1. How a service for young people in North Yorkshire works with other agencies to focus on all their emotional wellbeing, substance misuse and mental health needs. 

The service

Compass REACH is a specialist service that works with children and young people aged 9 to 19 (and up to 25 for those with special educational needs or disabilities) who have moderate or high levels of need related to their drug or alcohol misuse, or require sexual health interventions. It also works with children and young people who could benefit from receiving early help and prevention work to support their emotional wellbeing and mental health needs. The young people who access the service can receive interventions just for substance misuse or emotional wellbeing difficulties, or for a combination of the two.

North Yorkshire County Council commissioners set up Compass REACH (as North Yorkshire Risk Taking Behaviour Service) in September 2012 to provide consistent services across the county for young people. The service began as a substance misuse and sexual health service, based on a nurse-led staffing model which helped young people to access psychosocial support alongside clinical interventions for sexual health (such as emergency hormonal contraception) from the same practitioner.

In 2015, North Yorkshire County Council re-commissioned the school nursing service and the specialist substance misuse service under the umbrella of the healthy child service. They extended the Compass REACH service to include early help for emotional wellbeing and mental health issues. Since then, Compass REACH has provided specialist substance misuse interventions, and early help and prevention support for sexual health, emotional wellbeing and mental health issues.

What they have done

The Compass REACH service has been running for 5 years, half of which have included the emotional wellbeing and mental health work. It is now a well-established service with referrals growing by 170% from 2013 to 2017. In North Yorkshire, Compass REACH works closely with colleagues from the local authority prevention service. All services are co-located in what are known as ‘prevention hubs’. This has encouraged understanding and communication between professionals who work to support young people.

Compass REACH’s nurse-led model combines clinical elements such as emergency hormonal contraception, blood-borne virus testing, and hepatitis A and B vaccinations with psychosocial interventions, which are all provided by the same practitioner. Compass REACH has worked with colleagues from other local services, such as the healthy child service and child and adolescent mental health services, to develop a screening tool which helps professionals find the right service to meet the young person’s needs.

This has also helped them to establish a ‘no wrong door’ approach, as recommended by PHE’s guidance on providing better care for people with co-occurring mental health and alcohol and drug use conditions, so young people are not turned away from any service they access. The service providers are able to refer the young person to a range of partner agencies, which makes support much more accessible to them.

Care pathways have been developed and improved by Compass REACH and their partners to support the overall aim of helping every child in North Yorkshire meeting their potential. Outcomes are measured using various tools, such as Outcomes Star, Young People’s Outcome Records and a tool developed by Compass which measures how well the young person is doing by comparing how many vulnerabilities they have when they complete their interventions with the number when they first entered the service.

Main learning points

The nurse-led model, a single practitioner who is able to provide both psychosocial and clinical interventions, works well. Locating all the young people’s services together in prevention hubs that young people routinely access for support with careers, life-skills, parenting and housing has also added to the success of the service.

Since Compass REACH covers a large predominately rural area, outreach allows more young people to access the service. The nurses have the flexibility to meet with service users anywhere that is convenient and where they feel safe and comfortable.

There is ongoing work to ensure that all partner agencies throughout the county understand the role and remit of the Compass REACH service, especially the emotional wellbeing and mental health support they provide. They believe they need more work with partners, including the specialist child and adolescent mental health services, to make sure there are no gaps between the early help and prevention interventions and specialist services.

Next steps

Compass now provide a new school mental health and wellbeing project Compass BUZZ in North Yorkshire. Wellbeing experts work with schools and other partners in North Yorkshire to increase staff skills, confidence and competence in dealing with emotional and mental health concerns. The project also helps staff to provide low-level support to young people at the earliest stage possible, allowing specialist services, practitioners and nurses to focus their resources on children and young people who need a more intensive service.

  2. How joining up mental health, alcohol and drug misuse services in a Derby hospital provided better support for people with addiction and mental health problems.

Background

Co-existing substance misuse and mental health issues are very common. Having a team that can treat both of these helps them to provide better integrated care and allows a person’s substance misuse to be considered alongside their wider mental, physical and social health.

Derbyshire Healthcare NHS Foundation Trust set up a liaison psychiatry team at the Royal Derby Hospital in 2013 using the Core 24 model based on the Rapid Assessment Interface and Discharge (RAID) model of liaison psychiatry.  The liaison psychiatry service works with patients in the Royal Derby Hospital who have mental health and substance misuse needs. The service ensures that mental and physical health problems are treated equally and not separately. The team replaced 3 smaller services within the hospital.

This service was set up after an economic evaluation of a similar model in a Birmingham hospital showed reduced hospital stays and a cost to benefit ratio of more than 4 to 1. The service involves:

• 24/7 rapid response to requests for help
• quick response targets - 1 hour for the emergency department, 24 hours for hospital wards
• having a comprehensive range of specialist knowledge including mental health, substance misuse, self-harm, suicidal thoughts, dementia and delirium
• working with around 600 adult patients a month

What they've done

In the first year of operation, the number of contacts recorded by the team rose to over 8,000 compared to around 5,000 recorded by the 3 former services in the previous year. The number of contacts then fell in the second year to around 6,500 (in line with what was reported by the original RAID service) and it has stayed constant.

Over the first 2 years of the team’s operation, the average length of stay in hospital significantly decreased by 1.16 days for nearly all patient groups with mental health or substance misuse related diagnoses. Although the team has not been able to prove that the new service has directly reduced hospital stays, it is likely that the service played a significant role in reducing them.

Main learning points

Close working relationships between liaison, acute and community teams were essential to helping people receive appropriate community care, reduce readmissions to hospital, and cut delays to hospital discharges.

The liaison team has developed a good relationship with the community substance misuse service, to create a quick referral process and data sharing agreements. The team also hosts volunteers from the community team twice a week, to talk to patients and support them to continue seeking help if they need it after they are discharged from hospital. This engagement team from the substance misuse service also reaches out to patients who are in regular contact with the liaison team. The team has a research post to help continually evaluate everyday practice and ensure the service is efficient, high quality and sustainable.

When the new service was created, some clinicians were apprehensive about what reconfiguring the service meant for their specialties. But as the new service has developed, clinicians have been able to retain their specialties while developing a core set of generic skills and an ability to provide integrated care, resulting in a better quality of care for patients. The link between substance misuse and mental health problems is becoming more widely recognised as the liaison team has become more integrated with the care happening on the hospital wards and the mental health and substance misuse training for hospital staff has improved. There is also a greater sense that mental health and substance misuse is everybody’s business.