National report

On Wednesday 16 July I represented Leeds Community Healthcare NHS Trust at the National Confidential Inquiry into suicide and homicide by people with mental illness. The event took place at the Manchester Conference Centre and was opened by Niall Boyce, editor of The Lancet Psychiatry.

The first speaker was Stephen Habgood from Papyrus This was the sharing of the story of Stephens' son's death. It was titled ' All the Kings Horses'. When this gentleman spoke there was a total silence in the room as we heard the pain and loss suicide brings. Words from me to describe this story would be a very poor thing. The power of it struck me like lightning. What I can say it is that it was so right to start this event with these powerful and heart touching words. It set the centre and heart of what we were about to hear. I would like to use this space to thank Mr Habgood for his words and sharing. 

The second speaker was Professor Dame Sue Bailey, Consultant Child and Adolescent Forensic Psychiatrist at Greater Manchester West NHS Foundation Trust. This was an impacting speech. Professor Bailey drew from the Francis and Berwick reports to share her thoughts.  What I found so valuable were sentences which really struck and resonated with me. These statements don't need my commentary so I will record them as I scribbled them down. These are my summaries

          - one death - a ripple effect of thousands 
          - the need to listen to parents and families
          - the need for continual learning - all teach, all learn
          - prefix quality with safety. The two go together. If we get safety right quality will follow
         -  the need for intelligent kindness in healthcare
         -  quoting Bill Gates - 'It's fine to celebrate success but it is more important to heed the lessons of failure.'- the duty of candour

These may seem like truisms and obvious value statements. If however we all really lived and sourced them in our practice and services a real transformation could occur. 

The last speaker was Professor Louis Appleby, National Director for Health and Criminal Justice and Professor of Psychiatry at the University of Manchester.  Professor Appleby is Director of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. He presented the findings of the report. The findings can be found here. The presentation ended with recommendations. These included: 

       * suicide three days after hospital discharge should be regarded as a 'never event'
       * care planning needs to be careful and effective including for those who self-discharge 
       * adverse situations / events that precede admission should be addressed before discharge
       * the benefits of reducing length of stay in in patient stay should be balanced with risks and should not be an aim in itself
       * in intimate partner homicides, mental health services should play a full role in multi- agency work and case reviews. 
       * Crisis Resolution and Home Treatment might not be suitable for patients with too high risk or who do not have good family and other service support
       * economic factors should be recognised with patient suicides and support offered with housing, debt and employment.
       
There is here a real challenge for our mental health services and other care services. I would suggest it is even a bigger call than that. Three months ago I received a call at work that a friend of mine hadn't shown up at work. A visit by the police and his father to his flat the next day found him there. He had taken his life. This was someone who had a job he liked, lots of friends, a great career future and who did a lot of good to others. I and others still have no real answers as to why our friend took his life. He never had any contact with mental health services and as far as we know showed no signs to any of us of mental illness. The answer to this is bigger than any service. I think it lies in how we create cities, conversations and cultures where people can talk about their feelings and thoughts and where we can support people to find hope in the darkness they may be encountering. This report raises vital questions and recommendations for all us to work with.

John Walsh, York Street Practice

Celebrating Positive Pathways

Positive Pathways celebrated their first year of existence yesterday at St George's Centre in Leeds. Positive Pathways 'supports people who need to find suitable housing or are having difficulty managingwhere they live due to issues connected to their mental health'. The service is led by Community Links and is a partnership with Touchstone, Leeds Mind, Leeds Irish Health and Homes, St Anne’s Community Services and Leeds Federated Housing Association.

The event was opened by Catherine Donnelly, Service Manager at Community Links, who I first met 20 years ago when we both worked for Leeds Shaftesbury Project, the forerunner of Community Links. Catherine epitomizes everything that is good about the work we all try to do -  compassion, professionalism, vision, values, hope and commitment. Catherine introduced the event and the speakers. Chris Dickinson, Head of Commissioning at Leeds City Council spoke first about the work of Positive Pathways and the support of the local council for the scheme to deliver this valuable service to vulnerable people in Leeds. The next speaker was Councillor Bill Urry. Cllr Urry is the new lead for homelessness in Leeds and has already started to go out and meet services and clients. He visited York Street last week and the previous week had been out on the streets with services working with those rough sleeping. Cllr Urry gave a humble and gentle speech. He celebrated the event and asked what he could do for the agencies and service users there. He mentioned his predecessor Cllr John Hardy who worked so hard and so passionately for the homeless. It's a great thing that Leeds has a lead for homelessness and we commit ourselves to work with Cllr Urry to develop the best we can for our people who are homeless.

The third speaker was myself. I spoke about how Leeds can become best city. The day before I had meet with two good colleagues who work with the Health and Wellbeing Board - Peter Roderick and Rob Newton. We had talked about York Street, the passion we all have that Leeds is the best city for health and wellbeing and how we can proceed with this compassionate dynamic vision. I think I was still filled with the hope that meeting gave me as I decided to focus on that theme. I said that we become the best city by creating the best services for clients and the best cultures for staff. The two are not separate - it's all about caring for people. The need and hour for 'Integral Inclusion ' is now. I tried to map out ways for us to make those services that truly care for staff and service users.        

In attending the event and reflecting afterwards many things enter my mind. To pick three key things would not be easy but I'll try. The first was that it was so appropriate that Chris, Bill and myself spoke about what out third sector colleagues were doing. It was so right for the local authority and NHS to publicly acclaim and honour Positive Pathways and by implication third sector work. These three forces - the local authority, health and third sector working together and learning together offer a real hope to this city. This partnership triangle offers a sign and possibility for the future. This work can offer the most potent and supportive options for Leeds and it's people. The event was a microcosm of what we are and where we can go.

This brings me to the second key feature. We heard the voice of the service users. This was so key. That partnership triangle always needs to have that voice at its very centre. If we don't have patient- centred care then we are not offering the best models and practice. To hear the service users and volunteers was so powerful. Their stories, hopes and optimism touched, I think, everyone in the room. Anthony de Mello, the spiritual writer, once said that the shortest distance between a human being and truth is a story. The stories we heard connected us to people's lives and the work of the partners in Positive Pathways - work that helps people change their lives. The great health and wellbeing vision of Leeds mentions as an outcome 'People will be involved in decisions made about them'. This has to be key to our work. We have to make sure service users aren't just consulted but at the heart of what we do and are involved in what affects them.

 

The last thing that touched me was where we are in services locally and nationally. I think we are at a moment where we can do great things but to do this we have to think and act differently. As the events at Mid Staffs unfolded I remember wanting to know more. One Friday night I started to read and watch about what had happened. It was a heartbreaking experience. The next day a strange thing occurred. As I worked around the city centre I was still thinking about what had happened at Mid Staffs. Unbidden into my mind came a quote I had read a long time ago. The quote was, 'The darker the night the brighter the stars'. I didn't know who is was who said this but I knew what it meant. I looked the author up when I went home and it was the Russian novelist Dostoevsky who wrote this. Not that I have read him. I had not and still haven't. The quote however appeared as a real answer. The stars, despite the darkness, were the opportunity for something new and authentic. Not just the opportunity but that this was actually happening in different places. Those of us who want and work for new inclusive cultures for staff and great services for clients - this is our hour. The old cultures and  systems have shown in graphic deadly detail where they can lead. I believe those of us who have new visions, dream brighter pictures and work to make them come true that this is our time. Of course history and life will not automatically deliver these best services and cultures to us. We have to work for them and we have to fight for them. There are many of us in the third and statutory sectors who are sowing the seeds for this future and even seeing it happen before our eyes. If you are part of this work, thank you for what you do. If not, then why not join us?