Agenda item

Report of the Corporate Director of Adult and Health Services and the Director of Public Health, Durham County Council.

The Board received a report and update presentation from the Corporate Director of Adult and Health Services and Director of Public Health, presented by the Public Health Strategic Manager, Jane Sunter, Public Health Advanced Practitioner, Yusef Meah and the Associate

Director - MH/LD Partnerships and Strategy, Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV), Jo Murray on the Mental Health Strategic Partnership (MHSP) Plan (for copy see file of minutes).

The Public Health Strategic Manager noted that the MHSP Plan had been reported at the Health and Wellbeing Board previously, and that the plan had been agreed by the MHSP Board.  As part of an interactive poll, Members of the Board were asked to think of a word that came to mind when thinking about a time they felt their life was at a low, responses included: bereavement, divorce, stress, anxious, sadness, menopause, lonely, financial pressure, and family pressure.  The Board were asked to think of a word that came to mind when thinking about what things helped in terms of mental health resilience, responses included: family, exercise, friends, nature, purpose, holidays, fitness and walking.  The Public Health Advanced Practitioner thanked the Board for their responses and noted that it was important to understand the impact of low-level mental health challenges and what in our lives helped to build resilience and strength, and to provide opportunities to help contribute to others health and wellbeing. 

The Public Health Strategic Manager explained that this exercise helped to illustrate that broader population mental health and wellbeing is not just about services for those with severe mental health issues.  She explained the importance of data in helping to identify issues, noting the use of a Mental Health Dashboard, using Power BI, and reminded Members of the five priority areas: children and young people; suicide prevention; urgent care; dementia; and the resilient communities group.  The Public Health Strategic Manager noted that Mental Health Strategic Partners had co-produced delivery plans, and that an issue that had been highlighted was that of the benefits of physical activity on mental health.

The Associate Director - MH/LD Partnerships and Strategy, TEWV noted that she was the Co-Chair of the Strategic Board and explained as regards Community Mental Health Transformation work, including ensuring there was ‘no wrong door’ and that interventions were needs based.  She explained that the main issues that could lead to mental health issues remained similar to previously reported, namely: relationship breakdown; bereavement; financial issues; and housing issues.  She noted that there were many challenges, with mental health being a complex issue, and it was important that training in ‘making every contact count’ in respect of mental health issues was across all sectors and that expectations were managed.  She concluded by noting that the call to action was: ‘We will work together to make County Durham a place where Mental Health is a priority for all’.

The Chair thanked the Officers and asked the Board for their comments and questions.

P Sutton noted recent articles that had noted a trend in the UK, in contrast to wider Europe, that low-level mental health was often treated with medication, rather than looking at approaches to build resilience and asked if there was anything to consider from those articles and other approaches.  The Associate Director - MH/LD Partnerships and Strategy, TEWV noted that prescribing was part of the long-term work of the ICBs and that options other than medication would be looked at.  She noted public expectation in terms of prescribing of medication, and explained as regards local work to recruit a pharmacist to work between primary and secondary care She added that it may be useful to measure prescribing of medications, P Sutton agreed it could be useful in order to see any shift of the dial.  The Public Health Strategic Manager noted the work of the Mental Health Alliance in conversation with the community and voluntary sector (CVS), in relation to bereavement services, relationship and financial support, to help look at the underlying causes that could lead to mental health issues.  She added that ‘Wellbeing for Life’ was a service that offered opportunities to help improve behaviours, including self-help, as was not just for more severe mental health issues.

The Director of Public Health noted that it was not just about the services the NHS, Council and partners offered, it was linked to other health and wellbeing priorities, including healthy weight, smoking and alcohol, and how the strategies tackling those issues would also help in tackling low-level mental health issues.  She explained that it had been noted that mental health in general had declined since the pandemic and noted the very good work being carried out in schools.  She put the question, was the work at the right level and noted we would need to understand how the interface with other partners would work and to look at mental health at scale.

J Todd noted that where there were mental health teams within schools, TEWV had noted less referrals to them.  He noted that it was for the Health and Wellbeing Board to consider universalism in terms of broader wellbeing and for psychological therapy to be seen as core work for the Board.

The Corporate Director of Children and Young People’s Services, J Pearce noted that there was a balance and move to a diagnosis approach, but with an offer at scale in terms of mental health of children and young people.  He noted the impact of the pandemic on children and young people in terms of interaction with others, and that the impact was not necessarily a clinical mental health issue, but a system or societal issue.  He added that the Mental Health Teams within school had small resources and therefore there was a need for a push at a national level for greater resources as they have proven to be very effective in diverting and preventing mental health issues at a higher level.

Councillor R Bell asked as regards what support was available in schools to support children and young people’s mental health, and whether the support was the same within Local Authority controlled schools and Academies.  The Public Health Strategic Manager noted there were a number of approaches within schools in terms of maintaining the resilience of young people, as well as support within local communities.  She noted a range of offers included anti-stigma work, the 0-25 Family Health Service with their Emotional Resilience Nurses, as well as Community Champions.  She explained that it was important to get mental health on the agenda of all senior management within schools and that process was being reviewed.  The Public Health Strategic Manager noted that resilience in the local community was also important, with support for children and young people, as well as for parents.  She reiterated that co-production and helping to bolster autonomy within communities was important.  She added that it was also important to explain that low levels of stress and anxiety were normal, and to therefore help increase resilience through activities that individuals and families could undertake.

A Petty noted a lot of ongoing work in relation to ‘Right Care, Right Person’, and a reduction in demand upon Police time.  The Associate Director - MH/LD Partnerships and Strategy, TEWV noted that it was important to get it right in that regard, looking at any impact upon urgent care.  She noted the national programme and focus, with Durham Constabulary taking a pragmatic and cautious approach that was greatly welcomed.  She reminded the Board of the very good partnership with the Police and this and the excellent s136 response times were a solid start in this regard.  A Petty noted that in would be useful if this element was separate on any charts to ensure it was captured.  The Associate Director - MH/LD Partnerships and Strategy, TEWV noted that it was included within workplans.  The Corporate Director of Children and Young People’s Services noted there was a very positive approach in Durham and noted that at a recent LGA Roundtable event that there had been significant system impact, and some had noted a shift to the Ambulance Service where there had been Police efficiencies.  He noted it was therefore very important on how this issue was taken forward and to look at the data very carefully to balance any negative impacts in balancing Police efficiency and system impact.

Prof. C Clarke noted that the University worked very closely with health colleagues in respect of student’s mental health, with around 20,000 students within the city area.  She noted work had stepped up in terms of the support offered, with significant investment, and a ‘no wrong door’ approach from September 2023.  She noted the work of the University with the Council and that the University, as a large employer, also worked to look at the impact of mental health on staff.  She noted that while there was a great volume of research at the University, for example in terms of dementia care, she was not sure if the reporting lines to spread that information were as good as they could be.

The Head of Integrated Commissioning, Sarah Burns noted that County Durham, and the wider North East, had high prescribing levels and explained that the largest percentage of funding to the CVS was for first stage interventions.  She noted that she, with the Director of Integrated Community Services and Associate Director - MH/LD Partnerships and Strategy looked locally at the six Integrated Neighbourhood Teams within County Durham, with a first meeting with Teams being to look at mental health information sharing and how to understand needs within our population.  It was noted as regards the primary care network and research from the University and noted Integrated Neighbourhood Teams would be effective, but would need investment in terms of prevention, with CVS partners also being important in terms of prevention.

Resolved:

(i)     That the report be noted;

(ii)    That the progress of the development of the MHSP Plan was considered and noted;

(iii)   That the Health and Wellbeing Board endorse the new Mental Health Strategic Plan.