Mental health in adults (health and wellbeing needs in South Tyneside)

Mental health is defined by the World Health Organisation (WHO) as "a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community". 

Mental health problems are among the most common forms of ill health.

They can affect people at any point in their lives.

Mental health and physical health are inextricably linked. Poor physical health may increase the likelihood of developing poor mental health, and poor mental health may increase risks of developing, or not recovering, from physical health problems.

Traditionally a distinction has been drawn between severe and enduring mental illness, and common mental health problems:

• Severe and enduring mental health problems include psychotic disorders (including schizophrenia) and bipolar affective disorder and other psychoses which affect a person's cognition, insight and perception, with approximately 7 to 9% of all adults presented with a diagnosed severe mental illness.
• Common mental health problems include problems such as anxiety, depression, phobias, obsessive compulsive and panic disorders, with over 31.9% of the population presenting with anxiety and 33.7% with depression.
• Emotional Intensity Disorder (formerly known as borderline personality disorder) is a mental health personality disorder that affects the regulation of emotions. Emotional dysregulation is when a person experiences intense emotions that they are unable to manage in constructive ways.

Across England:

• 1 in 6 working age adults will have symptoms associated with mental ill health (MHFA England: Mental Health Statistics).
• Severe mental illness such as schizophrenia or bipolar disorder affects around 587,000 people (OHID (phe.org.uk): Severe Mental Illness).
• Together with substance misuse, mental illness accounts for 21.3% of the total burden of disease across the country.
• The costs of mental health problems to the economy in England have recently been estimated by the Mental Health Foundation at £118 billion (Mental Health Foundation).
• Half of mental health problems have been established by the age of 14, rising to 75% by age 24 (Mental Health Foundation: Children and young people statistics).
• Those in the poorest fifth of the population are twice as likely to be at risk of developing mental health problems as those on an average income (GOV.UK: Wellbeing in mental health applying all our health).

Mental illness is closely associated with social inequalities; they are experienced disproportionately by the most disadvantaged groups in society.

In terms of social inequalities, mental illnesses have a wide range of detrimental impacts on employment, benefits, social isolation, and housing (GOV.UK: Health matters reducing health inequalities in mental illness).

The number of people in contact with NHS mental health services in England (including those referred and those seen) has increased by 16.2% in the last year (NHS News: Mental Health Bulletin).

During 2021 to 2022, 3,256,695 people were in contact with NHS funded secondary mental health, learning disabilities and autism services. This is up from 2,803,244 in 2020 / 21 and 2,878,636 in 2019 / 20.   

This means that 5.8% of people in England were known to be in contact with those services during the year. This is compared to 5.0% of people in 2020 to 2021 and 5.1% of people in 2019 to 2020. 

The COVID-19 pandemic has also had an effect on the mental health of the UK population, with a general deterioration in mental health and wellbeing during lockdown periods.

Some studies have shown gradual improvements towards pre-pandemic levels following lockdown easing, though these periods of 'recovery' were not observed in all studies, and self-reported mental health and wellbeing across the population remains worse than before the pandemic (GOV.UK: Wider impacts of COVID-19 on health monitoring tool).

The mental health effects of COVID-19 were different for different groups of people, and general population statistics may mask more profound impacts on these groups.

Women, young adults, those with pre-existing mental health conditions, adults experiencing loss of income or employment, those living in deprived neighbourhoods, some ethnic minority populations, extraverts and those living alone may have been more likely to experience worsening or deteriorating mental health during this period.

For people in South Tyneside, the Adult Social Care Strategy outlines the Council's approach to delivering its statutory responsibilities in terms of wellbeing. It also outlines the need to safeguard adults at risk of abuse or neglect and ensure that local people get the information and advice that they need to make informed choices.

The approach aims to develop a place-based system of care and support by placing people, families, and neighbourhoods at the very heart of its work to achieve the best outcomes.

In addition, South Tyneside's Mental Health Strategy covers actions and plans around improving mental health and wellbeing from conception through to end of life and makes clear the contribution that other policy areas such as housing or community safety make towards people having good mental health.

Scope

The scope of this Joint Strategic Needs and Assets Assessment (JSNAA) is for adult mental health and should be read in conjunction with other JSNAAs such as dementia, learning disabilities, carers, autism or children and young people.

• Health inequalities: 10 years difference in life expectancy across different parts of the borough illustrates area-based mental and physical health inequalities. Higher levels of deprivation increase the risk of a range of mental health conditions.
• Marginalised groups: Experience barriers to accessing mental health treatment.
• Long term conditions: People who have a long-term condition are at an increased risk of poor mental health but report experiencing barriers in accessing mental health treatment.
• Severe mental illness (SMI): Mental health and physical health are to be treated equally. Anyone with a diagnosis of a SMI who is registered with a GP is entitled to a physical health check at least once a year.
• Access to mental health information, support and services: People's quality of life could be improved by timely access to appropriate information.
• Ageing population: The UK population is ageing, and people are living with physical and neurodegenerative conditions for longer. The mental health of this population is therefore going to be increasingly important for demand on health and social care services. Older people are just at risk of mental health conditions such as depression and anxiety disorders as with other parts of the population.
• COVID-19: Demand for mental health services forecast to increase across the Northeast and Cumbria as a consequence of the pandemic (Source: Fancourt et al 2020 Researchgate: Trajectories of depression and anxiety during enforced isolation due to COVID-19).
• Unemployment and economic inactivity. This has implications for people's mental health in South Tyneside. Education, training, and employment needs to be more accessible to people with mental health problems.

The Marmot Review: Fair Society Health Lives identifies a number of factors that have a negative impact on mental health. These include:

• Unemployment and stress
• Poor housing / homelessness
• Socio-economic deprivation
• Loneliness, isolation and bereavement
• Abuse, stigma and discrimination
• Poor physical health / trauma
• Substance misuse

The Marmot Report of 2010 described the role of addressing the wider determinants of health in improving health and reducing inequalities, and the contribution of positive mental wellbeing to preventing mental illness.

The adverse social factors linked to mental illness include unemployment, lower educational attainment, poorer material circumstances and increased risk taking behaviour (University of Galway: The influence of social, demographic and physical factors on positive mental health in children , adults and older people).

Mental illness is closely associated with many forms of inequalities.

Health inequalities are avoidable and unfair differences in health status and determinants between groups of people due to demographic, socioeconomic, geographical and other factors.

These differences can be in relation to prevalence, access to, experience and quality of care and support, as well as opportunities and outcomes. Health inequalities can mean reduced quality of life, poorer health outcomes and early death for many people (GOV.UK: Health matters reducing health inequalities in mental illness).

South Tyneside is one of the 20% most deprived local authorities in England and about 26.4% (6,770) of children live in low-income families (See:Our South Tyneside report (2023)). Life expectancy for both men and women are lower than the England average.

Groups at risk

Perinatal maternal mental health

This refers to women's mental health during pregnancy up to the time immediately after childbirth.

The incidence of some conditions, such as anxiety, is not significantly changed in the perinatal period. However, perinatal obsessive, compulsive disorder and puerperal psychosis are specifically associated with pregnancy and childbirth.

Perinatal mental illness impacts on the health and wellbeing of women, children and families and affects between 10 and 20% of women during pregnancy or within the first year after having a baby (Centre for Mental Health: Costs of perinatal mental health problems).

Adverse childhood experiences

Mental health problems are higher among children who experience poverty, low educational attainment, domestic violence, and bullying.

Children who experience abuse have an increased risk of experiencing illnesses such as depression and post-traumatic stress disorder in adulthood, looked after children have an increased risk of suicide attempt and having multiple adverse childhood experiences is a major risk factor for many health conditions (PubMed (nih.gov): The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis). 

Other vulnerable children include those with a parent who will have some degree of common mental illness, as well as alcohol or drug problems and personality disorders. Few children live with a parent who has a severe mental illness (Royal College of Psychiatrists: Parental mental illness).

Domestic abuse 

Domestic abuse is has a devastating impact on physical and mental health, emotional wellbeing, housing, finances, work and, where children are impacted, their schooling and educational attainment. It can also result in victims and families moving away from their own homes, local community, and support networks for them to feel and be safe.

South Tyneside Domestic Abuse Strategy outlines the development of safe accommodation and improving the range of support available across South Tyneside to address the needs identified because of domestic abuse directly and indirectly in accordance with the Domestic Abuse Act 2021. 

In employment

A major factor in maintaining good mental health is stable employment. The relationship between mental health and unemployment is bidirectional.

Good mental health is a key influence on employability, finding a job, and remaining in that job. Unemployment causes stress, which ultimately has long term physiological health effects and can have a negative impact on mental health, including depression, anxiety, and lower self-esteem (The Health Foundation: Unemployment and mental health). 

Employment can also be a source of stress, particularly within work contexts in which people experience high demands and lack of control in their work environment. Working in insecure, low paid occupations is also a risk to mental health.

People with mental illness are also more likely to experience discrimination in the workplace.

Older people

As people live longer protecting their mental health and wellbeing will become more of a need to meet and prevent.

Depression is the most common mental disorder in people aged 9 over 65 years.

Dementia (see our Dementia JSNAA), delirium, and substance misuse are also linked with poor mental health in older people and schizophrenia affects about 1% of the older population.

Having a long-term condition 

Long term conditions such as diabetes, arthritis, asthma, cardiovascular diseases, and cancer is associated with higher risk of poor mental health.

Long term conditions can lead to significantly poorer health outcomes and reduced quality of life.

People with long term conditions disproportionately live in deprived areas and have access to fewer resources of all kinds.

Link between long term conditions and mental health

Around 40% of people with depression and anxiety disorders also have a long-term condition (LTC) such as cardiovascular disease, COPD, diabetes, and musculoskeletal disorders.

Around 30% of people with an LTC and 70% with medically unexplained symptoms (MUS), also known as persistent physical symptoms) also have mental health comorbidities.

The relationship between poor mental health and poor physical health is complex and bi-directional.

It is likely to involve a range of biological, psychosocial, environmental, and behavioural factors, which can have an impact on a person's physical health, both directly and indirectly.

Carers

Carers are more at risk of mental health problems, such as anxiety and depression than the general population, and are less likely than the population generally, to ask for support.

According to the 2021 census there are an estimated 14,875 unpaid carers in South Tyneside, with 14,000 adult carers.

Caregiving, whether paid or informal, can be a stressful role to play, with many carers experiencing 'carer strain', leading to declines in physical and mental health.

Unpaid carers are at higher risk of common mental health problems, with 42% experiencing increased stress, 33% suffering from anxiety, and 27% suffering from depression. Bereaved carers also exhibit poorer levels of overall mental health compared to the general population (ScienceDirect: The acute effects of mental fatigue on balance performance in healthy young and older adults).

Ethnic minority

Cultural perceptions about mental health can affect both access to and experience of services. An individual's experiences of mental health services may additionally be influenced by factors such as age and gender.

This means that there is no single 'BME mental health problem'.

They may range from a person whose first language has no word to describe depression, through to a person who has no confidence in statutory services.

Data shows higher rates of common mental health disorders and psychotic disorders have been found in people from minority ethnic backgrounds.

There are disproportionate rates of people from ethnic minority populations being detained under the Mental Health Act 1983.

Lesbian, gay, bisexual and transgender (LGBTQI+)

Evidence suggests that people who identify as lesbian, gay, bisexual and / or transgender (LGBTQI+) are at higher risk of experiencing poor mental health (Cambridge University Press).

This higher prevalence could be associated with factors, such as discrimination, isolation, and homophobia.

Compared to the general population, members of the LGBT community have greater exposure to negative wider determinants of health, such as abuse, unemployment, and trauma.

They are recorded as having poorer experiences of hospital and residential care, poorer access to health and social care provision and are particularly subject to stigma, insensitivity, and discrimination. LGBTQI+ people have higher rates of poor mental health compared to the general population.

Offender mental health and wellbeing

Prisoners have been shown to have significantly higher rates of mental health problems compared to the general population.

Asylum seekers and refugees

Mental illness is more prevalent among asylum seekers and refugees.

Several factors have a detrimental impact, for instance experience of trauma, the process of claiming asylum and detention, separation from family, unemployment, and inadequate housing.

Veterans

A minority of veterans leaving the armed forces need access to mental health services, while others might require it later in civilian life.

Post-traumatic stress disorder, stress and anxiety are problems commonly experienced by veterans.

Homeless people

Mental illness is more common among homeless people.

Serious mental illness is present in 25 to 30% of people who are sleeping rough or in hostels.

Co-occurring mental ill health and substance dependence is common amongst people who sleep rough. Alcohol and drugs may be used to self-medicate poor mental health, and substances may also be used in conjunction to aid sleeping, pain, and cold temperatures.

It is common for people with mental health needs to have difficulties accessing treatment for co-existing alcohol or drug use, a particular problem for those diagnosed with serious mental illness, who may also be excluded from alcohol and drug services due to the severity of their mental illness. (GOV.UK: Health matters - Rough sleeping)

People with dual diagnosis

A person with dual diagnosis has both mental ill health and an alcohol or drug problem.

Elements of care, such as diagnosis and treatment are difficult and individuals have a higher risk of relapse, readmission to hospital, self-harm, and suicide.

Substance misuse among people with mental health problems is usual rather than exceptional and treatment for substance misuse problems often improves mental health.

Social inequalities and mental illness

Reduced life expectancy

People with serious mental health problems die prematurely.

The life expectancy of someone with a serious mental health problem, such as bipolar disorder or schizophrenia, is 15 to 20 years less than the general population. This is mostly from preventable physical health problems such as cardiovascular disease and cancers (GOV.UK: Wellbeing and mental health).

Life expectancy is 9.3 years lower for men and 8.1 lower for women in the most deprived areas of South Tyneside than in the least deprived areas. 

Poor physical health: People with common mental health disorders are more likely to engage in behaviours that are detrimental to overall health, such as poor diet, physical inactivity, heavy smoking and drug and alcohol misuse. 

In comparison people with Severe Mental Illness (SMI) often experience poor physical health as well as poor mental health, frequently developing chronic physical health conditions at a younger age than people without SMI.

It is estimated for people with SMI, 2 out of 3 deaths are from physical illness which are preventable (GOV.UK: Premature mortality in adults with severe mental illness).

Alcohol misuse

Excessive consumption of alcohol is associated with poor mental health. The risks of hazardous drinking increase following stressful life events.

There are an estimated 589,000 people who are dependent on alcohol in England and about a quarter of them are likely to be receiving mental health medication, mostly for anxiety and depression, but also for sleep problems, psychosis, and bipolar disorder (UK Health Security Agency: Alcohol dependence and mental health).

Smoking

Smoking remains the leading cause of premature mortality in England.

Smoking rates in people with Severe Mental Illness (SMI) are significantly higher compared to the general population (40.5% compared with 12.1%) with rates as high as 70% in people with schizophrenia and bipolar disorder.

There is also higher occurrence of smoking related harm among people with an SMI. Smoking is a key modifiable risk factor that contributes towards excess mortality in people with SMI, with an estimated 50% of deaths in people with SMI are attributable to smoking.

Depression

Older adults who are depressed are more likely to have existing physical health conditions and more likely to develop physical health conditions. In particular depression is associated with cardiovascular disease and diabetes (British Journal of Medical Practitioners: Depression in older adults).

Long-term physical health conditions

Long term physical health conditions are more common among older adults than those of a younger age, and they are associated with a twofold risk of poor mental health (Centre for Mental Health).

There is also evidence that people who have a co-occurring mental health problem alongside a physical illness have poorer outcomes for their physical condition, resulting in worse health for them and higher costs for health and care services.

Discrimination and stigma

Stigma is a common experience for people with mental health problems.

It may compound inequality, by reducing employment opportunities and weakening supportive social networks.

For some people, stigma is compounded by additional discriminations on the grounds of ethnicity, physical illness, cultural background or sexuality.

Social exclusion

People with mental health problems, particularly those with long-term psychoses, are among the most excluded groups in the United Kingdom.

They may be excluded from material resources (poverty), from socially valued productive activity, from social relations and neighbourhoods, from civic participation and from health and health services (Emerald Insight: Social exclusion and mental health - how people with mental health problems are disadvantaged).

The Commission for Equality in Mental Health (2020) has explored a wide range of ideas to boost mental health equality and whilst acknowledge there are no simple solutions or overnight remedies for entrenched injustices, have found that effective action is possible.

This is about communities, local organisations, and regional / national partners working together to generate change at scale to prevent social exclusion. Feedback received via the engagement work undertaken in South Tyneside also suggested that further community work is required to engage with and reach out to harder to reach cohorts.

South Tyneside is around 25 square miles (64 square kilometres) wide, with a population of around 147,800 residents.

It is ranked 26^th most deprived out of 317 local authorities nationally in the latest index of Multiple Deprivation (2019), ranking particularly poorly for employment, income, and health and disability.

The borough is more deprived than its Tyne and Wear neighbours and is 3rd most deprived borough overall in the North East region, after Middlesbrough and Hartlepool.

The health of people in South Tyneside is generally worse than the England average. 

Life expectancy for both men and women is lower than the England average. Life expectancy is 9.3 years lower for men and 8.1 years lower for women in the most deprived areas of South Tyneside. See Projecting Adult Needs and Service Information System (pansi.org.uk) and Projecting Older People Population Information System (poppi.org.uk).

The projected data in Table 1 suggests little changes in the key areas of mental health prevalence in the period 2023 to 2040 however we are expected to see an increase in the older population and any associated mental health need.

In 2022  /23, at 15.70% South Tyneside had a higher proportion of people with depression, which is slightly higher than that of the Northeast (15%) and significantly higher than that of England at 13.2%.

Table 1 suggests that the population (working age adults) will largely remain unchanged in the borough in the period to 2040 and beyond, with changes regionally and nationally mirroring increases and decreases in the population.

However, we are expected to see an increase in the older population with a diagnosis of depression as shown in Table 2.

^{Source for Tables 1- 4 POPPI / PANSI}

In South Tyneside the number of working aged people with a mental health condition is not expected to change (Table 4).

However, in England mental health demand modelling predicts that up to 10 million people will need either new or additional mental health support as a direct consequence of the pandemic.

Depression, post-traumatic stress syndrome and support with bereavement and loss are areas are areas which are projected to increase and demand for services increase.

Table 5 above outlines the prevalence rates of severe mental illness, anxiety and depression are similar to other sub regional areas across the North East and Cumbria.

Prevalence is generally higher amongst 35 to 65 year-olds and strongly linked to areas of deprivation. Depression and anxiety disorder rates are much higher among women.

Adults on the Severe Mental Illness Register (SMI)

As of 9 November 2023, there were 1,448 people on the SMI register. Of these 1,143 people had received all six physical health checks, an 86.4% achievement rate which is above the national average of 65%.

Data quality evidence suggests there should be 1,675 people with SMI on the register. South Tyneside remains the highest performing area in relation to the number of physical health checks undertaken in England. 

Table 6 shows count of people with SMI having had each physical health check in November 2023.

Following each consultation that is completed with a person around their health needs, appropriate advice / signposting or direct intervention is provided around identified needs.

Table 7 shows this further intervention. Whilst there has been some improvement within some areas, particularly around smoking, it is worth noting that further work is to be completed in this area.

In South Tyneside in 2022 / 2023 the smoking prevalence in adults with long term mental health conditions was 26.4%, this was similar to the region (24.2%) and England (25.1%). However, if reviewing those identified on the SMI register, it is noted that prevalence rate is 39.9 %.

Of the 458 people on a GP register meeting the threshold for intervention 421 people are receiving intervention, equating to 91.9%.

Substance missuse

There are 511 people experiencing substance misuse on the GP SMI register meeting the threshold need for intervention.

Of these there are only 5 people receiving intervention, this suggests there is further work with the South Tyneside Mental Health team and primary care needs to be completed to improve the uptake of intervention.

Adults in inpatient beds

In October 2023 there were 10 adults in acute mental health beds for over 60 days, this is slightly above the national target of 8.

Hospital admissions

In terms of hospital admissions during the period 2022 / 2023,  South Tyneside is statistically similar to both England and the region.

The South Tyneside Hospital Admissions Group with representation from South Tyneside Council, the Integrated Care Board (ICB), Cumbria, Northumberland Tyne and Wear NHS Foundation Trust (CNTW), South Tyneside and Sunderland NHS Foundation Trust (STSFT) and a range of third sector representatives reviewed the NHS data from 2019 to 2022 relating to the number of people using emergency department services (ED) broken down by older people and people of working age.

They also explored where people move onto such as into hospital or back into the community.

This review noted that working age adults are more likely to attend the emergency department (ED) than older people, and highlighted people are more likely to be admitted into psychological services if they have attended ED. 

During the timeframe 2019 to 2022 there was no significant increase due to mental health issues but a slight increase due to self-harm.

Access to Talking Therapies

Data around treatment within 6 weeks of referral and 18 weeks of referral is monitored along with the recovery rate of people attending at least two treatment contacts and moving to recovery.

Data at October 2023 shows that the percentage receiving treatment within 6 weeks of referral was 97.9%, and within 18 weeks was at 100%.

Whilst the data being around access to Talking Therapies is clearly demonstrating that people from different ethnic groups, ages, deprivation levels and gender are accessing the service at present, it is below the expected access rate, in respect to prevalence in the borough.

Waiting times

Feedback received from people who use services is that they would like better information on waiting lists which can often be a barrier for people with mental health engaging.

A priority is timely access to mental health crisis services and support.

Commissioned Community Mental Health Services

In October 2023 there were 2,590 people had received two or more contacts with community mental health services.

Hospital Admissions Self Harm

In the period 2021 / 2022 there were 380 hospital admissions for self-harm which is significantly higher than the national average but not significantly different to the regional average.

Not everyone who self-harms will have suicidal thoughts and not everyone that dies by suicide will have self-harmed. However, it is known previous serious and escalating self-harm, is a key predictor of completed suicides.

Long term conditions

Having a long-term physical condition can lead to social isolation, low self-esteem, stigma and discrimination.

You may feel tired, frustrated, worried or stressed, especially when dealing with pain, tests, treatments or flare-ups.

All of these things can make someone more likely to develop a mental health problem such as depression or anxiety.

Research shows that people with long-term physical conditions are more than twice as likely to develop mental ill-health.

Mental health problems can then make it harder for individuals to cope with their physical health condition.

Prevalence of long-term conditions (Table 8) therefore need to be considered alongside mental health support being available.

Where people live

Adults in contact with secondary mental health services who live in stable accommodation

South Tyneside is slightly worse than the regional average for people in contact with mental health services who live in stable accommodation (period 2021 to 2022).  

In January 2024 there were 162 adults with an active support plan in receipt of services from adult social care who had a primary support reason relating to mental health.

Table 9 shows a breakdown of services people are receiving.

South Tyneside Council is developing an All-Age Accommodation Strategy with the aim of providing focus and direction to the future provision of accommodation with care and support, this will include reviewing the people who are living out of borough and in need of residential care provision.

Overall trend analysis from the Homelessness and Housing Solutions team (Table 10) shows overall reason of approach to the team.

• Domestic violence cases continue to rise. Many of these cases have complex needs and there is currently limited provision for this type of presentation. However, this is being addressed as part of the Domestic Abuse Strategy.
• There was a total of 22 presentations following prison release.
• Evictions from supported housing has been identified as an issue, although work is ongoing with the Commissioning team, South Tyneside Council Housing Services and local providers to address this.
• There is a rise in the number of privately rented sector tenancies ending. The trend is attributed to landlords choosing to sell properties rather than rent, possibly due to rise in the cost of living and impact on pensions.

Commissioned accommodation and support for adults with mental health in South Tyneside

There are 3 commissioned providers specifically offering accommodation with support, dispersed and outreach currently in South Tyneside to adults 18+ with mental health needs.

The criteria to access this provision is; to have an allocated social worker, present with a range of complex mental health needs (this may include a concurrent mental health, mental health and substance misuse (dual diagnosis) or be subject to certain conditions under the Mental Health Act after discharge from hospital or having had contact with the criminal justice system.

There are two residential mental health care homes in South Tyneside.

Occupancy of provision (Table 11) has remained quite static with low numbers of vacancies.

Work being undertaken within Adult Social Care around the All-Age Accommodation Strategy suggests there is an opportunity for reviewing those in residential care settings to determine if this is the best and least restrictive option for them.

Safe Haven

In November 2021, South Tyneside was successful in its bid to NHS England to support a reduction in the risk of delayed inpatient discharge / risk of inpatient readmissions.

Changing Lives was commissioned to provide 4 Safe Haven beds, consisting of accommodation and on-site support to help people safely transition back into the community.

In total there have been 69 referrals into Safe Haven, 33 of these were accepted as appropriate referrals.

Since January 2023, 28 people who have successfully moved on have either moved back into their primary residence, moved onto supported accommodation, accommodated by family, obtained a property via South Tyneside Council, or moved into a residential setting, while 2 people were readmitted to hospital.

Out of the 33 people who were appropriately referred Safe Haven, 9 were moved on within the 28-day period. From the 33 people accepted into Safe Haven, 11 were referred via the Risk of Admission pathway and 22 via Discharge. 

The average length of stay for people accessing the service is approximately 72 days.

An understanding of why people have experienced delayed discharge from the Safe Haven included:

• Difficulties sourcing appropriate accommodation
• Delays in providing wrap around support
• Delays in assessing move on needs

There has been greater strengthening of relationships between Safe Haven and partners working into the service. For example contact with Bed Management, Community Mental Health teams and Adult Social Care have utilised beds on occasions ensuring move on plans are met.

The present level of need is being met by the service (there is no delay to accessing the service) and Safe Haven is at present able to maintain a proficient level of resilience of referrals to support the risk of the pathway blocking.

Areas for improvement, which have been a theme across both the provider and the people accessing the service, relates to more effective planning around the move on process and thereon, the lack of suitable accommodation options which are being explored further within the Adult Social Care All Age Accommodation Strategy.

The data on the labour market profile informs us South Tyneside has high rates of economic inactivity and gaps in employment.

A working group to explore employment opportunities has been identified through open forum discussions and what reasonable adjustments are needed to support those with lived experience of mental health in the workforce.

Based on the increased number of people claiming out of work benefits (116,008 additional people between March and September 2020 in the North East and Cumbria) the projected demand on mental health services is estimated to be 2,378 for major depression.

However, the full economic impact is yet to be felt.

• Whilst data shows there are people with severe mental illness with a need for substance misuse interventions, there are low numbers of people actually receiving interventions.  
• Access to Talking Therapies is below the expected access rates in relation to prevalence of mental health needs in the borough. Therefore, access to mental health support for people with additional needs has been identified.
• Mental health issues are a major cause of long-term absence from employment. Employers should promote workforce initiatives around work and mental health and provide support for employees who are experiencing mental ill health including anxiety or depression. There is a need to ensure people are supported into finding employment and that their mental health is maintained with the right support available.
• Having suitable and stable accommodation is a factor to support well-being and mental health. Having access to suitable accommodation and move-on options is an identified barrier.
• Minority communities including Black, Asian and minority ethnic communities (BAME) report that discrimination increases people's risk of poor mental health but that mental health services do not always meet their needs.
• LGBTQi+ residents also report that discrimination increases people's risk of poor mental health but that mental health services do not always meet their needs.

There are several key issues which may have implications for the demand of services.

• Projections suggest the number of older people with a mental health need will increase and people are living longer. Whilst the numbers of working age adults remains largely unchanged this has implications for the support required.  
• There is a need to ensure that the needs of people with mental health issues arising out of the COVID-19 pandemic are addressed. This includes the impact of long covid and support to people who were bereaved as a result of the pandemic (Office of National Statistics: Rising ill health & economic inactivity because of long term sickness).
• Local intelligence indicates that access to the privately rented accommodation sector is decreasing as landlords are choosing to sell. Being able to provide appropriate accommodation and social care support has implications in the current economic climate.
• There are a number of adults in out of area residential care homes. There is a need to review need and develop broader accommodation models in South Tyneside.

The South Tyneside Mental Health Offer below outlines organisations which provide services to people with mental health issues in South Tyneside.

Below is a summary of some of the services currently available:

Mental Health Support to improve coping and offer support, including support, advice and treatment in respect to anxiety, stress, depression, low mood, phobias. 

Services include:

• Healthy Minds team
• Kooth / Quell
• Lifecycle
• GP and primary care team
• Mental Health Primary Care practitioners
• Mental Health Concern
• Recovery College
• Age Concern South Tyneside
• First Contact Clinical

Serious mental illness to offer treatment which may include support within a hospital setting, including support delivered by teams of psychologists, psychiatrists, mental health nurses and occupational therapists. 

Services include:

• Mental Health Primary Care practitioners
• Community Mental Health team
• Early Intervention in Psychosis team
• Employment Support Service
• Supported Accommodation
• Mental Health Concern
• Primary Health Care Hub

Mental health support during pregnancy and 2 years after birth. 

Services include:

• Early Help Service
• Perinatal Mental Health Service
• Specialist Health Visitors and 0-19 service
• Specialist Midwifery Services

South Tyneside Council

The Council has a statutory duty relating to the 2014 Care Act to assess local people's needs and their eligibility for publicly funded care and support.

This is delivered via the Adult Social Care Strategy 'Living Better Lives' (2022-2026) which outlines the approach adopted locally. Services are delivered in the context of:

• Being able to access support which builds on their strengths, friendships, and aspirations.
• Live safely and well.
• Live independently as much as this is possible.
• Have an equal voice in coordinating their care and support.
• Tell their story only once.
• Have their rights protected.
• Be included and treated as equal citizens.

North East and North Cumbria Integrated Care Board

The North East and North Cumbria Integrated Care Board (or ICB) is a statutory NHS organisation which is responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in a geographical area, locally this being South Tyneside.

ICB's will:

• Improve outcomes in population health and healthcare.
• Tackle inequalities in outcomes, experience, and access.
• Enhance productivity and value for money.
• Help the NHS support broader social and economic development.

Primary Care Health Hub

The Primary Care Health Hub supports children, young people, and adults aged 14+ (including people with severe mental illness (SMI) with their physical health monitoring via a series of 12 physical health checks. This includes accessing a yearly health check and medication support.

The service is part of the 21 GP surgeries in South Tyneside and is delivered via an outreach approach.

Primary Care Network (PCN) workers

PCN workers facilitate mental health appointments allowing GPs increased capacity to address physical health issues.

PCN link workers based in voluntary sector organisations including Everyturn, Autism in Mind and ACTS provide specialist support to reduce need for secondary care services.

Mental Health Community Treatment Service

The South Tyneside Community Mental Health Treatment provision includes the Psychosis Pathway, Non-Psychosis Pathway, Early Intervention in Psychosis Service and Step Up Hub and is provided by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW).

The services provide specialist assessment, formulation and treatment to individuals with moderate to critical mental health needs that are complex and require an integrated approach to care and treatment. 

The teams are staffed by a range of specialist mental health professionals with training and experience of working with individuals and their families, carers and supporters.

These include qualified mental health practitioners from various professional backgrounds (nursing, social work etc), consultant psychiatrists, psychologists / psychological therapists, occupational therapists, support staff, peer support workers, employment specialists and with access to pharmacists and specialist services where appropriate.

The Mental Health Community Treatment services offer a range of recovery focused, co-produced and personalised therapeutic interventions including physical health, medical, psychological interventions, psychosocial interventions and vocational opportunities.

They also offer provision for those individuals with longer term conditions. 

South Tyneside Council Adult Social Care

South Tyneside Council Adults Social Care provides the statutory duties contained within the Care Act 2014, and the Mental Health Act, 1983, 2007 to adults within South Tyneside.

The service works with younger adults transitioning from children's services, as well as adults of the age of 18+, throughout the lifespan to support them to live the life they choose, as independently as possible and with overall choice and control.

The team have two primary functions; Mental Health Act assessment and Care Act assessment, as well as several other duties contained within the Care Act.

The staff team, work with people who are suffering with long term mental illness to support them to lead better lives based on the principle of the person knows best.

The service offers an integrated approach working alongside CNTW, housing, police and third sector / voluntary agencies to support improving outcomes for people living within the borough.

Support in a Crisis

ICTS

The Intensive Community Treatment Service is part of South of Tyne Children and Young People's Services.

ICTS provide intensive home based treatment for children and young people with complex mental health needs.

Home based treatment is a short term, high input intervention with the main aim being to avoid a hospital admission.

South Tyneside Lifecycle Primary Care Mental Health Service: South Tyneside and Sunderland NHS Foundation Trust

South Tyneside Lifecycle Primary Care Mental Health Service offer a free and confidential NHS service for people aged 16 and over who are registered with a  South Tyneside GP, providing a range of psychological therapies to help you feel better if you're feeling anxious, depressed, stressed or worried.

Other mental health support services in South Tyneside 

Qwell

Qwell is an anonymous website which helps adults (aged 26+) to feel safe and confident in exploring their concerns and seeking professional support about mental health.

It offers anonymous mental health support via digital therapy, community support and over 100,000 pieces of therapeutic content and personal development tools. 

Age Concern Tyneside South (ACTS)

ACTS provides a range of services to help people with their mental health.

This includes social activities, practical support and specialist services such as benefits advice.

ACTS can discuss whether the Talking Therapies service could be of help around any mental health difficulties people may be experiencing and help them access the support if needed.  

Age Concern Tyneside South Primary Care Network Support Service 

This service enables older people with mental health issues to actively participate in making positive changes with their health and wellbeing and reducing the risk of people not being able to access the services they need.

Age Concern Tyneside South (ACTS): Discharge Link Worker 

ACTS Discharge Link Worker pick ups the initial referral to make contact and offer a friendly approach to clients to give them an opportunity to talk through their needs and more importantly priorities these. 

South Tyneside Lifecycle Service is working with Age Concern Tyneside South (ACTS) to help target Talking Therapies support to older people.

Two community-based link workers seek to raise awareness of mental health issues such as loneliness and support and encourage access to the Lifecyle Service.

Together in a Crisis: South Tyneside and Sunderland Crisis Service 

Together in a Crisis can help if there is someone in crisis, but do not meet the requirements to access local NHS mental health crisis services.

The service will address social, practical or emotional issues that are impacting on mental health and wellbeing.

The service is available online or in community settings with link workers helping to understand the triggers which cause crisis situations and support to develop long term strategies to address similar situations in the future.  

Kind Mind Community

Kind Mind Community offers free, education and fun activities to help people improve their knowledge and skills around managing their mental health and wellbeing.

Activities include; Managing Anxiety, Mindful Relaxation, Positive Psychology, Mindful Photography, Confidence and Assertiveness. 

First Contact Clinical

First Contact Clinical is a social enterprise based in the North East specialising in delivering person centred behaviour change services (social prescribing) and skills training to people and professionals.

They strive to make a difference to the health and wellbeing of disadvantaged people and communities by enabling healthy change.

Carers Support 

Connected Caring, a partnership between Age Concern Tyneside South (ACTS), Vision and Hearing Support, and Your Voice Counts provides support to adult carers in South Tyneside. This includes:

• Advice and support based around the needs of the carer to enable them to continue their caring role.
• Access to emotional and wellbeing support.
• Peer support groups.
• Skills development, such as supporting with employment and training opportunities, as well as digital connection support.
• Working with young carers to support transition.

See carers for more information.

LGBT+ service

The LGBT+ South Tyneside Support Service provides support to adults up to the age of 25.

Specialist support includes one to one support, interventions, workshops, peer support and family work.

South Tyneside Adult Recovery Service (STARS) 

This offers ways for local people with drug and alcohol problems to become free from their dependence by working in partnership with a range of health, mental health, adult, children and young people's social care, criminal justice agencies, voluntary and community sector services.

Working with individuals to support recovery and reducing the problems that substance misuse causes to families, friendships, workplaces and communities in South Tyneside.

Manhealth

This service offers men the opportunity to chat in confidence, with calls taken by trained group leaders who can help men with their mental health issues and connect them to local peer support groups.

Compact for Racial Equality In South Tyneside (CREST)

CREST is a registered charity which aims to promote racial equality and to assist people from communities in South Tyneside enjoy a better quality of life by supporting those in need to gain access in education, training and employment, to raise aspirations and to ensure their voice is heard.

The Alzheimer's Society 

Dementia support workers offer information and practical guidance to help people understand dementia and cope with day-to-day challenges and prepare for the future.

This support is provided for people who are worried about their memory, people with a diagnosis of dementia, and their loved ones (carers).

Ongoing support is provided face to face, over the phone or in writing.

Alzheimer's Society also provides the following activity and support groups in the community: Peer Support, Singing for the Brain, and Dementia Cafe.

Even Better CIC 

Even Better provide mental health services in Jarrow and beyond, run by and for the community.

They use co-production and lived experience to create services which tackle issues which are meaningful to people with mental health issues and /or neurodiversity.

The National Trust

The National Trust provides a range of sport and exercise events for local people and families to support wellbeing and mental health.

This includes outdoor activities including multi-sports, adapt cricket, sensory ponies, alongside creative and water-based activities.

Moving Forward

Moving Forward supports individuals affected by severe mental illness who find it difficult to engage in activities. 

Support is given to people to promote self-confidence and regain skills to enable them to move on with their lives independently.

Liaison and Diversion Service: Cumbria, Northumberland, Tyne and Wear NHS Trust (CNTW) 

The Liaison and Diversion Service was developed to identify people who have mental health, learning disability, substance misuse or other vulnerabilities when they first come into contact with the criminal justice system as suspects, defendants or offenders and support them through the pathway, or divert to another service is appropriate.

The aim of the service is to reduce re-offending.

Safe Haven - Changing Lives

The service supports people with mental health needs by providing four self-contained flats for short-term (maximum 28 days), 24-hour crisis accommodation to support discharge from mental health inpatient units. 

The service offers a complex navigator role to support with transition into and out of the accommodation.

The complex navigator will support the individual to access temporary or permanent accommodation, working alongside partners, and establish continued support to build mental health resilience, community integration and engagement with other appropriate community support.

Almost two thirds of people who will need mental health support already have existing mental health needs, including severe mental illness, with the majority of people needing support for depression or anxiety, or both.

Others will need help for trauma symptoms and a range of other difficulties including complicated grief arising from bereavement and loss.

Awareness and understanding of mental health and wellbeing has increased significantly over the past decade.

Government and NHS policies have made significant commitments to improve support for people with mental health difficulties.

Since 2012, a number of important national policy documents have focused on improving mental health outcomes, preventative approaches, reducing inequalities, reforming services and mental health legislation and preventing deaths by suicide.

Long Term Plan

The NHS Long Term Plan outlines the key priorities and outcomes for health post the 70^th anniversary of the organisation.

In terms of support for people with mental health, it highlights additional spending at least £2.3 billion more a year on mental health care, helping 380,000 more people get therapy for depression and anxiety by 2023 / 24 and delivering community-based physical and mental care for 370,000 people with severe mental illness a year by 2023 / 24.

Long Term plan funding is being used to support the ambition in relation to transforming community mental health provision, with an additional £1 billion new Long Term Plan funding per year by 2023 / 24 to ultimately transform the provision of community mental health care for adults and older adults with severe mental illnesses. 

Within the context of this JSNAA, area of scope include: 

• Specialist community perinatal mental health
• Adult common mental illnesses (IAPT)
• Adult severe mental illnesses (SMI) community care
• Mental health crisis care and liaison
• Suicide reduction and bereavement support

Mental health transformation funding

South Tyneside was awarded funding, which became operational from April 2022, to develop a range of services that support community based mental health transformation.

Community based services are best placed to help reduce the need for clinical interventions (unless needed) and can offer support that helps to people that are discharged from hospital.

Third sector organisations are also well placed to offer support around housing, skills, employment, benefits that would not form part of the approach from a clinical perspective, helping to reduce stress and anxiety. Services cover all adults from 18.

In the Five Year Forward View for Mental Health the NHS outlines it's approach to the development of mental health services, which includes support for people with dementia.

This includes the need to ensure good quality, seven day per week commissioned services, and the need to ensure appropriate staff training offered. 

Both the NHS Long Term Plan and the Mental Health Five Year Forward View recognise the need to involve local people in designing and ensuring mental health services are fit for purpose.

The NHS Mental Health Implementation Plan 2019 / 20 to 2023 / 24 outlines this as:

• Ensuring engagement and co-production with local communities
• Involving people with lived experience of mental ill health and mental health services and their families and carers
• Involving people in the long term, such as in governance structures

Suicide Prevention Strategy for England 2023 to 2028

The need to develop local suicide prevention strategies and action plans that engage a wide network of stakeholders in reducing suicide, is set out in the government's 2012 national strategy for England: Preventing Suicide in England: a cross-government strategy to save lives (objective 1) and Public Health England's (PHE), Local Suicide Prevention Planning guidance developed in 2015 (objective 2).

The national strategy outlines 2 objectives:

1. To reduce the suicide rate in the general population.
2. And to provide better support for those bereaved or affected by suicide.

NICE published updated guidelines on the community engagement to improve health and wellbeing and reduce health inequalities in 2016.

These include:

• Working to empower communities in decision making in relation to planning and regeneration has been shown to increase resilience within communities.
• Community development approaches, like public health interventions more generally, are an opportunity to support empowerment.
• Addressing mental health equity for those that carry the highest risk of poor mental wellbeing, efforts to support this group to engage fully is a priority.

The 2014 Care Act introduced new duties on local authorities, which support primary users of social care services, including people with mental illness and their carers.

The act is about promoting wellbeing, setting out how care and support should be provided to adults with eligible care needs, it supports the personalisation of support services, putting the person at the centre of the process.

Local context

The South Tyneside Vision is:

"A place where people live healthy, happy, and fulfilled lives".

There is a need to ensure that the any changes to services contribute to the Council's vision for residents with dementia to live happy healthier and fulfilled lives, specifically the ambitions of being:

• Financially secure.
• Healthy and well.
• Connected to jobs.
• Part of strong communities.
• Targeting support to make things fairer.
• (and seek to reduce inequalities)

South Tyneside's Adult Social Care Strategy 2022 to 2026 outlines the Council's approach to delivering its statutory responsibilities in terms of wellbeing.

It also outlines the need to safeguard adults at risk of abuse or neglect and ensuring that local people get the information and advice that they need to make informed choices.

The approach aims to develop a place-based system of care, support by placing people, families, and neighbourhoods at the very heart of its work to achieve the best outcomes.

The 6 objectives include:

• Objective 1: Prevention and early intervention.
• Objective 2: Support people tom remain in control.
• Objective 3: Keeping people at risk of harm and abuse safe and well.
• Objective 4: Working in partnership to improve health and care.
• Objective 5: Working together with our communities.
• Objective 6: Have a sustainable and skilled workforce.

The South Tyneside Mental Health Strategy 2022 to 2026 outlines that being a mentally healthy borough means that we all feel normal to talk about mental health and that everyone, whoever they are, wherever they live and whatever they need, will be able to access good quality mental health support when needed.

The priority areas identified in the strategy are closely aligned to that of the national direction of travel to:

• Target mental health promotion and prevention within our community; with particular focus on those most at risk of poor mental health, suicide and self-harm.
• Reduce over representation of people from black, asian and minority ethnic communities admitted to hospital with a mental health crisis.
• Ensure education, training and employment is more accessible to people with mental health problems.
• Improve transition support for 14 to 25 year olds.
• Ensure all services recognise the impact that trauma or psychological and social adversity has on mental health. This includes an understanding of how to respond to adverse childhood experiences and embedding a 'Think Family' approach in all service models.
• Improve timely access to mental health crisis services and support and ensure that people receive a compassionate response.
• Help raise awareness of mental health issues with older people and ensure that they are able to access information, support and appropriate treatment that meet their needs.
• Improve the physical health of people with serious mental illness.

Carers

Whilst not specifically related to mental health, Carers Strategy 2022 to 2027 examines the needs of carers and the support available. The strategic priorities include, recognising and supporting carers, increasing access to stable and supportive employment, keeping carers connected and improving the health and wellbeing of carers.

The views of people with mental health and their carers have been sought on services in a number of ways in South Tyneside.

Secret shopper events took place with the aim of supporting local people to share their lived experience of services, helping the partnership to:

• Understand the extent to which they were aware of services prior to the engagement sessions on strategy development.
• Get their views on the current offer following attendance at the event.
• Seek their views how services need to adapt or gaps in the availability of provision services on offer.

General feedback overall -there was limited awareness of the services available.

• Many people thought that the only way to access MH services was via their GP.
• Some people preferred face to face than current online support.
• Information needs to be more accessible - local issues with numeracy and literacy highlighted and some people don't like using the telephone.
• Would be useful to have social services contacts in familiar community locations.
• Reduced confidence around talking about mental health due to lockdowns.
• Poverty on the increase.

This feedback was used in the development of the Mental Health Strategy.

Messages arising from the 'Mental Health - One Year on' event held in May 2023, which brought together local people and mental health support organisations based in South Tyneside following the launch of the strategy a year earlier showcased the development of mental health services in the borough.

This had been developed within the principles of the NHS Long Term Plan and the NHS Five Year Forward View and the local priorities of the South Tyneside Mental Health Strategy 2022.

It highlighted the Mental Health Transformation Programme which funds many aspects of new community based mental health provision. The event promoted networking with teams and local people to showcase their work and consider future opportunities of co-producing the development of new and existing services with people with mental health issues, families and carers.

Feedback from group sessions during the 'Mental Health - One Year on' highlighted areas of development to be:

• Employment
• Greater opportunities for joint working and developing a cohesive system
• Improve links between mental health services and the wider community
• Provide better information to people on waiting lists

Carers focus group sessions

As part of the development of the Carers Five-Year Strategy, the views were sought on the support carers of people with mental ill health and the support they need by undertaking a number of carer focus groups to suggest potential solutions and ideas raised raised by carers on what would make it better. This included;

• Recognising and Supporting carers
• Working Carers and those wishing to return to work after caring
• Keeping Carers connected
• Improving the Health and Wellbeing of carers

No additional JSNAA required.

The key contact for this JSNAA is Alison Moffitt, Commissioning Officer. 

Alison can be contacted by email at alison.moffitt@southtyneside.gov.uk or by calling 0191 424 6586.