Agenda item

To receive a report from the Head of Democratic Services that presents an update on the delivery of the Leeds Mental Health Strategy 2020–2025.

The report from the Head of Democratic Services presented an update on the delivery of the Leeds Mental Health Strategy 2020–2025.

The following were in attendance:

• Councillor Salma Arif, Executive Member for Adults Social Care, Public Health and Active Lifestyles
• Caroline Baria, Interim Director of Adults and Health
• Victoria Eaton, Director of Public Health
• Tony Cooke, Chief Officer Health Partnerships
• Caron Walker, Chief Officer Consultant Public Health
• Liz Hindmarsh, Programme Manager Transforming Community Mental Health, Leeds & York Partnership NHS Foundation Trust (LYPFT)
• Alison Kenyon, Deputy Director of Service Development, LYPFT  

The Executive Member for Adults Social Care, Public Health and Active Lifestyles explained that while mental health strategies largely fell into the remit of the Executive Member for Children’s Social Care and Health Partnerships, she would like to provide some introductory comments on her behalf. In doing so, the following points were raised:

• The Leeds Mental Health Strategy 2020- 2025 contributes to the wider Health and Wellbeing Strategy, with a vision for Leeds to be a mentally healthy city for everyone.
• The Strategy has three targeted passions which are to reduce mental health inequalities; improve children and young people’s mental health; and improve flexibility, integration and compassionate response of services.
• The Strategy also has eight key priorities, as detailed in appendix 1 of the agenda report.
• Data had shown mental health to be worsening for the population in recent years, particularly over the Covid-19 pandemic, with services experiencing high demand and long waiting lists for referrals.
• Anxiety and depression in school age children and young adults aged 18-25 had increased, which involved issues surrounding gender identity, ADHD and autism.
• Progress was being made by relevant services to improve provision and compassion however, challenges remained with long waiting lists and inequality between demographics.
• The Strategy has an important community grassroots focus and representation.

The Chief Officer Health Partnerships briefly introduced the report and gave an overview of some of the key challenges that the Strategy aims to address. Members were also reminded that the former Scrutiny Board had held a working group meeting on 9th March 2023 to consider the Strategy and in doing so, had particularly recognised the potential benefits linked to the Community Mental Health Transformation Programme. More detailed information on this programme had therefore been provided in the agenda report for Members’ consideration.

The Programme Manager Transforming Community Mental Health also explained some of the key aspects of the Community Mental Health Transformation Programme, which included the development of new Integrated Community Mental Health Hubs. These are to be trialled in autumn 2023 in three locations with the aim of scaling them up across Leeds in 2024. 

It was highlighted that a large focus of the community mental health model is around supporting people to recover and to continue to live a fulfilling life in their own community. Investment had been made in establishing the role of Community Wellbeing Connectors who will work with people to help them access a range of different types of support in communities.  Investment had also been expanded to community-based support through a grant funding scheme being jointly delivered by Forum Central and Leeds Community Foundation.  This was aimed at small to medium local organisations who offer support for people with complex and ongoing mental health needs. Details of successful grant bids had been provided in the agenda report.

The Chief Officer Consultant Public Health referred to her role as co-chair of the Mental Health Partnership Board and gave a brief overview of the work being undertaken in relation Priority 1 and Workstream 1 of the Strategy which focuses on targeting mental health promotion and prevention within communities most at risk of poor mental health, suicide prevention and self-harm.  As a response to the Covid-19 pandemic, work around supporting community volunteers to improve their resilience for themselves and to better support others was noted.The Leeds Mindful Employers Network also assisted developing a positive approach to mental health at work.  Reference was made to the programme of work around reducing suicide and self-harm, along with work to reduce stigma surrounding mental health, with a focus on minority ethnic communities.  It was also highlighted that the ‘Being You Leeds’ mental wellbeing programme had recently been launched, promoting group work, training and challenging stigma involving many third sector organisations across the city.

In response to questions from Members and subsequent discussion, the following was outlined:

• The backlog for neurodiversity assessments for children was challenging due to the increase in referrals, capacity being overwhelmed, workforce recruitment and retention issues and insufficient funding to meet demand.
• Pilot programmes and initiatives were ongoing to address the children’s neurodiversity assessment back log.  This involved looking at where support could be provided without the need for formal assessment and diagnosis. However, Members queried whether this approach would restrict access to specific support and funding streams that are linked to a diagnosis. Given the Board’s specific interest in this area, the Chair requested that a short briefing paper be provided to Board Members setting out the current scale of the challenge and the actions being taken to try and address this.
• In terms of complex rehabilitation needs, it was highlighted that multiple agencies are often utilised for rehabilitation needs and so a new model of home first or community care was being developed through the Leeds and York Partnerships NHS Foundation Trust with the investment secured for mental illness and learning disabilities for West Yorkshire.
• For people living with learning disabilities and/or neurodiversity the aim is to provide support in the least restrictive environment, which was usually at home. For more extreme cases, Members were assured that current data modelling showed sufficient capacity in hospital beds and that improvements to community provisions would help increase capacity levels even further.
• Complex rehabilitation services were partnered with the third sector, providing complex care packages, including occupational therapy, varied visiting times and assistance for normal life activities as part of the offer. The Community Mental Health Team would then assist once a patient was home.
• People could be self-referred or referred by others to the Community Mental Health Hubs, with response times aiming to be within 5 days.
• Addressing mental health issues for university students was largely done through the Leeds Student Medical Practice in partnership with the Universities and the NHS to tailor care to this specific demographic.
• It was acknowledged that crisis service performance data was not meeting expected or desired targets, which was largely due to workforce recruitment and retention issues.
• A 90-day learning cycle through the Leeds and York Partnership Foundation Trust had made up part of the transformation consultation process. The results were noted to be mixed due the short time scale and ambitious model; it had provided insight into key worker roles, workforce principles and culture changes.  Development of the model also included feedback gathered through Local Care Partnerships.
• The Leeds Involving People organisation ran a working reference group which encouraged lived experiences and was comprised of specialists from across the services to address barriers to access for people from different backgrounds.
• It was noted that 80% to 90% of mental health issues were created within communities and so health services alone cannot solve all mental health problems.
• Inadequate housing and exposure to poor social conditions and anti-social behaviour were noted to be common factors linked to people’s mental health and wellbeing.  Linked to Priority 1 of the Strategy, it was acknowledged that early intervention and preventive measures linked to these factors would have greater lasting impacts and therefore requires investment in local authority core services too.
• Measures for diverting situational mental health issues, leading people to use more adept services were outlined as social prescribing, encouraging good workplace practises and support and reducing inequalities, with specific links made to the Marmot City work.
• Staff shortages were noted across all professional groups. However, there was an aim to reduce spending on agency staff and increase the bank of permanent staff within the system. In terms of funding staff pay increases, it was noted that this would generally need to be found within the service.
• The workforce plans to address low recruitment and retention were outlined, which included the ‘refer a friend’ scheme; maximising the Apprenticeship Levy; and running recruitment campaigns; all of which had amounted to some success and remain ongoing. It was noted that international recruitment had not been overly successful for mental health service providers.
• Importance was placed on GPs having up-to-date and accurate information surrounding existing demand pressures and waiting times.  Work was therefore underway to improve communications with GPs so that they are better informed and can consider the range of options available when considering referrals.
• Members sought further information on the evaluation framework linked to the grant allocations set out in appendix B of the report.
• Members outlined the need for expanded agency involvement within mental health services to support people through accessing Universal Credit and food banks.
• Areas of deprivation had poorer mental health outcomes and the impact of inadequate housing and exposure to alcohol and addiction therefore need to be addressed. The approach of medicalising mental health issues in most instances may not be effective if other protective factors are not also implemented. Societal impacts can undermine mental health services and open, lived experience conversations can improve the wider response to the increasing poor mental health problems in the population.
• As Local Authority services are based on an individual’s address and patient services are linked to their registered GP address, Members highlighted that this can sometimes lead to difficulties for those people who require cross boundary service provisions and therefore emphasised the importance of collaborative working across the region.

In conclusion, the Chair provided a brief recap in terms of the additional information requested by Members and thanked everyone for their valuable contribution to the Board’s discussion.

RESOLVED – That the report, along with Members comments and information requests, be noted.