How Multiagency Meetings Can Join Up Support

Reflecting on the impact of joint working protocols and how they can build bridges between mental health substance misuse services


Joint working protocol

In 2017, Fulfilling Lives South East (FLSE) developed and implemented a joint working protocol between Hastings mental health and substance misuse services to improve experiences for clients who need access to both services. The protocol aimed to meet clients’ needs as a whole, through a combined approach, rather than separating mental health and substance misuse as distinct issues and was shaped and informed by representatives from both services.

In the intervening years the Joint Working Agreement has grown and evolved. There is now a wider multiagency meeting called the Co-occurring Substance Use and Mental Health (COSUMH) Conditions forums held monthly in both Hastings and Eastbourne that has helped further strengthen joint working and shared client support planning.

These forums are an opportunity for agencies to discuss any of their clients who have mental health needs, are using substances and whose current situations are felt to be particularly high risk. The aim is to work across agencies to ensure the client does not fall between the gaps and for the group participants to agree who will do what tasks and lead in what areas to best support the client, and further joint working approaches.

A range of agencies attend the forums including Adult Social Care, CGL, Housing, SWIFT, Staying Well, FLSE, Oasis, Optivo, Health in Mind, Probation, UCL, Psych liaison, Rapid Response, Rehab Pathway, Assessment & Treatment Service, and Crisis Resolution Home Treatment Team (CRHT).

How did the Joint Working Agreement start?

The Joint Working Agreement was the product of collaboration between CGL Star (The East Sussex Drug & Alcohol Recovery Service), East Sussex Mental Health services and the local Hastings FLSE team. First raised at the Hastings Dual Diagnosis meeting in 2016 (now the Co-existing Conditions Steering Group), the initial idea was to organise joint training sessions between the two services, so that workers would become more aware of how the other service worked.

It quickly became clear that ambitions for the partnership and the Joint Working Agreement went beyond training and that both services wanted to find a way to offer clients with co-existing conditions a better pathway to treatment; one which was person-centered and holistic.

What was included in the Joint Working Agreement?

The initial Joint Working Agreement included the following three aims:

  • Improve the experience of people who need to access both Mental Health and Substance Misuse services.
  • Enable clients to have their needs met, through a combined approach, which is informed by the expertise of both services.
  • Ensure that the client is treated as a whole person with overlapping support needs.

The Joint Working Agreement also set out detail of how agencies would address three key areas of joint client working: consent, assessment, and communication.

  • The Joint Working Agreement considered it to be good practice for workers conducting assessments to gain client consent to share information at the first opportunity. And that consent should be used purposely in a task-specific manner to ensure that information is shared between services when needed. Information sharing should be proportionate to risks and needs, ensuring that safe and appropriate treatment is provided.
  • The Joint Working Agreement recognised assessingclients who have enduring mental health problems, while also using substances, would take more time. To gather a full picture of who the person is and who they might wish to become an active, collaborative, engaging process was used. While acknowledging that recording the details of co-occurring mental health and substance misuse presentations would need to take place at separate meetings, each led by a specialist practitioner. Attempting to address problems in each of these areas required different models of treatment and different styles of engagement, enabling services to learn from each other by observing one another’s professional practice.
  • The Joint Working Agreement anticipated that mental health and substance misuse provision would need to be co-ordinated across services with one agency taking the lead, and that the lead agency might change as the client progresses through treatment. Good communication would be a pre-requisite between practitioners from both services so cases could be regularly reviewed and updated.  

When multiagency planning can work well

The Joint Working Agreement aims, and objectives have evolved and the COSUMH Forum is now a valued junction point in the support system, providing a space for joint working, joint problem solving and a place to plan support for people who have coexisting substance use and mental health needs.

Recent feedback from Forum participants has shown that staff working across services in East Sussex value the forum for the following:

‘The forum has been a fantastic help in raising the profile of our project and clients’ needs/role, as well as in getting to meet all the right people. We know this has helped us to get referrals, so in that sense, there’s a very clear benefit to us as a project and to the people who are getting support that they didn’t have before.  I like the presentations and I’m really grateful to the forum – for welcoming and including us – it’s hugely appreciated. Getting a holistic view of individuals we talk about is invaluable, the way everyone talks about things at the forum is very different – it doesn’t have formality of case meetings – and the willingness of professionals to be open, share thoughts and bounce ideas around in a caring and safe environment is very rare, refreshing and much valued.  There are so many people with different knowledge and skills and the way it is set up is very effective.’

(Quote from an attending professional)

However, the group remains ambitious and want to develop the Forum further. The Forum chair shared their thoughts on what they would like to see happen next for the meeting:

‘I enjoy having the opportunity to develop and maintain positive relationships across services in East Sussex through the COSUMH conditions forum network. The forums have strengthened understanding between partner agencies and their roles in supporting recovery, this happens not only through the forum presentations, but also during the referral discussions. We have a core group of professionals from SWIFT, Adfam, Oasis, SPFT and Probation who attend every forum. I would like to see this replicated across all agencies so that we have passionate advocates for our clients living with COSUMH conditions in every service across the county. I am delighted that the forums have been recognised as good practice and am now working with West Sussex to set up something similar.’

(Susi Whittome, Forum Chair)

Reflecting on the importance of multi-agency meeting spaces in support systems

AT FLSE, we believe that fostering new collaborations and creating new meeting spaces is a way to foster systems change.

This method of systems change involves creating new connection points to bring together previously unconnected representatives of agencies who hold the power to change the way the system is structured and operates. The process for this can include mapping existing multi-agency meetings and identifying gaps where it would be beneficial to bring unconnected stakeholders together in a new forum.

These new forums should nurture collaboration and foster learning and result in tangible positive actions that impact on the recipients of support systems. The COSUMH Forums are a good example of this in action locally.

Challenges of this method include the time and resilience needed for the new forum to become an effective catalyst for change, an initial over-reliance on key individuals to engage and breaking down barriers to sharing information that may be traditionally viewed as commercially sensitive.

However, the benefit of this approach includes increased cross-agency partnership working; increased access across the system to new skills and knowledge; and a shared access point for raising gaps and barriers in systems and joint problem solving. This is particularly useful when responding to new systemic challenges that are unlikely to have existing forums for conversations and nurturing collective action.

To read more about how multi-agency meetings can foster systems change, please read our blog on the Brighton & Hove and East Sussex Coexisting Conditions Steering Groups here


Author:

Alan Wallace, Systems Change Officer

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

Alan Wallace, Systems Change Officer:

alan.wallace@sefulfillinglives.org.uk  

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Stopping the Prison Cycle for Women

In just over six years of client facing work, the Fulfilling Lives project has worked with a total of 69 women across the three project areas of Brighton & Hove, Eastbourne and Hastings, of a total caseload number of 118 clients. The Fulfilling Lives offer is a flexible one; a mixture of practical support to address immediate safety combined with psychosocial, trauma informed interventions to support behaviour change, and has had a hugely positive impact on the lives of many of the women with multiple and complex needs that we have worked with.

Sometimes the more interesting learning comes from exploring where things haven’t been successful however. In spite of the intensive and flexible support offer from FL, some individuals haven’t been able to make significant change in their lives and remain stuck in patterns of repeat offending. Work has remained focussed on immediate crisis and risk-led interventions, rather than on planned or preventative work to support individuals to break the cycle of reoffending.

The women on our caseload who are in contact with the criminal justice system have some of the most complex difficulties of any of the clients working with Fulfilling Lives. All have mental health diagnoses, including anxiety and depression, personality disorder and bipolar disorder, all use alcohol and drugs and all have experienced domestic violence and abuse.

These individuals are engaged in repeat cycles of offending, often driven by active addiction. They receive short custodial sentences and are regularly released as street homeless where the chaotic nature of their lives leads to breaching license conditions and being recalled to prison after only a short time in the community.

The majority of female offenders with complex needs are also victims; this does not, however, result in them receiving better coordinated support.

The majority of female offenders with complex needs are also victims; this does not, however, result in them receiving better coordinated support. It is widely accepted that women need a dedicated pathway of support that takes account of the multiple trauma experienced and their victim status; but there remains a shortage of trauma-informed, gender-specific interventions for women locally.

At Fulfilling Lives South East we have worked really effectively with local multi agency partners including CRC probation colleagues (soon to be National Probation Service), Brighton Women’s Centre, Oasis and others in coordinating creative and flexible support arrangements to maintain positive engagement with women experiencing multiple disadvantage in the community. However, much of the positive work achieved in the community can be interrupted by recalls to prison which interrupt housing and support plans in the community.

We have recent case studies which highlight how women are trapped in cyclical offending patterns often driven by mental distress and desperate cries for help. The offender journey here highlights how a woman supported by Fulfilling Lives experienced mental health crises in the community after leaving prison homeless 3 times in one year; a cycle which was only broken by identifying a suitable accommodation placement on release with high enough support to manage her mental health needs.

The Fulfilling Lives project is committed to systems change. However, in terms of affecting real change, the systemic issues which contribute to these patterns of behaviour are difficult to tackle at a local level alone.

We know that short sentences don’t contribute to recovery or stabilisation.

We know that short sentences don’t contribute to recovery or stabilisation. The solution must lie in taking a genuinely systemic approach in addressing the underlying issues which are driving women to offend.

We don’t need to seek the answers. Many of the recommendations outlined in the 2007 Corston report are still relevant and mostly still not implemented. We want to see more specialist women’s support in the community, more liaison and diversion schemes to divert women away from custody into support and sentencing reform with greater use of alternatives to custody and women’s community support services.

With these national changes in place the excellent work that is happening locally to coordinate multi agency case support in the community for all women experiencing multiple disadvantage can be embedded further and more lives can be turned around.

Author: Jo Rogers, Senior Manager, Fulfilling Lives South East Partnership

Manifesto for Change

In November 2019, Fulfilling Lives South East published a new report, Manifesto for Change: Changing systems for people facing multiple disadvantage. It outlines the 6 key themes that have arisen from their work so far, and sets out their commitments under each theme going forward.

The Fulfilling Lives South East Project started in 2014 and is funded until July 2022 by the National Lottery Community Fund. It is led by Brighton Housing Trust (BHT), with the support of delivery partners Equinox and Oasis Project, and is one of twelve inter-linked projects running across England.

The Fulfilling Lives programme provides intensive and tailored support to people with multiple and complex needs, helping the most vulnerable and hard to reach. It also works alongside people with lived experience of multiple disadvantage, to make services better connected and easier to access.

The six themes explored in the manifesto are:

  1. Health Inequalities
  2. Domestic abuse and complex needs
  3. Criminal Justice System – repeat offending
  4. Treatment pathways for coexisting conditions
  5. Unsupported Temporary Accommodation
  6. Repeat removals of children into the care system

Download the full report here.

Greetings from Fulfilling Lives

Fulfilling Lives aims to achieve the following four overall project outcomes

  1. People with multiple and complex needs, previously not engaging well with services, self-report that they are better able to manage their lives, as a result of services being more accessible, targeted and better coordinated.
  2. Service users are empowered to directly influence service design and delivery within the project and externally.
  3. Services and roles will better meet the needs of service users through undergoing a process of review and evaluation, leading to lasting change in design and delivery.
  4. Long term improvements in systems, commissioning and policy will be achieved through shared learning and strengthened outcomes evaluation

Fulfilling Lives South East (FL) is funded by the National Lottery Community Fund. The South East project is comprised of Brighton & Hove, Eastbourne, and Hastings. It is led by BHT (Brighton Housing Trust), and works in partnership with Equinox and Oasis to deliver support to people with multiple complex needs.

This blog will be regularly updated with contributions from the various staff and volunteers from FL. We will be sharing project updates, reflections and learning that we hope will be of interest to those working directly or indirectly to support people with multiple and complex needs. We also hope that it may be of value to anyone with an interest in seeing the lives of some of the most vulnerable people in our society improved.