HM Government of Gibraltar’s significant investments in the GHA’s Mental Health service provision are having a direct and positive impact on patients, service users and their families.
The strengthened arrangements to support people in crisis are central to the implementation of the Gibraltar National Mental Health Strategy, which was launched in July of this year.
However, one of the things that Together Gibraltar fail to understand is that the Crisis Pathway is not intended to be a referral system for long-term Counselling or Psychology services. It aims to support people through their crisis, as an immediate response, which is when people are least in need of or clinically ready to engage in therapy. Many people using this service do not need therapy, but a range of supports and treatment to keep them safe and get them through the crisis.
Launched on 26th July 2021, the 111 clinical triage system provides a single point of contact for a Mental Health Crisis and is available 24/7. As in most modern mental health systems, the specialist assessment and support provided after triage is predominantly a service led by highly qualified nurses and offers alternatives to inpatient admission with better outcomes. By the end of October 2021, the service had received 169 calls. All callers are safely triaged and held by 111 clinical staff until the Specialist Mental Health Nurse led assessment or appointment is completed and plans are put in place to support the individual and their family. The service provides immediate reassurance to patients and families, whilst simultaneously ensuring that specialist Mental Health staff are more available to assess and support people in the community.
The results speak for themselves. All partner agencies are working well together and reporting better response times as well as improved quality of response. There is a 99% compliance with response times in the pathway, even though these are tougher than anywhere else this approach has been implemented, including the UK and Australia.
The introduction of the Crisis Pathway has also had a positive impact on bed occupancy levels at the Acute Admission Ward (Horizon). Historically over occupied, Horizon ward has never been more than 70% occupied and generally runs at 50% capacity since the introduction of the crisis pathway. This will further allow for the redirection of resources towards community support as an alternative to hospital admission. In turn, it has also freed up beds at Ocean Views to better support their work on the Substance Misuse Pathway and has eliminated the waiting list for inpatient detoxification prior to admission to Bruce’s Farm.
In addition to the Crisis Pathway, good progress has been made in other aspects of implementation of the National Mental Health Strategy. This includes the introduction of:
- Crisis Plans for known patients
- Activity coordinator roles to all wards at Ocean Views
- Recovery Star Training for rehabilitation staff, provided by Clubhouse Gibraltar
- Work to strengthen pathways for Drug and Alcohol, and Children and Young People
Gibraltar compares favourably both against other EU countries and Higher Income Countries when it comes to numbers of psychologists per 100,000 population. The two vacant positions for Clinical Psychologists have now been filled and backfill for absence has been put in place, with the service expected to be running at full capacity by the end of December.
Gibraltar has seen an increased demand for counselling and other treatment modalities. However, as recommended in the Mental Health Situational Analysis, the National Mental Health Strategy and the World Health Organisation’s Mental Health Objectives, the therapeutic offer needs to include a range of supports using a stepped care model with improved access to advice, accredited self-help/digital tools and counselling directly available in Primary Care.
Work is currently underway to further develop this offer, with service provision to be provided by a range of appropriately qualified professionals including registered nurses and a range of therapists and counsellors.
Minister for Health, the Hon Samantha Sacramento, said: ‘Whilst there is much work still to do, the changes to date have had a far-reaching, positive impact and both the 111 service and Mental Health Crisis Team are receiving very positive feedback form patients, families, and other agencies. As usual, Together Gibraltar have jumped on a bandwagon on the basis of anecdotes with little understanding of reality. Mental Health service provision requires a holistic approach in order to ensure that the right services are available to meet the needs of patients, service users and their families. This modern, streamlined and joined up approach is what the GHA is striving to implement.’