The Fulfilling Lives South East’s (FLSE) ‘Perspectives Project’ researched what good psychological support can look like for people with co-existing mental ill-health and substance use, prior to accessing formal substance misuse treatment. The aim was to identify new ways of working through learning from professionals who support individuals experiencing multiple and complex needs (MCN), providers or commissioners of substance misuse and mental health services, and sector leaders.

Many contributors stressed the importance and urgency of linking mental health and substance misuse provision more coherently, with one person reflecting.

“I fundamentally believe that joined up working should be an absolute minimum… Operational teams shouldn’t be reliant on building good relationships with other agencies, collaboration needs to be built into service design.“

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The objectives of both Brighton & Hove, and East Sussex Coexisting Conditions Steering Groups, echo The Perspective Project research findings and seek to strengthen working relations between mental health and substance misuse services at both operational and strategic or system level. In this blog we explore the journey of these Groups and reflect on their potential to positively impact the system in the future.

The Coexisting Conditions Steering Groups – formerly the dual diagnosis steering groups – in Brighton & Hove and East Sussex, are chaired by FLSE. The membership includes both statutory and non-statutory organisations including local commissioners, as well as leaders from mental health and substance misuse services and representatives from housing and the criminal justice system. The groups aim to be a source of learning and development to improve services for those who have coexisting conditions. The strategic overview that members of the groups have places a strong emphasis on deepening collaboration and partnership working across sectors. Through its membership the group promotes and shares relevant information, learning and best practice with the aim of increasing the knowledge and confidence of staff working with people who have coexisting conditions. As well as information sharing an important role of the group is to map the prevalence of coexisting conditions across Brighton & Hove and East Sussex. This involves working towards improving the identification and monitoring of coexisting conditions, leading to a better understanding of the gaps and barriers in our local areas and informing improved service responses.   

Prior to these forums, there was no dedicated space to discuss co-existing conditions in a multi-disciplinary setting.

As part of the group’s evolution, FLSE is supporting commissioners and group members to consider how these groups could sit within more formal local healthcare governance structures. FLSE believe the work of the current Coexisting Conditions Steering Groups should be integrated into local governance structures to enable coexisting conditions to be addressed more strategically.

What can the Co-existing Conditions Steering Groups offer the system?

We think there are three areas where the expertise and established relationships within the Coexisting Conditions Steering Groups in both Brighton & Hove and East Sussex can contribute to furthering the aims of a more co-ordinated approach to working with individuals experiencing multiple and complex needs. With the ending of Fulfilling Lives there is a need to find capacity within the local system to support and evolve this work.

Firstly, we think a local strategic plan is required to advocate for the needs of individuals experiencing MCN. The newly formed Integrated Care System, Sussex Health, and Care Partnership (SHCP) could lead on devising this plan. The Changing Futures Programme for Sussex is  well placed to provide additional resources to advise the ICS on policy requirements needed to realise the Black Review’s recommendations on re-establishing local partnerships.  The Coexisting Conditions steering groups could provide the space for such planning and reviewing the effectiveness of these plans.

Secondly, we think Multiple and Complex Needs (MCN) and Multiple Disadvantage should be clearly named in local healthcare policies, strategies, and service contracts and paired with clear commitments to meet the needs of this distinct group. Due to the stark health inequalities faced by people with MCN, their needs should be factored into local Equalities Impact Assessments and given the same profile as other protected characteristics. The Coexisting Conditions steering groups can advise on how these assessments could be accrued out and what would most need to be considered.

Thirdly, building on positive commissioning efforts dedicated Coexisting Conditions roles have been created in both substance misuse and mental health services across Sussex.  We call on the leaders of these teams and commissioners to consider co-location of these individuals. This would enable a more joined-up service response, pave the way for further development of joint working protocols and explore potential for a jointly commissioned service in the future. The Coexisting Conditions steering groups could help review the impact of these teams and guide future developments.

The Coexisting Conditions Steering Groups are a good illustration of the value local multiagency groups can play in championing continuous improvement and change. However, it is only when these groups become fully integrated into local governance structures that more systemic change for those experiencing co-existing conditions can be achieved.

In our next blog exploring coexisting conditions and multiagency forums, we will take a closer look at the ‘Coexisting Conditions’ operational forums held monthly in Hastings and in Eastbourne. These were set up to support operational developments and we will look at the impact they are having in shaping the system, promoting cross-sector collaboration and strengthening client support plans.

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Author:

Alan Wallace, Systems Change Officer

For further information about Fulfilling Lives work in this area, please contact:

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

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