The PSC and NHS Surrey Heartlands ICS have co-produced a new pilot approach to proactively prevent mental health crisis within the cohort that would not traditionally meet eligibility thresholds for more active intervention.
The PSC and NHS Surrey Heartlands Integrated Care System (ICS) have co-produced a new approach for supporting people who are experiencing mental health challenges, but are not meeting eligibility thresholds for more active intervention. The proactive mental health crisis prevention approach will offer preventative support to this cohort, including use of digital mental health tools (where appropriate) and technical support.
The Challenge
People with mental health challenges are significantly (3.6x) more likely to experience a potentially preventable emergency admission than those without such challenges (Nuffield Trust). Therefore, Surrey Heartlands ICS wanted to explore whether a new service could be designed to help support this cohort and intervene earlier to prevent crisis. This could improve citizen outcomes and experiences, as well as reducing avoidable admissions and reducing bed occupancy due to a mental health crisis.
System-wide discussion facilitated by The PSC revealed that there is a gap in mental health provision for adults living in Surrey Heartlands with lower-level mental health needs who may still be at risk of experiencing a mental health crisis.
These citizens are currently presenting to different mental health services within Surrey Heartlands but are not receiving active intervention or are being referred elsewhere as they do not meet eligibility thresholds at that time. This cohort therefore are ‘bouncing’ between services within the System, with no streamlined, central oversight of who they are, what their story is, or what support they might benefit from.
The Approach
Over the course of the 8-month project, The PSC team worked to:
- Identify areas of unmet need for adults experiencing mental health challenges.
- Co-produce a new preventative approach for this cohort of adults, including: a holistic wellbeing assessment to identify the cause of mental health challenges, not just their symptoms; the use of digital mental health tools and technical support for these; and data-sharing between System partners to ensure a joined-up approach and reduce the need for citizens to repeat their narratives.
- Develop a plan for piloting the preventative approach, working closely with Voluntary, Community and Social Enterprise [VCSE] organisations in Surrey to develop a delivery plan.
Our approach to the project consisted of four key types of engagement, all of which centred on co-production:
- A fortnightly Delivery Group, with representatives from ten System organisations, to test and share ideas with stakeholders from across the System.
- 1:1 lived experience engagements with over twenty citizens with lived experience of mental health challenges. These were used to identify unmet mental health needs in Surrey and test our approach.
- Over twenty 1:1 System stakeholder engagements with commissioners, digital and data experts, GPs, clinical staff and other stakeholders.
- Five 1:1 and group service worker engagements with staff employed by VCSE organisations in Surrey who provide community-based mental health support. These conversations were used to inform our pilot model and wellbeing assessment.
- Four user feedback sessions with citizens with lived experience of mental health challenges, to explore the use of digital mental health tools in the pilot.
Overall, we engaged with 16 organisations, over 100 stakeholders and undertook 2000 hours of discussion and research.
The Impact
The project concluded by producing a series of materials that will be used by Surrey Heartlands to set up and deliver the pilot. These include:
- A Project Mandate document, designed to form the basis of a business case and a funding application to the Surrey Mental Health Investment Fund
- A pilot implementation plan, with a high-level service design flow diagram
- Supporting materials including the wellbeing assessment and digital assurance documents
The pilot was designed to have a positive impact on both the System and citizens:
- By intervening upstream and investing to save in the long term, system pressures could be relieved. These include reducing bed occupancy and A&E attendance due to mental health crisis. This pilot may also be particularly beneficial for the Police, Paramedics and staff in Emergency Departments, who are often the first point of contact when an individual is experiencing a mental health crisis.
- The pilot will positively impact citizens in Surrey, by reaching people before their mental health deteriorates and staying in touch to ensure they access the right support in the long term. The wellbeing assessment is designed to understand a citizen’s holistic needs, uncovering the cause of their mental health challenges and not just the symptoms. This assessment will be shared, where appropriate, with System partners to ensure people do not need to repeat their stories multiple times, which can be frustrating or potentially re-traumatising.
The impact of the pilot on citizens and the wider System will be evaluated as part of the pilot itself.
Feedback
"Thank you, to you and your team, for running a session that really valued and respected our contributions to the task . . . Our discussions felt productive and well worth our time." - User feedback session attendee
“It feels like every thought or concern that I shared has been considered and weaved into this plan, so I just wanted to say thank you, it’s so nice to feel really listened to . . . As a manager, I can’t tell you how much I appreciate the fact that the members of my team, who are working directly with clients, are also consulted and that contributions are valued.” - Lucy Rowley, Service Manager at Richmond Fellowship
“It is an exciting delivery project. I am super impressed with your team’s work on this.” - Dr Gisela Unsworth, Clinical Services Manager IAPT at Mind Matters Surrey