Citizens Jury – Appropriate access to mental health services
Steven Barkess, Community development coordinator, VOICES
This month my colleague, Dean Spruce and I, attended a citizens jury presentation and launch of a report focusing on access to appropriate adult mental health services in Stoke on Trent and Staffordshire CCG’s who developed a committee in common to discuss; what is not one of the biggest health inequalities in the county. This is the second citizen’s jury to take place following the successful work done around diabetes and is the seventh community conversation to take place.
What is a citizen’s jury?
Essentially, a citizen’s during is a mechanism for participatory action research which allows people to be involved in the development of research leading to action on a local and national level. Citizen’s juries have been used widely throughout the United States since the 1960’s and were introduced to the UK in the 1990’s and have become common place in service evaluation, processes, planning and scrutiny within public services. Often people who are accepted onto the jury have some knowledge or experience of the subject that is be assessed or scrutinised. This isn’t of course the type of jury that will determine innocence or guilt but to propose possible recommendations, action or solutions to a widening problem which involves those who have been or who are affected by something such as mental ill health.
Research was carried out in a variety of ways including a survey, one to one interviews, and informal workshop sessions and were provided with local statistical data. When this was collated and analysed the jury were then able determine specific areas examine and research in more detail.
The event was held over two and a half hours and was used as a platform to launch and outline the recommendations of the report developed by the citizen’s jury, which were presented by the citizen’s jury members. Commissioners of mental health services locally were also in attendance representing CCG’s in both Stoke on Trent and Staffordshire. This was followed by an explanation from an independent evaluator from Birmingham University who worked closely with the citizen’s jury as part of his PhD research. As well as hearing from other patient congress members we were also asked to discuss these recommendations and consider how this could be implemented and what possible barriers there may be to achieving this.
The citizen’s jury report determined 14 recommendations focusing on five key areas highlighted following the analysis of the research and data collected which are as follows;
- To develop one single, memorable helpline number for mental health service users operating 24/7
- Introduce a staffed Community Staffed Resource Room in Locality Hubs and Health and Well-being campuses
- To review assertive outreach and early interventions teams
- To review the transition from CAMHS to adult services (to be increased to 14 – 25)
- Improve the Live Digital Directory of Services
- Improve communication between practitioners and services
- To commission Mental Health First Aid Training
- Ensure the Access Team has equivalent crisis response times to physical emergency care
- Access Team and RAID by existing patients and expert patient groups
- Research into a Mental Health A&E
- Care Navigators to refer to specialist assessment
- Review the dual diagnosis process and treatment options
- Increase the number of Support, Time and Recovery (STR) workers
- Ensure personal health budgets (PHBs) are easier to access
The commissioners have, in principle, agreed with all of the recommendations set out in this report by the citizen’s jury and they were congratulated and thanked for their work on this report which has been a process which has required intense commitment, dedication and hard work which each member has contributed. Moving forward the CCG are looking to develop a task and finishing group following the presentation of this report to the board on the 1st May 2018, with a view to developing action planning from 18th May 2018 onwards.
My initial thoughts:
It is clear from this report that there is a lot of work to be done around mental health in this city and that a lot of personal time has been volunteered from people with lived experience of mental health. Which for me is an amazing step forward in the development of services being developed by people local to that community. During the table conversations however, it did become apparent that those who are currently delivering these service were not spoken to and that the services currently available are poorly advertised or promoted. Another issue for me is the way in which services are commissioned. The locality of an organisation plays a huge part of how much they will invest in the community they are commissioned to service. For this to work and for services to understand both the urban and rural needs of the county we need to encourage our existing services to work together and examine what we already have and how this can be enhanced.
When we talking about developing and creating community hubs and directories the fact that most organisation regardless of their target client/customer group already have these in place and are not being utilised is still surprising (granted, this is a very demanding responsibility). Dual diagnosis is something that has been discussed for many years by various drug and alcohol services and although this is now being invested in I think we still have a long way to go to prevent competitive bidding; as we are all working to the same aim of supporting people with multiple and complex needs. As a community development coordinator I often speak to people who are not aware of what services are out there and what support they provide. For this reason we need to ask ourselves why are services not already working together? I love the recommendations of this report and would be happy to them all put into place. What we also need to look at however, is our culture of commissioning and the competitive nature of this within the city. I would love to see a collaborative approach to developing these recommendations and to see how social prescribing would complement this as the recommendations considers how social hubs or one stop shops can improve access to services, be a preventative measure to crisis, provide a point of contact, create a platform for awareness and advice.