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Southall_mental_health_needs_assessment

VIEWS: 165 PAGES: 56

									       A mental health needs
           assessment
                for
             Southall
     London Borough of Ealing




Ola Aroyehun
April 2006
Contents                                          Page



Part 1: Introduction                              3


Part 2: Profile of the London Borough of Ealing   9


Part 3: Community profile of Southall             15


Part 4: Prevalence of mental health in Southall   22


Part 5: Service mapping                           29


Part 6: Analysis of report, conclusion            54
        Recommendation                            55




                                                         2
Introduction

The present needs assessment is an essential part of the planning and delivery of
services in Ealing. A recent review of the mental health commissioning arrangements
by the Health and Social Care Advisory Service (HSAS) 1 commented that Ealing has
a good understanding of the nature of the population and the mental health needs of
the population. The mental health population was, however, estimated from national
data trends and trends set in the Greater London Authority report on access to
mental health services in London. Specifically, HSAS commented that, „these remain
estimates of need and fail to capture the detail and diversity that vary in levels of
deprivation‟.

In response to this, a needs assessment sub-group was set up from the Mental
Health Reference Group to conduct a needs assessment within the Southall
neighbourhood area (one of the five neighbourhood areas in the borough).
Information was collated from various sources and has been analysed in this report.

The aim of the sub group in conducting this needs assessment is to enable
commissioners to:
    Move away from commissioning based largely on past patterns of service
       provision and uptake.
    Ensure that services match as closely as possible the health and care needs
       of the local population.
    Ensure access to services is equitable and fair, with equal quality of service
       provision for equal needs.

The subgroup hope that this local model of needs assessment may be developed
and adapted to other areas of the borough

What is a needs assessment?
A definition of needs assessment is necessary to set the context for this report. A
needs assessment can be described as the first step in designing and delivering
integrated services to people with mental health.

This is a process which helps to inform planning of care for individuals and provides
the rationale for re-designing services to better target assessed needs. Needs
assessment is simply about identifying the needs of the local population so that
services can be planned and delivered to meet the identified needs.

According to HSAS2, there are two main approaches that can be used to estimate
the needs:
    a) Population needs assessment: this method examines the needs for services
       and resources of a given population.
    b) An individual needs assessment that examines the needs for resources and
       services of an individual service user by acquiring information about that
       individual.

HSAS has also identified a third approach called a clinical sub-group needs
assessment that focuses on the need for a local specialised service depending on
specific clinical needs.




                                                                                        3
For commissioning purposes, and therefore for the purposes of this report, a
population needs assessment is being considered for the Southall neighbourhood
area.

Methodology for conducting the needs assessment

Both quantitative and qualitative approaches can be used to assess mental health
needs. They include:
    Engagement with service users.
    Individual assessment of needs.
    Epidemiology: i.e. prevalence and incidence data from national and local
       surveys.
    Rapid appraisal techniques: this involves information gathered from
       interviews with individuals with knowledge of the community and service
       users, analysis of available documents about the neighbourhood and
       observations made inside homes and the community.
    Comparisons of levels and usage of provision i.e. service profiling.
    Review of effectiveness of interventions.

The methodology used in conducting this report focuses on epidemiology, collection
and analysis of information about the neighbourhood and service profiling.

Defining mental health
The term mental health problems can be used to describe the full range of mental
health issues from common experiences such as „feeling depressed‟ to more severe
clinical symptoms such as „clinical depression‟ and enduring problems such as
schizophrenia.

More common categorisation of mental health problems are:
    Common mental health problems including problems such as anxiety,
      depression, phobias, obsessive compulsive behaviour and panic disorders
    Severe and enduring mental health problems including problems such as
      psychotic disorders (including schizophrenia) and bipolar affective disorders
      (manic depression).
    Personality disorder – defined as „an enduring pattern of inner experience and
      behaviours that deviates markedly from the expectation of the individual‟s
      culture, is pervasive and inflexible, has an onset in adolescence or early
      adulthood, is stable over time and leads to distress or impairment.


Determinants of mental health
According to the World Health Organisation (WHO), health is based on a wide
number of determinants. Social-economic inequality has detrimental effects on
mental health as does an individual‟s life circumstances such as employment,
housing, education and environment. A needs assessment must therefore take into
account community characteristics to tackle the causes and reduce incidences of
mental health. Table 1 highlights the key determinants of health as identified by the
WHO.




                                                                                        4
   Table 1: The key determinants of health
     Fixed          Socio-             Environment       Lifestyle           Acce ss to
     personal       economic                                                 servi ces
     Genes          Poverty            Water quality     Diet                Education
     Gender         Employment         Housing           Physical activity   National Health
                                                                             Service
     Age            Social Exclusion   Air quality       Smoking             Social Servic es
                    Social                               Sexual              Trans port
                    Environment                          behaviour
                                                         Alcohol, drugs      Leisure

The community profile section (Part 3) further explores some of these community
characteristics and how they relate to people with mental health.

Risk factors associated with mental health
There are certain groups of people who are at high risk for common mental health
problems, including those with less education or who are unemployed. Chronic
physical illness and adverse life events such as bereavement or moving home also
increases the risk.

Other risk factors for mental health include a family of psychiatric disorder, violence,
childhood neglect, financial strain, family breakdown, long-term caring and
unemployment.

Gender also has a significant impact on risk factors. Women have a greatly
increased risk of depression, eating disorders and self harm. Rates of suicide are
four times as high for men as women.

Policy Context
There are two key national policy contexts that influence the ability to provide an
effective response to mental health provision. Both are listed here in some detail. An
appreciation of these policies would have an impact on the commissioning response
to the needs assessment. The two contexts are:
    a) National Service Framework for Mental Health.
    b) Mental Health and Social Exclusion.

a) National Service Framework (NSF) for Mental Health
The NSF addresses the mental health needs of people in the working age up to 65.
National standards and service models for mental health are set out. The framework
includes seven standards which are as follows:

Standard one: Health and social services should:
    Promote mental health for all, working with individuals and communities
    Combat discrimination against individuals and groups with mental health
      problems and promote their social inclusion

Standard two: Any service user who contacts their primary health care team with a
common mental health problem should:
      Have their mental health needs identified and assessed
      Be offered effective treatments, including referral to specialist services for
     further assessment, treatment and care if required

Standard three: Any individual with a common mental health problem should:



                                                                                           5
      Be able to make the necessary contact with the local services to meet their
       needs and to receive adequate care
      Be able to use NHS Direct for first level advice and referral on to specialist
       helplines or local services

Standard four: All mental health service users on the Care Programme Approach
(CPA) should:
    Receive care plans which optimises engagement, prevents or anticipates
       crises and reduces risk
    Have a copy of a written care plan
    Be able to access services 24 hours a day; 365 days a year

Standard five: Each service user who is assessed as requiring a period of care away
from their home should have:
     Timely access to an appropriate hospital bed or appropriate bed or place
     A copy of a written “after care plan” agreed on discharge which sets out the
       care and rehabilitation to be provided

Standard six: All individuals who provide regular and substantial care for a person on
CPA should:
    Have an assessment of their caring, physical or mental health needs
    Have their own written care plan, which is given to them and implemented in
      discussion with them

Standard seven: Local health and social communities should prevent suicide.


b) The Social Exclusion Unit (part of the Office of the Deputy Prime Minister)
The SEU examined how to tackle the cycle of deprivation linked to mental health. It
identified the reasons why mental health problems often lead to and reinforced social
exclusion. The five areas it identified include stigma and discrimination, low
expectations from professionals of what people with mental health can achieve, a
lack of clear responsibility for promoting vocational and social outcomes, a lack of
ongoing support to enable people with mental health problems to work and barriers
to engaging in the community.

A model for change was proposed (Figure 1).




                                                                                        6
Figure 1: Model for change for mental health


                                  Stigma and discrimination
                        Challenging negative attitudes across all sectors

                                     Health and social care
      Primary care as a gateway to generic advice and support
      Advice and support on vocational and social issues in secondary care
      Day services that promote access to mainstream activities in the community
      Focus on inequalities in access to services and tackling poor physical health



          Employment                                 Supporting families and community
      Access to employment                                      participation
       programmes                                   Increasing access to education,
      Easing the transition from                     volunteering and leisure
       benefits to work                             Support for effective parenting
      Help with ent erprise                        Enable participation in community roles
      Support for job retention                      such as jury service or school governor


                                      Getting the basics right
                       Housing stability
                       Affordable transport
                       Financial security

This framework should also help shape the issues that need to be considered in local
service provision. The SEU intends to focus on these specific areas in order to tackle
social exclusion amongst people with mental health problems.

Southall Neighbourhood Area
Southall is one of the 5 neighbourhood areas in the London Borough of Ealing. The
borough has a total population of 300,948 and Southall a total population of 64,470
(21% of the total population in the borough).

The five wards comprising the neighbourhood are Dormers Wells, Southall Green,
Southall Broadway, Norwood Green and Lady Margaret. The wards were changed
after the 2001 Census was published. Therefore, some of the data used in the report
might refer to the old wards (Glebe, Dormers Wells, Northcote, Mount Pleasant and
Waxlow). Despite the name and slight boundary changes, the old and new wards are
not statistically different with respect to the significance and analysis of the data. The
reader is advised to note that in some cases (particularly with census data), the old
ward names are used.

32.5% of the population are between the ages of 25 and 44, whilst the working age
population (16-64) comprise 67% of the population.

The main ethnic group in the neighbourhood are Indians (47%) followed by White
British (17%) with smaller representations of other ethnic groups. The total South
Asian population in the borough is 63.5%.

Four of the wards rank in the top 5 deprived wards in Ealing and all of them are
among the first 10 deprived wards in the borough.



                                                                                          7
Part 4 provides detailed information about the prevalence of mental health in
Southall.

National prevalence of mental health
The Psychotic Morbidity Survey from the Office for National Statistics (ONS) (2000) 3,
estimates that one in six of the general population has common mental health
problems. One in every 200 adults in the general population has experienced a
„probable psychotic disorder‟ and about one in 25 adults has a personality disorder.
One in 100 of the population are estimated to have schizophrenia at some point in
their lifetime and similar numbers will experience bipolar affective disorders.

The expected numbers with different types of mental health problems for Southall is
shown in Table 2.

Table 2: Estimated mental health prevalence in Southall
Type of mental health         National prevalence             Prevalence in Southall
problem
Common mental health          One in 6                        10,745
problem
Psychotic disorder            One in 200                      322
Personality disorder          One in 25                       2570
Schizophrenia                 One in 100                      645
Bipolar affective disorder    One in 100                      645

The implications of this are discussed in detail in Part 4.

Using the report
Parts 2 and 3 profile the London Borough of Ealing and the Southall Neighbourhood
area. Part 4 discusses the prevalence of mental health in the Southall neighbourhood
area. Part 5 gives an overview of current mental health services in the borough.
Finally, Part 6 discusses the recommendations and conclusion from the report.




                                                                                       8
Part 2: Profile of London Borough of Ealing
The London borough of Ealing is one of the 33 local authorities comprising the
Greater London Authority (one of the 9 regions of England). Ealing is a London
borough in the West of London. It is the 14th largest district in the country and the
third largest borough in London. The borough is composed of 25 electoral wards and
7 PCT (Primary Care Trust) neighbourhoods.

The Southall area, to which this report refers is made up of Southall (south) and
Southall (north), see Map 1.

Map 1: Map of the London borough of Ealing.




The profile of the neighbourhood has been informed by the 2001 Census report and
the 2002-3 Annual Public Health Report. The population of Ealing was estimated at



                                                                                    9
the 2001 Census to be 300,948. In September 2004, the ONS (Office for National
Statistics) issues a revised mid-2001 population estimate for Ealing of 307,276.

Population
The borough has a relatively young population. The average age in Ealing is 35.6
years and only 5 per cent of the residents are at the pensionable age (Table 3) . The
number of young people aged 20-39 comprise 22.5% of the total population. There
has been a 6% population increase since the 1991 census.

Table 3: Resident population in Ealing
 Section of the population                 Number or percentage
 Total population                                         300,950
 Hous eholds                                              118,000
 Female                                                     51%
 Male                                                       49%
 Under-16s                                                  20%
 Those of working age                                       75%
 Those of pensionable age                                     5%
Source: 2001 Office of Statistics (2001)



Ethnicity
The ethnicity profile of all groups is shown in Table 4. There is a large Asian
population within the borough (with Indians being the largest black minority ethnic
group representing 16% of the population), as well as large amounts of other people
who are described as „White Other‟. Ealing is the 4th most diverse borough in
London.

Table 4: Ethnic minorities in Ealing
 Ethnic group                                % of total population
 White                                                    58.7
 (of which Irish)                                          4.8
 Black Caribbean                                           4.5
 Black African                                             3.7
 Black others                                              0.6
 Indian                                                   16.5
 Pakistani                                                 3.8
 Bangladeshi                                               0.4
 Other Asian                                               3.9
 Chinese                                                   1.2
 Other                                                     5.8
Source: 2001 Office of Statistics (2001)




                                                                                   10
Religion
The main religions in the borough are shown in Table 5. Christians comprise about
half of the population with Muslims comprising 10.3%. All other religions are below
10% of the population and 13.4% did not report any religion.

Table 5: Religion profile of Ealing
Religion                                   Percentage of total
Christian                                  50.7
Muslim                                     10.3
Sikh                                       8.5
Hindu                                      7.8
Budhist                                    1
Jewish                                     0.5
Other                                      0.4
Not stated                                 7.3
No religion                                13.4
Source: 2001 Office of Statistics (2001)


Refugees and Asylum Seekers
About 5% of the population (i.e. between 13,000 and 15,600) people) are reported to
be refugees or asylum seekers. Migrants from Poland, South Asian and Caribbean
communities have traditionally settled in the borough. Newer refugees have included
people from Somalia and other parts of Africa, Afghanistan, the Middle East and
Eastern Europe.

Housing tenure
63% of people in the borough are owner occupiers. The division of housing tenure
into groups is shown in Figure 2

Figure 2: Profile of housing tenure



              16%         3%

        7%


        12%                                     62%




     Owner Occuper     Council tenants      RSL tenants
     Private tenants   Others

Source: 2001 Office of Statistics (2001)




                                                                                      11
Household composition
The household composition is shown in Table 6. The total number of households in
the borough is 118,023.There is a total of 30.5% one person households and 10.5%
lone parent households, contributory mental health risk factors.

Table 6: Profile of household composition
Household composi tion                     Percentage of total
One person household                       30.5
All pensioner family                       4.8
Married couple household                   31.2
Co-habiting household                      7.9
Lone parent household                      10.5
Others                                     14.7
Source: 2001 Office of Statistics (2001)



Special needs with respect to housing
A special needs survey with respect to housing was conducted in 2005 3 . The survey
identified an estimated 17,292 households with one or more members in an identified
special needs group. This represents 14.7% of all households in the borough. Table
7 shows the number of households with different types of special needs.

The largest group is people who are physically disabled. This group represents
14.7% of all households. People with mental health problems represent 1.8% of all
households.

Table 7: Special Needs Categories
Category               Number of           Percentage of all     Percentage of
                       households          households            special needs
                                                                 households
Frail elderly          4033                3.4                   23.3
Physical Disability    11,452              9.7                   66.2
Learning Disability    1113                0.9                   6.4
Mental health          2099                1.8                   12.1
problem
Vulnerable young       129                 0.1                   0.7
people and children
leaving care
Severe sens ory        1406                1.2                   8.1
disability
Other                  591                 0.5                   3.4



Employment
A total of 20.8% of people aged 16-24 are unemployed (the age for the onset of
mental health issues). For people aged 16-74, the employment within this group is
shown in Table 8. About one in three are economically inactive with just over one out
of four (28.5%) being long-term unemployed. Lack of employment is a contributory
factor to mental health.




                                                                                    12
Table 8: Profile of economic activity
Economic activity                     Percentage of total 16-74
                                      population
Unemployed                                    3.9
Never worked                                  11.5
Economically active                           68.4
Economically inactive                         31.6
Long-term unemployed                          28.5
Permanently sick or disabled                  4.6
Source: 2001 Offic e of Statistics (2001)


Health
8.3% of the population reported that their health was „not good‟ and 15.1% reported
that they had a long term illness (see Table 9).

Table 9: Health profile of the population
Health profile                       Percentage of population
People whose health is described as good      71.1
People whose health is described as „fairly   20.7
good‟
People whose health is described as „not      8.3
good‟
Source: 2001 Offic e of Statistics (2001)


Incapacity benefit
Around 2,670,000 sick and disabled people are currently claiming incapacity benefits
in the UK. The numbers are around 315,000 within London and 12,000 within Ealing.
In August 2004 there were 11,965 claimants of Incapacity Benefit (IB) in Ealing and
1,210 claimants of Severe Disablement Allowance (SDA), accounting for 6.38% of
Ealing‟s working age population. In terms of age, 34% of people claiming incapacity
benefit in Ealing are aged 50 to 59 years old and 26% are aged 40 to 49 years old.
Only 9% of claimants in Ealing are below 30 years of age. In total, 12% of the
claimants are aged 60 years of age or above.

In terms of the length of time that people in Ealing have been claiming Incapacity
Benefit, 14% have been claiming for less than 12 months, 11% have been claiming
for between 12 and 23 months, 24% have been claiming for between 2 and 5 years
and more than 50% have been claiming for more than 5 years.

Indices of deprivation
The level of deprivation is measured by the ODPM (Office of the Deputy Prime
Minister) Index of Multiple Deprivation (IMD). This index measures deprivation based
on seven areas: income, employment, health and disability, living environment,
health and disability, crime, education, skills and training, barrier to housing and
services. The indices for the wards in Ealing is shown in Map 2, below.




                                                                                  13
14
Part 3: Southall Neighbourhood area: a profile
This community profile discusses the characteristics of the community in the context
of the wider determinants of health and risk factors. This section does not give a
community profile of people who are known to mental health services as this
information is not collected. Rather, it gives an overview of what the mental health
needs of the general population in Ealing might be and identifies issues that are
important for consideration.

Population
The five wards comprising the neighbourhood, together with their respective
populations are shown in Table 10, below. The total population of the Southall
neighbourhood area is 64470. From this, an estimated 14927 (23% of the population)
have some form of mental health problem. Prevalence is discussed more fully in Part
4.

Table 10: Population profile of different wards in Southall
Ward                                        Population
Dormers Well                                13073
Southall Green                              12895
Southall Broadway                           13049
Norwood Green                               12647
Lady Margaret                               12806
Total                                       64470
Source: 2001 Offic e of Statistics (2001)


Southall has the largest increase in projected population by 2011 (by nearly 10%)

Gender
There are a total of 32,406 men and 32,064 women living in the Southall
neighbourhood. This represents an equal proportion of males and females .

Issues relating to gender:
Women have higher rates of common mental health problems than men. Men are
reported as being less likely to seek help than women and men tend to have an
earlier onset of schizophrenia and a poorer prognosis than women. Doctors are less
likely to diagnose men with depression. However, depression occurs as often to men
as to women. Men also appear to experience more health determinants and risk
factors that contribute to mental health such as long-term unemployment, being
involved in the criminal justice system, alcohol and substance abuse, than women

Age
Unlike most disabling conditions, various reports have identified that mental health
problems begin early in life4. It is estimated that half of all lifetime cases begin by the
age of 14 and three-quarters by the age of 24. The report identified that despite
effective treatments, there are long delays between the first symptoms and the point
when people seek and receive treatment. This can lead to the development of co-
occurring mental illness.

The report surveyed people who live in private accommodation (but did not include
people known to tertiary services or those that are homeless). The method adopted
for the survey, implies that the results could be underestimated. The survey
demonstrated that prevalence increases from the youngest group (age 18 to 29) to
the next oldest group (age 30-44) and then declines, sometimes substantially for the



                                                                                         15
over 60 age group. Common mental health problems peak for men aged 45-49 years
of age and for women of 50-54 years of age5.

Age profile in Southall
The age profile of the population is shown in Table 11. Totally, 32.5% of the
population are between 25 and 44 years of age. However, the working age
population (16-64) comprise 67% of the population.

  Table 11: Age profile in Southall
   Age range                             Population                            % of total
                                                                               population
   0-4                                   4345                                  7
   5-15                                  11014                                 17
   16-24                                 9688                                  15
   25-44                                 20961                                 32.5
   45-64                                 12326                                 19
   65-74                                 3548                                  5.5
   75 and over                           2587                                  4
   Total                                 64470                                 100
   16-64                                 42976                                 67
          Source: 2001 Offic e of Statistics (2001)


Ethnicity
The main ethnic group in the borough are Indians (47%) followed by White British
(17%) with smaller representations of other ethnic groups. The total South Asian
population in the borough is 63.5%. More than 75% of the population are from BME
groups.

Table 12: Ethnicity profile
Ethnic group                             Numbers                               % of borough
                                                                               population
White British                            10974                                 17
White Irish                              1393                                  2
Other White                              1783                                  3
Mixed                                    1653                                  3
Indian                                   30283                                 47
Pakistani                                5559                                  9
Bangladeshi                              333                                   0.5
Other Asian                              4255                                  7
Caribbean                                2835                                  4
African                                  3181                                  5
Other Black                              323                                   0.5
Chinese                                  217                                   0.3
Other Ethnic Group                       1681                                  3
Might not add up to 100 due to rounding numbers. Source: 2001 Office of Statistics (2001)


There are a number of factors that contribute to the mental health considerations for
people originating from Southern Asia. It must be emphasised that this is not a
homogenous group. Research has shown that Asian mental health service users
experience problems, including inappropriate treatment and care and a lack of
services specifically aimed at Asians with mental health problems. As this is mainly a
quantitative survey, it was not possible to validate this statement. The percentage
prevalence rates for some types of mental health are shown in Table 13, below.




                                                                                              16
A report by the Confederation of Indian Organisations 6 found a high prevalence of
depression caused by a combination of factors. These factors related to marital and
family relationships and socio-economic conditions, such as housing, employment,
low economic status and racism. The report also highlighted a lack of awareness of
existing local support services.

Another report7, showed the highest levels of depressive episodes by Pakistani
women (6.3%) and Indian women (5.7%). Both of these groups are showing a much
higher rate than their male counterparts.

According to MIND8, there are high levels of unreported psychological distress
among Asian women. The report states that „the cultural and religious beliefs of
Asian women are seldom reported in the planning and delivery of psychiatric
services. It was stated that many Asian women are isolated in their homes without
available support.

Table 13: Prevalence of mental health among South Asians
Type of mental                 Bangladeshi                   Indian                         Pakistani
health problem
                  a
Psychotic illness              0.6                           1.1                            1.4
Any neurotic                   12.3                          18.1                           19.6
        b
disorder
Depressive episodes            1.9                           3.8                            4.5
Any anxiety disorder           2.8                           4.4                            4.9
Obsessive                      1.0                           1.2                            1.7
Compulsive Disorder
All phobias                    0.7                           0.8                            2.1
Generalis ed anxiety           0.6                           1.2                            1.4
disorder
Mixed anxiety                  9.0                           11.9                           12.3
depressive disorder
Source: www.mind.org.uk/factsheets/statistics

a-Neurotics such as depression and anxiety are not considered as serious or disabling for the individual
b -Psychotic – severe distortion of a person‟s perception of reality e.g. schiz ophrenia or manic depression


There are over a hundred languages spoken in the borough.


Religion
Religion plays an important role in the way that people respond to mental health
problems and an understanding of a religious perspective is important when
addressing these issues. Religion is an important part of the lives of people from
South Asia, an understanding of which is important for staff working in the Mental
Health Resource Centre. Table 14 shows the groupings among various religions
within the neighbourhood.

As compared to the rest of the borough, there are a majority of people of Sikhs and
Muslims.
Table 14: Religious profile
Religion                               % in the neighbourhood                 % in the borough
Christian                              25                                     50.7
Sikh                                   32                                     8.5
Hindu                                  15                                     15
Muslim                                 17                                     10.3
Other/none/not stated                  11                                     23.5
Source: 2001 Offic e of Statistics (2001)



                                                                                                               17
Indices of deprivation
Deprived areas have the highest levels of mental health problems 5. Deprivation
influences the incidence and prevalence of mental health. The Multiple Index
Deprivation score (known as IMD) for the five wards comprising Southall
neighbourhood is shown in Table 15. The IMD score deprivation is a measure of
deprivation per ward based upon six areas: income, employment, health and
disability, education, housing and access to services.

Four of the wards are ranking in the top 5 of deprived wards in Ealing and all of them
are among the first 10 deprived wards in the borough.

Table 15: Indices of multiple deprivation
Ward                                        National IMD Rank (out of   Ealing Rank
                                            8414 )
Dormers Well                                634                         1
Nort hcote                                  1073                        2
Glebe                                       1165                        3
Mount Pleas ant                             1316                        5
Waxlow                                      2127                        9
Source: 2001 Offic e of Statistics (2001)


Housing
Decent and stable housing is critical to providing a sense of security. It is important
that people with mental health disabilities can take look for work and take part in the
community. Poor housing can have a significant impact on someone‟s mental health.
Compared with the general population, people with mental health problems are twice
as likely to say that they are dissatisfied with their accommodation or that the state of
the repair is poor and four times more likely to say that their health has been made
worse by housing5.

State of housing in neighbourhood
All five wards in the Southall neighbourhoods are among the most deprived housing
areas in Ealing (Indices of Deprivation Housing Domain Score). The analysis for
Ealing is shown in Table 16.

Table 16: Housing conditions in Southall
Ward                                        National IMD Rank (out of   Ealing Rank
                                            8414 )
Dormers Well                                59                          4
Nort hcote                                  2                           1
Glebe                                       6                           2
Mount Pleas ant                             144                         5
Waxlow                                      21                          3
Source: 2001 Offic e of Statistics (2001)


A recent housing needs survey undertaken in 2005 identified that 17.7% of all
households in the borough are living in unsuitable housing. With an estimated mental
health prevalence of 1.8% per household in the borough3, this represents 353
households in Ealing.

Household tenure
The housing tenure, as a comparison with the rest of the borough is shown in Table
17. There are slightly less people in Southall who are owner occupiers as compared
to the rest of the borough but there are more people in social housing (local


                                                                                      18
authority/housing association). Also, slightly less people rent privately as compared
to the rest of the borough.

There is very little research on existing or potential owner occupiers with mental
health problems.

Table 17: Housing tenure in the neighbourhood
Type s                                 Neighbourhood         Borough percentage
                                       percentage
Owner Occupier                         67                    69.7
Council/Housing                        20                    13.2
Association
Privat e rented                        10                    13.7
Other Rented                           3                     3.4
Source: 2001 Offic e of Statistics (2001)



Asylum Seekers and Refugees
There is evidence to show that depression, suicidal tendencies and post traumatic
stress disorders are more common among refugees 9. Two-thirds of the refugees
have experienced anxiety or depression.

There are no official statistics on the number of asylum seekers and refugees in the
Southall. For Ealing, the proportion of service users that are refugees is about 5% of
the population. In the Southall area, this represents 3224 persons.

According to the Supporting People needs analysis 9, Ealing has a high rate of mental
health problems as a result of the high levels of refugees and resident asylum
seekers who may have experienced traumatic incidents that may influence their
mental health.

Social economic factors
Socio-economic deprivation indicators are highly correlated to mental health. These
indicators are representative of risk factors that influence mental health. There are a
larger numbers of single adults, poor health and frequency of limiting long term
illness in the Southall area than in the general Ealing population (Table 18). This
implies that there will be an increased demand on services in the area.

However, the rate of unemployment, which is a risk factor for mental health
disabilities, is slightly lower in Southall as compared to the overall frequency in the
borough.

Table 18: Social economic profile
Socio economic indicator                Borough percentage   Southall percentage
Adult population single,                11.7                 19.6
widowed or divorced
Lone parent                             15.0                 13
Population resident in                  31.7                 29.3
household without a car or
van
Poor health                             8.3                  9.9
Limiting long term illness              15.1                 17.1
Unemployment                            3.9                  3.3
No qualifications                       21.7                 21.7
Source: 2001 Offic e of Statistics (2001)




                                                                                          19
Employment
There is a higher rate of unemployment in Southall as compared to the overall in the
population of the borough. Unemployment is one of the key risk factors contributing
to mental health problems (see Table 19).

Table 19: Employment profile
Employment status                      Borough percentage                  Southall percentage
Employed                               61.5                                61
Unemployed                             3.9                                 4.7
Economically active                    68.4                                61
Source: 2001 Offic e of Statistics (2001)


Incapacity benefit
Around 315,000 people in London and 12,000 in Ealing are claiming incapacity
benefits. An additional 1210 people are claiming Severe Disablement Allowance
(SDA), accounting for 6.38% of Ealing‟s working population. There has been a
particular rise in the number of people with mental health problems receiving
benefits, with an estimated 40% of total claimants citing illnesses such as
depression.

The Southall neighbourhood accounts for 30% of all the incapacity benefits and
severe disablement allowances claimants in the borough (see Table 20).

Table 20: Incapacity benefits
                            By Benefit Type                        IB and SDA Claim Rates

    Ward name                                       Claim       Claim       Claim      Difference Difference
                             IB       SDA
                                                    Rate        Rate        Rate       from 2001 from 2002
                         Claimants Claimants
                                                    2001        2002        2003         to 2002   to 2003

Norwood Green                    925          125    13.13%      13.68%      12.77%          0.55%      -0.91%
Lady Margaret                    575           55     7.76%       7.41%       7.35%         -0.35%      -0.06%
Southall Green                   775           70     9.64%       9.46%       9.64%         -0.18%       0.18%
Southall Broadway                735           65     9.42%       9.31%       9.08%         -0.11%      -0.23%
Dormers Wells                    690           70     9.13%       9.01%       8.66%         -0.12%      -0.35%
Ealing                        12,210        1,300     6.52%       6.53%       6.54%          0.01%       0.01%
Source: Department for Work and Pensions, (Information and Analysis Directorate), Information Centre.
Data are subject to Crown Copyright. (IB: Incapacity benefits, SDA: Severe Disablement Allow ance).



Health
It is important to pay particular attention to the physical needs of people with severe
mental illness. The NSF for mental health said that every person with a severe
mental health disability should have his or her physical health problems treated as
effectively as possible.

For administrative purposes, the PCT has divided Southall into two geographical
areas: Southall North and Southall South. However, these boundaries are more or
less coterminous with the London Borough of Ealing neighbourhood areas.

There are a total of 19 GP surgeries and 37 GPs in Southall. Three of the wards from
Southall are ranking in the top 5 most deprived wards for the health domain in Ealing,
with Dormers Well being the most deprived as shown in Table 21.



                                                                                                           20
Table 21: Health domain deprivation rank
Ward                                  National IMD Rank (out          Ealing Rank
                                      of 8414 )
Dormers Well                          635                             1
Northcote                             1796                            5
Glebe                                 1604                            4
Mount Pleasant                        1573                            2
Waxlow                                2907                            9
Source: Public Health Report 2002-3


Gaps in data collection
There are some important data that has not been obtained that could add value to
the profile of the community. This data is listed in Table 22.

Table 22: Gaps in data collection

Data missing                          Importance
Homelessness                              Being able to identify a „hidden population‟ and
                                             ensure that they are included in service delivery
                                          Homelessness is a risk factor for ment al healt h
                                          Be able to identify those who need support ed
                                             housing
                                          Identify rough sleepers who may have mental
                                             health problems
Income                                    This is one of the risk factors associated with
                                             mental health


Summary
In total, 71% of the population in the neighbourhood are under the age of 44. There
are high concentrations of young people living in Southall that should guide future
service provision since mental health problems tend to start at younger ages.

Any strategy to tackle mental health issues should focus on the Asian population.
The Mental Health Resource Centres should work in close partnership with the
mental health team responsible for children and adolescents is necessary for early
detection and response to the issues

The Southall neighbourhood area, with a high Asian population is the most deprived
area of Ealing. It ranks very high in terms of most of the risk factors that contribute to
mental health services. It has a range of social-economic factors that can be
associated with an increased risk of mental health problems. It is therefore assumed
that there would be a heavy demand on mental health provision.

A gender profile of people known to the services as well as a holistic approach to
service provision (as stated on page 6 - a model for change) should be considered
when planning the services.




                                                                                                 21
Prevalence of mental health in Southall
It is important to note that different sources of information would give different
pictures of needs. This fact reflects the different ways in which needs can be
expressed

This section of the report is useful for estimating the amount of people not known to
the services, i.e. people who do not meet the eligibility criteria for mental health and
social service provision

This section of the report has been divided into two main areas for consideration:
    1) Estimating the prevalence from published literature from community
        characteristics and treatment services
    2) Analysing the prevalence of people who have accessed the services at the
        borough and neighbourhood level.

Estimating prevalence from published literature
There are limitations when estimating prevalence from published reports. Firstly,
prevalence studies are biased towards medical rather than social needs. Secondly,
estimating prevalence assumes uniform prevalence across the country. Therefore
caution must be applied when using estimated figures at the ward or neighbourhood
level. Communities and neighbourhoods may have demographics and other
community characteristics that are different from the country‟s characteristics.
 However, prevalence studies is a useful analysis that should be treated as a
signpost of „what could be expected‟ when planning for the services.


1. Prevalence by key characteristics
Most of the information about estimating prevalence is obtained from „The Office for
National Statistics (ONS) „Psychiatric morbidity among adults living in private
households in Great Britain‟1 0. The report gives the prevalence rates of different
types of diagnosis based on different characteristics.

Prevalence by gender (people between 16 and 64 years of age).
The report estimates that the most common type of diagnosis is mixed anxiety and
depression (9.2%), with more females experiencing this than men. The least
common disorder in the survey is panic, affecting only 0.7% of the population (Table
23).

Table 23: Prevalence by gender
Diagnosi s and rate             Female              Male           All          Estimated in   Estimated in
(past week)                                                                     Southall       Southall
                                                                                (female)       (male)
Mixed anxiety and               11.2                7.2            9.2          7221           4642
depression
Generalis ed anxiety            4.8                 4.6            4.7          3095           2966
disorder
Depressive episode              3.0                 2.6            2.8          1934           1676
Phobias                         2.4                 1.5            1.9          1547           967
Obsessive compulsive            1.5                 1.0            1.2          967            644
behaviour
Panic disorder                  0.7                 0.8            0.7          451            516
Any neurotic disorder           20.2                14.4           17.3         13023          9284
ONS, 2000, Psychiatric morbidity among adults living in private households in Great Britain
All figures are shown in percentages



                                                                                                      22
Prevalence by housing type
A recent housing needs survey undertaken in 20053 identified that 1.8% of all
households in the borough included someone with a mental health problem.
According to the survey, there are a total of 19,623 households in the Southall area,
indicating that 353 households have one person or more with mental health
problems.

The ONS report provides prevalence rates for housing type. The prevalence rates for
people with mortgage but who are owner occupiers are much higher (47%) than
people who own their properties outright (Table 25)

Table 25: Prevalence by housing type.
Housing type                 Estimation             Estimation          Estimated in          Estimated in
                             with disorder          with no             Southall              Southall (no
                                                    disorder            (disorder)            disorder)
Owned outright               15                     25                  Not available         Not available
                                                                        from census           from census
                                                                        groupings             groupings
Owned with                   47                     49                  Not available         Not available
mortgage                                                                from census           from census
                                                                        groupings             groupings
Rented from local            26                     15                  1028                  593
authority or
housing
association
Rented from other            12                     10                  63                    53
source
ONS, 2000, Psychiatric morbidity among adults living in private households in Great Britain
All figures are shown in percentages

Prevalence by ethnicity
There is a high proportion of black minority groups in the area, In particular those
originating from Southern Asia. Table 26 shows the estimated numbers that we
would present to various services (including GPs).

Table 26: Prevalence by ethnicity
Type of mental               Banglad        Indian            Pakistani              White             Caribbean
health problem               eshi
Psychotic illness            20             333               78                     88                45
Any neurotic                 41             5935              1090                   1739              490
disorder
Depressive                   6              1151              250                    318               68
episodes
Any anxiety                  9              1332              272                    395               122
disorder
Obsessive                    3              363               95                     99                28
Compulsive
Disorder
All phobias                  2              242               117                    198               43
Generalised                  2              363               78                     154               37
anxiety disorder
Mixed anxiety                30             3603              684                    1196              340
depressive
disorder


                                                                                                              23
All figures are percentages
Source: online at www.mind.org.uk

The ONS study is showing the prevalence of mental health conditions among adults
with psychiatric disorders. In the absence of data on the numbers of people with
psychiatric conditions in the borough, it is difficult to estimate prevalence with respect
to the different characteristics.

2. Estimation by clinical diagnosis

The groupings of estimated mental health prevalence by clinical diagnosis in Southall
are shown in Table 27:
All figures are percentages (below table

Table 27: Estimation of clinical diagnosis
Clinical diagnosi s                   National Prevalence (%)       Southall
                                                                    Prevalence
                                                                    (predicted)
Total number of people suffering      26% to 32%                    1676 to 20630
from some form of mental health
problem
Number who receive treatment only     10.1% to 17.5%                6512 to 11282
in primary care
Number who will get an outpatient     1.14% to 2.4%                 7350 to 1547
appointment
Number who will be treated as         0.12% to 0.6%                 77 to 387
inpatients
Specific information
Number of people with schizophrenia   1%                            645
Number of people attending primary    11.6%                         7479
care with depression in one year
Number of people attending primary    9%                            5802
care with anxiety disorders in one
year
Number of people attending primary    3%                            1934
care with severe depression




                                                                                       24
Prevalence among people accessing the services
This section of the report highlights and analyse mental health prevalence among
people who have been accessing the services. In some cases, information is only
available at borough level and in some cases at neighbourhood level.

1. Borough-wide information
The following data sets are available at the borough level.

Hospital admissions
There were 417 hospital emergency admissions between April 2003 and March
2004, with a rate of 257 per 100,000 people. To compare, the outer London rate is
213 per 100,000 people. The mental health emergency admission rate is significantly
higher than it is the case in outer London (taking confidence intervals into account).
It is estimated that 166 people from Southall would be admitted for emergency
admission hospital for mental health problems in one financial year.

Hospital admission rates are, however, available at the ward level. There were a total
of 580 people (in Ealing) with mental health problems admitted to hospital between
April 2003 and March 2004. Totally, 169 people were admitted from the Southall
neighbourhood area. This represents 29% of all borough admissions.

Estimates from GP analysis
About 90% of people with mental health problems are cared for entirely within
primary care settings, primarily G.Ps. Some reports suggest that about 30% of all
consultations with GPs concern mental health problems.

Quality and Outcomes Framework (QOF) is a component of the new General
Medical Services contract for general practices (introduced in April 2004).
Participation by practices in the QOF is voluntary but in Ealing, all GPs have chosen
to participate in the scheme. The data set up to obtain information from QOF known
as QMAS (Quality Management and Analysis System) records disease specific
information for each disease within the clinical domain of the QOF.

The prevalence rate for mental health is shown in Table 28. The prevalence rate for
mental health among people registered with GPs in Ealing is higher than the national
average.

Table 28: Percentage prevalence of mental health from GP analysis
                   Ealing prevalence               Number at the end   National
                                                   of Jan O6           prevalence
Mental             0.90%                           3216                0.60%
Health
ONS, 2000, Ealing, Public Health data March 2006


The estimate is based on the number of people registered with their GPs. Assuming,
all Southall residents are registered with their GP (based on a borough population of
300,948 and GP registration of 314,451), and there would be an estimated 580
people in Southall who have visited their GP in the past year, due to mental health
problems. However, this could be an underestimation as there are higher risk factors
that could contribute to mental health in Southall.



                                                                                    25
NHS Direct
NHS Direct West London (comprising 5 PCTs) took 2514 calls for mental health
problems (including suicide) between April 03 and March 04.

In total, 374 (14.9%) of the calls were from Ealing residents. This is the second
highest rate among the 5 PCTs, with only the Hillingdon PCT being higher (20.3%).

In summary, 52.6% of the calls were for depression, 13% for anxiety, confusion
(21.1%) and suicide (7.9%). The majority of the calls were from people aged 30 to 59
(43.5%).

Cause of death
Mental and behavioural disorders were responsible for 4% of all deaths in the
borough in 2001. This equals 88 people dying as a result of a mental disorder.

2. Southall Neighbourhood information
The only information available at a neighbourhood level is the number of people
assessed by the Southall MHRC (Mental Health Resource Centre).

The Southall MHRC is one of the 4 sectors responsible for providing
assessment/treatment of mental illness and offer ongoing psychiatric care to people
with severe and enduring mental illness.

Up to the third quarter of the 2005/6 financial year (December 2004) 1147
assessments were completed by the team and 197 were discharged.

More detailed information is needed to analyse these figures further.

Other relevant data information
This information is important to commissioners as the data highlights the two areas
that have a significant impact on mental health services

Suicide
It has been generally reported that one in four people who commit suicide have been
in contact with mental health service specialist8. People with a diagnosis of
schizophrenia and manic depression tend to be at higher risks of suicide.

However, a recent report on suicide in London states that suicide rates have been
steadily decreasing11. The predicted rate for suicide in Ealing is 7.8 per 100, 000
people. For the Southall neighbourhood, the most recent results obtained are for the
1997 to 2003 period. During that time, there were 50 suicides. This represents a
quarter of all suicides in the borough during that period (198).

About a third of all people who commit suicide, have been in contact with social
services. However, this might be an underestimation as it was not possible in 38% of
the cases to conclusively know whether they had contacted the services. On a
borough basis, only 22% of people were not known to be in contact with services.




                                                                                      26
Table 29: Contact with psychiatric services at time of death
Contact at time of death             Southall                             Ealing
Yes                                  12                                   57
No, but past contact                 3                                    36
Never                                16                                   51
Not known                            19                                   44
Total                                50                                   198
Source: London borough of Ealing: Southall w ards – suicides and other unexpected deaths

Although the numbers are statistically, small, yet they give an indication of the type of
services that people are contacting. Most people were in contact with outpatient
services (58%). This is slightly higher than the borough contact at 47%.

Table 30: Type of contact with psychiatric service
Type of contact with                    Southall                             Ealing
psychiatric service at time of
death
In-patient                              2                                    13
Out-patient                             7                                    37
CMHT                                    2                                    14
Other                                   1                                    2
Not known                               0                                    1
Source: London borough of Ealing: Southall w ards – suicides and other unexpected deaths


Summary of Data sources and information
Table 31: Summary of data sources and information

Estimating                  Borough-wide               Information           Significant gaps in data
prevalence from             information only           (data)
published                                              available at
literature                                             neighbourhoo
                                                       d level
Hous ehold                  Hospital admission         Suicide               Profile of people known to
Psychiatric morbidity                                                        Southall Mental Health
studies                                                                      Resource Centre
Commissioning               GMAS (GP)                  Number of             GP consultations,
strategy (source            database                   people known          prescriptions and referrals
missing)                                               to Southall
                                                       MHRC
                            Road accidents                                   Disability register
                            Caus e of death                                  Other MHRC for comparative
                                                                             analysis
                                                                             Numbers detained under
                                                                             Mental Health Act
                            NHS Direct                                       Profile of people in children
                                                                             and adolescent services
                            Supporting People                                Secondary care data: Ment al
                                                                             Healt h Minimum Data Set
                                                                             (MHMDS)
                                                                             Numbers attending criminal
                                                                             justice community-based
                                                                             services
                                                                             Numbers at local college
                                                                             Information from probation
                                                                             and courts
                                                                             Substance misuse data



                                                                                                           27
Conclusion
This chapter is quite thorough in estimating prevalence. This should give
commissioners an idea of what should be expected in terms of service provision.
However, the lack of detailed information about true prevalence makes it difficult to
test the true measure of activity.

There are higher rates of suicide in Southall as compared to the neighbourhood
average. Among the 5 PCTs in the NHS Direct West zone, Ealing had the second
highest number of callers for mental health using NHS Direct.

Mental health prevalence within Ealing PCT is higher (0.9%) than the national
prevalence (0.6%). Hospital admission for Southall accounts for almost a third of all
hospital admissions in the borough for mental health.

The major gap in data collection is from GPs. Most people with common mental
health problems would visit their G.P and many would not go on for specialist
services.

The results weigh too heavily on estimated prevalence and there is very little
information about the „actual‟ prevalence of mental health at the local level. Thus, it is
difficult to compare „estimated‟ and „actual‟ prevalence and to conduct the analysis
accordingly.

There is a lack of comparative „actual‟ prevalence with other Resource Teams.

It is difficult to establish whether social-economic and other characteristics
influencing mental health have affected the provision in the Southall area.




                                                                                        28
Service mapping




Information culled from Information Pack for Mental Health (Carers Handbook) published by Ealing Primary Care
Trust, West London Mental Health Trust, London Borough of Ealing and Rethink. March 2005




                                                                                                         29
Service                                            Page
Help in a crisis                                   31

Health

        Community Mental Health Resource Centre   32
        Inpatient services                        33


Day service and other activities                   34


Talking therapies
    Art therapy                                   37
    Music therapy                                 37
    Counselling                                   38
    Behaviour and cognitive therapy               42
    Psychotherapy                                 42
    Clinical psychology                           43


Housing                                            44


Advocacy and support                               47


Women                                              51


Black and ethnic minority services                 52


Children services                                  53




                                                          30
Help in a crisis
For anyone concerned about the mental health of the person they care for, his or her
GP should be the first person to contact. This is particularly important for people who
are not known to specialist mental health services. GPs will know what to do next
and how to refer the person for further help.

If the GP feels the person needs an urgent assessment or treatment then that will be
arranged and the person will be seen by a member of the Community Mental Health
Team, at a Resource Centre or at the person‟s home. However, if the person who
requires a mental health assessment does not appear willing to accept mental health
services, and their behaviour is causing concern for their safety or the safety of
others, then the GP, or the nearest relative (see glossary below), should contact the
CMHT Duty Officer requesting an assessment. The person making contact will be
asked to provide as much information as possible over the phone so that the Team is
fully prepared for the assessment. If after the assessment the decision is to admit the
person to hospital but they are not prepared to go voluntarily, then an Approved
Social Worker (ASW) will apply for admission to the hospital under a section of the
Mental Health Act (the Mental health Act is explained more specifically in a further
chapter)

The patient can then appeal against the detention to the Hospital Manager or the
Mental Health Review Tribunal.

Duty Teams can be contacted on:

0208 9937781 (for residents of Acton W3 area)

0208 5662777 (for residents of Ealing W7/W13 areas)

0208 8415271 (for residents of Northolt, Greenford, and Perivale)

0208 5716110 (for residents of Southall and Norwood)

0208 8406900 (for residents of Ealing W5 areas)




                                                                                     31
                                     Health

Community Mental Health Resource Team
West London Mental Health Trust and the London Borough of Ealing provide 5
Community Mental Health Resource Centres. These are multi-disciplinary teams
providing treatment and care for people over 16 years of age with severe mental
illness living in the community. Specialist services, including behavioural cognitive
therapy and psychological treatments for people with an eating disorder are offered.
People need to be referred either by their GP or through the hospital after discharge.

           Avenue House.             This is for residents of Acton W3, W4 &
                                     NW10
                                     43/47 Avenue Road
                                     Acton W3 8NJ
           Telephone:                020 8993 7781
           Fax Number:               020 8896 2914
                                     020 8938 8442

           Cherrington House.         This is for residents of Hanwell/
                                     Ealing
                                     Cherrington Road
                                     Hanwell W7 3HL
           Telephone:                020 8566 2777
           Fax Number:               020 8840 8526

           Manor Gate.               This is for residents of Northolt,
                                     Greenford, Northolt and Perivale.
                                     1a Manor Gate
                                     Northolt
                                     Middlesex UB5 5TG
           Telephone:                020 8841 5271
           Fax Number:               020 8845 5086



           Southall and Norwood      This is for residents of Southall and
                                     Norwood Green.
                                     The Green
                                     Southall
                                     Middlesex UB2 4BH
           Telephone:                020 8571 6110
           Fax Number:               020 8574 6099




                                                                                   32
Inpatient Services

Beverley                          Dr Christine Dean (Locum)
                                  Dr A. Farah (Locum)
Ward Manager:                     Darmen Ramana
Acute inpatient                   Acton
                                  0208 3548149

Conway                            Dr Cramer
Ward Manager                      Raj Sookhy
Acute Inpatient                   West Ealing, Hanwell, W5
                                  0208 3548126

Campion Ward                      Dr Kate Hoxey
Ward Manager:                     Yin Yap
Acute inpatient                   Southall
                                  0208 3548011

William Sargant                   Dr Manisha Desai
                                  Dr Elin Davies (Locum)
Ward Manager:                     Terry Ishmael
Acute inpatient                   Northolt/Perivale/Greenford
                                  0208 3548017

Mary Seacole                      Dr Sue Thompson (Locum)
Ward Manager:                     Leonora Awai
Female only Ward

Blair Ward                        Dr Sue Thompson (Locum)
Ward Manager:                     Rajoo Soocheeta
Psychiatric Intensive Care Unit

Drake Ward                        Dr Rizar Akyildiz
Ward Manager:                     Jon Nursimooloo
Rehabilitation Unit
Rehab Services Manager            Helen Ernest-Adamson




                                                                33
                  Day Services and other activities
Links Project

The Links Project is a new Day Service that runs from two geographical bases: one
in the East of the Borough (Acton), and the other in the West of the Borough
(Greenford). The Links Project will endeavour to work with communities to promote
mental well being and support people with mental health problems.

The service aims to:
           Prevent or minimise frequent re-admission to hospital
           Promote the development of interpersonal relationships
           Allow people opportunities to explore their potential and follow their
              aspirations within the wider community
           Assist with seeking meaningful activities, courses and training
           Enable people to enhance their social and communication skills
           Promote independence and peer support

People eligible to access this service:

               Adults between the ages 16-65
               People who are experiencing severe and enduring mental illness
               People who need to develop and learn new skills
               People who want to engage in meaningful activities

The Links Project staff and service users will work collaboratively to plan, implement
and evaluate each care plan.

Contact :

            The Acton Base                           The Greenford Base
            Links Project                            Links Project
            8-10 Carlton Road                        133 Windmill lane
            Acton W4 5DY                             Greenford UB6 9DZ
            (Buses E3, 207, 607,266                  ((Buses E2, E3, E5.)
            440, 70; Underground: Acton
            Town, Turnham Green;
            British Rail: South Acton,
            Acton Central)

                                  Tel: 0208 742 3134




                                                                                     34
Community Activities Project Ealing (CAPE)

This is an activity-based project for people experiencing severe and enduring mental
illness who additionally choose not to make use of mainstream day services and are
considered “hard to engage”. The project‟s aim is to improve the quality of life of
service users.

CAPE has two main areas of development: the Link-work and the Café. Link Work is
an outreach way of working. It means the service initiates contact with the client and
assists the person to deal with practical, emotional and recreational needs such as
housing, money, employment, and access to health, sport and leisure.

Cape Café offers clients who no longer need full services and those who are not
“hard to engage” an opportunity to have a social venue to expand their social
networks and take part in group activities.

People who wish to use this service need to be referred by a mental health
professional, e.g. Social Worker, CPN, Psychiatrist, O.T., G.P, or support worker.

This service can be contacted via:

Suki Jones
239 A/B Acton High Street
London W3 9BY
Tel: 020 8896 2552


Footsteps Art Group

This is a user led art group aiming to increase the well being of its members through
creativity and Visual Arts.

The studio is open on Fridays between 10am and 3pm. There are a variety of art
activities including visits to art galleries and museums.

This service can be contacted via:

Joe Kelly
Footstep Art Group Co-ordinator
17 Beechwood Ave
Greenford
UB6 9UA
E-Mail: Footsteps@freeuk.com




                                                                                     35
Solace Centre
This is a social club run by Ealing Social Services for people with a mental illness.
Current programme includes video nights on Tuesday evening and a guitar group on
Friday evening.

The Solace Centre opens Monday to Friday between 4pm and 8pm; and on Saturday
– Sunday between 2pm and 8pm.

People do not need to be referred but they need to be accompanied by someone
who is already a club member. The person then needs to attend at least three times
before applying for membership.

This service can be contacted via:

Mirna Scholey (Manager) or Sally Ryan (Support Worker)
SOLACE Centre
58 Bowmans Close
West Ealing W13 5YT
Tel: 020 8567 3805
Email: Solace-centre@btconnect.com




M IND Action Centre (MAC)

This is a project offering two areas of services for people with a mental illness:

Employment support for people wanting to find, develop or maintain
opportunities in all forms of employment and training.

Recreational activities and the Café for people who want a venue to
socialise and learn new skills

Further information can be obtained by contacting:
Centre Co-ordinator
79 Gordon Road
Ealing W5 2AL
Tel: 020 8998 5148
E-Mail: info@mindactioncentre.co.uk




                                                                                   36
                       Talking therapy services

Art Therapy Department

This is a service provided by the West London Mental Health Trust as part of its
Psychological Therapies Treatment programme.

People are referred to this service to participate in Art (e.g. painting, drawing)
Therapy. Each person is assessed on an individual basis and therapy is offered as
part of a comprehensive care plan in consultation with multidisciplinary teams, the
patient/client and their GPs.

People who are referred to this service are adults who have been admitted to wards
or are attending a Mental Health Resource Centre within Ealing. Self- referrals are
not considered. There is usually a waiting time of approximately 2 weeks.

This service can be contacted via:

Art Therapy Department
Pegasus Centre, John Conolly Wing
Ealing Hospital
Uxbridge Road
Middlesex UB1 3EU
Tel: 020 8354 8528


Music Therapy Department

This is a service offered from within the West London Mental Health Trust. The
therapy work uses contact through music as the basis for thinking about the
relationship between therapist and client. As such, it is a medium that may be
especially useful for those who find words or language difficult.

The service is offered to adults with a mental illness, over the age of 16. Group or
individual sessions are available. Sessions are offered weekly, are usually 50
minutes duration, and take place either in the department (as detailed below) or in
the WLMHT Community Mental Health Resource Centres. The service is available
free of charge to NHS patients referred by their care co-ordinator or other health
professional. Self-referral is also possible

This service can be contacted via:
Sara Raiher
Music Therapy Department
Pegasus Centre
John Conolly Wing
West London Mental Health Trust
Uxbridge Road
Southall, Middlesex
UB1 3EU
Tel: 020 8354 8356




                                                                                       37
                                  Counselling

Asian Women Counselling Service

This is a project of the Asian Health Agency. It is targeted to Asian women residing in
the boroughs of Hounslow, Ealing, and Slough, who are facing problems within the
family, work, relationships, or experiencing isolation, depression, fear, abuse,
domestic violence or discrimination.

This service offers a free, one-to-one Counselling in Asian languages, allowing
women space to talk about problems and identify ways forward. Usually a set of
twelve 50 minutes sessions is offered. It provides trained women counsellors who
offer cultural sensitivity and support. They follow British Association for Counselling‟s
code of ethics throughout their practice.

There is a team of 8 Counsellors/Psychotherapists who are qualified to a minimum of
Diploma level.

Referrals are accepted from the statutory sector, voluntary organisations and self-
referrals.

Languages spoken besides English: Hindi, Urdu, Punjabi, Gujarati and Bengali.

This service can be contacted via:

Lopita Sen
The Asian Women’s Counselling Service
Neal’s Corner
Suite 10
2 bath Road
Hounslow TW3 3HJ
Tel: 0208 570 6568

Bereft

This is a Voluntary organisation and Registered Charity set up in June 1999 to fill the
need for professional bereavement support for the residents of the London Borough
of Ealing. Currently the Chair is Rev. Jacqueline Fox of St. Mary‟s Parish Church,
Acton. This service abide by the British Association for Counselling &
Psychotherapy‟s Code of Ethics

Should you wish to access our service simply call their number;

                                     020 8896 2800

A message can be left on their answer-phone. It is preferred that you to get in touch
personally. After this the Administrator will contact you so that you can discuss what
you feel you need and what the service can offer. An informal face to face
“assessment interview” may be arranged to ensure better understanding. Once it is
agreed that BEREFT would offer Counselling they will arrange a “match” with a
suitable Counsellor. This may take a little time.




                                                                                      38
This service can be contacted via:

Bereft
Bereavement Support for Acton and Ealing
Hawco House
35 Horn lane
Acton W3 6NS
Tel: 020 8896 2800


Ealing Abbey Counselling

This is a voluntary Counselling service part of the Ealing Abbey Trust, which is a
registered charity.

Individual one to one counselling is offered to anyone regardless of age belief, or
culture. However, the service is not suitable for people with a history of psychosis, a
recent history of violence or for someone abusing illegal drugs and not in
rehabilitation.

Sessions last for 50 minutes once per week. Group therapy has different
arrangements. This is a self-referral service only.

A number of languages are spoken besides English. These include most European
languages and Arabic, Gujurati and Farsi.

This service can be contacted via:

Frank Burke
Ealing Abbey Counselling Service
1A Montpelier
W5 2XP
Tel: 0208 998 3361


Ealing Drugs Advisory Service

This is a voluntary Counselling service part of the national organisation “Turning
Point” for people who are abusing illegal drugs. They are also affiliated to SCODA
(Standing Conference on Drug Abuse). It offers advice, information and support.
Their approach is harm minimisation.

People need to refer themselves to the service. They accept people with a diagnosed
mental illness if they are, additionally, using drugs.

On Mondays, Wednesdays and Fridays from 2pm to 4pm the service operates a
“walk in” surgery whereby people can be seen without an appointment. The service is
opened otherwise from Monday to Friday from 10am to 5pm.




                                                                                     39
Once the person is accepted for Counselling depending on the person‟s needs they
are seen for six weeks and then reviewed if necessary. There are no costs involved
but individual contributions are gratefully accepted.

           This service can be contacted via:

Ealing Drugs Advisory Service
14 Alexandria Road
Ealing
W13 ONR
Tel: 020 8579 5585/6

Primary Care Counselling

Access to Primary Care Counselling is through the GP, who can refer the person with
mental health problems. Counsellors are based in GP surgeries and offer short term
Counselling for relationship difficulties, mild to moderate depression, anxiety, loss,
stress and psychosomatic problems.

This service can be contacted via:

Jane Rosoman
Primary Care Counselling Service
Avenue House
43-47 Avenue Road
Acton
W3 8N
Tel: 0208 938 8426

Eating Disorders Service

This is a community outpatient assessment and treatment for people with eating
disorders living in Ealing. It is specifically designed for people aged 20 and over with
Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder.

To access this service, the person needs a comprehensive referral letter from their
GP, Psychiatrist, or other mental health professional.

This service can be contacted via:

Sue Harris (Clinical Psychologist); Kate Ellison (Dietician) or Lorraine
Carpenter (Therapist)
Avenue House Mental Health Resource Centre
43-47 Avenue Road
Acton London W3 8NJ
Tel: 0208 938 8434
Fax: 0208 896 2914




                                                                                      40
Asian Family Counselling Service

This is a confidential marital counselling service for couples. Counselling is also
offered to families and individuals of the Asian Community. Counselling is available in
several Asian languages. There is also a mental health support group for women.

This service is by appointment only and is open Monday to Friday between 10am
and 4pm. The service is free of charge for weekday sessions but there is a charge
(on a sliding scale) for evening and weekend sessions.

Appointments can be made in writing or by phoning during office hours. An
answering machine is available at other times.

This service can be contacted via:

Asian Family Counselling Service
Suite 51
The Lodge
Windmill Place
2-4 Windmill Lane
Southall UB2 4NJ
Tel: 0208 571 3933


Ealing Relate Family Counselling

This is a service for people who want to make their family relationships better. They
offer help to:

              Parents and children who are struggling to communicate
              Parents who disagree on how to bring up their children
              Adult siblings who don‟t get along
              Children and teenagers
              Blended families coping with their “new” families
              People who are recovering from the influence of abuse and the effects
               this have on family relationships.

The service is free to young people under the age of 18 years (Adults attending are
asked to pay based on their income).

This service can be contacted via:

Claire Milne
Family Counselling Co-ordinator
Relate Central Middlesex
Tel: 0208 8634543




                                                                                    41
Ealing Cognitive Behavioural Therapy Service
Cognitive Behavioural Therapy (CBT) is recommended as the treatment of choice
within the NHS for the treatment of Anxiety Disorders (Panic, Phobia, Obsessive
Compulsive Disorder, Generalised Anxiety Disorder, Post Traumatic Stress Disorder,
Health anxiety). CBT is also effective for Habit disorder; Anger management; and
recurrent, non-suicidal depression.

CBT differs from Counselling and Psychotherapy in that it works in practical ways to
help clients change unhelpful patterns of thinking and behaviour.

The service has 5 full time CBT therapists working in each of the 5 Community
Mental Health Resource Centres throughout Ealing. Therapists in some areas also
carry out sessions in primary care settings.

Direct referrals are accepted from GPs and Practice Nurses using the CBT referral
form provided for each practice. Referrals are also accepted from all qualified CMHT,
and inpatient Mental Health staff


This service can be contacted between 9am to 5pm Mondays to Fridays via:

Mark Kenwright (Senior Therapist/Manager), or
Debbie Kelly (Service Administrator)
Avenue House
43-47 Avenue Road
Acton
W3 8NJ
Tel: 0208 938 8433




Psychotherapy Department

This is one of several psychological services that work together in the locality offering
individual and group Therapy on behalf of the West London Mental Health Trust for
adults who live in Ealing.

Each member of our small team has a link with each of the mental health resource
teams. A link person from each locality takes referrals.

Patients are more likely to benefit from a psychodynamic approach when they are
interested in making sense of their lives and their distress and other difficulties either
in conjunction with other patients in groups or individually.

Besides offering a treatment service for patients, the Psychotherapy Department is
able to offer mental health professionals assessments, or consultations for complex
cases where understanding of the feelings and interpersonal dynamics involved may
be of some assistance in managing difficult situations.




                                                                                        42
This service can be contacted via:

Mrs Mary Marshall (Administrator)
Psychotherapy Department
John Conolly Wing
WLMHT
Uxbridge Road
Hanwell, Middlesex
UB1 3EU
Tel: 0208 354 8935
Fax: 0208 354 8142




Clinical Psychology

Clinical Psychology offers a range of assessments and psychological therapies, for
people with enduring mental illness. The service is available to both in- and
outpatients.

The methods available include Cognitive Behavioural Therapy, Cognitive
Restructuring, Motivation Enhancement Therapy, and Cognitive Analytic Therapy.

Neuropsychological assessments are also available for patients presenting with
mental illness and suspected memory loss, brain injury, or loss of cognitive functions
as a result of a variety of physical disorders.

There are 6 psychologists in post. One is located at each Mental Health Resource
and there is one with an assistant attached to the Rehabilitation Service.

Further information from your local Mental Health Resource Centre.


TASHA

Tasha foundation aims to provide information, support, counselling, training, and
holistic health care services to individuals affected by mental health difficulties and
substance misuse.

For further information and referrals please contact:

Tasha Foundation
Windmill Place Business Centre
Windmill Lane
Hanwell UB2 4NJ
Tel: 020 85719981
Fax: 020 85719983
Out of Hours Helpline
020 85606601



                                                                                          43
                              Housing services

The Mental Health Housing Team (MHHT)

This team offers a comprehensive housing service for people with a mental illness.
They will provide the following:

      Advice and Advocacy for people who are vulnerable
      Support to clients bidding for properties
      Directly manage 3 supported housing projects

   Further information:

Rifit Hussein
Manager Mental Health Housing Team
1st Floor North
Ealing Town Hall Annexe
New Broadway W5
Tel: 020 8825 6584


Other LBE housing services
Two new housing advice surgeries in Southall have been established. One is a
general advice surgery at the Featherstone Road Clinic and the other is at the
Southall Community Alliance Centre, and is aimed at the Somali community - a
growing ethnic group in Ealing.


Community Road

50 Community Road is a mental health rehabilitation hostel. Its purpose is to:

      Assess the potential for referred mental health service users to   develop the
       skills required for living in their own home
      Help them to develop those skills.

Accommodation is provided for assessment and for rehabilitation. Referrals are
usually via a care co-ordinator from the locality team (CMHRT).

50 Community Road is for men and women aged 18 to 65. People who are actively
abusing alcohol and drugs will not be accepted as residents. Also people who
manifest continuing violent behaviour, or whose history suggests a risk to others will
be deemed unacceptable to be in this hostel.

For further information contact:
Mike Foley
Registered Manager
50 Community Road
Greenford, Middlesex
UB6 8XF


                                                                                     44
Tel: 0208 5752684


Amadeus House (Richmond Fellowship)

This is a registered care home offering residential care to 16 people with a mental
illness, including survivors of sexual abuse, self-harm, schizophrenia and enduring
depression. Residents are offered a therapeutic programme together with practical
help and keyworking.

People can refer themselves provided they have appropriate funding to cover the
costs. Costs include full board and an individual therapeutic programme.

There is currently a waiting time of between 1 to 6 months. This is due to the referral
and assessment procedure.

This service can be contacted via:

Jeri Appiah (Manager)
Amadeus House (Richmond Fellowship)
18 Corfton Road
EalingW5 2HT
Tel: 020 8997 8015/3117



Group Homes

A Group Home is a house or flat shared by three to six people. There are no staff
living at the homes and the residents are free to organise their time as they wish, just
as in any household. The Group Homes service caters for adults from 18 upwards
who are considered vulnerable through mental illness. Some places are available for
elderly individuals who have experienced mental illness and would benefit from
support from the Group Homes Team. The aim of the Group Home service is to
provide a permanent or temporary living situation, where people are not isolated and
can develop skills and be confident to move to more independent accommodation.
The supporting team also helps clients in terms of seeking jobs, self-care,
relationships and individuality.

Each person has their own bedroom and shares the use of the bathroom, kitchen
and lounge. Household tasks are shared between the residents. Decisions
concerning people who share the home are jointly made by residents with support
from the Group Home social workers.

Potential residents must possess basic skills in terms of managing finances, personal
hygiene, medication, and domestic tasks.

Each Group Home resident would have to make a contribution to the services (within
Housing Benefit range), which are payable on a weekly basis.

People who are actively abusing alcohol and drugs will not be accepted as residents.
Also people who manifest continuing violent behaviour, or whose history suggest a
risk to others will be deemed unacceptable to be in this sharing environment.



                                                                                      45
Referrals to the service must come through Care Professionals such as Doctors,
Care Co-ordinators; Community Psychiatric Nurses, or appropriate workers, statutory
or voluntary in the mental health field.

This service can be contacted via:

Lorna Sharma
Group Homes
Room 217 Acton Town Hall
Winchester Street
Acton W3 6NE

Tel 020 8825 8961
Fax 020 8896 1923




                                                                                46
                        Advocacy and support

Rethink (formerly known as the National Schizophrenia
Fellowship)
This national and regional organisation has a well-established Ealing Carers Support
Project since 1996. They provide carers practical support, advice and assistance to
reduce the “burden of care” and to relieve the isolation that often accompanies the
caring role.

      Individual support: To meets the emotional and practical needs of the carer.

      Information: On mental illness, treatments available and medication. Also
       there is a regular newsletter covering local and national initiatives, new
       research and treatments.

      Advice: On services available and how to access them.

      Carer’s Assessments

      Advocacy: When people want representation and support at care planning
       conference and meetings. They help to include carer‟s views in service
       planning and policy-making

      The Support groups: Monthly meetings to give carers the chance of sharing
       experience and talk to others in a similar position.

The Ealing Carers Support Group meets the first Wednesday of each month at
7.30pm at: MAC, 79 Gordon Road, Ealing W5

The Southall Carers Support Group meets the last Tuesday of each month between
6pm and 8pm at: Southall Mental Health Resource Centre, The Green, Southall UB2
4BH

The Women’s Support Group meets each Thursday between 1pm and 3pm at: The
Dominion Centre, The Green, Southall

This service can be contacted via:

Dalvinder Jammu
Ealing Carers Support Project
Unit 47a Mill House
Windmill Place Business centre
Windmill Lane
Southall UB2 4NJ
Tel/Fax:0208 8138430




                                                                                    47
Community Benefits Team

This is an Ealing Council service that provides Welfare Benefits Advice and
Advocacy to Ealing residents. Clients are either referred through directly to the Team
on the appropriate Referral Form, or they may contact us for an initial discussion on
our Advice Line (see below).

We can offer general advice on claiming benefits to anyone, including carers and
care workers, family members and others over the phone.

However, if what is needed is help with a review or an appeal against an existing
decision, we request clients being referred to us by another professional working in
the health or social care field. Agencies that currently refer regularly to us include
Mental Health Resource Centres, Adult Day Centres, and voluntary organisations
such as MIND, Age Concern and others. We also accept referrals from GPs, Social
Workers and Care managers.

It undertakes regular monthly advice „clinics‟ at all of the Borough‟s Mental Health
Resource Centres (addresses on page 32).

While it offers advice on entitlement to and the initial claiming of benefits, it also
offers direct casework assistance with appealing against decisions and with
representation of clients throughout the entire appeal process. Its core remit is to
undertake „direct‟ work on matters of a complex nature within the benefits system,
which is after an initial claim for benefits, has been lodged.

For advice over the phone the team can be contacted on: 0208 8258555

Contact the Team via e-mail: CBT@ealing.gov.uk



Carer Education Support Programme (CESP)

This is a ten week structured training programme for carers. It is run by RETHINK
and was originally developed in partnership with the Sainsbury Centre for Mental
Health. The aim of the programme is to work towards coping as a carer through
education and support.

This service can be contacted via:

Dalvinder Jammu
Ealing Carers Support Project
Unit 47a Mill House
Windmill place Business Centre
Windmill Lane
Southall
UB2 4NJ
Tel/Fax: 0208 813 8430




                                                                                         48
Alzheimer’s Concern Ealing

This is a local organisation supporting carers and people living alone with
Alzheimer‟s. They provide 3 weekend day centres at:

           Penny Sangam, Gunnersbury Day Hospital and David Cousins Unit.

This service runs from around 9.30 in the morning till 3.30 in the afternoon on
Saturdays and Sundays.

Alzheimer‟s concern in Ealing runs a Community Dementia Service, whereby one of
their carers visits someone living alone once a week for a chat and to monitor their
situation. They also provide a Call and Care service for couples to offer the main
carer a break.

Alzheimer‟s concern also has an Advocacy service for people with dementia who are
inpatient at Ealing Hospital or at the mental health unit, John Conolly Wing. This is a
confidential and independent service. Referrals can come from individual
themselves, families, carers, GPs, community advocates, ward staff, doctors,
consultants, other patients, hospital visitors or any other interested party.

This service can be contacted via:

Alzheimer’s Concern Ealing
223 Windmill Road
EalingW5 4DJ
Tel: 0208 5684 448
Fax: 0208 5681 294
Email: alzconcern@btconnect.com



Ealing User Involvement Project (UIP)

The Ealing User Involvement Project (UIP) aims to enable service users and the
service users‟ perspective to be part of the planning, monitoring and evaluation of the
mental Health services in Ealing.

They support service users participation in the consultation process with regard to all
decisions that affect them. They also facilitate the Patients Council and the
Community Action Group and encourage service users to attend these meetings to
discuss and take forward their views on the service they receive.

The Patients Council meets twice a month every second and fourth Tuesday at 1pm.
This is for service user only. However, professionals are allowed to attend by invite.

Further information on this service can be obtained via:

Nicky Rampling
Project Co-ordinator
Unit 24, Mill House
Windmill Place
2-4 Windmill Lane
Southall, Middlesex UB2 4NJ


                                                                                     49
Tel: 020 8574 3580
E-mail: office@ealing-uip.ukf.net
Web: www.ealing-uip.ukf.net



Support Workers Outreach Team

Support work services are for Ealing residents aged between 18-65 with a diagnosed
mental illness and a care plan that includes support in the community. The team
helps people to:

            Improve daily living skills
            Budgeting and paying bills
            Establishing shopping routines
            Benefits and housing issues
            Official correspondence
            Encouragement in maintaining self care
            Develop self confidence
            Introduce people to community resources
            Encourage social interaction
            Accompany people to psychiatric and other medical appointments if
           appropriate.

This service can be contacted via:


Lorna Sharma
Room 217 Acton Town Hall
Winchester Street
Acton W3 6NE
Tel: 020 8825 8961
Fax: 020 8896 1923




                                                                                 50
                                     Women

Ealing Women’s Mental Health Forum

This group is for women experiencing or who have experienced a mental illness. Its
aim is to promote well being through participation in shared activities, whilst being
mutually supportive to each other‟s situations and experiences

Activities range from Glass painting to Bowling, to Trips to the Theatre and Cinema.

This group meet each Tuesday and Friday from 1pm to 3pm.

For further information please contact:

Dympna or Mirna
133 Windmill Lane
Greenford
Tel: 020 8578 2904




                                                                                    51
Black and ethnic minority services

The Forward Project

This is a multidisciplinary mental health organisation that provides a package of
community services for Black and Ethnic minority people living in the community or
admitted to hospital within the West London area. Currently they provide the
following services:

       24 hour supported Registered Care home
            Low supported resettlement scheme
            Floating Support Scheme (supporting people in their own homes)
            Advocacy and generic support service in Ealing, and
            Individual/Group and Family psychotherapy and Counselling to black
           people who live in Hammersmith, Fulham and Ealing

The Forward Project also offers a Supervision Service to students and /or
professionals (individuals & groups) who want to increase their knowledge with
working with diversity and difference. They work with the intra-psychic and
interpersonal aspect of the client‟s world. Supervisee‟s have the opportunity to work
with a supervisor with psychodynamic, existential or person centred orientations.
Supervisors are UKCP registered and BAC accredited

This service can be contacted at:

The Forward Project
Advocacy and Generic Support
133 Windmill Lane
Greenford
Middlesex UB6 9DZ
Tel: 0208 5781567
Fax: 0208 5757095




                                                                                    52
Children and Adolescent Services

The Adolescent Community Team is a small team of mental health professionals.
They offer a service to young people living in Ealing between the ages of 16 to 20
who are experiencing difficulties in their lives. They see people on an outpatient basis
and it‟s a free NHS service.

They are interested in the culture, race, language and religion of young people and
their families/carers. They will arrange for an interpreter if necessary. They also
maintain close links with the GPs of the young people they see. They deal with:
              Low mood
              Difficulties in coping
              Worries, obsessions, anxieties
              Family conflicts
              Self-harm

Any professional including GPs, social workers, or any other health professional, can
refer to the service. They can be contacted at:

Adolescent Community Team
Windmill Lodge
Uxbridge Road
Southall, Middlesex UB1 3EU
Tel: 020 8354 8800


Children and Families Consultation Service (CFCS)

CFCS is a team of child mental health professionals who offer assessment and
treatment. They provide a comprehensive service to address complex concerns
about behavioural problems, emotional well-being and/or mental health issues of
children and young people between the ages of 0-16. They are aware of differences
in the culture, race, language and religion of families in the borough and aim to be
sensitive to those issues. The use of interpreters can be arranged if necessary.

Referrals are considered from GPs, Health Visitors, Social Workers, Education
Psychologists, SEN Plan Meetings and other health professionals. The CFCS referral
form needs to be completed with the consent of the person with legal responsibility
for the child. Where there are urgent concerns, a telephone referral can be made
during office hours.

Further information can be obtained from:

Children and Families Consultation Service
West London Mental Health Trust
Windmill Lodge
Uxbridge Rd
Southall Middlesex,
UB1 3EU
Tel: 020 8354 8473
Fax: 020 8354 8391



                                                                                      53
Part 6: Analysis of the report
The report has described the community profile of Southall and established that it
has a lot of high risk factors that contribute to people having mental health problems.
This in turn, gives an indication of the potential demand for services and who should
be using it. This information is useful in setting a „baseline‟ for demand on services.

There is some „indicative‟ evidence emphasizing a high prevalence of mental health
disabilities in the Southall area (mainly from the hospital admission rates and the
suicide rates).

The report has also been quite useful in discussing the estimated prevalence of
mental health disabilities from the literature. Finally, the report has identified service
provision in the borough (not only in the Southall area).

However, for the purpose of assisting commissioning intentions, there are limitations
and gaps, namely:
     The report has focused exclusively on quantitative information. Needs
       assessments should include both qualitative and quantitative information
     The report is „too weighted‟ on estimated prevalence of mental health and
       there is very little information on actual prevalence and activity. This makes it
       difficult to establish whether there are gaps in services and whether services
       are meeting the needs of the local population (especially their ethnic needs)
     There is very little information about prevalence at a neighbourhood level in
       terms of reported incidences at GPs and Southall MHRC.
     Too much „essential‟ information is missing
     It is difficult to establish whether large numbers of people are not accessing
       services (including primary care services) and if not, what services they are
       receiving
     It is also difficult to establish whether social-economic and other
       characteristics influencing mental health have affected the provision in the
       Southall area.
     The lack of comparative data from other MHRC makes it difficult to establish
       the expected „more heavier‟ demand on services from this area.
     It is difficult to establish whether there are any gaps in services.
     The report does not establish what the key issues are for service delivery in
       the Southall neighbourhood area.

Recommendations
The recommendations are discussed for two different groups. These
recommendations are discussing the extra work that is proposed to comprehensively
establish the true prevalence of mental health in Ealing.

1. People not known to specialist services

      To ensure that the recommended „essential data‟ (page 27-28) is obtained at
       the neighbourhood level ( in particular GP information) to obtain the true
       prevalence in the neighbourhood
      To establish from voluntary groups the extent and demand on „non-treatment‟
       services from members of the community.




                                                                                         54
      To identify what services are appropriate for people who do not meet the
       eligibility criteria for specialist service provision.


2. For people known to the specialist services
     To gain the views of users, carers and professional staff about the demand
        for and appropriateness of provision
     To analyse the MHRC caseload in more detail in order to establish the actual
        prevalence and activity level
     To obtain more quantitative information about prevalence of mental health at
        the neighbourhood level
     To obtain comparative data from other Mental Health Resource Centres
     To aggregate individual assessments of needs from the case file audit



Conclusion

This report can at best be described as the first step in establishing the mental health
needs of the Southall Neighbourhood area.

The report has not captured the detail and diversity in levels of deprivation (as stated
by HSAS (Health and Social Care Advisory Service). A lot of the prevalence focuses
on estimated values rather than real activity and prevalence.

There is insufficient information at a neighbourhood level to determine whether
service provision and delivery is reflective of the community it serves.

It is important when formulating a response to prevalence that there is focus on
mental health disability prevention and promotion. This should be done because of
the large number of people who might not present their problems to the psychiatric
services.

More work needs to be conducted to establish the true prevalence of mental health
disabilities in Southall and to develop a model that could be replicated across the
neighbourhood areas in Ealing.

Once this has been done, it would be easier to identify gaps in the services. Gaps
can not be established without knowledge of the appropriateness of provision and
what type of service is needed for those who do not meet the eligibility criteria.




                                                                                     55
References
  1. Health and Social Care Advisory Service, March 2004. Review of the
      Commissioning Arrangements in Ealing Primary Care Trust. 12th -13th
      November 2002.
  2. Hall, John. Health and Social Care Advisory Service – local mental health
      commissioning project. Workshop on Mental Health Needs Assessment for
      Commissioning
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  5. Office of the Deputy Prime Minister,2004. Mental Health and Social Exclusion
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  11. London Health Observatory 2006. Suicide in London 2002-2004. An update




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