"As a result of the pandemic, demand for mental health services is increasing. Without early help, vulnerable people can progress to more serious mental illness, impacting them and their families and increasing the pressure on local health services.
"This review looked at primary care – the first point of contact in the healthcare system – and the voluntary and community sectors to understand the availability and accessibility of early support for adults.
"The Panel found a large variety of services in the borough with different ways of accessing them, including self-referral. We heard that lack of awareness, low confidence or confusion about services can prevent people from seeking the help they need.
"Our recommendations focus on understanding and removing barriers to self-referral.
"We have listened to the experience of residents to identify practical actions that the council and our partners can take to help people access support more easily.”
Councillor Mike Gibson, Chair: Health and Care Overview and Scrutiny Panel
Recommendations
The first 4 actions relate to Bracknell Forest’s draft Health and Wellbeing Strategy.
Target dates will align with the Health and Wellbeing Strategy action plan.
Recommendation 1
That the Health and Wellbeing Board consider the following points under the action to explore the development of a public facing marketing and communication campaign to raise awareness of services available and how to access them.
The board will consider how to:
- help people to understand each service to remove the fear of the unknown
- create personal connections which encourage engagement, such as using photos and first person accounts in communications
- include people with experience of the service as ambassadors to increase personal connections
- use outreach work to bring the service to the community
- emphasise the ability to self-refer and that there is no right or wrong ‘front door’
- demonstrate how people can direct their own care and recovery, making choices about their mental health
- use accessible language so people understand the approach and feel included
- include campaign information in councillor induction so councillors can signpost
Recommendation 2
That the Health and Wellbeing Board makes sure that the community map training for providers supports collaboration between services to help them understand each other’s work and improve signposting and referrals. In particular between GPs and practice staff and the voluntary sector.
Recommendation 3
That the Health and Wellbeing Board includes an event as part of the relaunch of the community map, to provide an opportunity to engage with the public to explain services and make connections.
Recommendation 4
That the Health and Wellbeing Board makes sure users are involved in the action to create and relaunch an improved version of the community map.
Recommendations 5 and 6 are made to the Executive.
Recommendation 5 supports the Health and Wellbeing Strategy actions, and 6 is for future work.
Recommendation 5
That the Executive Member for Adult Services, Health and Housing invites the Chair of the Health and Care Overview and Scrutiny Panel to present the mental health review report to the Health and Wellbeing Board on 7 June 2022.
Recommendation 6
That the Executive Member for Adult Services, Health and Housing works with primary care and voluntary sector providers to increase the opportunity for mental health services to be present in community spaces.
By December 2022, subject to the prevailing COVID approach.
Two recommendations are made to Frimley Clinical Commissioning Group (CCG).
Recommendation 7
That the Frimley CCG seeks agreement with primary care to clearly signpost mental health support on all GP websites.
Target date for Bracknell to be confirmed by Frimley CCG.
Recommendation 8
That Frimley CCG shares the findings of Talking Therapies’ work on low access rates from culturally and ethnically diverse communities and older adults with relevant health partners and voluntary and community groups.
Target date to be confirmed by Frimley CCG.
Key findings
The panel found that:
- there is a large variety of services available with different ways to access them
- a wide range of professionals can signpost and refer, for example, GPs, social prescribers, link workers and community nurses
- most early intervention services accept self-referrals
- services are making good use of resources and have the capacity to accept more clients
There is increased pressure on GPs for mental health services, which can be eased by greater use of self-care, self-referral and the voluntary and community sector.
During the pandemic, people with low level anxiety and depression did not access early support, meaning many developed more severe and complex needs.
The self-referral process is straightforward, but barriers to accessing help include:
- not knowing the service exists
- uncertainty about the service and what it does
- confusion that there might be a ‘right or wrong way’ to access help
- low confidence and low motivation
People are more likely to approach a service if there is a personal connection, and are more likely to engage with support if they are involved in directing their care.
Many services offer a blend of online and in-person activities. Online options offer additional capacity, more flexibility and can remove some geographical or mobility barriers. Physical options must remain for people who are unable to access the technology and to enhance the sense of community.
Young adults are increasingly in need of mental health support, and people from ethnically and culturally diverse backgrounds have low engagement with services. Services are working to better target the needs of these groups.
The longer-term impact of the pandemic on the voluntary and community sector is still unknown, and the council’s Voluntary Sector Champion will include the sector’s pandemic recovery in their areas of focus.
The panel found good working relationships across the organisations that deliver mental health services. This collaboration provides a strong base to support continuous improvement of mental health services.
Good practice
Service users spoke about the positive impact of being actively involved and directing their own care and recovery.
When activities are done ‘with’ people, not ‘to’ people, they present a series of positive choices to improve wellbeing. Services provided many examples of how they involve users and co-design their care. This approach is also reflected in the Frimley Integrated Care System Strategy 2019 to 2025.
Talking Therapies is the NHS’s primary service for supporting adults with mild to moderate mental health problems. In Bracknell Forest, the service is exceeding the nationally set targets for treatment timescales and recovery.
Talking Therapies shared their most recent key performance indicators, covering October 2020 to October 2021:
- Recovery rate target 50% – East Berkshire 58%
- Reliable improvement target 64% – East Berkshire 68%
- Treated within 6 weeks of referral 75% – East Berkshire 98%
- Treated within 18 weeks of referral 95% – East Berkshire 100%
Review findings
Demand for primary mental health services
Primary care services did not see the expected increase in demand for low level anxiety and depression services at the start of the pandemic. People did not access early support, meaning many presented with more severe and complex needs later in their illness.
Frimley CCG is now actively promoting earlier support to prevent more serious illness. The review recognised the benefits of early intervention, facilitated by self-referral.
All services the panel spoke to accept self-referrals. Many professionals can also refer, such as, the police, clinical pharmacists, paramedics. The variety of access options may not be well known and many people think they need to see their GP first. This introduces a delay in the process and may create a barrier for some people.
It also puts a strain on primary care. In Bracknell Forest, GPs experienced a 20% increase in mental health patients between April 2019 and April 2021. Over the same period the number of GPs decreased slightly. This pressure can be eased by increasing the use of self-care, self-referral and the voluntary and community sector.
Clear signposting to self-referral options will support this. The review recommends that access routes to mental health support are made clearer by adding a distinct mental health option to GPs’ websites.
Most of the mental health services the panel spoke to reported a decrease in demand at the start of the pandemic. For many, this is now growing and is expected to exceed pre-pandemic levels.
The services appear able to cope with the increasing demand. Friends in Need is now supporting around 25% more members than pre-pandemic, helped by their blended offering where the new online timetable increases choice and capacity. Talking Therapies is currently below target numbers and is able to increase their users by about 20%. As a relatively new service, Stepping Stones recovery college is also aiming to increase the number of students.
During the pandemic, staffing issues prevented Bracknell Forest Community Network from supporting their full caseload. Two more facilitators have now been recruited to return the service to full capacity. In the interim, a variety of services worked together to share the load, demonstrating good collaboration across mental health services to make best use of available resources.
Delivery of services
Face-to-face support for most services stopped during the pandemic. Many services quickly moved online to continue their provision.
Talking Therapies reported the benefits of their online service. Attendance and recovery rates have both improved and the service can access people in a variety of locations. For example, in a car for greater convenience or at home if they are unable to leave the house due to depression. It also helps relieve the pressure on rooms at GP surgeries.
Most services now offer both online and in-person support options. The additional online options provide more choice, increase capacity and can remove geographical or mobility barriers for attendees.
Bracknell Forest Community Network noted that the decrease in physical community groups meant there were fewer places to take clients. A return to face-to-face activities is crucial for some people to increase their community interactions, build relationships and start socialising. In-person options are also vital for people who are unable to access technology, or who do not find it a helpful way to get support.
Involve explained that some voluntary and community organisations had to stop operations during the pandemic, while others quickly changed their approach to continue supporting vulnerable people. They have launched a project to better understand the new landscape of voluntary and community groups and how to fill any gaps.
The panel noted that the longer-term impact of the pandemic on the voluntary and community sector is still unknown, and the council’s Voluntary Sector Champion will include the sector’s pandemic recovery in their areas of focus.
The panel heard about recent innovations in the voluntary sector, including the Bracknell Forest voluntary and community sector COVID Recovery Grant and the Older Peoples Consortium. These have all been possible because of good working relationships between the voluntary and community sector and statutory partners.
Council forecasts showed a budget overspend of £784,000 for council mental health and out of hours services in 2021 to 2022. This was due to the increasing cost of providing care as people are living longer and often have more complex needs. Although these services are outside the scope of this review, the panel recognised the difficulties of predicting a demand-led service, particularly during a pandemic where previous models may not apply.
Who is using services
Services are seeing more users from younger age groups. Before the pandemic, social prescribing clients were predominantly over 70, mainly experiencing social isolation and loneliness. Now, users are often in their 20s and 30s, presenting with anxiety about leaving the home and re-joining social activities. Bracknell Forest Community Network also reported an increase in younger clients.
Bracknell Forest Community Network are monitoring this age group and are working with Sport in Mind to identify more activities for younger people. Friends in Need have opened a young adults group which offers a timetable shaped by and tailored to younger members. NHS partners have established a task and finish group to consider the needs of those aged 10 to 29. These actions are suitable responses to the changing requirement.
Several services noted that they had low take up from culturally and ethnically diverse communities.
Talking Therapies reported that people from these groups represented about 20% of their clients. They also reported low access rates among older adults (aged 65 and over), who represented about 6% of their clients. Talking Therapies are now working with relevant clients from both of these groups to improve the access rates.
Stepping Stones reported that over 90% of their students identify as White English, Irish or Scottish. They aim to include some bespoke initiatives among local faith and ethnic community groups and will continue to work closely with statutory and voluntary sector organisations to provide more targeted, culturally sensitive workshops and courses.
The panel noted these activities to try to increase access from these groups, and recommends that the findings from Talking Therapies’ work are shared across primary and voluntary sector services so improvements can be more widely implemented. The review recommendations on improving communications and increasing access are also relevant in supporting these groups.
Access and engagement
The panel heard from 5 people with experience of Friends in Need, Talking Therapies and Stepping Stones.
Most people had self-referred to a service, following a suggestion from their GP or seeing an advert. They all stated that the process of self-referral was easy. The challenges were knowing that the service exists, then building the motivation to approach the service and to see it through.
The community map was identified as a key resource both for the public and for providers. The review supports the draft Health and Wellbeing Strategy action to review and relaunch the community map, with associated training and publicity. The recommendation to involve users in this work reflects the importance of ‘done with’ rather than ‘done to’ highlighted by users.
The panel heard how a personal touch helps people to engage. Users said being able to see the service and connect with providers removes the fear of the unknown and makes them more likely to approach. They value being able to talk to people at an early stage to get a feel for the organisation.
Community-based providers said many of their new clients were attracted through word of mouth. Personal recommendations establish a connection and build trust with the service, so the review recommends that services use people with experience of their activities as ambassadors.
One student built their commitment to the recovery college after visiting their stall on the community cart at The Lexicon. People are more likely to take the opportunity when a service ‘comes to them’ so outreach work is recommended. The recommendations to increase the presence of services in community spaces, and to host an event to connect with the public, will also help.
All of the clients valued the sense of community and team effort they experienced at the services. They felt they were making their own choices about their recovery and collaborating with other people to achieve. One contributor said,
“I feel respected. There’s more of a togetherness, not ‘them and us’. When you’re in a group, everyone has their own problems but you’re all contributing and it helps each other.”
The participants all appreciated the return to face-to-face activities, which help build community. They also noted the value of online services, particularly the online courses from Talking Therapies which provide an immediate way to get started.
One provider noted that there are many apparently similar services in Bracknell:
“People may think services are in competition with each other, or that they need to find the ‘correct’ service for them. The reality is that services are all working together. We need to engage with people and showcase the fact that we’re all working jointly to try to support them.”
The panel’s recommendation to increase understanding and collaboration across services reflects this, supported by the recommendations to improve communication with the public. The good working relationships that were observed across services provide a strong base to work from.
The council is a trusted organisation when people are searching for help. The review process highlighted opportunities to update the council’s website for better signposting of services. As a result, senior mental health partners have already worked with public health officers to review and update the pages.
"The pandemic has created many challenges and I have welcomed this opportunity to look at how partners are supporting mental health in Bracknell.
"Mental and physical health are so closely linked, and poor health in one often causes issues in the other. I am very pleased to see that our NHS partners and the Health and Wellbeing Board have strategies that recognise the link, and that aim for equality of wellbeing in both."
"This review has highlighted the range of mental health services on offer in Bracknell Forest and the great work our partners do in delivering them, especially through the pandemic. I would like to thank all our health and support workers for their hard work throughout these challenges.
"I would also like to thank everyone who has taken part in this review. One of our key findings was good working relationships across services and sectors, and this review has benefitted from the open and willing collaboration of many partners.
"The insights provided by residents with experience of services were also invaluable.
"One of the strengths of scrutiny is making things more visible. Through our public meetings, and the related press coverage, we have been able to show some of the many services that are there for people in the borough. There are many more options out there, and our recommendations are designed to help more people access the services they need."
Review panel
Review panel members were:
- Councillor Allen
- Councillor Mrs L Gibson
- Councillor Bhandari
- Councillor Mrs Mattick (Vice chair)
- Councillor Brossard
- Councillor Mrs McKenzie
- Councillor Finch
- Councillor Temperton
- Councillor Gibson (Chair)
- Also attending: Councillor Mrs Birch
| Name | Organisation |
|---|---|
| Nadia Barakat | Director for Mental Health, NHS Frimley CCG |
| Aidan Jordan-Lewis | Transformation Manager (Mental Health and Learning Disabilities) Bracknell Forest, NHS Frimley CCG |
| Heema Shukla | Consultant in Public Health, Bracknell Forest Council |
| Emma Priestly | Social Prescriber, Bracknell Forest Council |
| Sheetal Tanna | Development Manager Mental Health, Bracknell Forest Council |
| Kate Darrall | Project Manager, Jealott's Hill Community Landshare |
| Ansa Khan | Team Lead, Friends in Need |
| Bernadette Fisher | Stepping Stones Lead - Stepping Stones Recovery College |
| Dr Katie Simpson | GP, NHS Frimley CCG Clinical Lead Mental Health |
| Dr Alison Salvadori | Head of Berkshire IAPT (Improving Access to Psychological Therapies) & Mental Health Access Services, Consultant Lead Psychologist |
| Ed Rennie | Acting Deputy to Head of Service (IAPT), Clinical Service Manager East Berkshire |
| Philip Bell | Interim Chief Executive Officer, Involve |
| Residents with experience of Friends in Need, Talking Therapies and Stepping Stones Recovery College | |
| Councillor Birch | Executive Member Adult Services, Health and Housing |
| Grainne Siggins | Executive Director: People |
| Tony Dwyer | Assistant Director: Mental Health & Out Of Hours |
| Jen Lawson | Governance and Scrutiny Officer |
Local mental health services considered in this review
Social Prescribing Service
Links people who have social, emotional and practical needs to a range of local, non-medical support in the community to improve their health, wellbeing and resilience.
For example, help with debt and financial problems, unhealthy lifestyles, loneliness, confidence and goal setting.
Available to Bracknell Forest residents, aged 18 or over.
Where
Support provided by telephone
How
Self-refer, or referral by any health, social care, voluntary or other organisation
For more information visit the social prescribing service.
Bracknell Forest Community Network (BFCN)
Supports individuals and their carers to develop their confidence, life skills and resilience, to remain socially included and to better understand their mental health.
For example, help people to develop a meaningful routine by using their community facilities, trying things out, starting socialising and developing relationship skills.
Available to Bracknell Forest residents aged 18 or over who are:
- recovering from an episode of mental ill-health (usually accessing secondary mental health support)
- “stepping down” from Community Mental Health Team support
- at risk from suffering an episode of mental ill-health
How
Referrals usually come from Community Mental Health Teams or GPs.
Self-referral is available.
For more information visit the Bracknell Forest Community Network.
Talking Therapies
Addresses mild to moderate mental health problems, such as anxiety and depression, using Cognitive Behavioural Therapy (CBT). Evidence-based, lighter touch approach with high recovery rates.
Available to Berkshire residents aged 17 and over.
Where
Face-to-face support offered in GP surgeries and health clinics.
Online therapy programmes with immediate access are also available.
How
Self-refer, or referral by any health professional.
For more information visit the NHS Talking Therapies Berkshire.
Friends in Need
Peer-to-peer social support community for people with mild to moderate depression, social isolation and anxiety to promote resilience, empowerment and wellbeing.
Monthly timetable of events, including physical activities, craft and wellbeing options.
Available to anyone aged 17 or over.
Where
Various venues, such as community halls and coffee shops, around Bracknell and surrounding area.
Online events also provided.
How
Self-refer, or referral by any health, social care, voluntary or other organisation.
For more information visit Buckinghamshire Mind – Friends in Need.
Jealott’s Hill Community Landshare
Voluntary community project using the power of gardening to positively change lives, allowing people to enjoy being close to nature and sharing produce.
For example, growing produce, carpentry, craft and cooking. Sharing experiences, learning skills and drawing on individual strengths, skills and interests.
Available to anyone.
Where
Six acre site between Bracknell and Maidenhead.
How
Everyone is welcome, with particular focus on people with a disability or disadvantaged background.
For more information visit Jealott’s Hill Community Landshare.
Stepping Stones Recovery College
Free workshops and courses that use learning as a positive, life-changing experience for anyone experiencing challenges to their mental, physical and emotional wellbeing. Helps people find out what they need to live a meaningful life.
For example, creating a personal recovery plan, improving health and wellbeing or having fun with creativity.
Available to anyone aged 18 or over, who lives or works in Bracknell Forest.
Where
College is located at The Court House in Bracknell town centre.
Online courses are also available.
How
Self registration.
For more information visit Stepping Stones Recovery College.
Wellbeing service
Offers support for practical, situational and social challenges through supportive therapy for people who are below the threshold for secondary care.
For example, housing, money worries, substance abuse and loneliness, as well as general wellness, such as diet and healthy living.
A one-to-one phone call results in an agreed Wellbeing Pathway.
The service works closely with local health, social care and government partners.
Available to anyone aged 18 and over who is registered with a GP in East Berkshire.
How
Self-refer, or referral by any health or social care professional.
For more information visit Berkshire healthcare wellbeing service.
Outreach programme
Works with Primary Care Networks and clinical leads to contact people with severe mental illness and carry out annual health checks. Aims to help establish equality in physical health outcomes, regardless of mental health.
In addition, Talking Therapies is now co-located in areas traditionally associated with physical healthcare, for example, respiratory clinics, diabetes clinics and long covid clinics.
Mental Health Additional Roles and Responsibilities Scheme (ARRS)
Embeds expert mental health nurses in GP practices, as data shows more people are attending primary care with low level anxiety and depression.
Mental health nurses provide advice, triage and liaison with local mental health teams. They also offer shared decision-making and brief psychological intervention.
How
Accessed directly through GP surgeries without a referral.
Mental Health Integrated Community Service (MHICS)
Supports people with significant mental health problems using a multi-discipline team, including a psychiatrist, pharmacist, psychologist, mental health nurse and community connector, with admin support from primary care. Improves access to a wide range of specialist support and addresses a gap between primary and secondary care.
Offers person-centred care, support to transition to other services, advice and brief interventions.
How
Professional referral required.