In Norfolk, like everywhere else, we have to implement the national service framework for mental health (NSF) to meet the needs of the local population. A local implementation team, with a multi-perspective membership, has developed a way of adapting services to match people's requirements.
Rather than trying to represent all service users and staff, we created a team that was small enough to work effectively, but also brought diverse perspectives to the debate.
The team started by bringing together users, carers and interested agencies from across Norfolk to think about what was required from services. People were asked to imagine themselves in real situations - for example, hearing voices in the middle of the night - and to consider what they would want from services in those circumstances.
Most people said they wanted to be able to contact one central place and have someone take responsibility for getting them the right service. We also asked more general questions, such as what helps you to have a good day? People identified basic things, including having enough money, a job and a home they liked.
The team decided to look at the system of services as a whole, with a view to developing services based on actual needs - rather than forcing people to fit in with what was available and making them navigate a complex collection of organisations to find care to suit.
The system, as it stood, was too disjointed to patch up. Agencies were already overworked - co-ordinating with other organisations was therefore impossible. And the funding system, with agencies being forced to bid for funds for new projects, had led, over time, to services being "bolted on". Existing, good quality services would have a place in the new system, but others would have to be reshaped.
A whole new system of care needed to be mapped out. We developed a model of what needed to be done and how it all fitted together, but allowed for flexibility on the actual delivery of services. Flexibility is particularly important in Nofolk, a county that has urban, rural, deprived and affluent areas within it.
Norfolk, with its dispersed population, presents challenges to the NSF standards. For example, having assertive outreach teams is not always practical - in certain areas, there might only be sufficient levels of need to warrant one outreach worker.
One of the key changes will involve replacing generic community health teams with a larger number of highly focused services. There will now be separate teams, or individuals, to provide different aspects of mental health care - such as care co-ordination, support, crisis resolution, assertive outreach and early intervention.
We have already conducted an informal consultation to allow people to comment, and our model is about to go out for formal consultation. Both consultations aim to reach as many people as possible - we are circulating the document through statutory and voluntary organisations. The formal consultation is based on a six-page summary of the strategy, but full-length copies of the document are readily available.
Formal consultation is also being carried out via a widely circulated service-user newsletter. The costs associated with consultation have been minimised by creative use of resources, such as providing a telephone contact point for people to give their views. The costs of consultation, both in terms of time and finance, were shared among organisations.
There is great enthusiasm among local agencies to proceed with implementation of the mental health NSF but there is also some trepidation, as the changes will affect a lot of people.
