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Supporting community resilience and recovery: acting early to prevent people reaching mental health crisis point

Glen Monks Associate Director for Mental Health & Dr Fiona Butler Chair spoke at West London CCG at today’s Improving Mental Health Crisis Care conference on:

• acting early to prevent people reaching crisis point
• enabling people to recognize and respond to a crisis before it happens
• our experience of co-producing a community living well service in North West London


Supporting Resilience & Recovery: “the best crisis is an avoided crisis”.

The focus since the launch of the NSF has rightly been on providing high quality crisis resolution and home treatment services; responsive and flexible. This focus is re-emphasized in the Crisis Concordat (HM Government, February 2014) but crucially alongside a ‘whole pathway’ view that encourages Commissioners and Providers to look at the quality and availability of services that might better prevent crises occurring, and better support an enduring transition back into the community should a crisis episode have been unavoidable. 

North West London is one of 14 areas nationally to be identified as a ‘Whole Systems’ Pioneer by the Department of Health, which seeks to promote integrated care through innovation beyond existing service and agency boundaries. Within this, the Long-Term Mental Health Needs programme, agreed in January 2014, has provided a framework for innovative co-production to examine the needs of those with a long-term serious mental health issue on a population rather than referral/assessment basis.

In West London CCG there are almost 3,500 such services users registered and engaged by GP practices, 1,546 of who received care from the specialist mental health Trust in the last year. The remainder, just under 2,000, are cared for by GPs only. Pathway mapping of 438 patients, randomly selected from across the CCG, together with qualitative interviews and co-production workshops has identified a significant gap in the range of services provided to those attempting to ‘stay well’ in the community who are currently out of secondary care, and a need to bolster the availability of recovery-focused services available to those in secondary care in non-acute services. Additionally, GPs, service users and carers also need to be able to call on ‘navigator’ input, community-based, to support the development and delivery of appropriate, relevant and timely support packages, acting with ‘due vigilance’

The need for bio-psycho-social services at all stages of the pathway is underlined. Within this, ‘social health’ factors such as employment, secure housing, benefits advice, activities, social networks, relationships and a sense of hope and well-being may well be over-riding in ‘staying well’. Their absence was often felt to result in poor compliance to physical and psychological treatments, which in turn may lead to exacerbation of symptoms and crisis escalation. Co-Production was confirmed not only as the vehicle for best developing services but also the principles to be lived out in the new service ‘credo’, or ethos. 

At the Business Case stage, the presenters would like to share the journey to date, the emerging model of care, and reflect with delegates on this and next steps. 

The full presentation is available for download at the end of this page. 

Glen Monks has over two decades of experience as senior manager and director in the NHS, Local Government, Civil Service and Voluntary Sector, with experience gained at international, national, regional and local levels.  Glen has worked in mental health, substance misuse, HIV and community health fields in the UK, on overseas aid projects in North and East Africa, and in higher education. An expert in multi-agency partnership development, he has worked at Board level since 1999 in a variety of contexts: national and local policy and strategy, PCT/LA commissioner, establishing and heading up the regional office of the National Treatment Agency, NHS operations director and deputy executive director of strategy, performance and business development. 

Glen has an MSc in Public Health and a PGCE in Adult Education & Training both at distinction level. Since forming his own company in 2012 he has supported a number of public services with consultancy. Amongst these, he was Co-Director of the UK’s first CCG GP Mental Health Leadership Programme run for NHS London and its 33 CCGs in 2013. He led the Mental Health Strategy & Transformation programme across the 8 CCGs covering North West London, 2013-15, with a key focus on the redesign of Urgent Care services across the system. He is currently working as Associate Director for Mental Health at West London CCG.

Fiona Butler has been a GP principal in a large training practice on the Earls Court and Chelsea border for the past 15 years.  She is the CCG’s clinical lead for mental health, social inclusion and the Out of Hospital strategy.  Through this, Fiona is responsible for developing more integrated services as part of the Whole Systems Integrated Care programme.  This will deliver real change and improvements in services for patients, as health, social and charity/ voluntary sector providers collaborate to support patients with complex needs. 

Fiona’s leadership in mental health commissioning has overseen improvements in safer discharge, increased access to psychological therapies, enhanced Primary Care Mental Health Services enabling people to be treated at or closer to home and the development of the Mental Health Urgent Care Assessment pathway for North West London. 

Fiona chairs West London CCG which is made up of 55 GP member practices; serving a registered patient population of 229,000. The CCG has one of the highest prevalence of serious and enduring mental illness in the country and over 60% of this population are cared for solely in primary care. Fiona works across the system chairing the multi agency North West London Mental Health & Wellbeing Transformation Board which serves a population of 2m; an estimated 250,000 people have a common mental health condition, over 30,000 have a serious mental illness and 16,000 a dementia.

Future events of interest:

Smoking Cessation in Mental Health
Monday 11 May 2015 
Hallam Conference Centre, London

Information Governance in Mental Health: Implementing Caldicott2 & the New Code of Practice on Confidential Information
Monday 11 May 2015 
Hallam Conference Centre, London

Stronger Code: Better Care Implementing the Changes to the Mental Health Act Code of Practice
Tuesday 12 May 2015 
Hallam Conference Centre, London

Masterclass: The Mental Capacity Act and Advance Decisions
Wednesday 13 May 2015 
Hallam Conference Centre, London

Improving the Quality of Perinatal Mental Health Services
Tuesday 19 May 2015 
Hallam Conference Centre, London

Improving Physical Health for People with Mental Health Conditions
Wednesday 20 May 2015 
Colmore Gate Conference Centre, Birmingham

Psychosis & Schizophrenia in Adults
Monday 8 June 2015 
Hallam Conference Centre, London

Foundation Certificate in Dementia: 2 Day Interactive Training Course
Monday 15 June 2015 — Tuesday 16 June 
Hallam Conference Centre, London

Psychological Therapies for Severe Mental Illness
Wednesday 1 July 2015 
ICO Conference Centre, London

Implementing the national objective to end Prone/Face Down Restraint: Examining Restraint Positions in Practice
Tuesday 22 September 2015 
ICO Conference Centre, London

Download: Glen Monks & Dr Fiona Butler full presentation

30 April 2015


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