COMMUNITY MENTAL HEALTH SUPPORT SERVICES - EVIDENCE

The Committee considered the report of the Director of Housing and Adult Social Care introduced by Rebecca Harrington, Assistant Director, Strategic Planning and Joint Commissioning. Also present for this item were Councillor Martin Davies, Executive Member for Adult Social Care and Health, Councillor Kirsty Roberts, Mental Health and Substance Misuse Champion, Colin Plant, Camden Mental Health Trust and Shirley Scott-Norton, Camden Mental Health Consortium.

The report summarised research carried out in April and May 2008 in response to concerns expressed by Councillors that some people with mental health conditions living independently on Council Housing estates were not being provided with adequate support and consequently, nuisance was being caused to neighbours.

There were currently over 4000 people with serious mental health problems living successfully with support in the community and the report dealt with a number of issues arising from this including the high level of people suffering from mental illness in Camden, the range of services in the community to support them, housing and accommodation issues, inter agency working and communication, anti-social behaviour and the perceived stigma of mental illness.

Councillor Keith Sedgwick drew attention to the high concentration of people suffering from mental illness in Gospel Oak ward who were also indulging in anti-social behaviour and stated that the report failed to address how they should be dealt with. He then gave several examples of the behaviour being exhibited and the distress it had caused to those upon whom it had been perpetrated.

The meeting was informed that the Council in partnership with the Mental Health Trust was moving towards a recovery based model and that people suffering from mental health problems were more likely to recover if they remained in their own homes and in their own communities rather than being hospitalised.

Councillor Kirsty Roberts spoke briefly about Crisis Support and outlined the work currently being undertaken in relation to a Crisis House where mental health patients suffering a relapse could be taken for support. She stated that there were mental health issues in her ward similar to those outlined by Councillor Sedgwick and she supported the approach taken by the Council and the other agencies involved.

At this stage Shirley Scott-Norton, Camden Mental Health Consortium, pledged her support for the improvements set out in the officers report.

Councillors raised various other issues as follows:-

· A structured and coordinated approach was essential to ensure Council tenants and residents with high priority mental health needs received proper care and support. At present there was little evidence of this on Council housing estates. Housing staff had not been trained to deal with mental health issues and when Councillors became involved, they, too, found that there was no set procedure that could be followed.

· More needed to be done to address the issue of stigma. Also, criminalising anti social behaviour consequent upon mental illness was no solution as this would only succeed in degrading and humiliating the patient.

· BME communities, in particular, needed greater access to available services. Often, members of BME groups with mental health problems were sent abroad by their families where their condition often deteriorated.

· One member asked whether there was any way whereby tenants exhibiting mental health problems could be compelled to receive care. There was no formal process to enable District Housing Officers to call the Community Health Team. Any action they might take in response to an episode of mental illness appeared to be on an ad hoc basis. Often, details of mental illness were withheld from housing staff to avoid stigmatising the sufferer so that nobody knew there was a problem until an episode actually occurred. He continued that he suspected some mental health patients were using their vulnerable status to play the system and due to reasons of confidentiality, Council Housing staff were not even given the name of the patients GP.

· Another member asked whether people with mental health problems were better supported by being generally spread out as they were at present or whether they might benefit by being grouped in one area.

The meeting was informed that many forms of mental illness were not necessarily a life sentence and people could recover from them. There were different rates of mental illness within BME communities and the Camden Mental Health Trust was currently engaged on improving access to services for these patients to prevent their problems from escalating.

Colin Plant then spoke briefly about monitoring arrangements, particularly those concerning people with severe problems. There were currently 1,900 people living in the borough who were on enhanced CPA (Care Programme Approach) and receiving regular support from a multi-disciplinary team of health and social care professionals. He also mentioned public health campaigns to mitigate the effect of stigmatisation. The Mental Health Trust wanted to do everything possible to encourage patients to return to community living as this would facilitate a more effective recovery. However, he conceded that access into services was not always easy and that routes into the system varied but people could be directed into the services appropriate to their needs. The meeting agreed that general mental health training should be widely available for Councillors and housing estate officers.

Reference was made to the Gospel Oak Cluster. Rebecca Harrington stated that she had not been able to speak to all estate officers before producing the snapshot referred to in the report (paragraphs 3.5 to 3.8 refer) but 83 cases had been identified where a tenant was experiencing difficulties, which were being managed by Housing and Mental Health Trust staff. It was difficult to ascertain why there were so many more cases in Gospel Oak than elsewhere and it was necessary to examine each individual case before any pattern could be established. There was no substance to the perception that patients with mental illnesses were being shipped in to Gospel Oak. Generally, there were high levels of mental illness in most cities and this was generally accepted as being part of living there.

In discussion, it was stated that the perception that mental illness was a contributory factor in many cases of anti-social behaviour was not born out by the facts. The Councils Anti Social Behaviour (ASB) team dealt with between 800 and 1000 cases of ASB at any one time of which only 20 or so might involve people with mental health problems.

There was no one size fits all escalation programme. In response to a Councillor who was critical of this, officers agreed that a consistent approach was necessary and that there should be better coordination between Council officers and those of the Mental Health Trust. More training would be provided for Council officers.

Councillor Martin Davies, Executive Member for Adult Social Care and Health made a brief statement pointing out how difficult it was for people who were actually suffering from mental illness. They were vulnerable and needed to be supported either in their own homes or elsewhere. The Council had three or four facilities with thirty or forty places where people suffering from crises could be cared for until they could be restored to the community.

Councillor Keith Sedgwick highlighted the word vulnerable which he felt was a catch-all and an imprecise form of terminology that enabled people who were not suffering from any form of mental health condition to escape from the consequences of their own anti-social behaviour by relying on the reluctance of the authorities to stigmatise genuine sufferers. He asked whether there could be categories of need such as acute, medium or mild. Rebecca Harrington did not favour this approach and preferred a case by case investigation. Councillor Sedgwick also asked whether a person suffering from mental illness should be required to undergo compulsory treatment before being accepted for council housing. Again, Rebecca Harrington could not support this proposal although the use of introductory tenancies might provide an alternative solution.

After further discussion concerning, Rebecca Harrington was asked to prepare notes in good time on the following matters:-

Investigation of the Gospel Oak Cluster and the possible causes of the high level of mental illness in that area.
Investigate a more formalised approach to intervention (for example a process ladder) for people living in council housing suffering mental health crises.
Explore the categorization of vulnerable, its ambiguity and possible misuseby people not suffering from mental illness to avoid anti-social behaviour orders.
Consider the alleged moratorium on Enhanced CPAs in Gospel Oak.
Stigmatisation, awareness raising and crisis care.
Action By:- Rebecca Harrington