Our Multimorbidity and Mental Health theme recently held the first of its planned learning events about the early planning phase of the Best for You model of care, and our evaluation of it.
The first learning network event, held 8th November 2022, invited clinicians and leaders of Best for You to share reflections from their first-hand experiences about the planning and early implementation of this ambitious and innovative new programme.
Best for You is a new flagship model of care that aims to integrate mental health care within paediatric and emergency settings in Northwest London. The service was developed in response to the needs of children and young people and their families that aims to provide a model for collaborative working and partnership building across NHS and community services by offering children and young people and their families more agency in their care.
The model was developed by multidisciplinary stakeholders from three NHS Trusts, CW+ and community-based organisations along with children and young people and their families. The learning network event was hosted by Dr Dasha Nicholls, Clinical Reader in Child Psychiatry at Imperial College London and theme lead for Multimorbidity and Mental Health, NIHR ARC NWL.
Our panellists were:
Chris Chaney, CEO of CW+
Dr Johan Redelinghuys, Clinical Director of CAMHS Provider Collaborative in Northwest London
Dr Frances Connan, Consultant Psychiatrist at Central North West London NHS Trust
Dr James Ross, Paediatric Consultant at The Chelsea and Westminster Hospital NHS Trust
James Porter, Director of Major Projects, CW+.
Chris Chaney described how the programme was conceptualised and co-designed with clinicians. There had been an increased demand for psychiatric care within emergency healthcare, a phenomenon that worsened, during the pandemic. A key factor influencing the design of the service was the need to tackle psychiatric causes of medical emergencies, which if left untreated can lead to life-threatening events, and requiring multiple hospitalisations within a year.
A Digital Hub provides an online e-resource.
A Day Service for Young people presenting with eating disorders requiring high acuity service provision where specialist multidisciplinary care in an outpatient setting will be provided.
A Young People’s Assessment Centre to provide multidisciplinary assessment and early intervention to signpost to the most suitable care pathway within 72 hours.
A community partnership programme provides opportunities for young people to join community activities closer to home after being discharged from hospital.
Johan Redelinghuys described how apps were chosen and sourced, and how the Digital Hub was co-designed and launched in November 2021 through a collaboration with ORCHA to ensure content assessed, accredited and deployed appropriately. Young people can freely access reliable apps suitable for their personalised health concerns free of charge. These can be used as a resource for: ‘active waiting’ whilst waiting for care; ‘supplementary’ to care; and as ‘maintenance’ once they have been discharged from care. Training in the use of the Hub is provided and the use of the Hub is supported by clinical referrers in many associated care pathways, and community organisations.
Frances Connan described the provision that will be available from a newly created Day Service. A varied programme of activities for young people and a family therapy-based approach designed to build skills and confidence among young people and their families and carers form the core components of the service with the aim of ensuring they don’t fall through the gaps of services avoiding long term mental health services. Service users with high acuity eating disorders, or complex emotional needs associated with medical symptoms will benefit from this service.
James Ross, Lead for the Young People’s Assessment Centre, emphasised the value of closely examining existing service provision, with the whole care team involved. Taking account of the patient’s journey from the hospital Emergency Department, onto the ward, through to discharge from hospital provided the opportunity to fully understand where improvements could be made and what new interventions would be relevant and likely to provide solutions to existing problems. So far, the care team have designed and implemented staff training to understand the role of mental health provision in medical emergencies. They identified a need to recruit and retain multidisciplinary staff to ease the dependence on expensive agency staffing. To move forward with the Best for You programme, a key challenge right now, is to identify and agree a physical location for the new Centre and establish a long-term staffing plan, within available resource.
Planning and early implementation of the community partnerships component of the programme was presented by James Porter. In the set-up phase extensive community engagement took place, engaging around 1800 young people. Among the key issues surfaced because of the engagement activities, were that young people wanted to access information and support in community settings. However, there was a potential for lack of trust in service provision that had historically been hard to access and in which culture clash may have served to prevent best use of it. The planning team has engaged a variety of intermediary organisations such as: local charities and voluntary organizations, football clubs, and educational organisations who already support young people in Northwest London and who are happy to collaborate with the Digital Hub.
All panellists pointed to the benefits of co-design and co-production of the Best for You Model, whilst also highlighting that stakeholder involvement and management is challenging. A key factor in planning the programme has been to find common ground, vision and sense of purpose between the Trusts and organisations involved in taking the programme from planning to implementation whilst taking account of different priorities, strategies and organisational cultures.
Participants interacted in live Q&A sessions with panellists and in “break-out sessions” designed to elicit what their interest in the Best for You programme model is; what issues mattered most to them; and what they’d like to get out of future learning events.
Participants indicated that their interest in learning about the Best for You Model was to: get new ideas, understand what resources were required to set up the service, and to register an interest in future networking opportunities.
Priority issues going forward are likely to be: advice; peer support and discussion of how to initiate and plan; learning more about the potential for partnership working, staff recruitment, establishing integrated models of care, decision making about age cut-offs for this type of service, demands on resources, and shifting organisational and working culture. Looking ahead, attendees would like to hear from young people who have been through the service.
The evaluation team presented an initial programme theory and current service process mapping which has been co-produced with the service planning team. Together these planning and evaluation tools provide a co-produced vision for the implementation of the Best for You Model, and an agreed understanding of what the service looks like before the innovation begins. As such they provide part of the baseline data, from which progress can be measured. This is included in our protocol, available at https://doi.org/10.1136/bmjopen-2022-067074
Analysis of routinely collected, anonymised patient records in Northwest London (2015-2022) were presented, including the number of young people who visited the emergency department in mental health crisis, and resulting hospitalisations. Emergency admissions for mental illness related emergencies has increased since 2015, especially during the Covid-19 pandemic, and for young people with eating disorders. Length of stay, cost of care, and out-of-region displacement were higher for emergencies rooted in mental illness compared to physical ones.
Key findings from a systematic literature review of models of integrated care for young people experiencing medical emergencies relating to mental illness were presented. This demonstrated proof of concept that the programme is expected to improve quality of care for young people.
The next learning network meeting will be scheduled for late Spring (week of 22nd May). Our plans for the next learning event are to present up to date learning from the ongoing implementation of the Best for You Programme. There will be an interactive session providing a space to share experiences and an opportunity for participants to discuss issues of interest. We would especially like to hear from participants their thoughts about the potential for the scale up of Best for You in other geographical contexts than Northwest London.
As an indication of interest, please contact s.barber@imperial.ac.uk and we will send you an invitation to hold the date in your diary. Please circulate to any colleagues that may be interested.
