A few days in Nottingham…

Michael Pearce's picture

At the Faculty of Old Age Psychiatry Conference in Nottingham last week, 2 sustainability scholars set up a stand on sustainability in mental healthcare.

We presented a poster looking at the concept of sustainability in mental healthcare and introducing what the 4 scholars are doing.

We also presented posters on some of Dr Daniel Maughan’s work on reducing the financial and carbon costs of depot prescribing, and a trust sustainability survey, highlighting the variations in sustainable practice.

There was interest in the Occasional Paper 97 - Sustainability in Psychiatry, and delegates were able to look through copies. In addition delegates were able to sign up to Psych Susnet.

We also highlighted the 4 principles of sustainable healthcare and the position statement on sustainability in mental healthcare which can be seen here:  http://networks.sustainablehealthcare.org.uk/networks/psych-susnet/position-statement-sustainability-mental-health-care

The conference itself had interesting speakers and themes, many of which aligned with the sustainability agenda. For example the CEO of NAViGO Health and Social Care CIC (a not for profit social enterpise running all local mental health services in North East Lincolnshire) opened a debate about how revolution in older peoples mental health is the only way forward to confront the challenges of an ageing population and increasing resource constraints.

Overall a successful trip to Nottingham!

Comments

Revolution in older people's mental health

Frances Mortimer's picture

Hi Mike,

sounds like a good conference on Old Age Psychiatry. I'm interested in the debate you mentioned, opened by the NAViGO CEO. What sort of "revolution in older people's mental health" was proposed, and what were the reactions?

Frances (CSH Medical Director)

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Great question Frances,

Michael Pearce's picture

Great question Frances,

Yes it was a lively debate entitled: 'Care and Older Peoples Mental Health. Revolution is the only way forward'. The NAViGO CEO was proposer, citing examples of the NAViGO initiative itself and challanging the audience to imagine the possibilities of a social supermarket, whereby socially isolated older people who may otherwise be in traditional care homes, might teach skills such as healthy cooking to younger disadvantaged or mentally ill people, thus generating a social environment/network, a transfer of skills, a sense of worth, a resilient community, health promotion etc etc.

The opposer was a consultant looking at development of current services, ie. evolution rather than revolution.

Interestingly the audience was against revolution prior to the debate, but afterwards the majority had swung in favour of the revolution!

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Social supermarket

Frances Mortimer's picture

Interesting! Does NAViGO already run a "social supermarket" for older people then? How would it interface with more traditional services, or would it replace them?

Frances

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reply

Michael Pearce's picture

I'm not entirely sure if the 'community supermarket' is theoretical or if they have actually put something similar into practice. It would be great to find out because if so it could act as a blueprint. The idea could first be as a supplement to provide alternative income and be an innovative way to promote healthy communities. Perhaps this could then be expanded to somehow replace certain services...

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Revolution - and community supermarkets

Kevin Bond's picture
Without too much detail I proposed broadly two things -   Organisations that are fully geared to concentrate on the needs of vulnerable groups of people. We know MH and LD and I suspect older people with complex needs fare badly in generic systems where everything (cancer, GP, diabetes, A+E etc, trumps the complex needs of such groups. Organisations that can pose and enable any solutions to the major issues and support needs of such folk. Where health, social care, education, support are simply not concepts for boundaries. Where what works is simply the focus. Navigo is somewhere along that continuum and gains mostly great results. Providing health, social care, employment, training, accommodation and many other things either ourselves of via others (but with us taking responsibility). We will happily do anything that works. If isolation is a key issue for older people (and it is) then lets ensure our whole system is geared to provide opportunities to alleviate this. We do not have a community supermarket yet, we do have a fully commercial garden centre and it increasingly provides community presence, jobs, protected training, education, social supports etc. The community supermarket idea goes further alongside other services to trade direct with the community, provide community support without stigma and meet many problems in diet and habit in long term illness without overly clinicalising. Also creates a community cohesion, you invest here profits go to helping your community. Such schemes try to address the appalling situation of long term mental health and early mortality from preventable illness. Teaching people to use food, changing habits and subsidising from profit of trading with the rest of us meeting our needs, healthier diets for a period early in care. They would also make a real difference to isolation, without the unwitting possible demeaning of people by giving charity in 'come and receive' models that ask nothing in return. Or am I just beholding?   Complex topic happy to discuss further/debate as this does not do it full justice. But connecting people back to their organisations and their needs is vital. Our membership is staff, people who use services and carers all with equal voting rights.   The other part is being able to do new models as present ones don't work well. Care 'homes', standard DGH units for delirium where independence is lost etc. Such orgs can and do think differently whilst having the clinical skills to do so safely. Home from home our scheme with the DGH inreach outreach covering the whole acute phase back to home is one example. Relatives get to stay and be admitted, same staff do acute community and beds, staff a mix of MH, physical etc, social needs met directly all contribute to great results. There are many more.   Finally cant resist it - scrap this daft expensive and crazy system of commissioning where contracts are abused and huge amounts of money is wasted in bureaucracy!   Enjoyed the chat and welcome a chance for a longer more in depth one. Psychiatrists really need to get together more and offer more powerful solutions to an MH world that is floundering a bit at present.   We haven't finished the revolution comrades! Kevin Bond Chief Executive   NAViGO Health and Social Care CIC
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inspiring stuff

Michael Pearce's picture

inspiring stuff, really does embody the idea of social sustainability. Thanks for clarifying the details for us Kevin

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The revolution-evolution spectrum

Arif Ahmed's picture

That debate at the conference sounds like it would have stirred up a few delegates!

I agree with your comments Kevin about psychiatrists needing to be more involved and thinking more broadly and into the future. This scholarship has certainly given me that opportunity and it would be nice to see some CCG's being more brave and diverting funds to involve such community collaborations (power to the people!). However, I don't believe there is a 'one size fits all' and see this debate as a useful reflection for people to see what would best work for their local population on the spectrum of revolution-evolution - I don't think it need be one or the other. I do agree though, that the current trend has been too far towards evolution with an 'innovative' label - we really do need to harness the potential which exists in our communities, which I believe is in heart of all the four principles of sustainable mental health. It is really a sad state of affairs when you reflect upon statistics such as these: http://www.ageuk.org.uk/health-wellbeing/relationships-and-family/befriending-services-combating-loneliness/

  • Around 1 million older people often go an entire month without speaking to anyone
  • 1 in 10 people aged 65 or over say they are always or often feel lonely
  • Half of all older people consider the television their main form of company
 
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Mike - I'm glad the

Suhana Ahmed's picture

Mike - I'm glad the conference went well. I think it was a great idea to present there given the challenges facing old age psychiatry with the increasing older population. I worked as an SHO in old age psych 5 years ago and am now working there again and amazed at how the referral rate has gone up. It will only continue to do so.

Kevin - i think your ideas discussed are really interesting. I think social isolation is an increasing problem in the old age population - I now see more and more people who clinic who have very little social contact and barely see their family. I did see someone yesterday who has close involvement from the Salvation Army/Church who provide her with much needed social support, activities, help her to appointments, and essentially are a surrogate family. I think without them she would not be living independently. We need to be providing more holsitic care to meet people's individual need if we want sustainability of services.

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reply to arif

Kevin Bond's picture

Arif

Glad we are mostly on same page I think.

Only area is that I suspect services get much more innovative when they truly involve and feel responsible to people who use them. That I think is where the NHS is going horribly wrong now (much as I love it and the ethos), many people running it are dancing to some strange tune that no longer seems to have people at its centre. Isolation is one of the biggest if not the biggest determinant of older people being in hospital i understand, so lets really do something about that and redesign other things to fit about it.

Love the debate though

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sustainable communities

Oliver Bashford's picture

Thanks Kevin, I enjoyed the debate at the conference and love what I hear about NAViGO. Have you any plans to branch out to other parts of the country?

A little while ago I met a lady in her 60s who told me that she and a group of friends were planning to sell their respective homes and club together to buy a disused hotel or care home, do it up and then grow old looking after one-another in a sort of anarchist commune for the elderly.  This perhaps illustrates a long-term and sustainable approach to community building that would reduce the need for social care. The question of course is how to bring this kind of radical thinking out of the far fringes and into the consciousnsess of the mainstream...

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Sustainable communities

Kevin Bond's picture

Had heard of something similar, wonderful. Not met many people who want to spend their later years in present options for 'care homes', this idea sounds great, really something. Would love to get alongside something where we were direct employees/ resource to the people. Wonderful.

whilst navigo is naturally an ongoing concept, it is often abused by commissioners who I think would wish to be in control rather than the membership (people who use it and staff). They therefore very disproportionately denuded it of funds. The more that we earn direct the more they have taken. This I think is the only flaw, generic commissioning does not treat vulnerable groups or the organisations that serve them well.

navigo is mostly a local service for local people, controlled by local people, this is its strength. If it went seeking contracts all over that would probably damage it.

 

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