Mental Health Acute Care Pathway (MHACP)
The mental health acute care pathway review (MHACP) was co-produced between NHS Dorset Clinical Commissioning Group (CCG) (the organisation responsible for commissioning – or planning and securing – healthcare in Dorset), Dorset HealthCare (DHC) and people who use services and carers plus a range of other external partners including all the local authorities. Co-production means that the options have been developed working together with people who use mental health services and people who work in mental health services. The approach enabled us to create options collectively.
The purpose of the MHACP is to improve services for people who experience serious mental illness, and for those who at times, may be in need of crisis/acute mental health care.
This is because people who use services told us that they are not meeting their needs. People who work in mental health also told us that services were not supporting people as well as they could.
People who work in mental health services also told us that services were not working as well as they could to meet service users’ needs, partly because the demand on services had risen which made them less able to respond when people were experiencing a mental health crisis.
The review has been undertaken in stages: data and needs analysis, view seeking and modelling. We are currently within stage four, public consultation.
Proposals – our original proposals
We want to improve our existing 24/7 crisis telephone line to include a new service called Connection. This will have extra staffing during peak hours from 6pm to 2am when demand is higher.
People will be able to get through to Connection by phone, email and Skype. It will offer emotional support to individuals in crisis or distress, appointment times and self-resolution through supported conversations.
Community Front Rooms
We also want to introduce three Community Front Rooms. These would be based in familiar community settings, such as cafes or day centres, libraries or supported housing services.
The Community Front Rooms would be staffed by peer support workers, who have lived experience of serious mental illness, and health professionals. They will help people to manage their own crisis.
We think that these Community Front Rooms will make it easier for people to get to services in rural parts of the county where transport is poor.
Another proposal is to create two Retreats, a Retreat will be a place where people can take themselves to get the right treatment and support when they need it. These will be calm and quiet places, and will be supported by a mix of clinically qualified staff and people with lived experience.
The main difference between the Retreats and the Community Front Rooms is that the Retreat would be linked to a Community Mental Health Team and based in an NHS setting.
This means immediate access to the right level of support, be it contact with a psychiatrist or community psychiatric nurse or a peer support worker.
Retreats would provide alternatives options when someone is in mental distress, rather than them ending up at emergency departments or police stations.
In our preferred option, we propose that one Retreat would be in the Bournemouth / Poole area and the other would be in the Dorchester area.
We would like to know whether you prefer the retreat in the west of the county to be located in Dorchester or Weymouth.
In addition, we would like to have Recovery Beds in both the east and west of the county. Recovery beds can provide an alternative to hospital admission. They are based in homely settings and can also help people get home after they’ve been in hospital.
At present we have seven recovery beds in the west of Dorset but none in the east. The number of recovery beds will depend on how many community front rooms we will have and we would like to know your views on this, too.
Our preferred option would be for seven recovery beds and three community front rooms.
We think this would make the services available to the highest number of people where and when they need them. But we could have 10 recovery beds and two Community Front Rooms.
There will be times when some people with serious mental illness need to be in hospital. We want to have more beds and have them where they are needed most.
This will mean adding 16 acute beds: 4 more inpatient beds at the Forston Clinic near Dorchester and an additional 12 at St Ann’s Hospital in Poole.
We also want to move 15 beds from the Linden Unit at Westhaven Hospital in Weymouth and put them in the east of Dorset. This means the Linden unit would close.
Consultation – how the public were consulted
The MHACP proposals were shared with the public in a formal public consultation from 1 February to the end March 2017. In total there were 1,156 responses to the Mental Health Acute Care Pathway Review Consultation Questionnaire. 623 were postal responses and 533 responses were via the online survey. There were 43 easy read surveys returned, and 9 organisations provided formal responses.
The results were independently analysed by The Market Research Group at Bournemouth University. A report written by Bournemouth University Market Research Group provided detailed information on the feedback received on a range of options to improve services in Dorset.
A summary report of the responses to the consultation was shared in June 2017.
This report informed the final business case which was presented and considered by the Governing Body of NHS Dorset CCG in September 2017.