Daphne McKenna Part-time Independent Reviewing Officer, London Borough of Lewisham Chris McCRee

2. Workshop B:Putting 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

3. Putting the Guidance into Practice Different Approaches in Lewisham and Southwark Chris McCree Daphne McKenna

4. Small group exercise • Two groups • Share first experience of your parent’s fallibility

5. 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).

6. Southwark

7. 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.

9. 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 1:55. 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).

10. 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.

11. 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

12. A&E 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 Lewisham Services

13. Voluntary sector provision in Lewisham A search of the internet for charitable organisations working with mental health issues in Lewisham revealed 54 entries

14. 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.

15. 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 North East Locality - Support and Recovery Team North West Locality - Assessment and Brief Treatment Team North West Locality - Support and Recovery Team Occupational Therapy services: Adult Acute Inpatient and Crisis Services, Southwark- Guys Hospital 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 Southwark Services

16. Southwark Voluntary sector A search of the internet for charitable organisations working with mental health issues in Southwark revealed 87 entries

17. 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..

18. 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.

19. Initial Impressions- Lewisham • Findings of practice survey had not been widely shared • Change in Senior Management • Imminent inspection • SCR’s did not directly involve mental health issues

20. 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

21. 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

23. 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 Children’s social care and Adult mental health.

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

25. In Southwark “this Strategy represents an attempt to develop a family orientated approach within adult mental health services to strengthening the link with children’s services to support family life and well being. By “family” we mean anyone who is identified by a service user as their family”

26. 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.

27. 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,

28. Issues of concern to users • Fertility Treatment • Pregnancy • Access to services • Separation • Medication

29. 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.

30. 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.

31. Staff Training

32. User Focused Monitoring

33. Continuing User Involvement

34. 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.