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Trust in partnership develops a project to provide services aiding psychological and economical needs of young criminal offenders, granting employment and access to better healthcare

ORGANISATION:
Barnet, Enfield and Haringey Mental Health Trust
CATEGORY:
HSJ Value Awards 2019/ Community Health Service Redesign AwardHSJ Value Awards 2019/ Mental Health Services AwardHSJ Value Awards 2019/ Specialist Service Award
AWARD:
Winner: Mental Health Services Award/Specialist Service Award  Highly Commended: Community Health Service Redesign Award

Challenge

    • High rates of homelessness, unemployment, mental health difficulties and gun/knife crimes
    • Material, social and racial disadvantages led to poorer physical/mental wellbeing of young men
    • Improve their access to health, education and employment
    • Provide holistic, social and occupational well-being opportunities

Action

    • Established Project Future - a mental health delivery service for young men involved in offending/violence
    • Introduced psychological models like attachment theory, community psychology and narrative therapy
    • Engaged them in activities like cooking and CV writing, facilitating social inclusion
    • Created a peer referral system to generate engagement at individual, group and community level
    • Employed men with lived experience of offending/youth violence

Result

    • Resulted in an engagement of over 260 young men with complex well-being needs
    • 100% actively sought support, while 72% accessed the mental health service
    • Led to 70% men working towards employment goals and 47% accessing education/employment/training
    • Diverted young people from the criminal justice system, reducing economic costs

Synopsis:

Project Future is an innovative community mental health and well-being service that seeks to transform mental health delivery for socially excluded young men aged 11-25, labelled as gang members and offenders with serious youth violence. In partnership with BEHMHT, Haringey Council, Mind in Haringey and Metropolitan Police, the objectives are to improve mental health, reduce offending, increase access to education, employment, training, and bridge them into services.

Underpinned by psychological models (attachment theory, community psychology and narrative therapy), Future is fully co-produced with young people to receive holistic mental health interventions. Evidence-based psychological models are wrapped around activities (e.g. cooking, CV writing) to enable them to engage in a service user-led pace and safe context. An innovative peer referral system is used to generate engagement and more sustainable change at an individual, group and community level.

Future has engaged over 260 young men with complex, multiple well-being needs who have difficulties in accessing services, in the four years it has been running. In addition to direct work with young men, the project seeks at local and national levels to influence and design delivery of mental health services that are more accessible for this group.

See uploaded document - Executive Summary and weblink for Film created by young people.

Challenges:

Future is situated in Haringey, in the top 10% most deprived wards in the UK, with higher rates of homelessness, children in care, unemployment, mental and chronic physical health difficulties; gun/knife crime, higher proportions of young black men. Material, social and racial disadvantages contribute to poorer physical and mental wellbeing. Young people in the criminal justice system are three times more likely to have unmet mental health needs.

Future engages the most difficult to engage young men with complex multiple well-being needs, who fall through the net of services, in vicious cycles of offending.

Main objectives are to:

-provide holistic emotional/mental, physical, social and occupational well-being. -reduce offending, -increase access to education, employment, training, -support access into services and meet their stability needs, -longer term, reduce economic impact of serious youth violence and chronic unmet physical and mental health needs to society. Our core target is to work in an integrated partnership across organisational boundaries as no one agency holds the solution to their complex challenges. Services work collaboratively to provide tailored holistic care thereby reducing bureaucracy. Future effectively meets multiple vulnerabilities through funding streams from NHSE, Public Health, Social Care, Comic Relief, The Big Lottery, charitable donors; demonstrating sustainability despite funding restrictions.

See uploaded document - Executive Summary

Outcomes:

The effectiveness of Future has been evidenced through an independent evaluation by the Centre for Mental Health. 198 young people engaged between 2015 and 2018, with the following outcomes:

• 100% actively sought support across multiple areas of their life

• 72% accessed mental health support, with a significant reduction in mental health symptoms

• 70% worked towards employment goals

• 70% accessed other services via Project Future, eg. DWP, CONEL,

• 47% accessed education, employment and training

• 60% accessed offending support.

The London School of Economics completed an evaluation to capture economic savings generated by the service by diverting young people from acute services and the criminal justice system. The report shows, at Future it costs between £900 to £8,800 per year for a young person to engage at various levels. This is significantly cheaper than not intervening, with cost to public services for a prison sentence for possession of a weapon costing £27,700 a year, and a fatal stabbing amounting to £1.2 million (ONS).

Young people are often mistrustful of professionals, therefore engagement has been an ongoing challenge. Future employs these men with lived experience of offending and youth violence, increasing help seeking and co-production amongst some of the most vulnerable young men. We have been able to overcome organisational boundary challenges through Partnership working.

See uploaded LSE, CfMH and Youth Employment Reports

Spread:

The team and young people have co-delivered training, consultation and dissemination of their learning at local, national and international forums. Training has been provided to NHS mental health teams, prisons, probation, drugs and alcohol services, schools and youth workers. Training covered underlying principles of the approach, providing a template from which to learn and shape services.

Future has become a platform for young men to raise awareness around issues that contribute to getting caught up in vicious cycles of poor mental health, violence and offending. The approach has been disseminated at conferences within NHS England, Division of Clinical Psychology, British Psychology Society and internationally at the IIMHL & IIDL (2018). The young men launched Future’s findings at House of Lords and led on setting up exhibitions nationally and internationally.

Future’s replicability and scalability has been demonstrated as below: - Development of schools based intervention informed by key principles of the model and coproduced with pupils, parents and teachers. - Acquired funding to embed the model at two local youth centres, seeking to tackle intergenerational patterns by applying learning to younger cohort (11-15 yrs). - Pilot being commissioned to scale up the model for pan London NHSE Liaison and Diversion services.

See uploaded documents - Dissemination List, Soho Exhibition and weblink for Film created by young people.

Value:

As demonstrated by LSE’s economic evaluation, over the past 4 years Future has proven excellent value, making innovative use of charitable monies, alongside NHSE and Local Authority funds, given the context of funding challenges. This demonstrates that multiple funding streams can work well together alongside operational alignment of different organisations.

Based on STP recommendations, partnership/integrated working across organisations has enabled reductions in bureaucracy, recognising barriers and reducing obstacles for service users to move easily between services. Work across multiple levels ensures change across the system to alleviate social and health inequalities experienced by marginalised communities; increasing stability and reducing the likelihood of offending, thus decreasing the economic impact to society. Savings, therefore, are generated across health, social care and the criminal justice system (given that each stabbing costs £1.2 million - ONS).

In line with parity of esteem, Future’s integrated approach to supporting wellbeing holistically, demonstrates the need for mental health interventions to not be delivered in isolation or at the exclusion of other needs. Future’s work demonstrates a streamlining of services, supporting more efficient navigation of care across the system. Future’s work effectively meets individual needs, positively impacts upon environmental and social sustainability of the local community and reduces demand on crisis services, harnessing community assets and resilience.

See uploaded LSE, CfMH and Youth Employment Reports

Involvement:

Key stakeholders include BEH MH NHS Trust, Haringey Council, Haringey Mind and the Metropolitan Police. Despite varying levels of buy-in at the start, we were able to engage senior decision makers through creating a shared strategic and operational policy and governance, drawing on best practice from each organisation, including involvement from eminent MPs and the Mayor of London.

Contributions from each partner have been instrumental in enabling delivery of a robust service that draws upon expertise and opportunities from various specialisms including mental health, public health, offender management, and community safety. This integrated approach provides comprehensive, timely and efficient care without passing care between organisations thereby saving time, reducing fragmented care and enabling positive outcomes.

Co-production has enabled us to engage service users and community members as key stakeholders within the project. Young men were initially mistrustful of the service based on their previous experiences of help seeking and statutory services. Co-designing every aspect of service with young people has encouraged meaningful engagement and increased access to multifaceted interventions in a safe and trusted space. This has significantly impacted on their positive outcomes.

Engaging the community as key stakeholders has increased community capacity building through enrolling local resources (e.g. community centres, businesses) to participate in supporting these young men to thrive, reducing their reliance on statutory and costly acute services.

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