Agenda item

Jill Britten, Public Health, and Sue Hogarth, Strategy and Commissioning Public Health were in attendance, and made a presentation to the Committee, copy interleaved

During consideration of the presentation the following main points were made –

·         Islington has one of the highest level of mental health needs in the country, and this is reflected in high levels of diagnosed conditions. Almost one in six adults in Islington are diagnosed with a common mental health illness and women accounted for 61% of diagnoses. Middle aged adults are more likely to have a common mental illness and white British and white Irish followed by White and Black Caribbean ethnic groups have a higher prevalence compared to the Islington average. Islington has a higher prevalence of serious mental illness (SMI) (2018) figures, than London and England. Black and mixed ethnic white ethnic/black Caribbean ethnic groups have the highest prevalence of SMI. All groups experience mental health conditions, but prevalence rise significantly in groups experiencing deprivation, disadvantage and discrimination

·         Impact of COVID 19 on mental health and wellbeing has affected all ages and will continue to do so, some issues apply to all ages, and those with drug and alcohol issues. Large national surveys have found higher numbers of people experiencing anxiety and depression and social isolation is more widespread

·         Modelling and needs assessment – young people are worried about education, finances and future. Parents are concerned about children’s mental health and wellbeing and women more worried than men. More BAME residents reported worries about COVID 19, and people not in paid work have poorer mental health than the full time employed. Mental health had deteriorated somewhat for LGBTQ residents, and there was a gap in services for people with learning disabilities. Unpaid carers have suffered anxiety about loss of available support. People who have had severe COVID 19 are at risk of anxiety and depression, especially health care professionals

·         Many Islington residents have tried to adapt to cope with the pandemic most commonly by spending more time with family and friends. For those who need further help there are many services and community support structures for example SHINE, Parks for Help, Financial and Debt advice, in work support, food provision, social and community assistance, healthcare services, and psychology groups

·         Additional activities as a result of the pandemic included – ensuring that the Council has a good understanding of the issues, ensuring a system wide strategic response, service and training developments, children, young people and families

·         Clinical support changes at early stage of pandemic – NCL CCG worked to bring forward Crisis Team expansion, acute hospital psychiatric liaison, home treatment and community response, resulting in 24/7 crisis cover across NCL

Specialist services and teams who can respond in a crisis. Increased support for young people with autism/Learning Difficulties and challenging behaviour. Increased support with schools, bereavement, mental health, first aid training for CYP workforce. As with all services there was an expansion of remote working and digital solutions, but continuation with face to face services for the most at risk or excluded. KOOTH mental health app has seen increased take up

Crisis services changed considerably as there was a strong desire to reduce A&E attendance, a new urgent care Assessment and Treatment centre opened at St.Pancras to relieve A&E departments, crisis recovery teams increased capacity to treat more people at home, i COPE changed to remote working and introducing 30 minute emotional well-being sessions for all new referrals within 48 hours of referral. Also i COPE offering 3 session short treatment for COVID psychological distress and bereavement and LBI also increases its VCS bereavement offer to match this. Community based services such as Islington MIND moved to remote working offering telephone and video chat support etc.

·         Most services adapted to offer their interventions remotely or provide a mixed model. Some people preferred this however some services have reopened buildings, with social distancing in place

·         Practice based mental health provided by Camden and Islington – a team of consultants, nurses and psychologists that work alongside GP’s and other primary care health professionals within practices. Offers mental health expertise, advice, training and consultation to GP’s, and practice staff and sees patients for comprehensive medical assessment. Practice based mental health referrals have returned to pre-COVID levels

·         i COPE – Offers mainly cognitive behavioural therapy for a range of common mental health problems, alongside adapted therapy options for people living with long term physical health conditions or medically unexplained symptoms. The service has seen an increase in clinical complexity or people

·         Crisis teams provided by Camden and Islington – teams operate 24/7 and undertake rapid assessment in the community for urgent and emergency referrals, and support crises at home. Black communities and White Irish people are likely to be seen in crisis than other ethnic groups, and this links to over representation in secondary care bed use amongst these groups. In response to a question as to why White Irish were over represented it was stated that this could be generational and linked to social isolation issues

·         In response to a statement that many BAME residents did not want to admit to mental health problems due to stigma in the community it was stated that work is taking place with community organisations to support counselling, including language counselling, around mental health and work is also taking place with Healthwatch in this regard. The Mental Health Transformation programme would also address this

·         Islington Recovery Pathway provided by Islington MIND – Islington’s main VCS mental health services operating in 3 locations across the borough. The services provide a range of practical and emotional support. Overall the number of people engaged with the service has increased, however new referrals are generally lower than pre-pandemic levels with the exception of LGBTQ residents

·         Enhanced bereavement support – bereavement support training for services engaging with the Public, and increased capacity from existing counselling/bereavement providers. Bereavement service provided by the Accept service offers up to 10 weeks support for adults living in Islington and/or registered with a GP in Islington. This service is important for people who have experienced the death of a family member, relative or another important person in their life

·         Public Health England Prevention and Promotion fund for better mental health forms part of the Government’s Mental Health Action recovery plan 2021/22 to ensure the mental health aspects of COVID are rapidly addressed and allocated to top 40 most deprived boroughs. There is a long list of criteria as to what and what cannot be funded, and money needs to be spent and outcomes delivered in this financial year

·         Drawing on the rapid needs assessment and overview of service patterns and needs, investment through this grant was targeted to younger age groups, and addressing protective and risk factors for adults, both with a cross cutting focus on Black Asian and other ethnic minority communities

·         A Member stated that she felt the term well-being service was beneficial to young people due to the stigma around mental health. Noted that funding was available for looking at behavioural issues in schools

·         The view was expressed that there needed to be improved signposting of services on the website and it was stated that this was being addressed in order to provide a more streamlined version with better signposting to services

·         A Member referred to the a recent issue that had been raised in relation to CAMHS services in some schools not being given a link person, and it was stated that this would be investigated

·         Reference was made to some cases where care in the community did not appear to be working satisfactorily, and whilst care in the community generally worked well, there was some isolated case where residents with mental health problems were causing distress to neighbours. It was stated that if these cases were reported to Public Health following the meeting the issues could be investigated. It was noted that  a secure, safe environment to live was a prerequisite for a person with mental health issues

RESOLVED:

(a)  That the scrutiny initiation document  be approved, subject to the addition of the words ‘ Progress on the recommendations of the Health Inequalities Public Health report 2019/20, in the scope of the review

(b)  That Councillor Kay be informed of the situation regarding CAMHS services in schools referred to above

The Chair thanked Jill Britten and Sue Hogarth for their presentation