principles into practice network

Long term mental illness and recovery

Topics covered in this article: Services and support, Care & treatment

Highly commended

Gateways SAMH 7/8 Broomhill Way Greenock PA15 4HE

Contact: Colin Philips, Project Manager Business and Service Development, SAMH, Cumbrae House, 15 Carlton Court, Glasgow G5 9JP

http://www.samh.org.uk/services.php?display=listing&service_id=55

SAMH Gateways works with people experiencing severe and enduring mental health problems in Inverclyde, providing an alternative route for activity that promotes mental wellbeing. Clear evidence suggests that Inverclyde has significant health challenges and we know mental ill health has a direct impact on levels of exclusion and deprivation. In response Gateways supports recovery through tackling social isolation and developing natural support networks, where self management is promoted enhancing the quality of peoples' lives.

Gateways has a strong focus on the principles of social inclusion, which encourages and enables people to develop and sustain wider social networks within their own communities using local resources, which in turn positively reduces the reliance on specialist supports. Referral routes include CMHT, OPMHT, Day Hospital, Psychology and Psychiatrists.

Gateways demonstrates positive community engagement and integration through facilitated support to access and use local resources in the following areas: Sports, Education, Vocational, Health, Helping Agencies, Volunteering, Social Activity. The data base currently has 820 local resources for people to access. and the service plays a pivotal role in enabling people to navigate through barriers to access these resources by adopting a 'broker' like role.

Gateways promotes positive risk taking and uses the strengths and abilities of people to overcome obstacles and barriers to lead 'ordinary lives'. A rolling programme of induction is offered for new Inverclyde referrers to ensure that they have awareness of this service.

People who engage with Gateways are offered the opportunity to create 'Your Plan', a personal development plan developed in partnership with an experienced Facilitation Worker where a person's goals and outcomes are identified over a period of time. The Plan is developed detailing where, when and who will support and facilitate each step, allowing people to meaningfully measure and reflect on areas of progress. By profiling each individuals strengths, skills, capabilities, employment and education aspirations we believe that we help empower people and give them a sense of ownership and recognition of the value and pursuit of their own recovery journey. This personalised approach for people is important as it allows the journey to be shared and to be positive. The Plan is monitored and reviewed with the person who can map their own progression, choices and ambitions, and alter as they see fit.

Gateways relies heavily on feedback, from people using the service about their progression within the service, their experiences, and the sustainability of inputs from Gateways to ensure it meets the service aims and objectives.

Gateways supports other local resources and services to build their knowledge and understanding of mental health issues, raise awareness, improve attitude and challenge stigma. In turn, Gateways staff are the mental health representation in various forums, including See Me Stakeholder Group, Education and Literacy Sub-group, Practitioners Forum for Employability, and are on the Board of Inverclyde Community Care Forum.

One of the main purposes of the Service is to evidence that successful community engagement creates recovery pathways for people with severe and enduring mental health problems, we believe Gateways achieves this.

SAMH Gateways was commissioned by Inverclyde Council to fulfil their duties with regards to the Mental Health (Scotland) Act 2003. This Act required Local Authorities to promote wellbeing and social development in people who have (or have had) mental ill health, and support their personal recovery through community engagement and social inclusion.

Staff are trained in Social Inclusion and Community Mapping in partnership with the National Development Team. In addition, the service is successfully integrated in the wider community and not simply seen as mental health service.

Emphasis is placed on strengths and abilities of the person rather than the impact of their mental illness. Gateways works with people to recognise the skills and potential that they have and to help them realise the benefit and contributions they can bring to their own lives and their community.

The service recognises the need to look at practical issues affecting the person's life and mental health before moving on to the more social aspects for the person.

An 'Outcome Framework Tool' is used within the service which is 3 tiered. The ethos of the tool requires meaningful engagement and endorses a person's recovery progression by initiating and recognising that progression will only happen when the person can realise their starting point.

Tier 1 maps out the local resources that people may want to engage with. Our experience suggests that many of the people at this point do not know what they want to achieve, therefore the facilitation workers' skill in adopting motivational techniques is crucial to enable the person to begin to plan meaningful activity. This can take a considerable length of time and requires a consistency in approach.

Tier 2 captures soft indicators including confidence, self esteem, barriers, independence and past engagement. This is a key component both for the facilitation worker and the person to recognise and measure successful outcomes. The tool is effective because it provides visual representation. This becomes the person's 'Your Plan' using their language, experiences and scoring.

Tier 3 captures the wider impact of meaningful engagement and recovery. This measures such things as reduction in prescribed medication, re-engagement with family, reduction in addiction behaviours, debt management improved, resolved housing issues, tenancy sustainability, and offending behaviour. This evidence base of impacts and outcomes for people and their distance travelled is reviewed with the person and may be influential in their Care Planning with other agencies. It can also reflect added value for investment and evidences sustainability to our Local Authority.

To be truly socially inclusive, Gateways is delivered in the most accessible, least restricted way to those it serves. The service is equipped to deliver throughout Inverclyde by utilising an innovative and flexible approach to sourcing locations and venues. This is further enhanced by the comprehensive database also being mobile. Venues include GP surgeries, Community Learning Centres, Short Stay Psychiatric Wards, Continual Care Wards and Alcohol & Drug Services. The service has a presence in foyers of local health centres, hospitals and local employers where we offer signposting and information of relevant community resources and increases peoples' understanding of mental health. Gateways also provides access to Mental Health in the Workplace Training and Mental Health Awareness Training to employers, front line staff and volunteers. This vital training was introduced to tackle issues regarding attitude and discrimination experienced by people who had accessed community resources.

People with severe and enduring mental health problems inevitably come with risk and vulnerability. The service manages risk and vulnerability by adopting a style that can adapt support needs to the person in a creative way that prevents the risk being an obstacle of engagement. Staff adopt a non judgemental, solution focused attitude to risk and vulnerability. If risk is identified to be a barrier then the service works with the person to break down the risk and address vulnerability in manageable bite sized chunks. In identifying risk the service also identifies key partners that people can work with in supporting them through risk management.

Referral routes include people who are in psychiatric hospital. The service sees this as a priority in the transition from hospital to the community. Early intervention with service models of this type is crucial for successful discharge planning and meaningful engagement. Gateways 'Outcome Framework Tool' demonstrates that people's hospitalisation experiences are shorter, have become more focused on recovery and the model supports an integrated pathway. To date 386 people have accessed the service (since Apr 2007).

In conclusion, SAMH Gateways demonstrates that participation is an active, inclusive process that enables people to claim their rights and achieve their potential through mutual ownership and shared responsibility. The service has been able to develop awareness and understanding for ourselves and the wider Inverclyde community, and is viewed by all stakeholders as an excellent example of a recovery focused mental health service.

The service has also recently been evaluated by Inverclyde Council (report attached).

Some quotes from the evaluation conclusion are shown below:

"The Gateways service continues to provide a first-rate support service to individuals with severe and enduring mental health problems. It continues to … promote social development, social inclusion and recovery for those experiencing long-term mental health illnesses."

"it also provides seamless and practical solutions"

"It is meeting the needs of those in the community to improve quality of life; particularly those most marginalised by their illness"

"The partnership and specialised brokerage approach compliments many existing therapeutic and medical alternatives in supporting the well-being and recovery agenda."

"It also now has a proven record of helping to remove many long established institutional barriers and stigmas associated with this client groups attempts to become fully integrated as part of the community."

"The evidence produced in this evaluation supports the need for services of this type, not only based on its demand, but also based the obvious success it has achieved."