How NCPs are preparing for the mental health tsunami, part 2

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With warnings of a post-pandemic mental health tsunami to hit the NHS, NCPs are working on how best to meet the needs of their local people. But with difficult-to-navigate joint funding deals and recruiting headaches – which likely won’t be resolved by Network DES’ update that they can now recruit an additional mental health practitioner through the ARRS – NCPs are also exploring different ways to meet the wave of need that GPs say is already here.

Emma Wilkinson examines what they put in place and the challenges they face.

Take a different approach

Mental health is incredibly broad and it depends on what NCPs are trying to address to determine what the best approach will be, Baird says. “Apart from the difficulty of getting staff, NCPs are going to have to think about their needs, how they are implementing staff and what they are going to do and how to get the most out of them.”

Dr Simone Yule, clinical director of the Vale Network PCN in Dorset, says recruitment for the jointly funded post – which has just moved into another recruitment round – has been impossible.

“But in the meantime we have sat down with the Community Mental Health Trust and the Dorset Mental Health Forum and the CCG and set up a pilot project with peer helpers entering primary care.”

The CGC-funded program has been running for about 15 months and its success means more NCPs are now looking to get involved. The peer support workers are trained and were already working in the Community Mental Health Trust. They have appointments of 45 minutes to an hour and have free access to the GP or mental health team if needed.

“What we’re seeing is a lot of low-level mental health issues related to social, economic and emotional distress and they want someone to offload. Patient feedback has been brilliant.

They also have social prescribers and some support from the local Steps 2 Wellbeing organization and the PCN has a good relationship with the community mental health provider based in the same building.

Dr. Yule also notes that the latest contract specification from March expands the definition of what is allowed under the ARRS to include peer support workers and community mental health connectors, which could help NCPs identify the right role for the needs of their patients. “We had recruited a mental health practitioner and she was very senior at group 7/8 level and a prescriber and she found it really very unsatisfying because it was not the type of work she was used to.”

You have to think about children and young people, says Dr. Lee. She has run a GP-led service with two local schools for four years. Now funded by the NCP, demand among 16-18 year olds who can access the device has tripled with issues including eating disorders and anxiety. They report, encourage counseling and provide a single point of access. This reduced referrals to their mental health service, says Dr Lee. It’s a perfect scheme that a CPN could be involved in but the one they recruited cannot treat under 18s.

“We have a social prescribing team, but patients must also be over 18. This is an important need. We hope to recruit a CAMHS CPN to the team.

Kentish Town South PCN is one of the first wave sites of the new Community Mental Health Framework. NCP clinical director Dr Jonathan Levy said this meant more foot soldiers in the field with an increase in CPNs and mental health trust peer support workers as well as psychiatrist time for people with severe mental illness whose PCN has one of the highest rates in the country.

The wave of anxiety and depression predicted by the pandemic has definitely arrived, he adds. “One of the projects we are running is to increase the use of physical health checks for people with serious mental illnesses. The completion rate of these have dropped through the ground during Covid and we need significant assertive outreach to help improve them. Another project we are undertaking is to examine patients with serious mental illnesses who are also on waiting lists for joint replacements. Patients are generally highly motivated to ensure the best results from their joint replacements, so we are seeing if we can capitalize on this and engage SMI patients in the preoperative period to improve their physical health and seek to improve other broader determinants of their well-being, for example, around their accommodation, friendship circle, hobbies or work.

In Kentish Town South PCN they have their own social prescribing charity called the Freespace Project which connects patients with community support but also offers a range of wellness and art therapy activities.

‘It has been in place for 14 years and recognizes that patient wellbeing is determined not just by their physical and mental health, but by the impact of broader determinants of wellbeing such as social isolation that we see a lot in a lot of urban areas,’ says Dr Lévy.

In their experience, centralized funding does not necessarily recognize the specific needs of their population. “Many of the initiatives we run are not funded through the base contract or locally commissioned services, but through applications to charitable funds and, more recently, to the Health Inequalities Fund.”

The latest example is their work as a pilot site for the Complete Care Community program to address health inequalities, a project they have been working on for 10 months and is about to kick off. “We are trying to tackle the stigma associated with poor mental health in our BAME communities. We work with a local charity called Hopscotch, which specifically works with our local Bengali community at the interface of racial and gender inequality. We know that in these communities there is a lot of stigma around mental health and we seek to empower these communities to try to raise awareness of mental health issues, seek help and find out about the services available.

Mental health charity Mind believe that funding additional roles through NCPs will bring much needed extra capacity to primary care and help people access early intervention and they are well placed to support this.

Vicki Ensor, Mind’s Senior Policy and Campaigns Officer, added that the new contract provides much more flexibility for voluntary sector organizations to deliver services.

“They have a strong track record of delivering high quality, innovative services tailored to the needs of their community and are well positioned to support primary care through the ARRS program.”

Their active monitoring program of a six-week guided self-help intervention for people with mild to moderate symptoms was recently expanded and implemented in over 80 medical practices, with 84% of patients showing improvement in their mental health.

“Local Minds have significant experience in providing mental health practitioner roles, including peer support workers and community mental health connectors,” she says, adding that they welcome the expansion of the roles of the ARRS.

But several factors need to be considered, including sufficient funding, training and support for practitioners, shared primary and secondary care engagement and collaboration, and data sharing, Mind points out.

But, says Dr Gandhi, their fantastic Third Sector suppliers in Nottingham are struggling with the same problems as everyone else. “Many of our local third-party providers also have astronomical waiting lists. They willingly collaborate with us but they don’t have the staff either.

Complete the relevant CPD modules on men’s health on Pulse learning by signing up for free or upgrade to a premium subscription for full access at just £89 per year.

Complete relevant mental health CPD modules on Pulse learning by signing up for free or upgrade to a premium subscription for full access at just £89 per year.

Complete the relevant CPD modules on men’s health on Pulse learning by signing up for free or upgrade to a premium subscription for full access at just £89 per year.

Complete relevant mental health CPD modules on Pulse learning by signing up for free or upgrade to a premium subscription for full access at just £89 per year.

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