Using the 15 Steps Challenge at GP practices

Using the ‘ 15 Steps Challenge’ at GP practices to tackle mental health stigma

“Ensuring Gloucestershire is a mental health friendly county” is one of themes of the All Age Mental Health & Wellbeing Strategy for Gloucestershire 2018 -2023 Activities to achieve this include Increasing the work with, and inclusion of, people with lived experience Tackling stigma with statutory health and care workers in organisations in Gloucestershire Working with Patient Participation Groups to ensure that tackling mental health stigma and “talk mental health” messaging reaches into every GP practice in the county

Working with GP practices and Patient Participation Groups The strategy promises that the Mental Health and Wellbeing Partnership Board will report The number of changes made as a result of quality toolkits from a patient’s perspective being undertaken such as the 15 Steps Challenge The number of Patient Participation Groups in GP surgeries actively involved in tackling mental health stigma and talking about mental health The number of tackling stigma events undertaken with GP/primary care involvement

What is the 15 Steps Challenge? “I can tell what kind of care my daughter is going to get within 15 steps of walking onto a ward” • An NHS quality improvement approach that focuses on ‘walkarounds’ by a team of patients, carers and staff, using a toolkit • Toolkit ‘prompts’ help teams record their first impressions • Helps organisations understand service users’ first impressions, and how this impacts on their experiences of care • Every challenge shows that small and simple changes can make a big impact on people’s experiences

Pilot project – Forest of Dean The Forest of Dean Integrated Locality Board decided to pilot the project • Trailblazer - Dr Sophia Sandford, Brunston & Lydbrook Practice • A toolkit was co-developed, building on ²gether NHS Foundation Trust’s experience as a pilot site for the 15 Steps Challenge in mental health • Collaboration between Practice Managers, Patient Participation Group members, and ²gether NHS Foundation Trust Experts by Experience; coordinated by its Social Inclusion Team

Pilot project – Forest of Dean • Approached all 11 practices • 6 positive responses • Visited 7 surgeries (some practices have 2 premises) • Noted the things each practice did well; as well as small changes that could help to make things better • Report for each practice, including examples of good practice, and suggestions for development

Pilot project – Forest of Dean It was good to see signs in black on yellow, which work well for all readers The reception desk was at a good level for all users including wheelchair users There is no quiet waiting area for people experiencing emotional distress, with learning disabilities or autistic spectrum conditions who might find a busy room to be overstimulating There was a Children’s Health notice board – this included details of the Children’s Helpdesk but not children’s mental health

Pilot project – Forest of Dean Interesting and varied posters and information – Forest of Dean Stroke Club, Stoma Care, Macular Support, Fussy Eaters, 2 gether Trust Memory service - but they are all mixed up together “You take care”, said with compassion, was heard from one member of staff, as a patient was leaving. Friendly and warm exchanges by the HCA were also observed. Interactions felt caring, kind and proactive The leaflets are on a rack above people sitting in the waiting area – members of the team didn’t feel they would be comfortable reaching over to pick them up

Typical suggestions for change • Arrange leaflets and posters in thematic groups • Consider providing drinking water in the waiting area • Top tips displayed on how to get the most out of your appointment would be welcome, e. g www. mentalhealth. org. uk/publications/gp-visit-guide • Information on tackling mental health stigma would be helpful - e. g www. time-to-change. org. uk/resources • It would be helpful to have quieter waiting spaces available for people in distress, those with learning disabilities, autistic spectrum conditions, dementia, etc • Signs and information in Easy-Read would be particularly helpful

Tackling Stigma workshops • Practice staff showed an appetite for greater understanding and insight into mental health stigma • 1 -hour ‘Tackling Stigma’ workshop offered for staff training days • Feedback has been positive – many staff said they would behave differently as a result of the workshop Very grateful for raising awareness and provoking thought – we need more of the same Having an Expert by Experience is an amazing idea. I found this really helpful Eye-opening. I feel I recognised some of my own prejudices (not a comfortable feeling but at least I can challenge it now)

Gloucestershire Tackling Mental Health Stigma Group Reports to the Mental Health & Wellbeing Partnership Board. It includes • People with lived • Healthwatch experience of mental Gloucestershire illness • Police • NHS organisations • Inclusion Gloucestershire • Public Health • Adult Education • Independence Trust • Kingfisher Treasureseekers • Nelson Trust • Swindon & Gloucestershire Mind • Other VCS groups