Agenda item

The SCCG Mental Health strategy was requested at the last meeting with specific reference to the ongoing review into ‘Access to Health Services in Southwark’ and the reported increase in the number of people with Mental Health issues going to A & E and the accessibility of primary care & other relevant services.

5.1  The chair announced that this agenda item and the next two items would be taken together and invited everybody to introduce themselves: Gwen Kennedy, Director of Client Group Commissioning (CCG); Dr Roger Durston, GP Clinical Lead for Mental Health CCG; Harjinder Bahra, Equality and Human Rights Manager CCG; Juney Muhammad, SLaM and local Pastors Jonna Bish, Jacqueline Best – Vassell and Janet Kotoka.

5.2  The chair invited Gwen Kennedy to do a short presentation. She reported that data showed that people with psychosis from BME communities tend to be admitted later, often in crisis and with more complex needs; moreover there is a higher frequency of people being admitted through a Section or via the judicial system. The CCG draft strategy highlighted that better data is needed and will be gathered. She said that one issue is the stigma of mental health and that there is a need to look at the range of risk factors, as well as models for recovery and early intervention. She reported that the CCG are on a trajectory to agreeing a joint strategy for Mental Health. She added that there are significant financial factors driving the need to make better use of resources, including a growing and older population. She ended by commenting that the BME church pilot is very encouraged.

5.3  Harjinder Bahra explained that he is working nationally to reduce stigma around Mental Health, particularly with Sikh and Muslim communities. He explained that the pilot Black Majority Churches  programme is a cutting edge project in London and that Juney Mohammad and  delegates from the churches will speak about how participating in the course has increased their awareness and made a difference .

5.4  Juney Muhammad commented they the Black Community is often referred to as hard to reach, however often people find services inaccessible. She added that people’s experiences are often difficult and challenging. She referred to Black History Month and the stories of people escaping from slavery and its impact in mental health. She said it is important to acknowledge the traumatic consequences this legacy held for many.

5.1  Juney Mohammad explained that in some communities medicine is seen as oppressive. She emphasized that people from BME communities with psychosis are much more likely to enter the system through coercive means. She referred to deaths in custody and reported that there are high levels of fear. She went on to explain that the programme facilitates difficult conversations about stigma, engagement and people’s experience of duress – for example the course explores concerns around ‘Sectioning.’ Participants are also taught how to recognise signs of distress and there is an emphasis on mental health literacy. She reported that there is under-detection of mental health problems and events to reduce stigma can help. Once completed the participants are clearer where they can help people to access help, for example referral to GPs. She said that some of the course outcomes are about safeguarding. The Victoria Climbe case highlighted that certain beliefs can cause a great deal of harm, for example cultural views about possession.

5.2  She reported that some of the conversations are to do with why people see things differently. The course involves people from a range of religions, including Buddhist and Rastafarian, and that participants are engaged around spirituality, rather than religion. The centrality of faith also allows the people to go beyond prayer - and move to pastoral care.

5.3  The Black Majority Church delegates, local Pastors Jonna Bish, Jacqueline Best – Vassell and Janet Kotoka, then gave evidence.

5.4  .The first delegate commented that she works for SLaM but coming from a faith perspective and participating in the course as a pastor was completely different. She explained that the course allows church leaders to offer and promote primary care as the training enables pastors to improve their ability to support and signpost people. She said that people are now much more open and reported that a new Ministry was born of this training. A member asked if this was just to the congregation and the delegate emphasized that the Ministry had an outward focus and goes out to the community and includes a Food Bank. She said that this is reflected in the name; the Ministry is called ‘Reach’.

5.5  Members enquired why they thought there was a need for more training and delegates said that one reason was the cultural norm around not airing dirty laundry in public – the ethos can be ‘don't talk, just pray’. They reported that the course allows participants to talk about the issues. A member asked if the emphasis was now on praying and talking and if there had been any assessment of the impact. A delegate responded that the course has been an eye opener and agreed that there is a culture where people are very reluctant to disclose sensitive issues, and confidentially is highly maintained. She explained one of the outcomes has been having an on -call minister; who will contact people who have withdrawn, to establish contact. She added that people are now encouraged to see GPs and refer on appropriately. She emphasized the importance of addressing spiritual sides before anything else.

5.6  Juney Muhammad commented that this is a ten week course, done on a volunteer basis, and then the learning is taken out into the church and community, rather than a professional course with high levels of capacity to measure the impact. Another delegate agreed and said that it increases the ability to recognise the signs and symptoms, to deal with services and effectively sign-post.

5.7  A member asked about the physical health needs of people with mental health problems, and if these were also addressed and commented that it has been reported that one police officer on every shift is needed to deal with people in mental health crisis. Gwen Kennedy reported that when anybody comes to a GP with a mental health problem the CCG is encouraging doctors to undertake an assessment of physical health, so that body, mind and general wellbeing are considered together. She added that the course looks at the whole person. Harjinder Bahracommented that the course promotes early intervention,  signposting and looking at   underlying issues - going to a doctor can help address all health issues.

5.8   Dr Roger Durston explained that records are kept of all people with mental health needs and there is targeted promotion of the health test with at risk populations. He pointed out that there is a drop in life expectancy of ten years from Dulwich to Camberwell and a drop of another ten years for people with mental health problems.

5.9  A member returned to the question about police time and asked if an investment in this course would lead to less police time being spent on people in mental health crisis. Juney Muhammad responded that police have introduced new processes whereby they record the how much time they are spending on different types of incidences and she thought that this question around the value of preventative work is very pertinent. Gwen Kennedy said that she thought the plan for early intervention would ensure that there are less people ending up in a very disturbed state and at A & E.

5.10  A member commented that he thought it was very exciting to see this soft approach and asked the delegates if this programme could reach more people. The delegates responded positively and explained that they will be working with families to enable people in distress to be better supported and that churches are also making contacts with the police.

5.11  A member asked if officers thought it was better to have separate services or if one size fits all. Gwen Kennedy responded that the CCG aim to ensure that services are as integrated as possible and that the mainstream health services are accessible as possible. However, she added, sometimes there is also a need for specialist services - whilst progress is being made on making mainstream services more accessible. She ended by saying that given there are more constrained resources there are more limitations on the ability to provide tailored services but the CCG are commissioning for what works, and this will include targeted programmes.

5.12  The chair and committee thanked the officers and pastors for their time and a very worthwhile presentation.