Daphne McKenna

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Workshop BPutting the SCIE Parental Mental
Health Child Welfare Guide recommendations into
practice in the London Boroughs of Lewisham
Southwark
Daphne McKenna Part-time Independent Reviewing
Officer, London Borough of Lewisham Chris
McCRee Community Manager Leading on Safeguarding,
Southwark Adult Mental Health, Children Families
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Putting the Guidance into Practice

• Different Approaches in Lewisham and Southwark
• Chris McCree
• Daphne McKenna

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Small group exercise

• Two groups
• Share first experience of your parents
  fallibility

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Lewisham

• 2001 census- Lewisham has a population of
  248,922. Its population is 66 White, 12 Black
  Caribbean, and 9 Black African. Fifty percent of
  households are owner-occupiers.
• Lewisham is ranked 39 out of 354 local
  authorities in England in terms of average
  deprivation. (Where 1 is most deprived).

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Southwark
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• Southwark is the 9th most deprived borough in
  England.
• 49 male, 51 female.
• Nearly half population from minority ethnic
  community.
• The largest BAME group are black or black British
  (25.9). 8 are black Caribbeans and 16.1 black
  Africans the largest black African community
  nationally.

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Lewisham and Mental Health

• Lewisham has significant rates of mental illness.
  Suicides contribute significantly to the number
  of premature deaths in the borough. The Mental
  Illness Needs Index 2000 (MINI 2K) score for
  Lewisham for schizophrenia and other psychoses is
  155. This score indicates that Lewisham has
  comparatively greater mental health needs than
  other PCT areas in the country.
• Lewisham borough has the eighth highest level of
  deprivation of all Primary Care Trusts/Local
  Authorities in the UK. There is evidence that
  those from a poorer background are more likely to
  suffer from a psychotic illness
• Lewisham has the fourth highest level of
  substance misuse of the six boroughs in the South
  East London Sector 5.7 people per 1,000
  residents aged between 15 and 44 were in drug
  treatment programmes in 2001-2002 (National Drug
  Treatment Monitoring System).

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Southwark and Mental Health

• The MINI 2000 score for Southwark is 2.32
• Severe and enduring mental illness
• General practice data for February 2006 shows
  that there are 2423 Southwark residents with
  severe long-term mental health problems who
  require and have agreed to regular follow-up.
  Many of these will have schizophrenia or bipolar
  depressive disorder. Schizophrenia is a severe
  and in many cases enduring mental illness.

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Mental Health Resources in Lewisham

• The inpatient mental health teams provide
  assessments of needs to people with severe and/or
  enduring mental health problems.
• Access to Community Mental Health services in
  Lewisham is via one of our three Community Mental
  Health teams. Northover, Southbrook and Speedwell
  community mental health teams The Community
  Mental Health teams are multi-disciplinary teams
  run jointly with the South London and Maudsley
  NHS Trust (SLAM) and consist of Psychiatrists,
  Social Workers, Community Psychiatric Nurses,
  Psychologists and Occupational Therapists

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Lewisham Services

• AE Psychiatric Liaison Service, Lewisham 
• Clare Ward - Lewisham Central and Eastern Sector 
  
• Community Forensic Services 
• Community Opportunities Service (Central
  Lewisham) 
• Community Opportunities Service (North Lewisham) 
  
• Community Opportunities Service (South Lewisham) 
  
• Deptford Primary Care Mental Health Team 
• Edward Street 
• Heather Close 
• Jigsaw 

• Johnson Unit 
• Ladywell Social Work Team 
• Lewisham Psychological Therapies Service -
  Secondary Care  
• Lewisham Psychological Therapies Services -
  Primary Care 
• Lewisham Residential Services Team 
• New Hope Project 
• Newstead Road 
• Northover CMHT 
• Powell Ward - Lewisham North Sector 
• Southbrook CMHT 
• Speedwell CMHT 
• Triage Ward 
• Wharton Ward - Lewisham South and South West
  Sector

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Voluntary sector provision in Lewisham

• A search of the internet for charitable
  organisations working with mental health issues
  in Lewisham revealed 54 entries

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Mental health Resources in Southwark

• The Southwark Directorate provides a
  comprehensive mental health service for adults of
  working age. There are 4 Locality Teams in
  Southwark these are East, West, St Giles and
  Lordship Lane. The teams are fully integrated
  with Southwark Social Services.

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Southwark Services

• Occupational Therapy services Adult Acute
  Inpatient and Crisis Services, Southwark-
  Maudsley Hospital 
• Peckham Befrienders Project 
• Psychological Medicine - Liaison Team Guys
  Hospital 
• Psychological Medicine - Liaison Team Kings
  College Hospital 
• Ruskin Ward 
• Southwark Community Forensic Team 
• Southwark Community Outreach Team (SCOT) 
• Southwark Psychological Therapies Service  
• Southwark Section 136 Suite 
• Southwark Vocational Team 
• Southwark Welfare Benefits Team 
• Southwark Wellbeing Workshops 
• St Giles Locality - Assessment and Brief
  Treatment Team 1 
• St Giles Locality - Assessment and Brief
  Treatment Team 2 
• St Giles Locality - Support and Recovery Team 1 
• St Giles Locality - Support and Recovery Team 2 
• START Team (Outreach Service for homeless
  people) 
• STEP Southwark team for early intervention in
  psychosis  
• Traumatic Stress Service 

• Cambridge House Advocacy (Mental Health) 
• Cares of Life Services 
• Clinical Decision Unit - ES2 
• Clinical Decision Unit - JBU 
• Community Link Centre 
• Co-ordinated Psychological Treatment Service  
• CREST - North Southwark Home Treatment Team 
• CREST - South Southwark Home Treatment Team 
• DB2 Ward 
• ES1 Ward - Psychiatric Intensive Care Unit 
• ES2 Ward 
• High Support Team 
• Intensive Psychological Treatment Services  
• Jim Birley Unit  
• John Dickson Ward 
• Lordship Lane Locality - Assessment and Brief
  Treatment Team 
• Lordship Lane Locality - Support and Recovery
  Team 
• Mental Health Liaison Team 
• North East Locality - Assessment and Brief
  Treatment Team 

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Southwark Voluntary sector

• A search of the internet for charitable
  organisations working with mental health issues
  in Southwark revealed 87 entries

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The Guidance- a summary

• Screening
• Ensure screening systems routinely and reliably
  identify and record information
• about adults with mental health problems who are
  also parents.
• Assessment
• All organisations need to adapt existing
  assessment and recording processes
• to take account of the whole family and train
  staff in their use.
• Planning care
• Care planning needs to take a holistic approach
  to include appropriate care
• plans for each individual family member as well
  as the family as a whole and in
• doing so staff should aim to increase resilience
  and reduce stressors.
• Providing care
• Commissioning, funding and management processes
  should ensure that they
• address and meet the full spectrum of needs of
  parents with mental health
• problems and their children.
• Continued..

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continued

• Providing care
• Commissioning, funding and management processes
  should ensure that they
• Address and meet the full spectrum of needs of
  parents with mental health problems
• and their children.
• Reviewing care plans
• Reviews should consider changes in family
  circumstances over time, include both
• individual and family goals and involve children
  and carers in the process.
• Strategic approach
• Multi-agency, senior level commitment is required
  to review and implement policy
• and practice guidance and the training and
  workforce development needed to
• provide a successful service to parents with
  mental health problems and their
• children.
• Workforce development
• Major investment is needed in training and staff
  development for front line managers
• And practitioners particularly joint training
  that addresses how to work with
• complexity, think individual, think family and
  work across service interfaces.

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Initial Impressions- Lewisham

• Findings of practice survey had not been widely
  shared
• Change in Senior Management
• Imminent inspection
• SCRs did not directly involve mental health
  issues

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Initial Impressions Southwark

• Great that will add much needed national support,
  it cannot be ignored now!
• Its so much work we will need to continue to take
  it in stages
• How can SCIE help with the implementation
• It will be hard work getting all agencies to sign
  up and made aware of this guidance
• Wish some of these ideas could be pulled together
  nationally

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The Way Forward Lewisham

• Set up a small multi-agency group to review
  existing provision/ procedures in the light of
  guidance
• Identify key drivers in Lewisham
• Presentation to LCSB re. aspects to implement and
  consider details
• Agree with SCIE how these can be measured to
  provide an evidence base for future guidance

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The Way Forward Southwark

• Family strategy produced in 2007 will need to be
  updated
• Parents network bid
• Staff training re Think family pilot the Family
  Partnership model
• Service developments need to continued to be
  supported Building bridges and AMH in Children
  centre service
• Parents film bid
• Plan a local conference/workshop to highlight the
  guidance and inform the network about what we are
  doing.
• Continue the monthly F.S meetings try and involve
  more staff
• Work to raise money for an evaluation of the
  strategy and its various components
• 12 month Joint funded post between Childrens
  social care and Adult mental health.

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Conclusion

• Different Boroughs
• Different needs
• Different resources
• Same guidance
• Different approach
• Same aim- better outcomes for families affected
  by parental mental health difficulties!

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Developing Implementing the Family
Strategy, the User Perspective. September 2007
Jolie Goodman Teresa Priest.
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In Southwark

• this Strategy represents an attempt to develop
  a family orientated approach within adult mental
  health services to strengthening the link with
  childrens services to support family life and
  well being. By family we mean anyone who is
  identified by a service user as their family

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Strengths of the Strategy

• It grapples with the continual paradox of risk,
  child protection and genuine user involvement.
• It is written with sensitivity so that risk is
  not the all consuming focus of the work. If
  service users engage with services all risks are
  minimized.
• It is clearly articulated in the Strategy that
  one of the primary reasons that service users do
  not engage with services is because of the fear
  of having their children taken away from them.

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In this talk we aim to

• Highlighting examples of users experiences where
  services have in the past failed to support
  family life.
• We want you as users and workers to consider how
  to make the best use of this strategy to
  improve the experiences of families in the
  future.
• We suggest mechanisms to begin the cultural shift
  required to embed the Strategy,

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Issues of concern to users

• Fertility Treatment
• Pregnancy
• Access to services
• Separation
• Medication

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Support.

• Sensitive and appropriate support can keep
  families together in their different and diverse
  family roles.
• Supporting people to develop coping strategies
  and point them in the direction of non
  pharmaceutical solutions such as complementary
  therapy and talking treatments.

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Being a parent

• Being a parent is real challenge for everyone and
  is one of the most important jobs we will do.
• As the strategy recognizes all of us will need
  support from strategic services while bring up
  our children slide.
• One of the greatest strengths of this Family
  Strategy is it promotes working with users in a
  non-judgmental and compassionated way.

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Staff Training
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User Focused Monitoring
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Continuing User Involvement
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Finally

• This Strategy can be a vehicle to bring about
  change, challenge stigma discrimination, build
  good relationships and make our lives and your
  jobs happier.

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