Rob Warriner, chief executive of Walsh Trust writes of his IIMHL experience learning about a new model of crisis mental health care in Glasgow, Scotland.
For some time now, I have increasingly and latterly more overtly argued the need for a transformation in how we conceptualise, plan, develop and deliver service that respond to the distress and poor mental health of people. Voices for transformational change have gradually shifted from activists and the fringes of more established thinking, to the forefront of discussion, debate and strategic thinking.
IIMHL Leadership Exchanges are unique in that they have consistently offered participants the opportunity to gain knowledge. More critically the “matches” enable participants to be exposed to new ideas and discussion, to participate and engage in new experiences, to realise new possibilities and potentials… unencumbered by our assumptions and “givens”.
This was very much reinforced throughout my exchange in Glasgow, Scotland. The exchange was headed “ask once, get help fast,” based in the development of a Distress Brief Intervention (DBI) pilot.
Distress Brief Interventions (DBIs) is an initative that emerged from the Scottish Government’s Suicide Prevention and Mental Health strategies. Work on implementing these strategies indicated that responses to the needs of people in distress would be far more effective if there was improved coordination across multiple agencies, far quicker access to support and more consistency in the care, support and compassion they are offered.
The DBI pilots do share some similarities with the Awhi Ora pilots being offered through the Waitemata and Auckland DHBs. They are both interested in providing prompt, short term responses to people experiencing significant distress in their lives. Whether intentional or not, challenge of some existing concepts, practices, and language typically associated with mental health service provision has emerged in both pilots. Genuine enthusiasm and commitment is clearly evident in all staff; as well as a clear determination “make this work”, and to ensure responsiveness to people’s needs. In both situations there is an awareness of the [welcome] potential of these new service options to contribute to change - even transformation - of how mental health services are generally conceived and offered.
There are also some differences.
Awhi Ora seems more overtly led by and designed against a national (primary mental health care) strategy. Awhi Ora is principally structured around a GP practice / medical centres, as a means of connecting people with support services. While building relationships with the GP practices is a core element of service development and delivery, processes to date are strongly transactional. GPs in general, are relatively passive in the day to day provision of Awhi Ora - and certainly so in regard to further development.
DBI appears to more clearly represent a collaborative human response to distress, based upon a shared interest, commitment and vision across quite discrete, but complementary agencies. The partner agencies (Police Scotland, Scottish Ambulance Service, A and E departments, GPs, NGOs, University of Glasgow, NHS Mental Health Services) are demonstrably committed with a clear, shared interest in this area.
There is less focus upon determining mild, moderate, severe illness;’ instead the focus service is distress a person might be experiencing. The initiative defines “distress” as “an emotional pain for which the person sought, or was referred for, help, and which does not require [further] emergency service response.” What is impressive is that all responses are expected to take place within 24 hours of an offer of referral being accepted.
Probably the most vivid “take away” was the example of what can be achieved through genuine partnerships that reflect both commitment and a shared vision. The powerful sense of partnership between the parties was especially tangible. This was not a case of signing an MoU, and then returning to “business as usual”, with some differences. The partnerships were regarded and acknowledged as powerful moderators and informants of a new “business as usual” for each partner.
The ability to establish and maintain effective, mutually supportive relationships based in shared interests is commonly regarded as an essential element of good mental health. It is refreshing and innovative that the DBI pilots model such fundamental principles. We could too.