Mental health, loneliness and the needs of Croydon

By - Wednesday 18th May, 2016

Richard Pacitti, director of Croydon Mind, looks at one mental health project that made a difference to vulnerable people

Like most people working in mental health, I was pleased by the government’s announced allocation of another billion pounds to mental health services. But, like many others, I was also concerned that the money should be spent in a way that would have the most positive impact on peoples’ lives.

In particular, I know that it is just as important in mental health to spend money on social and practical services as it is on clinical ones. Most clinicians working in mental health will tell you that the work that doctors and nurses do is greatly supported and enhanced by practical services in the community that keep people well. This enables clinicians to focus their time and resources on those who need it most. We all know that prevention is better than cure, but, unfortunately, we don’t seem to have organised our mental health services in accordance with this wisdom.

When community services close, the vulnerable go to A&E, GPs, the police, pubs and betting shops

In mental health, social care and healthcare are two sides of the same coin. If you reduce social care spending then it is very likely that you will have to increase health spending. The health interventions are usually more expensive than the social ones, so one pound of cuts in social care might cost the state five or ten pounds of health care, putting more pressure on the NHS. We know that when the community services that people need are closed down, many vulnerable people either stay at home and become unwell or go to those services that are open, even if those services are not able to help. Such services include A&E departments, GPs, the police station, pubs and betting shops. Although all of these services (to a greater or lesser extent) perform useful social functions, not all of them are suited to support people with mental health problems.

An apt case in point is loneliness. In 2016 the Local Government Association stated that loneliness is as big a public health issue as smoking and obesity, as lonely people are more likely to have poor physical and mental health. In 2013 the Campaign to End Loneliness reported that 10% of visits to GPs were made by people who were lonely, rather than those having any medical need to visit. Only 13% of GPs said that they were confident that they could help a patient who was lonely.

People wanted somewhere to go and a place to feel safe

A few years ago a new set of mental health day services was commissioned in Croydon. Mind in Croydon subsequently became aware that many people were not getting the same level of support that they used to, and as a result were relapsing and using statutory services more. They felt less able to access support in areas such as help with form-filling, advice on bills and debts and community issues (such as disputes with neighbours) and as a a result, a third of people said that their mental health had become worse or much worse since the changes. 40% said that their physical health had become worse or much worse. 40% said that their quality of life was worse or much worse and a third of people said that their social inclusion was worse or much worse. Two-thirds of people were seeing their GP more frequently and nearly 60% said that they had been admitted to hospital more frequently.

None of the people that we interviewed felt that they needed lots more clinical input. People did not want a structured programme of life skills or sessions with a therapist. They wanted ‘somewhere to go and something to do’; a reason to get up in the morning, a place to feel safe and be in the company of others, and somewhere that they could just ‘be’, rather than a place where they had to take part in structured activities.

In 2014 we published a report on how the day service changes in Croydon were affecting people, entitled ‘Somewhere to Go, Something to Do’. At the same time I became aware of concerns within our Clinical Commissioning Group (CCG) (the part of the local NHS that commissions health services) about very high demand on psychiatric inpatient beds, which in turn put pressure on budgets.

Our offer to the CCG was therefore that for no extra funding we would open on a Saturday and run a service that provided the things that people had identified as helpful to them in staying well. Commencing in April 2014, the Hub drop-in service was open every Saturday. Existing staff ran the service alongside volunteers, many of whom were ex- service-users and without whom much of the Hub’s invaluable work would not have been possible.

The Recovery Star measures showed huge improvements in peoples’ mental health

Between 5th April 2014 and 5th April 2015, 256 people were referred to the service from a range of health and social-care professionals. 60% of referrals came from secondary mental health services, 20%from GPs and 33% were referred to relieve isolation and reduce loneliness. 71 clients were referred to enable socialising and to facilitate eating of nutritious meals in the company of others. 45 were referred for benefits help and 45 needed help with ‘form-filling’. We used a system called the Mental Health Recovery Star to measure the impact on people’s lives. We also asked people to tell us how often, in the year prior to joining our service, they been to the GP, how often they had used secondary mental health services, and how often they had been admitted to hospital.

After a year, the Recovery Star measures showed huge improvements in peoples’ mental health and the service also reduced significantly people’s use of statutory services.

The Hub showed an annual cost saving of £3971 per person who attended

In the year prior to attending the Hub people had made 1,117 visits to their GP. A year later this figure had reduced to 486 visits. The number of people visiting their GP more than 24 times in a year decreased from twenty-three to five. The number of people making no visits increased from 7 to 23. This equates to a financial saving of £28,395 (i.e. 631 visits at £45.00 each). In the year prior to attending the Hub, there had been 42 hospital admissions. A year later, this had reduced to 3. Based on median length of stay in Croydon, this equates to a financial saving of £418,509. In the year prior to attending the Hub, people had accessed secondary mental health services 1,098 times. A year later this had reduced to 636 visits. This equates to a financial saving of £21,714.

The total cost savings (excluding reduction in hospital admissions) for 118 people was £50,109, giving an average annual cost saving of £425 per person who attends the Hub. The total cost savings (including reduction in hospital admissions) for 118 people was £468,618, giving an average annual cost saving of £3,971 per person who attends the Hub.

Based on these findings, the CCG has invested more in the project so that we can open for a second day every week. At the time of writing this, we have 445 people benefitting from this service.

Richard Pacitti

Richard Pacitti

Richard Pacitti was born and brought up in Croydon. He is the Chief Executive of Mind in Croydon and has spent the last 25 years working in mental health services. As well as having a role in local mental health services, he has worked with a number of national bodies including the Royal College of Psychiatrists, NICE and the Care Quality Commission.

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