access and provision of mental health services.
• Ensuring that public services work together to provide an integrated approach.
• Ensuring substance misuse co-occurring with mental health problems is managed effectively and remains a key focus.
• Reduce homelessness and help people with mental health problems sustain tenancies.

It is acknowledged through our report that Kerrigan is a ‘positive work in progress’, with clear recommendations for supported continuation of the original proposals.

Cwm Taf Pilot

The Cwm Taf bid stemmed from recognition amongst partners that meeting the needs of people in Cwm Taf with co-occurring substance misuse and mental health problems is a challenge for partners in both the statutory and voluntary sector services. It was acknowledged by staff working with this client group, that no single body or sector is able to meet the needs of people with co-occurring problems. Instead, a co-ordinated approach is required with effective partnership working between health professionals in both primary and secondary care, Local Authorities, the Third Sector and the Independent Sector. Most importantly services user and carers must be at the heart of decision making and care planning; in control of their treatment journey as far as possible.

Whilst individual organisations in the area had previously produced their own procedures for the treatment of patients (e.g. Cwm Taf Health Board’s Procedure for the Treatment of Patients with Severe Mental Health and Substance Misuse Illness) this approach had limitations and often led to a fragmented service. As a result, partners were committed to a multi agency, multi disciplinary approach. The pilot therefore aimed to produce a coordinated approach to assessment and intervention which involved a range of partners.

To deliver this approach the pilot sought to develop a set of joint working protocols which aim to achieve:

• Optimum opportunities for recovery
• Improved care through adopting a more holistic approach to assessing and addressing service users’ needs. Improved access to appropriate treatment and support
• A reduction in the harm caused by substance misuse. Increased stability in the individuals mental health
• Ease of access to services, which includes clear coordination from one key worker to another.
• Services best suited to client needs and if additional services are involved (which is usually the case) co-ordinated with as little disruption to the service user as possible.
• Avoidance of duplication in the assessment process and subsequent interventions wherever possible of mental health and substance misuse services.
• Emphasis on a preventative and recovery model in which services work closely together to provide the best and safest possible care for the service user, their carers and families

Progress so far

To date we have worked with key partners to put forward a pilot proposal to tease out the key product to be produced. We facilitated a small working group with key stakeholders which has benefited from excellent support and attendance. A workshop was also organised and delivered at the end of 2013 which brought together representatives from a wide range of statutory and voluntary sector organisations. This workshop focussed on the themes of management of risk, joint working and communication, and training. Work is now progressing on developing the document.

E Learning Package

As part of the Dual Diagnosis pilot, the Network with the assistance of the Public Health Wales Older People, Vulnerable Groups and Inequalities Team have modified and re-hosted a robust Dual Diagnosis e-Learning package originally developed by PROGRESS and Coventry University. The e-learning package is an online resource suitable for the full spectrum of professionals within the social care, healthcare and criminal justice setting. The online course consists of 4 interactive modules, including case studies and video footage, ending in a self assessment section. Embedded in the Welsh version of the course are key NHS and Welsh Government documents and policies to aid and compliment the users overall learning experience.

The English version of this course is currently available at www.dualdiagnosis.co.uk and it is hoped the Welsh version will be available on the PROGRESS and NHS Wales website by April 2014.

You can download the resulting publication here.

For any further information on the pilots or this work in general please contact us or Claire Cunliffe at Claire.cunliffe@swansea.gov.uk