1. Primary Care and Community
Mental Health Service Redesign
Consultation document March 2014

2. What is a Clinical Commissioning Group (CCG)?
Since April 2013, CCGs have been responsible for planning and
buying NHS services for their local population. All of the GP
practices in your area are members of your local CCG.
The CCGs that provide services for Birmingham residents:
What is this consultation for?
The purpose of this document is to gather feedback from as many
people as possible in relation to:
• Personal experiences of using primary care and community
mental health services.
• Your views about the information that is currently available
about primary care and community mental health services.
• Access to primary care and community mental health services.
• Your views on the model proposed.
• Any further views as to how we can make primary care and
community mental health services better.
INTRODUCTION
2
A34
A38
A38
A452
A456
730,000
patients
250,000
patients
222,255
patients
Birmingham CrossCity CCG
Birmingham South Central CCG
Sandwell and West Birmingham CCG

3. Why do we want to redesign services?
We have made many changes to mental health services since
the launch of the ‘Better Mental Health for Birmingham’ Mental
Health Strategy (2011-2016); however, we still have some further
work to do to:
• Improve people’s experience of services
• Increase support for people when they no longer require
specialist mental health services and are discharged back to their
GP practice
• Promote wellbeing
• Help people to recover and live fulfilling lives
• Make access to mental health services in the community easier
and increase access to services
• Improve access to information about the availability of mental
health services in Birmingham
• Improve partnership working between service providers to make
things better for people
What age groups are these services for?
Generally, we are focussing on services for adults, which mean
those people over 18 years of age. However, some services work
with young people from 16 years of age, so those services are also
included in the redesign.
3

4. What services are we talking about?
Talking therapies can help you work out how to deal with negative
thoughts and feelings and make positive changes in your life.
Currently two types of services are available; Improving Access to
Psychological Therapies service (IAPT) and counselling services.
The IAPT service is accessible for people who are experiencing
depression and/or anxiety disorders. The service is currently
delivered by Birmingham and Solihull Mental Health Foundation
Trust and the service is accessible in GP practices, community
venues and specialist mental health care premises. The service is
delivered by therapists and psychologists who have to undergo
specialist training to deliver the service.
The counselling services are accessible for people who may feel
stressed in connection with current or past life challenges and
may experience depression. These life situations could include
bereavement, domestic violence, cultural specific or gender specific
issues, relationship breakdowns, pre and post-natal depression
and work stress. These services are provided by third sector
organisations by trained counsellors and volunteers who are
trained, supported and supervised by trained counsellors.
Your local CMHT service is provided by Birmingham and Solihull
Mental Health Foundation Trust across locations within the
community. A community mental health team coordinates
your care if you receive community-based mental health care.
This includes carrying out mental health assessments, planning
treatment and delivering care.
You are normally referred to a CMHT if you have more complex
mental health needs and would benefit from the care of more
specialist mental health workers such as psychiatrists, psychiatric
nurses, social workers and occupational therapists.
We currently buy a range of services from experienced third sector
organisations to support more people in the community. These
services support people who may be recovering from a mental
health condition, people who may have developed a mental health
condition but may not require specialist mental health care, and
provide information to the general public.
The services range from volunteering opportunities, mental health
awareness training, learning new life skills, advice and support
about wellbeing and lifestyle and a range of other community
activities in order avoid people becoming socially isolated.
4
1. Talking Therapies 2. Community Mental Health Teams (CMHT)
3. Recovery, Enablement and Prevention Services

5. 5
What do we already know?
Following completion of a local needs assessment in Birmingham
in 2011 we discovered:
BACKGROUND
It is estimated that 1 in 5 people
in Birmingham aged 18-64
(1 in 4 people across all ages)
experience mental health problems.
There is a gap between the number of
people expected to have mental health
problems in Birmingham (140,582) and
the number of people recorded by GPs as
having a mental health problem (91,467).
A person living in an inner City ward is
twice as likely to experience mental health
problems than someone in neighbouring
affluent wards.
Many mental health services are focused on
delivering care for schizophrenia and more
serious mood conditions. This does not cover
the whole spectrum of population need.
There has been a steady increase in
prescriptions for anti-depressants, which
raises questions about whether and how
anti-depressants and psychological therapies
are balanced in treatment pathways.
10.5% of women (out of 18,479) declared
at the first maternity booking that they had
experienced previous mental health problems.
There is under representation of BME groups within
mental health services. Of the services provided by
Birmingham and Solihull Mental Health Foundation
Trust; White, Asian and Black populations receive:
73.8%
11.1%
White
Asian
Black 5.4%

6. 6
A plan to shape Mental Health Services in Birmingham already
exists. This is called The Joint Commissioning Mental Health
Strategy ‘Better Mental Health for Birmingham’ (2011-2016).
We consulted with people who use mental health services and
their carers. The main issues they told us were:
• More patient choice had to be included in commissioning new
services.
• They were worried about the lack of information in GP surgeries.
There was strong support for:
• a pathway approach to mental health services and mix of
providers
• improvement in quality of primary care mental health services
• increasing the choices of psychological services as well as medical
interventions, including greater choice more generally about
mental health services and more culturally appropriate services
• ensuring services meet the specific needs for asylum seekers and
refugees
• improving a single database of available services and making
substantial improvements to a single access point.

7. 7
We will be reviewing the following in each service area:
Access, Patient experience, Outcomes, Value for money.
What are the outcomes that we want to achieve and how will we know if we have made a difference?
Outcome How will we know if we have succeeded?
1. Clearer pathways for service users,
carers and referrers
• Positive feedback from service users, carers, referrers, the public
• Access to services is easier
• Better information is available to all in relation to what services are available
• Health professionals have clearer referral routes into services
2. Improved access to talking therapies
(or psychological therapies)
• A wide range of therapies are available to suit the needs of our local population including hard to
reach communities
• More people have access to talking therapies
• More people recover following access to services
3. People will be better informed and
will feel more able to manage their
condition
• More people feel that they have been involved in planning their own care and support
• Better information is available to all in relation to available services
• People tell us they feel better informed about mental illness, how to manage their condition, what
help is available and where to find it
4. The right care at the right time • People are able to access the right service when they need it; appropriate care for people’s needs, care
and support delivered by the most appropriate workforce, care and support is delivered at a variety of
locations that is suitable for people
• Better information is available to all in relation to what services are available in their community
5. People feel more supported in their
community
• Better information is available to all in relation to what services are available in their local community
• Care and support is delivered at a variety of locations that is suitable for patients
6. Integrated support, incorporating
wellbeing as well as treatment
• Service providers are able to work more closely together to ensure that services are wrapped around
people’s individual needs and all people receive a service
7. Localised services enabling recovery • Access to services are available at different locations across the city tailored to local needs
• Feedback from service users, carers, referrers and the public is used to shape future services
• All service outcomes are improved and recovery focussed
• Positive patient experience feedback
8. Greater financial efficiency, resources
are directed appropriately and to those
in need
• Quality services are delivered that are value for money
• Access to services are available at different locations across the city tailored to local needs
THE SERVICE REVIEW

8. 8
The proposed primary care and community mental
health model:
Referral from GP /
Health Professional
Direct referral
options still in place
Single Point of
Access and Triage
GPs and health
professionals will
make a referral into
the single point of
access.
Direct GP referrals
for some services
will still be in place.
All referrals will
go into one route
and will be assessed
by appropriate
professionals.
Talking
Therapies
Talking Therapies can help you work out how
to deal with negative thoughts and feelings
and make positive changes. Currently two types
of services are available; Improving Access
to Psychological Therapies service (IAPT) and
counselling services.
BSMHFT
secondary care
services
Our local specialist mental health care services
which are provided by Birmingham and Solihull
Mental Health Foundation Trust include;
Inpatient Services, Community Based Services
and Specialist Services.
Community
support and
wellbeing
service
Our vision is that people will be able to access
local wellbeing services that will support the
delivery of the outcomes. A team of community
support workers will provide direct support in
GP practices and community venues to help
people to find and access the right services to
suit their needs. The service will also have a
strong relationship with local specialist mental
health care services, third sector and statutory
services.
Social Inclusion To attempt to prevent people with mental
illness becoming socially isolated we provide a
range of services in order to help people with
specific issues and to raise public awareness in
relation to mental health issues. Some of these
services are: advocacy and peer support; carer
support services; mental health promotion and
prevention programmes; day services in the
community; employment, volunteering and
education support services; domestic violence
support; debt advice and guidance.
Direct referral
options still in
place
Direct referral
options still in
place
Referral from GP /
Health Professional
Single Point of
Access and Triage
Talking
Therapies
BSMHFT
secondary care
services
Community
support and
wellbeing
service
Social
Inclusion

9. 9
What will happen to the information that I provide?
The information will be reviewed and shared with our
communications team who will analyse all of the feedback
received and put it together with other sources of information
that we have collected as part of our pre-consultation engagement
into a summary report.
During the consultation process we will engage with:
• the public
• service users
• carers
• health professionals
• providers of mental health services and statutory services
including (but not limited to)
• housing
• probation
• police
• job centres
• benefits agencies.
THE CONSULTATION

10. 10
Why have we suggested leaving the options for direct
GP referrals in place?
Some GPs are confident to make referrals into the right mental
health services, including third sector services, for their patients
and we feel where this good practice is in place it should continue.
Why does the diagram state that only GP or health
professional referrals are allowed?
Following feedback that we have received, we are looking at how
we can widen access to the referral routes.
What is happening with child and adolescent mental
health services (CAMHS)?
We are aware that there are issues for some people moving from
child and adolescent mental health services to adult mental health
services; therefore we plan to redesign these services to improve
the pathway and prevent disengagement from services due to
transitions. We are currently working with young people, carers
and families and mental health services to look at ways that the
services can meet the needs of people from 0-25 years old. This is a
separate process to the Primary Care Redesign. The new pathway
for 0-25 year olds is to commence in October 2015. A 12 week
Public Consultation is due to finish at the end of April You can find
out more at www.bhamsouthcentralccg.nhs.uk/patient-and-public-
engagement/0-25-mental-health-services
What is happening with Attention Deficit Hyperactivity
Disorder (ADHD) services?
We currently commission a service from Birmingham and Solihull
Mental Health Foundation Trust for people aged 16 plus. ADHD
services are included in the CAMHS service consultation.
What is happening with Dementia services?
‘Give me something to Believe in’ the Dementia Strategy for
Birmingham and Solihull 2013-16 is now undergoing formal
consultation (until 7th April 2014) through Birmingham City
Council’s website Be Heard. Please follow this link to add your
views: www.birminghambeheard.org.uk/adults-communities/
birmingham-and-solihull-dementia-strategy. The strategy will be
formally launched on 19th May 2014 during Dementia Awareness
Week.
What are the future plans for Learning Disability
Services?
The Joint Commissioning Team is working closely with Birmingham
Community Healthcare to remodel specialist healthcare services
provided to people with learning disabilities. We are seeking to
commission services that focus on supporting people in their own
homes and local communities, and reduce reliance on inpatient
assessment and treatment services for people with complex and
challenging behaviour. To achieve this we are proposing to invest
significantly in community outreach services in 2014/15.
FREQUENTLY ASKED QUESTIONS

11. 11
Term Definition
Anti-depressants A type of medication used to treat
depression or prevent it recurring.
Attention Deficit
Hyperactivity
Disorder (ADHD)
A group of behavioural symptoms that
include inattentiveness, hyperactivity and
impulsiveness.
Dementia A syndrome (a group of related symptoms)
that is associated with an ongoing decline
of the brain and its abilities.
Enablement Supporting people to become as
independent as possible; this may involve
doing more for yourself or being able to
make your own decisions.
Learning Disabilities Affects the way a person understands
information and how they communicate.
Needs assessment This is a systematic process for determining
and addressing needs by gathering specific
information, highlighting the gaps and
coming up with recommendations to
improve current performance or to correct
a deficiency.
Outcome What is achieved by a service or
intervention.
Prevention The action of stopping something from
happening or arising.
Primary Care
Services
Services that are provided at the first stage
of illness.
Term Definition
Single point of
access
One access route into a range of services.
Specialist Mental
Health Services
In many parts of the country, mental
health services are organised by specialist
mental health trusts. Mental health trusts
provide inpatient care, community and
rehabilitation services and day clinics. Our
Local Trust is Birmingham and Solihull
Mental Health Foundation Trust.
Statutory Services Services that are required to exist by law.
Third Sector Service
Provider
Organisations who are ‘not for profit’ and/
or non-governmental. Sometimes these
are charities or private organisations.
Transitions The movement from one service to
another, often when the person is a
certain age.
Triage A process for arranging people into
groups based on their need for or likely
benefit from medical treatment.
Wellbeing The state of feeling healthy and content.
GLOSSARY

12. Please send feedback and requests for hard copies to:
You can contact us to book a place at one of the events,
request a copy of this document or send consultation
feedback:
WHAT HAPPENS NEXT?
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Joint Commissioning Team, Zone 5, 1st floor,
desk no: 1140, PO Box 16467, Birmingham, B2 2DR
NHSBCCCG.BirminghamJCT@nhs.net
www.birminghambeheard.org.uk
0121 675 8270
www.bhamcrosscityccg.nhs.uk
www.bhamsouthcentralccg.nhs.uk
www.sandwellandwestbhamccg.nhs.uk
We want to hear your views and we are running three
consultation events. Please come along and tell us what you think.
You can book a place by visiting one of our websites, eventbrite,
telephone or by email. Please see details below.
Wednesday 26 March 2.30pm – 4.30pm
Saffron Centre, 256 Moseley Road, Highgate, B12 0BS
Tuesday 8 April 6.00pm – 8.00pm
Midlands Arts Centre, Cannon Hill Park, Edgbaston, B12 9QH
Saturday 10 May 1.00pm – 3.00pm
Library of Birmingham, Centenary Square, Broad Street, B1 2ND
Public event dates:
You can book a place on these events by visiting www.eventbrite.
co.uk and search for ‘Birmingham Primary Care Mental Health
Events’
You can book a place on these events by visiting www.eventbrite.
co.uk and search for ‘Birmingham Primary Care Mental Health
Events’
You can book a place on these events by visiting www.eventbrite.
co.uk and search for ‘Birmingham Primary Care Mental Health
Events’
When the consultation closes on 6 June 2014 the consultation
summary report including all of the feedback that we have
received will be finalised and then considered by the CCGs in
order to help them to make a decision on redesign plans.

13. 13
1. Tell us about yourself, are you:
A current or previous user of talking therapy services
A current or previous Carer for someone who suffers with
mental health problems
A general member of the public who has not accessed the
services
A health professional
A statutory service provider
Other (please specify)
2. How did you find out about the services?
Through your GP practice
Through promotional materials, leaflets, magazines, radio,
online
Through recommendation by family
Through recommendation by friends
Through recommendation by community groups
Other (please specify)
3. What was your experience of accessing the services?
On a scale of 1-5; 1 being easy and 5 being hard
Did not access the service (please explain why)
4. Where do you think would be a good place to receive these
services?
At the organisation’s offices
Community venues (such as community centres, leisure
centres, libraries or colleges)
GP practices
Other (please specify)
5. If you have personally accessed these services what do
you think has worked well and what do you think could be
improved?
6. Would you recommend these services to your family/friends if
they experience mental distress?
Yes
No
Consultation questions – please tear out these pages and return the form in the envelope provided.
SECTION 1: We are particularly keen to find out your views in relation to:
1. Talking Therapies, Improving Access to Psychological Therapies service (IAPT) and counselling services

14. 14
1. Do you know how to access your local service?
Yes
No
Unsure
2. What was your experience of accessing the services?
On a scale of 1-5; 1 being easy and 5 being hard
Did not access the service (please explain why)
3. Have you had direct experience of using these services?
No
Yes (please explain what you think worked well and what
could be improved?)
4. Do you have any other comments or suggestions about the
services?
5. Would you recommend these services to your family/friends if
they experience mental distress?
Yes
No
2. Community Mental Health Teams

15. 15
1. Do you know how to access your local services?
Yes
No
Unsure
2. What was your experience of accessing the services?
On a scale of 1-5; 1 being easy and 5 being hard
3. Have you had direct experience of using these services?
No
Yes (please explain what you think worked well and what
could be improved?)
4. Do you have any other comments or suggestions about the
services?
5. Would you recommend these services to your family/friends if
they experience mental distress?
Yes
No
3. Recovery, Enablement and Prevention Services

16. 16
1. Do you think the single point of access model will help
patients to access the right services more quickly? Please add
your comments.
Yes
No
2. Do you think that the community support and wellbeing
service will provide good support in the community to guide
people to the right services? Please add your comments.
Yes
No
3. Do you think that it is important for the community support
workers to be based in GP practices and community venues?
Please add your comments.
Yes
No
4. Do you have any other comments or suggestions about the
model?
SECTION 2: The proposed primary care and community
mental health model
1. How do you usually access information about mental health
services?
2. Do you have any ideas about how we could make information
about mental health services more available and accessible?
SECTION 3: Information about mental health services