Mental Health

Baroness Janke Excerpts

Thursday 15th January 2015 Lords Chamber

[Baroness Janke (LD)]

My Lords, I, too, am grateful to the noble Baroness, Lady Tyler, for initiating this debate. I shall focus on the significant numbers of people with multiple and complex needs. They might be street drinkers, homeless people, an aging drug-using population; people with wide-ranging mental health issues, including complex trauma histories; many women trapped in the sex industry with significant multiple needs; and young people, including 16 to 17 year-olds. They might be individuals with serious health-related needs and long-term conditions who have a range of complex needs, some of whom are at the end of their lives, as well as increasing numbers of people who are unable to be housed due to the complexity of their needs and the risks associated with their behaviour.

These people often have at least three of the four needs areas: mental ill heath, homelessness, drug and alcohol misuse, and offending. They are also likely to have other significant factors such as: poor physical health, including long-term conditions; experience of complex trauma in childhood or early years; and experience of domestic abuse. This group is often the farthest away from services or only comes into contact with services when in crisis; they perhaps come into contact with the police, A&E or mental health crisis teams. In addition, gaps in services, or the way that services are provided, can mean that, in the worst cases, help is not available, or that people are passed round the system, having to deal with several different agencies—or, worse still, that they get into the revolving-door syndrome where they are constantly repeating their experiences and not receiving the support to ever move forward.

Mental health needs in this area are often undiagnosed, undisclosed, untreated, masked and compounded by other needs. It is an area where people have problems that are often considered too entrenched or too complex and they have no one to turn to. It is an area where traditional ways of working are simply not working. It is understandable that many of these people feel excluded and without hope. The conventional services are not addressing their needs but are being used in an ineffective and costly way. People with long-standing mental health needs are not well served by repeatedly ending up in A&E or in police custody. As many experts have said, the services provided for those with multiple and complex needs have to change. Indeed, the noble Lord, Lord Patel, said today that it is the services that are hard to reach.

I would like to highlight one project today that is particularly focused on this area of need; it is called the Golden Key project. The idea is that this golden key will unlock services. It consists of a partnership board, resulting from a Big Lottery Fund bid by a consortium of agencies working with Bristol City Council. The project helps people to drive their own recovery by providing support, by reconfiguring services, and by enlisting the help of people who have had the experience of living through similar issues and who have come through it to regain their own lives.

The project is at an early stage. As I said, it is run by a broadly based partnership on which the full range of interested groups are represented, including agencies that provide services, commissioners, clinical commissioning groups, peer mentors who have real experience, business, and city leaders who are championing this project. Key elements include a group of 300 individuals who sign up to the project “walking the journey” with a lead co-ordinator at a pace that is right for them. At the heart of the scheme are the peer mentors, who bring their own lived experience to support, and to inspire hope. Golden Key agencies and services are pledged to work together to make services accessible and sympathetic to needs.

Innovative aspects of this project include small personal budgets that encourage staff and their customers to think carefully about which practical measures might create early successes. There is a “telling your story once” website, with access controlled by the client, so that people do not have to repeat their personal information and story. One symptom of the current service is that an individual seeking support may have to tell his or her story to a range of different agencies. This website tries to bring services together and shape them to the individual who needs them. There will be a psychologically informed environments approach to deliver more effective services through a deeper understanding of clients’ needs. There will also be training and action learning to embed change.

Very many of us are aware of this complex area of need and care about these most deprived and excluded people. It is essential that these people’s acute need is fully recognised and that we look at ways of building on national and international examples of good practice. Through this, we must find ways of unlocking the future for a group of people who often do not believe that they have one.