ESSEX COUNTY COUNCIL

0618

Mental Health Intensive Enablement Services

SPECIFICATION

Issued XXXXXXXXXX

  1. Background & Vision
  2. Essex County Council (ECC) is dedicated to improving Essex and the lives of our residents. The ‘Future of Essex’ sets out an outline of the council’s commitment to the people of Essex and is supported by the Organisation Strategy, which sets out the strategic aims and priorities as follows:
  • Enable Inclusive Growth
  • Help people get the best start and age will
  • Help create great places to grow up, live and work
  • Transform the council to achieve more with less

1.2 Mental Health issues are widespread, at times disabling, yet often hidden. One in four adults experiences at least one diagnosable mental health issue in any given year. People in all walks of life can be affected and at any point in their lives and for some people their mental health problems impact on their ability to have a settled place to live.

1.3 The care and support linked to housing issues is generally recognised as being a central part of an effective recovery pathway for those people with high levels of mental health needs. Having a ‘front door’ is important for individuals to recover, receive support and help to return to work or education. For all of us, where we live and our networks of support are a critical part of our wellbeing; both physical and mental, and this is even more important for people managing a mental health condition.

1.4 ECC and the Clinical Commissioning Groups (CCG’s) in Essex launched the Mental Health Strategy in July 2017, ‘Let’s Talk’ setting out ambitious plans to transform Mental Health across ECC by making whole system change to address the issues of capacity and supporting people to recover.

1.5 ECCknow that for adults coping with mental health issues, safe, secure and stable housing is central to their health and wellbeingand their recovery and the strategy sets out an ambition to improve support for recovery and social reintegration through better access to peer support, accommodation and employment. The strategy states that as a result of improved services, more adults in contact with mental health services will access appropriate accommodation with a reduction of people living in mental health residential care.

1.6 ECC spends approximately £12m annually on social care services for adults with mental health issues who have an accommodation need. Historically ECC has spent a greater proportion of its budget for mental health services on residential and nursing care than other similar authorities and in line with the ambition in the strategy wants to transform the current delivery model into services that:

  • Are person centred and outcome focussed;wrapping care and support around the individual rather than where they live (separating care and support from accommodation.
  • Are recovery focussed delivered through strengths based approaches.
  • Ensures adults in receipt of support are enabled to do more themselves and to have more control over decisions.
  • Ensures scarce resources are targeted at things that adults believe make a real difference for them.
  • Enables people to feel part of and participate in their local community.

1.7 To deliver the ambition of the strategy, ECC is committed to working in partnership with all stakeholders to ensure it delivers the best possible outcomes for individuals, and recognises that it needs to support the development of a diverse market that can support more people to live independently in the community.

1.8 ECC recognises that it is unable to make all the changes it wants to all in one go. This specification is the first phase of transforming care and support and ECC is seeking to work with innovative, forward thinking providers who share this ambition to make a real change for those adults who are chaotic and coping with a complex mental health condition.

  1. Current Service Provision

2.1 ECC currently provide care and support for people for around 600 adults with mental health and accommodation issues through what is known as the Mental Health Accommodation pathway. Within this pathway there are a number of different schemes supporting people with differing levels of need

  • Residential Care –supporting people with the most complex needs, usually as the first step from hospital settings.
  • Intensive Enablement – step down into accommodation with a tenancy from hospital or residential settings, providing intensive support for an 18mth to 2 year period.
  • Supported to Independence – supported living accommodation.

2.2 ECC knows from evidence that we are delivering good outcomes for some individuals as they are moving on to live independently, but not for as many adults as the authoritywould like. ECC know this because individuals become ‘stuck’ in the system because they are fearful of moving on. There are also some people who when they make a move in to fully independent accommodation, become unwell they begin a cycle of losing their accommodation again.

2.3Profile of Mental Health in Essex

2.3.1 In Essex, 136,053 people (16.1 %) aged 18-64 are predicted to have a common mental health disorder. 84,484 women (19.7%) and 52,038 (12.5%) men surveyed met the diagnostic criteria for at least one common mental disorder. 3,382 people (0.4 %) aged 18-64 are predicted to have a psychotic disorder (0.3% of men and 0.5% of women). 60,683 people (7.2 %) aged 18-64 are predicted to have two or more psychotic disorders.

For further information about the profile of Mental Health in Essex, please use the following link:

2.4Engagement with people with lived experience and providers

ECC is fully committed to coproducing services. During 2017 ECC undertook focussed engagement with people with lived experience and providers to establish where the issues are in the current pathway and to determine what ‘good’ would look like. The information obtained through these interviews has informed the changes that need to be made.

2.4.1People with lived experience told us:

  • “ECC” don’t always get it right and ECC could improve the way they do things
  • The level of support in the pathway is not always right
  • Certain groups find it harder to achieve recovery
  • People need continuity of support as they recover
  • People worry about recovering and losing their support

2.4.2 Providers told us that:

  • There are issues with case management and the ‘systems’ that support the pathway
  • Expectations of individuals are not always managed very well
  • Conversations about where someone lives does not start early enough in the case management process
  • They would be willing to collaborate with other providers to deliver a more joined up services

2.4.3 A detailed report with more information can be found using the following link: Shaping the Accommodation pathway for people in mental health recovery

  1. Service Brief

This specification sets out the requirements to begin to make the transition from traditional time and task specifications that have been in place in the past to fully recovery and outcomes focussed care and support that is person centred.

The focus of this service is to support individuals who are able to recover, to live independently without support

3.1.Recovery

A recovery approach sets out the values for a person to build a meaningful life for themselves, with or without the continuing presence of mental health symptoms. Recovery emphasises the importance of ‘hope’ in sustaining motivation and supporting expectations of an individually fulfilled life[1]There are different definitions of recovery, however through delivery of this specification ECC is committed to supporting individuals to become as well as they can be, feel connected to their local communities and begin to contribute either through paid employment or volunteering. ECC want people to gain confidence in their abilities an achieve their potential, rather than fostering dependence on services[2]

3.2 Service User Recovery

  • The provider(s) will need to support individuals to find places to live if they no longer have settled accommodation to return to. The provider will work with the care coordinator and the individual to find the most appropriate place to live
  • ECC expects that service users leaving this service will be engaging with services such as GPS and accessing help and support and will be tenancy ready.
  • The adults will have acquired independent living skills to facilitate successful move on to more independent settings. The support provided throughout the duration of the service should be flexible, realistic and based on individual need and should mean that a shorter timeframe can be worked towards where possible.
  • Move on planning should form a key part of the support planning process and should start when service users enter the service. Providers should identify through the review process, in partnership with the care coordinator, when a service user is able to move on to more independent accommodation. Providers must be proactive in providing appropriate support to enable the service user to successfully transition to their new accommodation and to have strategies in place to ensure the move can be sustained.
  • In cases where it is identified a service user will be unable to acquire independent skills to move on successfully (no matter how much support is provided), disengages with the service or is at risk of eviction, the expectation is that providers will work with the care coordinator to identify and agree alternative arrangements as soon as possible.
  • There may be circumstances (e.g. a life event) where a service user is progressing towards independent living but then requires the service for a longer period. This will be agreed on a case by case basis between the provider, care coordinator and ECC.
  • Service users eligible for a personal budget when they move on from the service may also choose to receive resettlement / on-going support from providers, particularly service users who move to an independent setting.

3.3 Outcomes

The outcomes to be delivered for adults by this service are based on the eligible needs as described in the Care Act and focus on delivering the key outcome of ‘People live independently without support’:

  • People have good mental health and recover
  • People maintain their independence
  • People have choice and control
  • People maintain networks of support
  • People have opportunities to become economically active

Evaluation of the standard of service provision will be based upon providers demonstrating their achievement of outcomes and the difference that the service has made.The change ECC needs to see through delivery of this specification is that people are able to live independently without support. Providers will be expected to demonstrate that they are providing quality support that achieves customer satisfaction. The outcomes, performance and quality indicators and measures for this contract will be agreed with the providers following contract award. An indication of the likely measures and indicators are set out in Schedule ?

4 Service description, eligibility, volume, contract period

4.1 The primary purpose of Intensive Enablement is to deliver good quality, safe, efficient and personalised care to people who have chaotic lives and who also have complex enduring mental health issues.

4.1 Intensive Enablement will provide outcome focussed intensive levels of support delivered by a flexible team of highly skilled and experienced mental health staff. Services will be short term and they will support some of the most complex cases in mental health services.

4.1 There will be an expectation that providers will work with universal services and community resources in order to meet needs in the most effective and sustainable way to promote self-management of support needs in the future; minimising the need for statutory services.

5 Service eligibility (who is the service for?)

5.1 This Service is for people aged 18-65yrs with severe and enduring mental health and accommodation needs and who need a period of intensive support from a skilled staff team to prepare them to live independentlyi.e. ‘to be tenancy ready’ (there may be instances where an individual whose recovery would be best delivered through Intensive Enablement is over 65yrs. Where this arises, ECC will negotiate on a case by case basis with the provider

The service is for those adults who:

  • are moving from residential or in patient care
  • or those who are at risk of moving into residential or in patient care
  • or for those people at risk of or who have already lost their tenancy/accommodation because they have a mental health problem.

5.2 Inpatient Care should be taken to mean:

  • Acute psychiatric hospital settings.
  • Low,and Medium Secure Hospital Settings.
  • Locked and Open Rehabilitation Hospital Settings.

People referred from this type of care will have had successful periods of leave.

5.3 Adults using these services may be subject to the restrictions under the Mental Health Act and/or via the Ministry of Justice. These restrictions may be linked to:

  • S7 (MHA) Guardianship Orders.
  • S17A (MHA) Care Treatment Orders.
  • S37/41 (MHA) Supervised Discharges.

5.4 Adults using this service could present with high level risk, including:

  • Arson
  • Sexual offences
  • Previous housing determinations
  • Substance misuse
  • Being at risk of, or already engaging in offending behaviour
  • Being unmotivated or having a chaotic lifestyle
  • Presenting challenging and/or anti-social behaviour
  • Needing support to manage medication
  • Having no history of successful independent living
  • Being at risk of exploitation or harm from others
  • Being at risk of alleging harm from staff or fellow tenants.
  • High Risk Suicidal and/or Self Harming Behaviours.
  • Eating Disorders
  • May have needs over a 24 hour period, or needs which can rapidly develop.

5.5 The needs of People who use this service will be primarily linked to their mental health needs, however, they may also have co-morbidities, including:

  • Learning Disabilities
  • Physical Health Difficulties which could include incontinence
  • Substance Misuse Difficulties, including Alcohol Dependence.

6Referrals made to Intensive Enablement services will be for people who meet the following:

  • have a named Care Coordinator;
  • be in receipt of secondary Mental Health Services; and
  • meetCare Act thresholds or be subject to a S.117 (Mental Health Act, 1983 amended 2007).

Accessing the Service

6.1 ECC is reviewing all the systems and processes that support the accommodation referral process to ensure ECC can deliver the best possible support but also allow adults choice and control. ECC currently have two different referral pathways either via our Social Care Funding forum or via the Joint Referral Pathway (JRP). ECC will start the review of the referral process shortly and will confirm the process with the successful providers once the awards have been made. Whichever route the referral comes from professionals will agree on the most appropriate placement for the adult dependent on need and outcomes.

The provider shall start to provide the service to the adult on the start date and shall continue to provide the services until the end date, as set out in the contract letter, unless the package is terminated, suspended or varied in accordance with the contract.

6.4The adults will have been assessed for eligible unmet Social Care needs consistent with The Care Act eligibility criteria, meaning they will have needs around:

  • Managing and maintaining nutrition - support may be required to ensure that the Adult has access to food and drink to maintain nutrition, and that the adult is able to prepare and consume the food and drink.
  • Maintaining personal hygiene - support may be required to ensure that the Adult can, for example, wash themselves and launder their clothes.
  • Managing toilet needs - support may be required to ensure that the Adult is able to access and use a toilet and manage their toilet needs.
  • Being appropriately clothed - support may be required to ensure that the Adult is able to dress themselves and to be appropriately dressed, for instance in relation to the weather to maintain their health.
  • Being able to make use of the home safely - support may be required to ensure that the Adult is able to move around the home safely, which could for example include getting up steps, using kitchen facilities or accessing the bathroom. This should also include the immediate environment around the home such as access to the property, for example steps leading up to the home.
  • Maintaining a habitable home environment - support may be required by the Adult to ensure that they are able to sufficiently clean and maintained their accommodation, and that their home is habitable, safe and has essential amenities. An adult may require support to sustain their occupancy of the home and to maintain amenities, such as water, electricity and gas.
  • Developing and maintaining family or other personal relationships - The adult may present as lonely or isolated, either because their needs prevent them from maintaining the personal relationships they have or because their needs prevent them from developing new relationships.
  • Accessing and engaging in work, training, education or volunteering – The Adult may need support to identify and accept an opportunity to apply themselves and contribute to society through work, training, education or volunteering, subject to their own wishes in this regard. This includes the physical access to any facility and support with the participation in the relevant activity.
  • Making use of necessary facilities or services in the local community including public transport and recreational facilities or services – Adults may need support to get around in the community safely and consider their ability to use such facilities as public transport, shops or recreational facilities when considering the impact on their wellbeing.

6.5All adults referred will have an identified accommodation outcome that needs to be met, along with two or more additional outcomes; all of which are significantly impacting on their wellbeing.The levels of presenting need and behaviours will be chaotic andvery complex. People accepted in to the service may never have held a tenancy, not be able to cook, have never paid bills and have no connections in the local community.