Enfield Integrated Mental Health Care Model | News

For the last three years, community teams in Enfield have been working on a new model of access and care for people experiencing mental health issues.  

Access into the service is now more integrated through closer working with external partners, such as the voluntary sector, to make sure service users and carers get the support they need.

The aim of the transformation is to move towards a “needs-based” point of entry into the service, so people have access to the right care depending on the complexity of their needs.

By offering those with mild to moderate levels mental health problems wellbeing and prevention options, the team is aiming to:

• Reduce waiting lists for specialists’ services
• Stop patients’ mental health from deteriorating while they wait for treatment
• Reduce the number of A&E attendances and hospital admissions
• support people in the community to prevent re-admission

People are referred into the service via professionals across Enfield. Once accepted into the service there are 4 main areas that service users are supported by depending on their needs. Details of the different teams are outlined below:

1. Single Point of Access Team

The Single Point of Access team initiates the triage process with the service user. This team is integrated to social services and the local authority around providing health and social care at point of entry to include vulnerable people. The team have consultants, nurses, graduate mental health workers, consultant psychiatrist, and social workers in the team.

1. Community Engagement Team

Service users can then be referred to the newly formed community engagement team. This team will support people with moderate to mild mental health issues. They offer education & awareness, wellbeing workshops and 1-to-1 interventions. Enfield Community Mental Health team is formed by voluntary sector colleagues, employment, and advocacy experts to deliver soft mental health interventions.

1. ARRS (Additional Roles Reimbursement Scheme) team

 In collaboration with Enfield primary care networks, this is an additional offer delivered by advanced clinical practitioners and soon mental health nurses with non-medical prescribing skills. This team is integrated to GP surgeries. They offer complex physical and mental health assessment, and clinical interventions. 
 

1. North and South Core Teams

These existing teams will continue to offer support to people who have more complex needs, offering comprehensive mental health care and interventions. As part of the transformation programme, psychology pathways are now integrated to core delivery, in addition to other integrated pathways such as Community Rehabilitation, EIP- Early Intervention Psychosis and  the 18-25 pathway, which supports transition of service users from Children and Young People into Adult Services, .

All the teams have representation or strong links to other organisations in Enfield, showcasing true integrated working.

The teams use DIALOG+, a care planning tool which enables service users and carers to co-produce the service user’s journey, improving patient experience, quality and outcomes.

Erika Paula, who leads on community transformation in Enfield said:

“This model is one of the first truly integrated front doors to community care. We have worked closely with service users and carers to co-produce the model so that it works to and for the people who need our support.

Working closely with community organisations across the London Borough of Enfield, means we look at care holistically and offer support in lots of different areas of their lives. For example, employment, relationships, and housing; all things that we know impact mental health.

DIALOG+ is a great innovation to care planning that we use every day with our service users to look at the main areas in their lives that need improvement. Thank you to everyone who has been involved in this work, it is a fantastic achievement.”

The Enfield community teams are now working to share their model and experiences with other boroughs across the partnership. Following last year successful experience, we are planning to co-produce another community engagement event in the beginning of 2024, to showcase integration and collaborative work across Enfield.

If you would like more information on the model, please contact Erika Paula - e.paula@nhs.net