Birmingham and Solihull Mental Health NHS Foundation Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People were involved in the assessment of their needs and support was provided where needed to maximise their involvement. Assessments considered the person’s health, care and wellbeing needs to enable them to receive care and treatment that has the best possible outcomes. Assessments were up to date and regularly reviewed. Staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. Information was shared between teams and services to ensure continuity of care. Relevant staff, teams and services were involved in assessing, planning and delivering people’s care and treatment and staff worked collaboratively to understand and met people’s needs. People were supported to manage their own health, care and wellbeing needs by staff who understood their needs and preferences. People were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. People experienced positive outcomes which met agreed expectations as set out in legislation, standards and evidence based clinical practice.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We observed when visiting people at home with staff that people were happy with the care and support they received. People told us that staff supported them with all their needs including their housing and finances. They said they had not realised the impact their other needs had on their mental health which had improved once these had been addressed. People said that staff spent time with them to ensure they understood their care plan.

Staff told us they assessed all the needs of the person including their physical and mental health. Staff said when they received a referral for a person, they completed an initial assessment to see if the person was suitable to receive the service. They looked at the person’s needs and the priorities such as employment support, does the person need to be referred to social services or need to access a food bank. They then discussed their assessment with their supervisor and took the assessment to the multidisciplinary team meeting to discuss the person’s needs further. They completed a risk assessment as part of their initial assessment and reviewed this further when the person used the service. Clinical leads told us how they focused on people’s physical health needs and how this interlinked with their mental health needs. They said staff completed a full bio psychosocial assessment using a trauma informed approach focusing on what has happened here, what has affected you and what will help now. Staff involved the person so they could say what they wanted from the service. This helped staff identify when a person did not need the community mental health service. As part of the assessment staff liaised with social services to see if the person had any social worker involvement. Staff told us about the new records system in place called ‘DIALOG+’ for people on Care Programme Approach. They said this helped the person to get involved, set their goals and was solution focused. The manager at Yewcroft community mental health team told us that the team lost their building 8 years ago, so they were sharing a building with other teams. This impacted on people using the service not getting as many face to face appointments and some new assessments were completed remotely via video calls. Staff in other teams told us they planned to meet people’s sensory needs during assessments by adapting rooms or using other rooms in the building if needed.

Care records which included assessments were mostly good, however some lacked detail and did not reflect the service users voice. The electronic care records were not always very easy to follow as information was not always together. However, all records contained up to date assessments and care plans. Sometimes this information was found in the medical letters which were shared with the person and their GP.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff told us they worked with people’s GP’s, housing services, probation and court services and the psychiatric liaison teams based in hospital emergency departments to support people using the service. As part of the mental health transformation programme there were now neighbourhood mental health teams within the GP surgeries. These teams supported people who did not meet the criteria for accessing the community mental health teams and supported people when they were ready to be discharged from the teams. Staff told us they had good links with the neighbourhood teams. Staff told us they worked well as a multidisciplinary team and shared ideas on how to support individuals who used the service. Staff said they had good relationships within the team so they could have honest, collaborative discussions about their work and the needs of people who used the service. Some staff expressed difficulties with referrals to home treatment teams not being accepted. There were physical health nurses working within the teams who referred people to other agencies when needed such as substance misuse services and sexual health clinics. Staff worked with charities within the community such as food banks and substance misuse services. Managers told us they had weekly meetings with other team managers to share ideas and learning.

Records showed that staff liaised with other teams and services to meet people’s physical health needs, to ensure people received the medicines they needed, employment services, worked with housing services and the local fire service when concerned about a person’s property. People’s records showed that when people attend the clinic to monitor their medicines, they were also seen by staff from the physical health team who worked together. One person’s records showed that staff supported the person to a hospital appointment to ensure they received the treatment they needed.

People said that staff advised them on healthy eating, smoking cessation, drug and alcohol advice and how to meet their physical health needs such as managing their diabetes. People said that staff had helped them to access yoga and relaxation classes which had improved their confidence.

Records showed staff from the physical health team supported people and gave them advice and support on living healthier lives. People’s records showed that staff advised people on healthy eating and alcohol use and made referrals where needed to other health or social care professionals for additional support.

People told us that staff had helped to improve their mental health and wellbeing and helped them to be optimistic about their care and the future. People said that art psychotherapies had improved their wellbeing and given them the ability to deal with their trauma that they had not been able to do through talking therapies. People told us that staff had helped them to set goals which had improved their quality of life. They said that staff had helped them with budgeting and housing. We observed staff asking a person what they wanted to improve and how. Staff gave the person options to try to find out what activities the person liked. People said that staff helped them to get out of the house more which improved their anxiety. They said staff help them to go to activities, so they were less frightening. We observed staff discussing with a person different distraction techniques and ways to manage their anxiety. They also helped the person to apply for their benefits and discussed their sleep pattern and techniques to improve this.

Occupational therapy staff said they supported people to use public transport to improve their confidence and increase their use of social groups and interaction. They said they worked with local mental health groups and charities who provided activities and groups to improve the range of activities available. Staff told us the Trust had invested in art psychotherapies which improved outcomes for people who were unable to express themselves in talking therapies. Psychologists said when needed to see a person at their home due to a person’s accessibility needs. The Trust had trained nursing staff in cognitive behavioural and dialectal behavioural therapies so they could use these skills when working with people to improve their outcomes. Staff said they explored other options where people did not want to take medicines such as attending groups. They then reviewed this to ensure they had a positive outcome on the person’s mental health.

Staff audited outcomes for people using therapies, groups and medicines. These were reported back to the community clinical governance committee to monitor. Clinical leads said that people can access psychological support, but it could take between 8-10 weeks for an assessment and then up to two years for 1-1 treatment. They said that access to group therapy was quicker, and people were offered this to help improve their outcomes. Mental Health wellbeing practitioners were now employed as part of the team to deliver lower-level psychological interventions, for example, managing voices and confidence building. Staff assessed people as suitable to refer to wellbeing practitioners so that they could ensure the right treatment to meet the person’s needs.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.