Leading questions: mental health lead Emma Tiffin

Dr Emma Tiffin, GP and associate clinical director for mental health and learning disabilities in Cambridgeshire and Peterborough integrated care system (ICS), speaks to senior reporter Beth Gault about designing mental health services in primary care

Beth Gault (BG): How do you think adult mental health services should be organised?  

Emma Tiffin (ET): A community mental health service needs to be built around places and geographic locations. I don’t think a single point of access on a big scale usually works very well because there needs to be strong relationships between practices, PCNs, voluntary sector, local authority and secondary care mental health services. That is critical.

We know that there are national issues around staffing numbers in specialist mental health services and not all patients need a specialist mental health intervention. So, we need a joined-up system that meets all the needs of a patient and improves their mental wellbeing, rather than it being just medically or community focused. What that means is looking at a model where third sector partners can come in and provide a lot of community support and help with prevention. If a system can break down the interfaces between primary, secondary and community care, that can make a real difference. And ICBs should be the driver of this.

BG: What does your adult mental health service look like in Cambridgeshire and Peterborough?

ET: In terms of the whole philosophy, the vision is around bringing together the clinical side with community support and engaging the whole system so that we all own our mental health model and help patients together. It’s moving from isolated silos towards wrapping services around the person using a stepped care model.

Patients are managed in the community where possible but we still have inpatient care and secondary mental health services. We introduced two levels of care between the GP and secondary care which are the Psychological Skills Service (PSS), and the REDS (Relational, Emotional Difficulties Service) which provides a more intensive psychological offer.

We wanted to move away from diagnosis towards needs based services. So, our psychological skills service doesn’t worry about what diagnosis you’ve got, it focuses on skills such as  managing low self-esteem, anger, low mood and stress.

We also wanted to move away from segregation of primary and secondary care towards integration. We realised the importance of relationships in this ambition, so we invested in senior mental health liaison roles, that really broker the primary secondary care relationship.

For example, if there’s a patient that no one is able to help, they will troubleshoot, working out what the patient needs and where they can access that. We now know where every patient is in the system with a mental health referral, whereas in the old days, we didn’t.

We also have a service called HAY (How are you) which is designed to improve wellbeing at population level. There are six geographically local digital spaces that are interactive and allow people to experience what’s available in their local community, for example yoga, pilates, and mindfulness classes.

We’ve also put in place an outreach team for substance misuse in Peterborough, community mental health pharmacists, a physical health team which are band four healthcare assistants who are specifically trained to help engage patients with serious mental illness with physical health checks and accessing physical health interventions. We also have a public mental health consultant who works with data analysts and is doing our mental health needs assessment – which is important if you’re trying to prioritise funding for mental health – and community connector roles who are social prescribers with mental health training who are provided by Cambridgeshire, Peterborough and South Lincolnshire (CPSL) MIND and Greater Peterborough Network.

We also have contracted PCN clinical mental health leads, who work one session a month. It’s made a big difference in terms of supporting PCN clinical directors with mental health service provision and creating the time. These roles work with the PCN clinical directors to really raise the profile of mental health and address the challenges.

BG: Do you employ staff through the ARRS for this? 

ET: We implemented community connector roles (social prescribers with specific training in mental health) through our ARRS budget. Most are employed by CPSL Mind, some are employed by our GP Federations, and they’ve been really successful supporting people in a non-clinical way.

Psychological interventions and medication will help some but not all patients, so having that social, wellbeing support and focus on the resilience side makes a big difference.

BG: What role can PCNs play?

ET: They are all different, so each PCN needs to have a grip on what the mental health needs of its population are and what its demography looks like. Services that work in one area of ICB geography may not work in other areas, so you can’t compare – each PCN’s needs are different.

Once it understands its needs, the PCN can look at what services should be put in place. But I think all PCNs should also be working towards integration as well. Given the current challenges around the clinical mental health workforce it is even more of a priority to focus on working with the third sector, local authorities and all the other non-clinical organisations that can make a difference to mental health.

BG: And what can the new Government do to help the adult mental health space?

ET: Supporting the community mental health transformation that’s already happening, supporting NHS England and policies that support the sharing of ideas from systems that are ahead of others.

I always remember a comment from Positive Practice in Mental Health, an organisation that seeks to raise the profile of mental health among policy makers, that ‘a perfect mental health service exists, it’s just not all in one place’.

What we’ve tried to do is to map out our patients’ needs, identify the gaps and look at what we have and where it does or doesn’t work. Given that funding is challenging, you’ve got to do more with what you’ve got and it’s usually around joining up the dots and coordinating what you’ve got that can make a huge impact. You don’t necessarily need a whole lot more.