The Valentine’s Day Collaborative breakfast was a slightly quieter affair than January’s meeting, with everyone able to get a seat around Abbevilles’ table this time. However, there were some extremely important items on the agenda, including a substantial update from the Living Well Network Alliance and a discussion on suicide prevention in Lambeth

Living Well Network  Alliance

Neil Robertson introduced an update on the transformation work within the Living Well Network Alliance (the Alliance). He said the priority is to transform community services and reduce reliance on acute care, as well as addressing inequalities, especially for black people in Lambeth, who are over represented in services. He pointed to the Living Well Centre paper, which had been circulated, which provides more detail on proposals. Neil handed over to Sue Field, who talked through a presentation and discussed the proposed new community pathway.

• A borough based single point of access, which will allow people to be directed to the right place, first time.
• This will be a multi-disciplinary team of ‘trusted assessors’, meaning that services will not need to re-screen people for eligibility, therefore reducing the likelihood that people will bounce back and forth between services.
• A new crisis offer, which will include a mobile crisis response, an extension of the Sanctuary at Mosaic Clubhouse meaning that it will operate 7 days a week and a peer support line.
• The mobile response unit will be a group of nursing staff, which can go out to people in crisis within 4 hours and it was welcomed, and seen as vital that people can be visited in their own homes.
• Living Well Centres (LWCs) which will have an integrated offer from the voluntary sector, social care, nursing and people with lived experience of mental health issues.
• The LWCs will mirror the current Local Care Network localities (North, South East and South West).  The Alliance team is conscious of changes to these areas as more work is done in neighbourhoods, and will try to ensure work is aligned with these geographical changes in future.
• The LWCs will have an integrated front door function, which will offer short term support overseen by a consultant psychiatrist also working closely with primary care.
• There will also be an integrated focused support function, which will work with people with more medium to long-term needs, including those who  currently have a care coordinator.
• Sue also mentioned the importance of the wider range of services, which make up the Living Well Network and highlighted that communication between these services and the LWCs will be vital.
• She suggested that we need to learn more about what is going on in communities so that we are able to connect people to different offers and this will be part of the role of the outreach function.
• This will be a dedicated resource with voluntary sector expertise, which will focus on working with communities to build resilience, develop relationships and build up networks.
• Sue highlighted there will be an event in April to focus on the range of the Alliance’s transformation work.

There were a number of questions and discussion points following Sue’s presentation, including the following:

• How will people be followed up in the community after discharge? How will people be able to access services when they are feeling unwell again? Neil responded that there is a commitment within the Alliance that people go back to the team they are discharged from and who they are familiar with, rather than having to go around the system again.
• Could Healthlocker be used to better address problems  between different services?
• Need to ensure that IAPT (Improving Access to Psychological Therapy) is reflected in the community offer,  as well as the range of other front doors, including A&E.
• How will peer support function within the new model? Sue responded that work is being done on specification for peer support but this needs to run alongside, and be a key part of the offer. The ambition is to embed this throughout the service offers including LWCs, Sanctuary etc.
• There needs to be a focus on physical health. Neil suggested that SLaM and primary care are mandated to focus on this and SLaM are appointing community pharmacists to focus on medication issues. It was also discussed whether physical health screening clinics attached to the LWCs would be helpful? The issue around a lack of training in physical healthcare among both psychiatrists and nurses was also acknowledged. Need to get dual trained nurses or physical health nurses to support with this issue.
• How will we know that people ‘like’ the services that we are offering and are people getting better?

It was noted that July 2019 will mark the Alliance’s first year and we should use this to review progress.

Suicide Prevention

Stef Abrar opened a discussion on the important issue of Lambeth’s suicide prevention action plan for 2018/19 and beyond. She stressed that it is extremely important to consider what is to be done in the next year and vital to agree clear, identifiable goals. She talked through a presentation which highlighted a number of key points, including:

• On average, 25 people die from suicide in Lambeth each year, which is in line with the London rate.
• Nationally, two-thirds of people who complete suicide are not in touch with mental health services and 50% who attempt suicide do not seek help.
• Lambeth has higher levels of several risk factors for suicide and high risk groups include those who are vulnerable due to economic circumstances, children and young people, people who misuse substances, people in the care of mental health services and BME groups, migrants and asylum seekers.
• A Lambeth suicide prevention plan was agreed at June 2018 Health and Wellbeing Board and key elements of the plan included developing crisis offers – such as the Sanctuary and Solidarity in a Crisis, suicide prevention training for front line staff (STORM) and a dual diagnosis action plan.
• There were also a range of other elements including training through Mental Health First Aid, Samaritans signage at suicide hotspots and providing better bereavement resources.
• Stef outlined some of the key challenges for Lambeth before opening up the conversation around the action plan for 2019/20. Challenges included reducing the risk in men, reducing isolation and loneliness, engaging BAME communities, engaging young LGBTQ communities, getting regular, real-time suicide audit data and developing an offer for people with suicide ideation who do not have a plan.

There were a number of reflections:

• The challenges around dual diagnosis and eligibility criteria were acknowledged and it was agreed that this needed to be a focus for suicide prevention.
• Suggestion that there is a connection with the vulnerable people’s pathway, which involves another high risk group.
• There was a question about intention and what the figures were collecting. For example, assumed that the figures do not pick up people who choose not to take up services and slowly deteriorate, even though this is intentional self-harming behaviour.
• There was a question around whether we could we train parents and children more systematically, as we need to skill up people in the community, not just services.
• The issue of debt and warning letters sent from the Council to vulnerable people was raised, which provokes considerable anxiety in some people. It was suggested that the wording of this correspondence should be carefully considered.

It was agreed that the information from coroners/Coroner’s Courts is vital and data flows need to be sorted as a matter of urgency in order to better monitor this activity.

Other Updates                                       

Crisis Sanctuary

• Chris Thomas updated on the Sanctuary.
• Over the last month, there have been 106 attendances from 17 people, with 12 new referrals. The Sanctuary is aiming to help people to address crisis and then move on within 3 weeks.
• They are in the process of expanding the service to 7 days a week and therefore recruiting for additional staff.
• The expansion is designed to link in with the start of the mobile response unit.

Peer Support

• Karen Hooper updated that the Lambeth Peer Support Network (which has been meeting monthly) held a special reflection meeting on Monday 11 February and it is hoped that a later Collaborative Breakfast will focus on peer support when the group will feedback.

Black Thrive

• Harriet Ballantine updated on Black Thrive.
• There is an event focusing on Wellbeing Matters/prevention on 28 February at St Martins Community Centre, SW2 3QX – details were circulated.

SLaM Service User and Carer Advisory Group

• Alice Glover and members of the group updated on recent activities.
• They have been involved in the development of the new SLaM strategy and have been reflecting on the notion of right care at the right time – especially for inpatient care.
• They have also been involved in the Alliance’s acute working group.
• They have been working with Certitude, speaking to people in the organisation’s supported housing.
• There had also been reflections on the challenge around workforce in Lambeth, with a large number of bank workers being used and questions around skills and commitment in certain cases. Is there potential to think about workforce differently and use more peer support workers for example?

Next meeting Thursday 14 March, Abbevilles, 8-10am

Pictured Abbevilles workforce over the years with chef Luigi who left last month.