Active Monitoring is an early intervention service for primary care, enabling GPs to refer patients to specialist mental health practitioners as soon as they present with symptoms of anxiety, depression, low self-esteem or stress. Rather than deteriorating while they sit on a waiting list for talking therapies, patients get support quickly and learn how to proactively manage their mental health.
GPs refer patients directly to a dedicated local Mind practitioner, who guides them through a self-directed, psychoeducational programme of five face-to-face sessions over eight weeks. Patients develop both a better awareness of their mental health and the tools needed to manage their wellbeing. By offering support at an early stage, Active Monitoring aims to help prevent people’s mental health problems from escalating.
This improves outcomes at the client level and reduces pressure on more intensive and more costly interventions.
Since its initial development in 2014 in conjunction with Tameside, Oldham and Glossop Mind, Active Monitoring has been scaled up to 8 localities across England and Wales. In 2018/19:
An evaluation completed in April 2017 showed that 86% of patients that completed the service improved GAD-7 scores, while 83% improved PHQ-9 scores. Ongoing monitoring shows that these outcomes are replicated in every delivery site, while participants also see a substantial improvement in wellbeing (WEMWBS).
Each Active Monitoring site is funded independently, with the majority coming from local Clinical Commissioning Groups and Health Boards. Active Monitoring services have also attracted funding from Primary Care Networks, NHS Transformation Funds and local trusts and foundations.
Local people using mental health services and carers reported there was little help available, particular out of hours, to help avert a crisis and potential A&E visit or admission.
Since 2017, Northamptonshire Minds in partnership with the local trust Northamptonshire Healthcare Foundation Trust (NHFT) has provided several Crisis Cafés from Monday to Sunday being open between 2pm-10pm. Services are offered to those who are 18 plus and feel they have reached a point of crisis and need further support.
People visiting will be offered support by a peer support worker or a mental health worker (NHFT) who can provide support and guidance on how people can get further help, including accessing other Mind services (advocacy, employment support, women’s only drop in services) or support from their GP or mental health and social services or emergency help. The service reports that most people attending in immediate need for support, find this aspect the most useful.
The total service costs £24,363 per month to operate with a saving of between £7,978 and £22,425 per month. Across the year saving of between £95,746 and £269,105 on A&E tariff, Police, East Midlands Ambulance Service and Urgent Care and Assessment Team only. The wider systems savings (GP time, NHS 111, etc) have not been included in the cost saving analysis
In the last financial year the Crisis Cafes had 1525 attendances across the 16 weekly sessions. A high number of people attended for ‘immediate needs’ i.e. in crisis and this has had a positive impact on use of A&E and other services, such as the Home Treatment Team and GP.
Peer support workers from the Local Minds are trained and supported by the NHFT. Reported system impact has been stronger links with third sector and access to support outside of the trust. Builds out of hours resilience for those experiencing a crisis and releases pressure on typical crisis response services such as police, A&E out of hours GP.
It was reported that people:
Had increased feelings of being safe and supported
Experienced improved service user experience.
Experienced better access to community services through improved pathways.
Sheffield Mind’s Age Better Wellbeing Practitioner service offers free counselling to people aged 50+ - delivered in people’s homes, community venues or at their office. They support older people to develop social capital, confidence, self-worth, self-help skills and a sense of purpose.
The project is part of a £6m investment programme funded by NHS Sheffield CCG and led by South Yorkshire Housing Association (SYHA) to reduce isolation in people aged 50+. The programme is governed by the ‘Age Better in Sheffield Core Partnership’, which includes older people, representatives from Sheffield City Council, Sheffield 50+, NHS Sheffield CCG, Sheffield Hallam University, the VCF Sector and SYHA.
Sheffield Mind has a strong record in service user involvement. This model of community engagement - offering encouragement, training and support to people, who go on to support other community members to get involved - was a dynamic and positive contributor to the principle of getting services and citizens to work together. Their positive local reputation enabled us to target and recruit volunteers and staff who reflect the communities they serve s; for example 50+ counsellors.