Non-pharmacological alternatives to PRN psychotropic medication

Psychotropic medicines are used frequently in mental health settings; however, concerns have been raised over the safety and lack of evidence of effectiveness of this practice. Greater Manchester Mental Health Trust conducted a survey exploring the non-pharmacological interventions used by nurses to support agitated service users. It used their responses to create a clinical aid that maps out suggested interventions under the themes of physical health, relaxation, distraction, environment and psychological health.

The survey by GMMHT explored non-pharmacological interventions as alternatives to pro re nata (as-required) psychotropic medication in mental health settings. This article explores its results, which have been developed into a clinical aid suggesting possible interventions.

A total of 34 distinct non-pharmacological interventions were identified, which fell under five themes: physical health, relaxation, distraction, environment and psychological interventions. Our analysis of the free-text comments revealed how the interventions and themes interacted and overlapped, which enabled us to develop a thematic map of nurse-led interventions as an alternative to PRN psychotropic medication (Fig 1). This is a visual schematic map for use by both staff and service users to allow them to identify non-pharmacological interventions that could be used in a moment of crisis, as well as to identify those interventions that the service user would not find helpful. We discuss the map’s five themes below, with reference to both survey responses and supporting literature.

See full article here

Source: Nursing Times, 22nd February 2021

Adult social care and mental health services to be ‘streamlined’ in Trafford

Agreements have been struck between the NHS and Trafford Council to improve mental health services and care for vulnerable adults across the borough.

One Section 75 partnership agreement has been signed between the local authority and Greater Manchester Mental Health NHS Foundation Trust (GMMHFT). 

Another is due to be signed off between the council and Trafford Clinical Commissioning Group (CCG).

Both agreements are aiming to pave the way to better, more streamlined care for residents.

The arrangement for mental health provision in the borough is an update on the current agreement between GMMHFT and Trafford council.

The deal between the council and the CCG for streamlining adult social care is also an updated one and is due to be signed off at Trafford council’s executive meeting on Monday July 26.

It solidifies the adult social care in Trafford under one management system, continues to simplify and improve services in the borough and allows the use of council funding by the CCG and vice versa from a collective funding pot.

Coun Jo Harding, Executive Member for Adult Services, said: “The importance of good mental health is finally being recognised and this agreement makes sure the systems are in place to make sure people can get the right treatment at the right time.

“For the council, a major priority is enabling people to live as independently as possible. This agreement is a key part of delivering on that priority.”

Claire Fraser, head of operations for Trafford Mental Health Services at Greater Manchester Mental Health NHS Foundation Trust, said: “We have welcomed this opportunity to review and renew our partnership with Trafford residents.

“In Trafford there has been and continues to be an unwavering commitment to improve our collective approach to neighbourhood and partnership working, building on some of the excellent work that already exists.

“It has been a constant discussion point for years and some amazing progress has been made in terms of integrated and multi-disciplinary neighbourhood teams and this commitment to Trafford residents ensures mental health care and well-being is connected to the wider health and social care system.

See full article here

Source: Manchester Evening News, 22nd July 2021

New Crisis Mental Health Hub Open at North Manchester General Hospital

A new mental health facility, based at North Manchester General Hospital’s Emergency Department, is welcoming patients who are in need of urgent mental health care.

Manchester Evening News, 4th August 2021

The joint programme between the North Manchester General Hospital (NMGH) and Greater Manchester Mental Health NHS Foundation Trust (GMMH) repurposed an area adjacent to the Emergency Department to divert people in mental health crisis away from the busy A&E into a more appropriate area, staffed by mental health professionals and offer urgent appointments as part of the GM Urgent Care by appointment scheme. 

‘The Green Room’, is a new facility which accepts patients who are experiencing a mental health crisis. They will be cared for in calm environment, away from the Emergency Department, which can often worsen crisis mental health situations.

Individuals needing critical mental health care are treated and supported by the most appropriate mental health professional. This has obvious benefits for the patient in crisis who receives timely care in the right place, but it also frees up staff in the Emergency Department to treat people who have urgent physical health needs.

Full article here

Source: Manchester Evening News, 4th August 2021

Three young people have died at Prestwich mental health hospital in the last nine months

“We are deeply concerned to see a pattern of deaths of young people in this hospital. Families expect that their children and loved ones are in the safest place possible when they are a mental health inpatient.”

Jodie Anderson, caseworker at the charity INQUEST

Three young people have died in a nine month period at Prestwich Hospital.

Rowan Thompson, 18, died at the mental health hospital in Bury, in October, followed by Charlie Millers, 17, in December, and Ania Sohail, 21, in June.

The series of deaths has led campaigners to call on the Care Quality Commission to ‘urgently inspect the service’.

In response, the Care Quality Commission told the Manchester Evening News they were reviewing ‘the information available to us and considering what actions’ to take.

In a 2018 CQC report Greater Manchester Mental Health Foundation Trust, of which Prestwich Hospital is part, was rated ‘good’ overall.

But Paul Elliot, Deputy Chief Inspector for hospitals and lead for mental health said there were ‘areas for improvement’, adding: “We have made it clear that the trust needs to focus further on safety.

“In acute wards for working age adults and psychiatric intensive care units, staff were not following the trust’s policy in relation to rapid tranquilisation and in child and adolescent mental health wards, checks to ensure that equipment was safe to use had not always been carried out.”

The Trust has 13 locations with 875 beds across 59 wards.

A CQC report published in January 2020 again rated the Trust ‘good’ overall, but the category of ‘Are Services Safe?’was said to require improvement.

Jodie Anderson, caseworker at the charity INQUEST, which is supporting the families of Charlie and Rowan, said they were ‘deeply concerned’.

“Families expect that their children and loved ones are in the safest place possible when they are a mental health inpatient. Yet too often, this is not the case,” she said.

“We await the inquests into these premature deaths, which must ensure the utmost scrutiny. However, we cannot wait for action on this hospital. In light of these three very recent deaths of young people in concerning circumstances, we call on the regulators the Care Quality Commission, to urgently inspect this service and ensure other young people in mental health crisis are kept safe.”

In response, Brian Cranna, the Care Quality Commission’s head of hospital inspection (and lead for mental health), said: “We can confirm, that we are aware of the deaths of three patients at Prestwich Hospital in Manchester, which is run by Greater Manchester Mental Health NHS Foundation Trust, and our thoughts are with their loved ones.

“We are reviewing the information available to us and considering what actions we may wish to take.

“Our priority will always be to ensure consistently safe, effective and responsive care for people using health and social care services.”

Full inquests will be held into the deaths of Ania, Rowan, and Charlie at Rochdale Coroner’s Court. No dates for the hearings have been set yet.

See full article here

 Note: NHS trusts investigate deaths in their own mental health facilities, with no independent body looking into the death.

The charity Inquest provides support to bereaved families of those who have died in state custody. It said in 2015 the lack of an independent investigation into deaths in mental health detention is a ‘glaring disparity’.

A later report in 2016, submitted to the Care Quality Commission in the wake of Southern Health’s disastrous handling of patients’ deaths, warned the ‘approach to investigations and investigation reports are inconsistent across trusts and mainly very poor in quality’.

Source: Manchester Evening News, 26th July 2021

Hearing Voices | Seeing Visions | Making Zines with Liv Winter and Voice Collective (September 2021)


Do you want to help people understand what it is like to be a young person who hears, sees, or senses things that others don’t?

Join artist Liv Wynter for a series of online zine-making workshops to explore experiences of hearing voices and seeing visions! Open to anyone aged 16-25 with lived experience of voice-hearing. No artistic skills necessary!

The digital zines we make at the workshops will be shared on Understanding Voices ­– a website containing information about different ways of understanding voices and supporting people who are struggling to cope.

Hearing the Voice is collaborating with Voice Collective and artist Liv Wynter to run a series of online zine-making workshops for young people (aged 16–25) who hear voices or see visions that others don’t.

It’s an opportunity to …

  • Share your story
  • Explore how voice-hearing intersects with other aspects of who you are
  • Meet other young people who hear voices
  • Make some zines!

The workshops will take place on Zoom over four weeks in September on the following dates:

  • Thursday 9 September 2021, 6.30–8pm (BST)
  • Thursday 16 September 2021, 6.30–8pm (BST)
  • Thursday 23 September 2021, 6.30–8pm (BST)
  • Thursday 30 September 2021, 6.30–8pm (BST)

More information about the workshops and information on how to express an interest in participating can be found here

Long-covid mental health and psychological support service to launch by Pennine Trust

Recent research from The Lancet shows that an estimated 34 per cent of people diagnosed with Covid-19, go on to have a neurological or psychiatric diagnosis within the following six months

Pennine Care NHS Foundation Trust has received £593,000 in funding from Greater Manchester Health and Social Care Partnership to establish a new long-covid mental health and psychological support service.

The new service, expected to launch autumn 2021, will be based at Pennine Care’s existing
Psychological Medicine Service in Oldham; and will co-ordinate the care and support for people with mental health and psychological difficulties caused by Covid-19 in Oldham, Bury, Rochdale, Stockport and Tameside and Glossop.

Anna Dalton, long term conditions strategic and operational lead at Pennine Care, said, “Our innovative Psychological Medicine Service in Oldham already supports people with complex physical health problems and long-term health conditions who may also have mental and emotional difficulties.

Since autumn last year, we have helped more than 50 people in the borough who have had
on-going psychological difficulties and complications due to Covid-19. This new dedicated
service means we can help people across all our five boroughs in Greater Manchester receive the mental health help and support they need.”

See full article here

Source: About Manchester, 19/07/2021

Pennine Mental Health Trust failed young musician due to gap in provision

Self-taught drummer James Theophine was reported to the police in April 2019 and his mum Melanie Theophine said that the allegations ‘rocked his world’.

James became dependent on alcohol and died from multi-organ failure in October 2020, aged 20.

The court heard that James slipped through a gap in mental health services in the run up to his tragic medical episode.

James, from Heywood, suffered a series of mental health issues throughout his life and relied heavily on his mum.

In 2007, he was diagnosed with ADHD and four years later, he was diagnosed with autism.

He had a severe form of eczema which was prone to infections, lived with OCD from a young age and struggled with bulimia later in his life.

Mrs Theophine said her son’s mental health suffered a blow in April 2018 when police investigated an allegation involving him – and while this was dropped, James had found the police’s handling of the case traumatic.

The court also heard that James slipped through a gap in mental health services in the run up to his tragic medical episode. 

The court heard that after his 19th birthday, James had struggled to access mental health services after getting too old for the children’s mental health team.

He was considered ‘too complex’ for the adults’ community mental health team and was referred to an organisation called Lanc UK, which was commissioned to run some mental health services.

But Mrs Theophine felt this would not help her son, and in January 2020 she spoke to Pennine Trust enhanced access nurse Gillian Fletcher, along with James.

Ms Fletcher told court that she referred James to Pennine Trust’s ‘open door’ team and arranged for a psychiatrist to see him.

By July, James’ case was discharged by the trust, as he had again been referred to Lanc UK.

Lanc UK director Dr Neil Rutherford told court that his organisation had already considered that James was too complex for the organisation to help him one month earlier – an issue his mum had previously highlighted.

Ms Fletcher said Pennine Trust had not been made aware of that, and would have found an alternative solution for James had it known.

Asked whether she believed there had been a gap in provision for James, Ms Fletcher said: “Yes.”

She added: “I’ve had a lot of time to reflect on James’ case. I did meet him twice. James did speak to me on his own for quite a good period of time.

“He was a very lovely person and a very gentle young man. On reflection I wish that we had also referred him to alcohol services. He was using alcohol and admitted to self-medication.”

A report into the care received by James was read to the court by Cheryl Henry – the community services manager at Heywood, Middleton and Rochdale Community Mental Health Team.

The report also concluded that there was a gap in James’ care.

See full article here

Source: Manchester Evening News, 24th July 2021

Game-changing homelessness project in Greater Manchester facing an uncertain future

‘Housing First works’ – but government funding currently runs out next year

Housing First – an approach to entrenched rough sleeping already used to huge success in other countries, including Finland and the United States – has been undergoing pilots in Greater Manchester, Liverpool and Birmingham since 2018.

It works on the basis that once someone has a long-term roof over their head, support for complicated problems such as physical or mental health illness, addiction or offending – and in many cases more than one of the above – can then successfully follow, for as long as is needed.

According to a new report by a cross-party group of MPs, as well as the mayors for each of those city regions, homeless charities, international experts and scores of people helped by it, Housing First simply works ‘exceptionally’ well.

round 90pc of those it sees with the most complicated, overlapping problems end up staying in accommodation permanently via the programme, including in Greater Manchester.

The evidence from the three pilots and from its own inquiry over the past few months, says the report from the All Party Parliamentary Group on ending homelessness in its conclusions, is ‘resoundingly clear’.

“For people that have the highest and most serious support needs compounding their homelessness, Housing First works.”

It also saves money, as it cuts back on A&E attendances, welfare, police call-outs, criminal justice costs and social service demand. Yet it faces a ‘cliff edge’: government funding runs out in 2022.

As a result, both those running and being helped by the programme are now living with ‘a huge uncertainty’, warns the APPG, urging the government to extend funding into the future and roll the programme out nationally.

“The government has already demonstrated a welcome understanding of Housing First by investing in three city-region pilots in the Autumn Budget of 2017,” it says.

“However, this funding is due to end in 2022, and as it stands, there is no clarity about how the 1,100 Housing First places across these pilots will be financed past this point.

“This has generated a huge amount of apprehension and uncertainty for both providers and clients of these services.”

A commitment to ‘scale up’ the programme nationally is also ‘urgently needed’, warn the MPs. Charities estimate around 16,000 Housing First places are required across England.

The inquiry into Housing First was partly prompted by the success of ‘Everyone In’, government’s attempt to accommodate rough sleepers across the country during the pandemic.

The report tells ministers they now have a ‘unique’ opportunity to build on what they did last year, which it says proves that with enough ‘political will’ and bold thinking, success is possible.

Other rough sleeping programmes, including the government’s Rough Sleeping Accommodation Programme, are playing their part too, says the report. But, partly because they are done on a short-term basis, they ‘fall far short’ of what is needed.

Estimates by the think-tank Centre for Social Justice suggest that for every £1 spent on Housing First, £1.56 is saved. The Joseph Rowntree Foundation estimates it would save the public purse £200m a year within two years of being rolled out nationally.

Andy Burnham, who made rough sleeping a priority after taking office in 2017, says ‘there is no doubt about it – Housing First works’..

Meanwhile for people with the most complex issues, temporary accommodation ends up being about ‘managing’ a person’s homelessness, rather than ending it.

“I call on the government to embrace the results of the pilots and to turn Housing First into a permanent, national scheme,” he adds.

“Housing First is not just a good housing policy. It is also a good health policy. Just one night sleeping rough does considerable harm to people’s physical and mental health.

“We have seen how Housing First in Greater Manchester has helped people with severe health problems to recover. Sajid Javed set up these pilots as Communities Secretary, and deserves great credit for that, but I hope he will now use his position as Health Secretary to support Housing First and secure the health gains it has achieved.”

Jon Sparkes, chief executive of the homeless charity Crisis, echoes that view.

“Housing First works,” he agrees, adding that it provides a ‘solid foundation’ for those who have been stuck in homelessness for years, struggling to address trauma, addiction or mental health issues.

“Evidence from these three city regions and around the world shows that Housing First is the most effective approach to ending the homelessness of people with complex needs.

“It is unthinkable that the pilots could be stopped from providing that vital support to over a thousand people. Now is the time to expand Housing First across England and make it accessible to more people, not fewer.”

Full story here

Source: Manchester Evening News, 20th July 2021

GMMHT receives 30,000 calls to 24/7 Helpline since March 2020

Mental health phonelines run by the NHS have answered around three million calls during the pandemic since being fast-tracked a year ago.

The dedicated 24/7 NHS mental health crisis helplines were fast-tracked four years earlier than planned to ensure support could be provided during the pandemic.

The lines are staffed by mental health professionals who can refer people to local urgent, acute and routine mental health services. This may include phone and video consultations, as well as urgent face-to-face assessments where necessary.

Most callers are able to receive treatment over the phone or can be referred to a face to face assessment and fewer than 2% of the calls have resulted in an A&E attendance or a blue light response from ambulance or police.

The helplines have been set up by the 54 mental health trusts across England and some have now been running for over a year, with three million calls between May 2020 and May this year.

At the start of the pandemic Greater Manchester Mental Health NHS Foundation Trust (GMMH) set up a 24/7, all-ages helpline within a week, staffed by experienced mental health practitioners from a range of services, many of whom were shielding themselves but supported to work from home.

In their first ten days, over 1,500 calls were received, and during the height of the pandemic the call handlers received almost 550 calls per day.

Since 20 March 2020, they have handled almost 30,000 calls and since its expansion in May, have supported the Greater Manchester Clinical Assessment Service (CAS) and NHS 111 service by streaming their calls and supporting the caller to a solution which helps relieve pressure on other services, including ambulance call outs and attendances at A&E.

It has undoubtedly prevented many service users and families from experiencing a crisis in isolation with no support. The main outcomes have resulted in callers being supported with crisis intervention to prevent self-harm, including suicide prevention and safety planning with the service user so they continue to be cared for at home.

One caller, who would like to remain anonymous, said: “I turned to the helpline in the middle of the night when I was feeling very low. I would like to express my gratitude to the helpline team for helping me reach my birthday. I would have not got this far without your support.”

The service has been able to intervene at a critical point in the crisis pathway and divert people, who do not need urgent physical health care or require assessment under the Mental Health Act, from attending A&E departments and potentially being admitted to an acute mental health bed.

This resulted in reduced pressure on the local urgent care systems across Greater Manchester and the provision of a more timely and appropriate care pathway for people in mental health distress.

See full story here

Source: Rochdale News, 15th July 2021

NHS is failing half of young people with mental health issues

Up to half of all children and teenagers referred to mental health, learning disability and autism services in the run-up to the pandemic were left without proper support, with parents telling the Observer of children waiting years for treatment and a seven-year-old girl denied support as she was not suicidal.

Data published by NHS Digital shows that in 2019-20 – the most recent figures available – 23% of the 547,590 under-18s referred to NHS mental health, learning disability and autism services had no contact from health workers to deliver care, nor meetings between health workers to support their care. Another 26% – 144,384 people – had their referrals closed without receiving treatment. Some were told they needed social care instead, or passed on to charities, with others simply refused care as local services lacked sufficient capacity.

The pandemic has seen a rise in demand for young people’s mental health services. It was revealed last week that referrals rose by a third in 2020-21 compared to 2019-20.

Mental health minister Nadine Dorries recently tweeted that “we lead the world in the delivery of [mental health] services” and “we are not in the middle of a MH crisis” after a deluge of parents described their negative experiences of CAMHS.

See full article here

Source: The Observer, 18th July 2021