Written evidence submitted by Surrey County Council (CMH0156)
Call for evidence: Community Mental Health Services January 2025
Context
Subject to final review from Select Committee, this is Surrey County Council’s proposed response to the call for evidence from the Parliamentary Health and Social Care Select Committee’s inquiry into Community Mental Health Services.
The inquiry is designed to examine what good looks like from the perspective of people who draw on services and their carers/families. It will consider how people’s wider health and social needs can be addressed, alongside assessing to what extend the Community Mental Health Framework is driving improvements in integrated, person-centred care.
It focuses on adults with severe mental health needs e.g. schizophrenia, bi-polar disorder, severe depression.
Key lines of enquiry
1. What does high quality care look like for adults with severe mental illness and their carers/families?
High quality care is where all people, regardless of any specific access requirements, location or protected characteristics, can access timely mental health support that meets their needs, recognises their strengths and gives equality in outcomes and experience. It is recovery focused, and person centred with the aim of supporting people to achieve their goals. Surrey County Council have led an approach with our health and wellbeing board to clearly articulate priority places and populations. Surrey’s health and wellbeing strategy has a particular focus on priority populations and certain geographic areas of the county which experience the poorest health outcomes in Surrey.
Surrey Health and Well-Being Strategy - update 2022 | Healthy Surrey
People with severe mental illness (SMI) continue to have lower life expectancy than the general population so any mental health interventions need to be accompanied by a holistic approach which includes physical health and wellbeing, housing, employment, education, training and skills. This is acknowledged, addressed and monitored through our priorities in the health and wellbeing strategy and through commissioning activity. A range of information is also freely available online and through the First Steps to Support phoneline.
Mental wellbeing | Healthy Surrey
More focus needs to be on earlier help/intervention and support, and this help to be near to where people live. People often articulate a feeling of being ‘bounced’ across different services; local co-produced solutions to this would help the customer journey. In Surrey, the county council leads the commissioning of ‘community connections’ services, which are co-designed services providing universal access to over 7,500 people with mental health needs (based on 2023-24 activity data) to stay well in their communities through social connections, wellbeing activities and support networks. There are three lead providers that cover the county of Surrey.
Community Connections - Catalyst Support
Community Connections - Mary Frances Trust
East Surrey Community Connections - Waythrough
Led by Surrey County Council, in the county we have a robust Joint Strategic Needs Assessment (JSNA) that is used in service design and commissioning. The development and delivery of mental health care actively reduces inequalities by understanding the local population, its demographics, care needs and any gaps in service provision therefore promoting equality and addressing health inequalities.
Emotional and Mental Wellbeing in Surrey Adults | Surrey-i
Support for carers and family members is vital. In Surrey, Adult Social Care recognise this and commission a wide range of universal carers support services. We also commission specific support for carers of people with SMI.
Supporting carers who care for someone with poor mental health | Action for Carers
Space 2B You Mental Health Support Services
Having the appropriate housing with support is a determinant of good mental health and wellbeing. Alongside our housing strategy, Surrey County Council lead a ‘right homes, right support’ programme of work, which includes a focus on transforming and modernising accommodation with care and support for people with mental health needs. We also proactively work with the provider market to develop appropriate supported independent living to meet people’s needs. Local government reform will be a key enabler to ensure people with SMI can access appropriate and affordable housing.
Annex 1 A Housing Strategy for Surrey.pdf
Part 1 Cabinet Report - Master Mental Health AwCS.pdf
Market Position Statement - Right Homes, Right Support
Supported living accommodation new provider application - Surrey County Council
It is also important to ensure there is equitable access to high quality Adult Social Care services which are underpinned by the Care Act, Mental Health Act, Mental Capacity Act and the Human Rights Act. Social workers use a strength-based approach in their work and use least restrictive principles in mental health which lead to better outcomes for residents. However further development and embedding is needed across the system to ensure partners understand the role of not only social workers but also Approved Mental Health Professionals. Mental Health Act reform may bring further opportunities and challenges. Right Care Right Person has illustrated excellent partnership working with the Police.
Mental health social workers offer people with SMI a holistic approach and a rights-based perspective, which is truly person-centred. They focus on improving independence for people who need care and support and actively engage with individuals and their carers to help bring positive outcomes.
Establishing a co-production approach embedded across all service design and delivery is also key to improve the customer journey, so that the lived experience of individuals, their carers and families is at the heart of service developments. In Surrey County Council, our CQC inspection acknowledged the work we have done to develop co-production guidance for staff and how we co-produce our strategic approach.
Overall Summary - Care Quality Commission
High quality care should involve the person and their chosen representative in creating their care/support plan, ‘no decision about me without me’. This creates a culture of accountability both for the client/carers and professionals. Often, health care does ‘to’ or ‘for’ people rather than ‘with’ them. Individuals who have more knowledge, skills and confidence to manage their health and health care are more likely to engage in positive health behaviours and to have better health outcomes. Affording people dignity, compassion and respect is centra, such as the approach offered by the Mental Health Trust’s Recovery College, where trainers have lived experience.
Individualised support is a sign of high quality care, and the need to consider the person's unique needs, goals, and aspirations. Strength based commissioning of services and practice is key,and moving away from treating patients as a set of diagnoses or symptoms, without taking into account their wider emotional, social and practical needs or those of their carers.
High quality care needs to be trauma-informed and sensitive to the person's experience. Service commissioning, delivery and practice needs to fully understand the impact of trauma and how it can present in different ways. The need to avoid re-traumatisation, empowerment and cultural sensitivity. This is an area where greater work needs to done with secondary mental health services to ensure better outcomes and reducing reliance on hospital admissions (which can be containment and not treatment focused) . Trauma-informed care has been shown to increase the effectiveness of treatments and interactions with patients, the approach needs to be specifically designed for each patient’s needs.
If we have an approach where outcomes are routinely measured and an ongoing improvement cycle that would be helpful. If routinely, all protected characteristics data was collected across all MH services, then local inequality of access, experience and outcome could be measured and any issues addressed. This is an approach adopted across Adult Social Care’s mental health commissioning
2. What is the current state of access to community mental health services?
Access to primary care services proves difficult for people living in Surrey, which also puts a barrier to access to primary care mental health services. Standard GP appointment booking processes and the length of time allowed for appointments may not always be suitable for people with SMI. This issue around access to primary care is being scrutinised by Surrey County Council’s Adults and Health Select Committee on 6 March 2025
Browse meetings - Adults and Health Select Committee - Surrey County Council
The number of people accessing mental health services has increased dramatically and continues to do so however the funding has not matched this increased demand. For example, the demand on NHS talking therapies has increased and people are experiencing long waiting lists and a time limited service (6 sessions). There is a lack of long term psychological therapy for people with severe mental illnesses. Access to good quality crisis care is lacking, individuals are having to wait in ED’s for mental health assessments or if brought in by Police on a section 136. Demand for Adult Social Care mental health services has also dramatically increased over the past 4 years. The requests for mental health act assessments have increased significantly in the last 5-10 years and continues to do so. The low bed numbers result in people being placed in hospitals outside of their local area which has a significant impact on carers and family members.
Locally in Surrey, there has been a drive to transform mental health services. New primary care MH services have been embedded across all PCNs, alongside other transformational work. The next phase of work looking at aligning community MH services to communities is in development which will hopefully improve access.
It is imperative that the community offer is improved, with more focus on supporting people earlier and preventing mental ill health. Improving earlier access to psychological therapies for people with SMI is required alongside more investment to enable this. The focus must move from acute hospital care to community support, as per the Darzi report. This must also apply in mental health, not just physical health care.
Supporting people before they reach a crisis is also a priority. In Surrey we have Safe Havens, however we need to line these up with urgent treatment centres and more aligned with other services. Our Safe Havens and bed based crisis support at ‘The Retreat’ (enabled by Surrey County Council commissioning relationships with supported independent living and community connections providers) are effective in preventing hospital admissions- we need a way to shift the funding to these preventative services and not just invest in more in-patient beds.
Safe Havens : Surrey and Borders Partnership NHS Foundation Trust
Retreat (Crisis House) : Surrey and Borders Partnership NHS Foundation Trust
3. Has the community mental health framework been an effective tool for integrated, person-centred care?
The framework formed the basis for the Community Mental Health Transformation programme within Surrey. Phase I was primary care focused and saw the development of a new integrated model of care. Initiatives included General Practice Integrated MH services (GPimhs) which saw lived experience practitioners employed by the voluntary sector. Other developments are Home First and Adult Eating Disorders Integrated Mental Health Service (AEDimhs).
Our experience and feedback from Surrey citizens is that delivery of primary care mental health services is inconsistent; it depends on how engaged the GP practice is.
Phase II will focus on integrated 5 different areas of work to improve integrated, person-centred care.
Local evaluations of this work arising from the CMHF would suggest it has been effective but still more to do e.g. on Mental health rehabilitation.
Surrey County Council strongly supports the inclusion of voluntary sector partners as core members of the integrated model. We invest in long term contracts with the voluntary sector to deliver mental health services (5+1+1 years). Health commissioners do not always have the same approach which often seriously limits what the VCSE sector can do, and we are keen to have a local government led approach to the commissioning of mental health services, particularly in light of the opportunities arising from local government reform and the real opportunity to address the wider determinants of mental health such as housing and access to green space, so we can have a strategic approach to moving away from hospital/treatment-based approaches and genuine commitment to earlier help, support and intervention.
Surrey County Council’s commitment to the voluntary sector is illustrated through our mental health investment fund (see later response for more detail)
Mental Health Investment Fund (MHIF) | Healthy Surrey
4. How can community mental health services work with social care, the third sector and local government to better address people’s wider social needs that are wider determinants of mental health outcomes?
Clear pathways/flow into and out of mental health services, joined up risk management plans, collaborative leadership with the person at the centre. In Surrey, we are on our third iteration of our mental health housing protocol, led by adult social care commissioners. This protocol, developed with housing and mental health trust colleagues, outlines different scenarios and how organisations can work more effectively together to make sure people with mental health needs can access and retain appropriate accommodation.
Surrey County Council clearly lay out their commissioning intentions in mental health via the published market position statement.
Market Position Statement - Adults with mental health needs
Surrey has developed an overarching system plan that brings together all the transformation work under the following 5 priorities: prevention; community transformation; crisis pathways; neurodiversity transformation and complex/underserved groups.
In Surrey a partnership agreement is in development between the Mental Health trust and local authority. The principles of partnership working/collaboration have been shared and are being tested by front line teams.
Further promotion and embedding of The Top Tips for Successful Collaborative Partnership Working across MH services developed by the LGA, ADASS and Partners in Care and Health. This document was used as the basis for partnership workshops held in Summer 2024 to start the development of the Partnership Agreement.
Funding and enabling ASC and Public Health commissioning to lead approaches that address the wider determinants of mental health. Real recognition and investment in earlier help is vital. Local experience has illustrated that the County Council can work effectively with, and value, the voluntary sector. The NHS seem more committed to treatment and traditional mental health services. Local government officers and Councillors are well placed in local towns and villages to listen and act on what is going on. They are aware of small charities and how they support people with SMI and Surrey County Council can support small charities to access funding.
Surrey County Council are well positioned to commission services that support people with SMI. A co-design and co-production approach is embedded, which ensures that system change is built out of the voice of lived experience. As a local authority we have to deliver a balance budget, and we believe that we commission best value services. Our skills and focus on managing provider markets, ensuring good outcomes and value for money could be transferred to the mental health services currently commissioned by ICB colleagues. If there was an opportunity for mental health service funding to flow directly to local authorities, we believe this could make a massive impact on the health and wellbeing for people with SMI.
5. What blockers or enablers should policy interventions prioritise addressing to improve the integration of person-centred community mental health care?
We need to prioritise help that is more whole person orientated and strengths based- this approach is embedded in adult social care and can make a significant difference to people with SMI.
The role of the local authority as leaders of Place could be leveraged and be a significant enabler. Our civic responsibilities, community focus and ability to work with communities to make towns and villages good places to live all enhance mental health. Adult Social Care is also an enabler around transformation and promoting independence, where clinical colleagues may have a more medical approach. Also to note the ‘value add’ of Adult Social Care: we are good at analysing and managing risk in the community, and advocating on behalf of individual. Support needs to be available in the community to enable this approach.
Other enablers could include:
There are some blocks around:
6. What are the examples of good or innovative practice in community mental health services?
Mental Health and Housing Pathways Discharge and Flow Project
The Mental Health and Housing Pathways Discharge and Flow Project is dedicated to ensuring that residents with mental health and housing needs receive timely and appropriate support during and after hospital discharge. This initiative focuses on reducing homelessness, preventing avoidable hospital admissions and readmissions, and promoting stable, long-term living conditions for individuals in transitional periods or crises.
To achieve these goals, the project is:
This 12-month project, running from October 2024 to October 2025, is strategically aligned with Surrey’s Right Homes, Right Support programme and SABP’s initiatives, including the Mind and Body programme, community rehabilitation, and the crisis and flow programme. It aims to leave a lasting legacy by transitioning into business-as-usual processes, ensuring sustained improvement in mental health and housing pathways across Surrey.
In Surrey we have the Mental Health Investment Fund (MHIF):
The MHIF is a joint fund established by Surrey County Council and Surrey Heartlands ICB in September 2022 consisting of a £6m contribution from Surrey County Council and a £4.5m contribution from Surrey Heartlands ICB. It was a council decision to invest in mental health in the Voluntary sector.
The non-recurring fund originated through a direct allocation from the 2022/23 council tax to stop vulnerable populations falling further behind. There was public support for allocating council tax increases to targeting areas of need that were causing real concern for Surrey residents.
The MHIF is a Surrey wide, all age resource to enable the delivery of the outcomes in Priority Two of the Health and Wellbeing Strategy. This priority area is focused on prevention, removing barriers, and supporting people to become proactive in improving their emotional health and wellbeing. The fund is for new and/or expansion of existing non-statutory services delivered by Voluntary or Community organisations. The ambition of the MHIF was to bring new capacity into the system and support innovative approaches to addressing the rising demand on mental health services. Focusing on preventing mental ill health will have a long-term impact on reducing need and demand on mental health services.
Supporting community, grass-root organisations to deliver these innovative approaches will support the statutory services in place, lead to a diversity in approach to mental ill health prevention and enable the delivery of local services which work for local populations.
All funds have been distributed through three principal routes:
One of the significant successes of this programme has been the collaboration with CfS who have been able to match fund their award with private donors, thereby overly doubling the £2.7m award to £4+m. This has been distributed to programmes which focus on scaling up mental health prevention activities for Children and Young Adults.
A detailed evaluation programme is being supported by Unity Insights to ensure impact and outcomes are clearly demonstrated and early outcomes from this evaluation, and other assurance processes, are positive.
Surrey Health and Well-Being Strategy - update 2022 | Healthy Surrey
Mental Health Investment Fund (MHIF) | Healthy Surrey
February 2025