The York Pathways, Together for Mental Wellbeing, works alongside colleagues in the emergency services to tackle the problems at the root of a person’s distress. We support individuals to identify the three hardest things that are currently making their lives difficult. Our staff team then works with them to build their own resources and resilience in order to overcome these issues. This could include support to help manage their mental wellbeing, find a job, a local activity to take part in or a place to live.
The number of mental health incidents dealt with by the police has risen 33% over the past three years and police are now spending up to 40% of their time dealing with people experiencing mental distress. In 2015, Deputy Chief Constable Tim Madgwick of North Yorkshire Police identified a group of people who repeatedly call on emergency services when experiencing mental distress.
When a person is in distress they may not know how or where to get support. Their needs might not meet the eligibility criteria for certain services, such as accessing support from a Community Mental Health Team. Or, if they are in contact with a number of services, these might not effectively communicate with each other. As a result, when a person reaches crisis point, they may just call 999.
The reality is that police and the emergency services are often not equipped to provide the support that these people need. This is because the job of emergency services is to treat immediate risk quickly. When an individual experiences mental distress this is often reflective of a range of complex underlying needs. These could include substance misuse, homelessness, extreme poverty, trauma or abuse.
The York Pathways, run by national mental health charity, Together for Mental Wellbeing, works alongside colleagues within the emergency services to tackle the problems at the root of a person’s distress.
We support individuals to identify the three hardest things that are currently making their lives difficult. Our staff team then works with them to build their own resources and resilience in order to overcome these issues. This could include support to help manage their mental wellbeing, find a job, a local activity to take part in or a place to live.
Those that have used the service have been positive about what it has enabled them to achieve. They have told us that before Pathways they didn’t know where to go for help and were struggling with managing their mental wellbeing and other practical things such as finding suitable housing. A number of individuals have told us that they felt listened to and understood by Pathways Workers and many individuals say that they now feel more positive about their future, as a result of receiving support from Pathways.
The service also supports the work happening as part of the Crisis Care Concordat. Crisis responses only go so far, what Pathways provides is support both before and after a crisis in order to prevent it from reoccurring. In addition, the service encourages strategic leads for emergency services to take account of the precipitating, longer-term factors behind emergency service use and ensure individuals have access to support to addresses these.
In York, in addition to the benefit to the individual, money is saved through a reduction in the number of calls to emergency services, which in some cases can cost up to £40,000 per individual, and a reduction in police time spent dealing with individuals on a repeat basis, since their needs have been addressed. This demonstrates the positive impact the service is having on the individual and those working within the emergency services.
Initial analysis of data collected from individuals the service has supported has shown that they have decreased contact with the crisis teams by 30%. Furthermore, they have reduced their use of emergency services significantly. The service is also being formally evaluated to measure the outcomes, and this is explained later on in this entry. There is also a case study of someone the service has supported to show the real difference the service has had on someone’s life.
Wider Active Support
The service is delivered by Together for Mental Wellbeing, a national mental health charity, in collaboration with the Lankelly Chase Foundation, Vale of York Clinical Commissioning Group (CCG), City of York Council (CYC), Tees, Esk and Wear Valleys NHS Foundation Trust, North Yorkshire Police and other critical health and social care partners.
The Pathways team works effectively with these partner organisations and has also built positive relationships and networks with local mental health services, emergency services and local voluntary sector organisations to identify individuals in need of support.
The team nurtures these relationships to ensure the service runs effectively and also work strategically with these services to develop ways in which they can work together more effectively and, as a result, help prevent individuals from reaching crisis point.
More widely, the service is funded by the Lankelly Chase Foundation, which supports the Promoting Change Network, a group of people and organisations committed to working together to drive change for people who have multiple needs and experience severe distress.
Being part of this network enables the York Pathways service to share ideas and learn from others also supporting people. Collectively these services aim to illuminate the hidden aspects of the experience of people facing severe and multiple disadvantage, shift commissioning practices, find new ways to give power to service users and provide excellent, person-centred, transformative services.
Co-Production
The York Pathways service is run by national mental health charity, Together for Mental Wellbeing. The charity has a dedicated Service User Involvement Directorate which ensures that people with lived experience of mental distress are not just involved in shaping the way its services run but that they lead the way. The Pathways service has worked closely with the Service User Involvement Directorate to ensure that it has its own specific service user leadership strategy.
Pathways was designed in line with the wants and needs of the people it supports and the service puts those that use, the staff and friends, family and carers at the heart of its ongoing development. It looks to these people for feedback on how it can continually improve. The service primarily does this in four ways: Active involvement in the way the service runs; People that use the service are experts by experience. The service sought feedback from them before designing the service and shared this with the Assistant Chief Constable of North Yorkshire Police and with the Mental Health Liaison Inspector. Pathways continues to involve service users in its ongoing design, continuously gathering feedback on our service and asking how we could do an ever better job. Pathways also uses feedback from staff and family and friends, in the form of both compliments and complaints, in order to continually improve its offering; Involving people in support planning; Enabling individuals to be involved in their own recovery planning is a fundamental aspect of the service. The staff aim to empower people to make their own choices and take control of their lives – this all starts with asking them what is making their life difficult and what they might be able to do to change that; Ensuring information is accessible.
We recognise that providing information in formats appropriate to people’s needs and preferences (including language and literacy needs) is of upmost importance. We ensure everyone is able to access and understand what our service offers, allowing people to make an informed choice about whether to use it. Furthermore, we make sure we present involvement opportunities in a way that each individual can understand so that people can be actively involved.
Strategic Involvement – People that use the service contribute to the strategic decision making of the service. They are represented at business planning meetings, involved in delivering tender presentations and the recruitment of staff. One services user wrote a letter to the strategic board explaining the way in which the service truly understood her for the first time. This level of feedback helps to show the board the positive impact the service has on people’s lives. An excerpt of the letter is below:
“I am a disabled lady who has been involved with various services over the years and have never had one that dealt with everything I needed. In the few months that Pathways have worked with me, even though I haven’t been the easiest or nicest person to deal with at times, the staff have persevered and got to the bottom of me, which is very important to me. I am not just disabled, I am not just a person with mental health issues, I am a whole person that cannot be put in a box.
Whilst there seems to be various departments for this box or that box, all these boxes make me. I find it incredibly ridiculous that no one sees that all the little boxes make a person, but Pathways do!”
Involving people including staff, service users and carers in a number of ways, ensures that the service is continuously adapting to meet people’s needs.
Looking Back/Challenges Overcome
When the Pathways project first started in York, a lot of time was spent forming and establishing stakeholder partnerships. However, when the service was established and started accepting referrals it became apparent that there was a low level of awareness with managers and front line staff about the service and what it offers. This made it difficult to obtain referrals and build pathways of support for individuals.
The team has learnt that from day one strong positive working relationships need to be developed with all levels of staff, across statutory and voluntary organisations, in addition to stakeholders. If the project was to start again, or if a similar service were to open elsewhere, they recommend that this was undertaken when setting up the project initially.
Initially there was some reluctance by one of the key agencies involved with the service to sign an Information Sharing Agreement. This made it hard to identify the individuals that were placing the greatest demand upon one of the emergency services. However, the Pathways staff persisted and have now established a monthly meeting to discuss those that are placing a high demand on their service. Through this we can now establish joint working plans with these agencies and help to inform their practice when dealing with individuals in distress.
Another challenge was working with other agencies to manage the hospital discharge process. Often at first, community support services, such as Pathways, were not invited to hospital discharge meetings which made it difficult to provide advice or information on the challenges the individual may face when they are out in the community and then plan for these. To overcome this, the Pathways team have started the process of getting consent to attend planned hospital admission meetings.
Sustainability
The Pathways service in York is run by a national mental health charity, Together for Mental Wellbeing. The organisational support that Pathways receives ensures that there is a high level oversight of the project and that effective methods of recruitment and retention of staff are in place, so that the service can continue running effectively at all times and can continue to have a positive impact on people’s lives.
More widely, the Pathways service has strategic support from Together’s Criminal Justice Directorate to ensure that the lessons learnt in York can be shared with others who support people experiencing mental distress and that the model can be replicated in other areas.
Locally, the Pathways team supportively (yet assertively) leads high-demand service users away from dependence on agencies through a range of strategies designed to promote personal responsibility and provide alternative coping-mechanisms. These tools provide proven, sustainable solutions that will out-live the project. By focusing on this core group of high-volume service-users, the project aims to sustainably reduce calls for service on the police, ambulance, hospital emergency departments, mental health services, council services, Fire Service and other agencies.
Evaluation
Initial analysis of data collected from individuals the service has supported has shown that they have decreased contact with the crisis teams by 30%. Furthermore, they have reduced their use of emergency services significantly. The service is also being formally evaluated.
Together for Mental Wellbeing has commissioned Applied Research in Community Safety (ARCS) Limited, to undertake research focusing on the York Pathways project. The research began in April 2015, and will continue until March 2017, when the final report will be submitted. A key purpose of the research is to assess how effective the project is in supporting people in distress and signposting them to other services, and in improving the way in which a range of service providers coordinate their work to address identified needs.
The second aim of the research is to describe the costs and benefits of work delivered by the Pathways project, in order to draw some conclusions about overall cost-effectiveness.
The research team is using a combination of data sources and data collection methods (both qualitative and quantitative), and is also focusing on both process and impact.
Key strands of the research include: Collection and analysis of project data; Construction of individual case studies; Assisting the project in measuring changes in individual wellbeing; Collection of feedback from service users, key staff, agency representatives; Ongoing monitoring of the relevant research and practice literature, to ensure that findings from the evaluation are properly anchored in current evidence.
Sharing
The Pathways service uses what it learns when supporting people to develop ways in which emergency services and other key organisations can work together more effectively. As a result they can help prevent individuals from reaching crisis point.
As part this, Pathways has delivered basic mental health awareness training to the City of York Council, including housing estate managers, Police Officers and Anti-social Behaviour Officers. The team is also active in promoting and forging positive relationships with partnering agencies and often attends team meetings and presents information about the service to partners. The team also invites partners to attend their own team meetings as a means of sharing best practice and improving on a collaborative and consistent approach across services when supporting those engaging with the service.
As part of the independent evaluation, Together will be supporting the dissemination of the evidence base that will highlight how effective the project has been in supporting and securing services for people in distress, and in improving the way in which a range of service providers coordinate their work to address identified needs. It will also help make the case for overall cost-effectiveness of early intervention services. We will use our external communication strategy, which includes using social media as a tool to reach a wide range of audiences.
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A case study of someone that has used the service:
Mary was referred to the Pathways service in May 2015 due to frequent use of emergency services. When referred, Mary was experiencing high levels of mental distress linked to her physical disability and pain management, isolating herself from her family and presenting as reluctant to engage with the project. Initial contact with Mary was challenging for the Pathways team due to high levels of intoxication and aggressive behaviour towards staff. Mary was not actively engaging with any support services at point of referral, although she did make regular use of a 24 hour mental health help line.
The Pathways team have worked with Mary to communicate her feelings and needs more appropriately in order to have her needs met, as past behaviours have been deemed aggressive which has resulted in disengagement from services. Since this time, the 24 hour mental health help line has been pro-active in communicating concerns with the Pathways team and active in trying to resolve the difficulties they have had with Mary over the phone, reported having noticed a positive difference in her communications with the team and informing Pathways that although she still presents as verbally aggressive at times, she is able to acknowledge that this is the case and apologies to staff accordingly.
Pathways have supported Mary to communicate with her doctor and build a relationship with the surgery in order to review her pain medication, for which she was placed on new medication. Mary has also been able to reduce her alcohol intake and identifies the negative consequences of this and the impact it has had on her relationships with loved ones.
