Saturday, 15 July 2017

Full Circle (Community Crisis Intervention Service)

It’s odd at times how things come back to the beginning. When I sat down to put this piece together I came to think about my reason for starting the Diary of a Derry Mother blog. My first article published on Jan 12th, 2014 came about because of the anger and frustration I felt over Foyle Search & Rescue & HURT being denied funding for a crisis intervention centre in the city. Funding denied by a politically weighted steering group, but more on that later. 

If you’ve been following any of my blogs you may recall that in my previous article I highlighted the ongoing scenario around a proposed Community Crisis Intervention Service for the city. This article stemmed from attending a meeting of Derry and Strabane District Council’s Health and Community Committee on Thursday 7th July. During the course of this meeting attendees witnessed relevant questions relating to the establishment of a Community Crisis Intervention Service raised by SDLP and Independent Councillors totally disregarded by Council Officers involved in discussions around the proposed service.

At this meeting, it was agreed that Council would initiate an open procurement process to advance the establishment of a Community Crisis Intervention Service in the city. This meeting raised a number of questions, primarily, will this proposed service be sufficiently run on the funds secured? This in line with the need identified by Council via an initial scoping exercise and through the community planning process which found this service to be a ‘priority need.’

In my last blog, I listed quite a few questions. These questions and more were later sent to the following people: Karen McFarland Director of Council’s Health and Community Department. Elisha McCallion MP, a member of the Addiction Task-Force, the Community Crisis Intervention Service working group and subsequent Project Team. I also wrote to Martin Connolly, member of the Addiction Taskforce, Community Crisis Intervention Service working group and Project Team, and Maeve McLaughlin former Sinn Fein MLA and Chair of Stormont Health Committee and Addiction Taskforce member.  

To date the only ‘actual’ response I have received has been from Martin Connolly who advised that I contact the statutory agencies for the answers I required. This was despite his membership in the groups listed above.  Martin also admitted that his vision of the project has ‘not progressed to a successful conclusion.’  I did receive an electronic auto response acknowledgement from Elisha McCallion’s office but no answers to the questions and to date no acknowledgement or response from either Council’s Health and Community Department or Maeve McLaughlin.

After the meeting on July 7th there was a sense of frustration from those attending and local campaigners, however thanks to the efforts of Crisis Intervention Services campaigner Monica McClements I have been able to piece together a picture of some of what is happening.

In a question posed I asked, What is the actual nature of this proposed service and what is considered low threshold in this case?’
In the absence of an answer from Council or the others I put the questions to I have been able to establish that on Thursday April 7th, 2016 Council Officer Michael Gallagher who had been tasked by Council to draw up a related business plan advised the Crisis Intervention Service Working Group that the service would cost in the region of £300,000-400,000. Here he also suggested that consideration be given to a pilot service that would minimise the cost yet deliver an adequate service. This cost was eventually set at £80,000 and now sits at £50,000. £40,000 from Council and £10,000 from the Western Health and Social Care Trust. Now as you read this article I’d like you to bear that £40,000 from Council figure in mind the relevance of this will be explained further down.

On April 18th, 2016 the Crisis Intervention Service Working Group discussed a proposed model of what the weekend CCIS would look like. 

Following this at a meeting on December 16th, 2016 the following was discussed in relation to the business case (financial figures). 

At the same meeting, the possibility of the Addiction Task Force becoming the project board and overseeing the delivery and evaluation of the initial Community Crisis Intervention Pilot Service was discussed. This raises a further question for me, because on May 12th 2015 in the course of a Stormont debate Sinn Fein’s Maeve McLaughlin stated “Over the last year, Sinn Féin has established an Addiction Task Force in the city”. So, the question I have is, with this task-force having been established by Sinn Fein, could the Addiction Task-Force potentially overseeing the pilot service and evaluation have implications for council in terms of political neutrality? This of course would depend on the current membership of the addiction task force board, however I feel the undue influence of a singular political party does need to be addressed in as much that it did when the SIF steering group denied funding for a crisis intervention service 3.5 years ago.

What is a matter of major concern is, that the envisaged pilot service has gone from a proposed time-span of 18 months as discussed on February 7th 2017, to a 12 month period suggested at a meeting on April 14th 2017 and has now been reduced to a six month period. I’m hoping someone can explain the rationale behind cutting this pilot service by one year, but then again getting any substantive information on this has proven difficult.

Another line of questioning put forward related to the evaluation of the pilot service.  ‘Has the University (Ulster University) undertaken to carry out this evaluation free of charge?’ If not, what money has been allocated for this? Or will this expenditure come from the current £50,000 funding budget?

Since then, the information obtained by Monica McClements shows that Professor Siobhan O’Neill from the University of Ulster has secured the funding for the evaluation. So why council officers refused to answer this when asked by Independent Councillor Gary Donnelly at the last meeting is beyond me. As let’s face it it’s hardly a matter of national security.

I also asked ‘How will this service be any different to what is currently on offer? With Foyle Search and Rescue currently offering a Community Crisis Intervention Suicide Prevention Programme.’
Having read the documentation it is very clear that Foyle Search and Rescue in conjunction with HURT will be playing a pivotal role within the Community Crisis Intervention project as out of the agencies invited to give a presentation to Council follow up discussions have centred around Hurt and Foyle Search and Rescue’s business plan proposal. So, if what both organisations have to offer is the closest to the Council’s vision of what this service should be I would ask that outside of the counselling aspect from HURT how will this service be any different from what is currently on offer? And again, what is different from what Foyle Search and Rescue and HURT proposed a number of years ago, to what is being proposed now? Time will tell!

And now for a further question, on March 29th, 2017 the Community Crisis Intervention Service working group proposed that Derry City and Strabane District Council manage the CCIS contract as part of the community planning project. Council official Seamus Donaghey agreed to ‘confirm any risks and liability associated.’  Does this mean that on the basis of Mr Donaghey’s findings Council will manage this contract? Of course I'll not be holding my breath waiting for an answer.

Now if you cast your mind back to the start of this blog I asked you to keep in
Lord Rana
mind the £40,000 figure. In the run up to the City of Culture £80,675.30 was spent on clearing the former Tillie & Henderson factory site at the end of the Craigavon bridge via funds from Council and the DOE. What must be noted is this site was owned by the Multi-millionaire hotel owner Lord Rana, a man whose pockets were surely deep enough for him to clean up his own mess. Yet today the best our ‘Super’ Council can muster for a service described as a priority need and hoped to keep people safe is £40,000 which says it all really.

As explained in my previous blog, I am supportive of this project but believe that things must be done right if this service is to prove beneficial both in the short and long-term. I would go further and clarify that I have the utmost respect for Foyle Search and Rescue and HURT who it would seem from the documentation I have read to be the preferred service providers. In fact, as stated above these organisations were the inspiration behind the setting up of this blog with my first entry an article on how Foyle Search and Rescue in conjunction with HURT were refused £220,000 from the Social Investment fund to establish a facility for people found in crisis at the River Foyle. Had this money have been allocated from the much criticised OFMDFM £80 million slush fund in 2014 then we wouldn’t be sitting here today 19 years on from the Good Friday Agreement reliant on the scrapings of the local government money pot to help save lives.

As the Stormont Assembly continues fail with undeniable dysfunctional grace, legacy issues remain one of the key stumbling blocks. Now whether it’s a case of the orange or green legacy is not something I am privy to, but what I do know is in a report published by the Victims and Survivors Service in 2015 levels of mental illness identified in other post-conflict zones have been lower than in the north. This suggests additional issues may be affecting the rates in the north of Ireland. The report states; “that given the high prevalence and economic impact of mental health problems, it is important to understand other factors and how they interact with conflict exposure to effect mental health”. 

The people of this region were failed in 2014 by the refusal to fund a crisis intervention service and sadly there have been lives lost in those intervening years that may have not been had additional resources such as this proposed service been available.  I just hope in 2017 that a proper Crisis Intervention Service is established, resourced and managed properly and is not just some tokenistic form of appeasement.

The bottom line is that if it’s not done right an opportunity to prevent unnecessary loss of life may be missed.

Thursday, 6 July 2017

Crisis Service in Crisis?

In April 2016 Derry and Strabane District Council announced their intention to put together a business case for a Crisis Intervention Centre in Derry. This followed an initial scoping exercise which determined the need for this type of service in the city. The need was further consolidated via the Community Planning Health and Well-being Thematic Group as part of the City’s One Plan which identified a Community Crisis Intervention Service’ (CCIS) within the Council area as a priority need.’

If implemented and run properly this service would be a vital resource for the City as Derry is known to have one of, if not the highest suicide rates in the North. What further compounds this, is the impact of many of the social and economic determinants which influence poor mental health, such as high unemployment, poverty, poor housing and high deprivation. So ideally as well as having a service here to support those in crisis the underlying factors that influence mental health & wellbeing need to be included somewhere in the equation.

The proposed Crisis Intervention Service has recently been the subject of some public discussion. However, this pales in comparison to the attention the issue received in advance of the last Assembly Election. Here Sinn Fein’s MLA candidate Elisha McCallion (MP) announced that the service was weeks away from being opened outside of ‘dotting ‘I’s’ and crossing a few ‘t’s.’ As you would expect, this announcement was widely welcomed despite being quickly disputed by Independent Councillor Warren Robinson who through a response from council officials discovered that the proposed service was still at the discussion stage.

To seek further clarity on the matter, a few months ago  local campaigner for addiction / crisis intervention services Monica McClements and I met with two members of the North-West Addiction Task Force, a group which has worked closely with Council on this project. These members stated that a Community Crisis Intervention Service would be operational by this summer and that the initial pilot service would run for a period of 12-18 months.

So where am I going with this?

Today members of Derry City and Strabane District Council’s Health and Community Committee were asked to approve the initiation of an ‘open procurement process for a low threshold responsive Community Crisis Intervention Service (CCIS) over a six-month period.’ This with a budget of £50,000. £40,000 from Council and £10,000 from the Western Health and Social Care Trust. At this meeting Councillor Brian Tierney proposed that the subject be brought out of ‘confidential council business' and into the public arena, this proposal was supported by his SDLP colleague Councillor Shauna Cusack. Here many councilors raised genuine concerns. Despite this, few substantive answers were provided. 

In absence of answers from Council here’s what we do know. The Community Crisis Intervention Service is set to provide:

‘A timely non-clinical community response to individuals experiencing social, emotional or situational crisis over the weekend period. It is envisaged that this service will be provided within a neutral venue with fair and equitable access.
It will have a prominent community aspect and individuals of all ages can be brought to this central facility where they can be supported, receive comfort and individual staff will focus on de-escalation, risk assessment, stabilisation, reconnection e.g. with family/support or onward referral to statutory services as appropriate. Whilst this service is not perceived to be a service exclusively for those experiencing harmful alcohol and drug misuse it is anticipated that the protocols will reflect the safe and appropriate management of individuals who are under the influence and do not require immediate medical intervention.’

In theory, this looks promising, but a few things jump out at me, the first being the six-month pilot service period which falls short of the expected 12-18 months. Another issue for me is the £50,000 budget. Even a quick calculation of this figure against potential running costs doesn’t seem right. Now for the sake of expediency and counting each month as 4 weeks, if this service is to run over a 48-hour period each week over six months this service will be expected to run on a budget of £43.40 per hour. And we need to bear in mind this figure needs to cover staff costs, running costs, staff training costs (to meet NISCC standards) admin, IT and public liability insurance, and these are just a few of the things which come to mind.

According to the proposal The proposed service would be subject to on-going evaluation, which the Ulster University, Magee has agreed to undertake. The pilot will facilitate further development and evaluation of any CCIS delivery model should more long-term procurement of a service be required subject to the evaluation outcome being positive.’  They haven’t said how this evaluation would be paid for, and even today at the Council meeting council officers refused to answer this.

In the event of a positive evaluation outcome the various agencies set to benefit from the service (according to the Council document) such as the PSNI and Emergency Services will ‘be required to commit funding on the basis of a co- design Community Plan approach should the initial evaluation determine an extension of or development of a long-term service is required’. My question here is has anyone within Council confirmed that these agencies will be happy to, or have the budget to commit funding, or has whoever drafted this document on behalf of Council just decided that this will be a requirement? To take this a step further, if the agencies who are set to benefit from this service see the merit from the outset, then why have they not contributed in advance to the running costs?

I just want to make it clear that I am fully supportive of a Crisis Intervention Service but like many others across this city & beyond I want to make sure it’s done right, this is too serious and too sensitive an issue to play games with.

In the absence of clarity I would take this opportunity to ask the following questions:

Has work on this Co-design Community Plan started?

How can you evaluate something properly over a period of 6 months when it takes time for any new service to bed in?

What is the actual nature of the service and what is considered low threshold in this case?

Will this service prove sufficient in terms of the need identified? This with the initial scoping exercise by council following on from a high-profile campaign for a Detox Facility.

Has this service been modeled on evidence based practice?

How will the success of this project be measured, what are the Key Performance Indicators?

How will this service be any different to what is currently on offer?

Foyle Search and Rescue offer a Community Crisis Intervention Suicide Prevention Programme. As such, how will this service differ?

Has the University (Ulster University) undertaken to carry out this evaluation free of charge? If not, what money has been allocated for this? Or will this expenditure come from the current £50,000 funding budget?

Has consideration been given to how operating on a relatively small budget could have an adverse effect on the quality of service and the final evaluation?

Essentially, will £50,000 cover sufficient levels of staffing and additional running costs? If so please provide a breakdown in line with Council’s business plan.

As part of the overall initiative will Council place an added focus on courses such as Safe Talk, Mental Health First Aid and Applied Suicide Intervention Skills Training (ASSIST) for the wider North-West community? This to build on the excellent work carried out by the Derry Healthy Cities CLEAR Project

From a personal point of view, with a small budget and a lot hinging on a positive final evaluation after six months my concern is that any chance of a sufficient long-term sustainable service will be reduced.

In the past, I have asked related questions of council only to be told that my questions would need to be answered by the preferred service provider, which is a nonsense, with council having a lead role in this project.

I would now call on Derry and Strabane District Council, the North-West Addiction Task Force and the local MP Elisha McCallion who has worked on this ‘tooth and nail’ to provide answers.