Derbyshire Dales review

Derbyshire CCG, as part of their GP Practice quality assurance work, should review the availability of information to carers and family members who may be living with mental illness or problematic substance and alcohol use. Considering the impact of the individual’s difficulties on any carer or family member disclosed by them and registered with the practice and the support that they may need for example, carer’s assessment; guided help and education; signposting to support services; involvement of Social Prescribing link workers.

The Derbyshire Domestic Abuse and Sexual Violence Governance Board should work with Derbyshire Local Authority and Derbyshire’s NHS funded services to support their communication strategies regarding services for carers and families living with mental health needs or problematic substance and alcohol use. The communication strategy should consider the use of different mediums to maximise accessibility for different groups within the community including those who may not use information technology.

Derbyshire Recovery Partnership should introduce a written policy for Did Not Attend, to formalise their new working practices where a service user misses appointments. The policy should also outline factors to consider in relation to the impact on carers or family members of the individual who has not engaged and any actions required to address their needs.

Learning from this review should be used by agencies within the Safer Derbyshire partnership as part of ongoing learning and development. Health agencies contributing to this DHR should use the learning to inform their work with carers and families specifically: I. The importance of carer and family perspectives in gaining a full understanding of the person’s circumstances and presenting risks II. That family members may not identify themselves as ‘carers.’ There is a need for proactive engagement to identify and support family and carers living with mental illness and problematic substance and alcohol use. Learning from the review may also be used for national learning purposes, communicated through the Home Office Public Protection Unit specifically: I. That all Health and Social Care support services to take a Think Family approach in their assessments and plans for service users, particularly when assessing risk to others. II. For NHS England to reinforce the need for GPs, when treating depression, to be mindful of risks associated with domestic violence and abuse and to use professional curiosity when exploring high risk behaviours and emotional instability of patients. III. Bodies such as National Institute for Health and Social Care Excellence should consider incorporating into relevant Quality Standards (such as suicide prevention and coexisting severe mental illness and substance misuse) a risk assessment process for use when people do not attend appointments. The risk assessment should include information from carers or family members of the individual who has not engaged and the impact on them of the person’s mental ill-health and any coexisting substance misuse.