Written evidence submitted by Roy Milner (CMH0092)

I am currently working as a social care worker in the Mental Health Social Work Team in Worcestershire. I have worked in mental health since 2000 – the majority of that time seconded to the Community Mental Health Team under a Section 75 agreement. I also acted as a Trustee for a local mental health charity for most of that time. These are my thoughts on the provision of mental health care in Worcestershire.

What is the current state of access for adults with severe mental illness

The service is becoming more and more a crisis-led service. I don't have access to referral numbers, but it seems that there is a much greater throughput than before, and now that mental health practitioners also work across GP surgeries, the support is now spread much more thinly. Patients with severe and enduring illnesses are typically seen a small number of times by a mental health practitioner e.g. often up to 6 sessions. There is no care co-ordination, so after their small number of sessions, clients could be referred to a group for anxiety management or managing emotions and then typically discharged back to the GP. There is very little third sector provision for mental health, so any on-going support needs are met (if eligible) by care agency support via a social care referral. Care agency staff don't tend to have specific mental health training - also, if someone is not eligible for free care under Section 117 of the Mental Health Act, they need to make a contribution  to the care received – even for someone receiving benefits, this can often be in the order of £80-100 a week.

Has the Community Mental Health Framework been an effective tool for driving the delivery of more integrated, person-centred community mental health services? 

The delivery of mental health services has been more affected by local factors e.g. the decision of Worcestershire County Council to rescind the Section 75 agreement. Now the social work teams are completely separate from the neighbourhood mental health teams – they have different management structures, are based in different buildings, have separate IT systems etc. This feels like a step back to me. WCC has also withdrawn funding from the 'Reablement' service described below.

The CMHF has also been overtaken by other factors e.g. the much greater demand for mental health services following Covid, so it's difficult to assess how effective it's been.

How can community mental health services work with social care, the third sector and local government to better address service users’ health and wider social needs that are wider determinants of mental health outcomes?

An obvious improvement would be for neighbourhood mental health and social work teams to merge as before. The two teams would be in a better understand each other's roles and constraints – this generally worked well locally until the Section 75 agreement was rescinded.

There is little third sector provision for mental health locally. There was a plan a few years ago to provide 'seed money' to provide more impetus for third sector support, but unfortunately this didn't amount to much. In my experience, most effective smaller charities rely on a small number of dynamic, forward-thinking individuals - if these are lacking, then 'seed money' type initiatives are unlikely to succeed.

What blockers or enablers should policy interventions prioritise addressing to improve the integration of person-centred community mental health care?

People with severe and enduring mental health problems now have a much reduced service. As described above, front-line workers are now spread more thinly, there is more demand and the service is becoming more and more crisis-led. As a result, there are a significant number of severely mentally unwell individuals receiving little support – either because they have been discharged back to the GP, or because the local neighbourhood teams do not have the resources to provide the support they need.

Employment support is definitely an area in which interventions are lacking. Aside from the neighbourhood team's employment support, there is very little for someone to access. It is difficult for someone who has been out of work with mental health issues to access the work market and often they are left to their own devices. There is no third-sector employment support available locally.

What are the examples of good or innovative practice in community mental health services?

 The 'Reablement' service was provided by neighbourhood teams until about 6 months ago. Workers would work through the Recovery Star model with clients, look at all aspects of their life, support them with identifying goals and also support with identifying and overcoming possible obstacles e,g, anxieties around using public transport. Unfortunately, this service was stopped due to lack of funding.

The neighbourhood team also provides an employment support service which can support people through the initial stages of getting back to work (e.g. voluntary work, training, placements, applying for jobs and interview technique) as well as support whilst the person is back in work. This is a valuable service – we just need more of it!

February 2025