Borderline The Ongoing Saga Of Main House Birmingham UK Mental Health Services

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RECAP : In February 2010 the last three service users at Main House entered a suicide pact. They all recovered but Main House The Mental Health Tier 4 Borderline Personality Service in Birmingham UK was closed quickly. On January 12th Emma Brady (Ex B'ham Post Journalist) for the Trust had stated:

“The Trust is committed to maintaining an open and sensitive dialogue with both Main House residents and staff during what will naturally be an anxious and unsettling time.” (Bham Mail Source)

By Feb 20th Sue Turner reportedly stated of the suicide-trio :

"Sue Turner, chief executive of Birmingham and Solihull Mental Health Trust, said: “The three residents broke the rules, going out drinking alcohol, coming back and developing between them a pact to self harm and take overdoses." (Alison Dayani Bham Mail Source)

By then, halfway through the sensitive patient and public consultation, Main House was closed . It could no longer be a point of protest or "risk" - even to the Trust's reputation for sensitivity ?

Below is the continuing story of the Borderline Tier Main House story and its connection to a wider picture of need in the often serviceless Personality Disorder community ..

MAIN HOUSE AND PERSONALITY DISORDERS SERVICE

17th March 2010 Birmingham Overview Scrutiny Committee Birmingham

Remit : To Hold Health Services To Account Over Consultations

EXTRACTS

The Chairman commenced the discussion by advising that she was disappointed that changes had been made to the service before the consultation had been completed. Sue Turner, Chief Executive of the Birmingham and Solihull Mental Health Foundation Trust, advised that there had been no other way of managing the situation. She explained that patients had come to the end of their treatment period and that in the previous week there had been only 3 patients remaining at Main House. She had contacted commissioners, but it had become clear that the service could not be sustained.

The clinical viewpoint was that Main House should close and that a follow-up package should be provided for the 3 remaining patients. The Chairman was concerned that such action would not have been taken in the case of patients with a physical illness, but she was advised by Sue Turner that there was a danger of problems arising that could have been coped with only if a larger group had been present to maintain the community process.

Sue Turner advised Councillor Margaret Byrne that arrangements had been changed 18 months previously to improve the funding process and that 8 potential patients had been assessed and had been awaiting funding approval. She confirmed that that number of patients awaiting funding approval was not unusual and advised that funding approvals had declined significantly in recent years.

Members noted the explanation regarding the 8 potential patients given at page 4 to the report. Councillor Barbara Tassa expressed concern regarding the situation and that the service would not be commissioned now that the facility had closed. However, Sue Turner confirmed that the consultation was actively continuing, even though there were no patients in Main House at present. Councillor Jane James advised that she had an understanding of the situation from her own previous work experience, but expressed grave concerns regarding some of the details in the report and questioned what the implications would be for patients in the future. She was advised by Sue Turner that employees had been redeployed on a temporary basis, but that a clear and explicit statement would be needed from commissioners regarding the Tier 4 model required for the future.

In response to a question from Councillor Margaret Byrne regarding whether an assessment had been made of overall outcomes, Sue Turner advised that that had not been undertaken in detail, but that some patients would have left early and would probably have benefited from their time at the unit. Jane Collier, Pan Birmingham Health Commissioning Director at NHS Birmingham East and North, advised that Birmingham Commissioners believed there would be a need for residential treatment, but questioned what level of need there would be in the future in view of the predicted level of 3 patients per year from the Birmingham population. In the past, Main House had been the only facility available and there had been a need to develop community services.

Sue Turner confirmed to Councillor Anne Underwood that the Trust was consulting with commissioners, users/patients and major stakeholders. She confirmed that the Trust believed that the 3 patients were being safely treated in other services and advised that they were likely to meet, as such meetings were not unusual. With regard to employees, the Trust was maintaining their expertise and holding weekly employee group meetings with the 20 to 30 employees involved.

Councillor Jane James requested a written statement on the future funding of the service and questioned the viability of the national service. Jane Collier advised that she could answer only regarding Birmingham residents and that it was important that local services were provided, close to home. Sue Turner advised that she was not convinced that providing additional funding would increase the take-up of the residential service. The Chairman noted that the closure had been discussed with employees, but questioned whether 1 senior member of staff had been absent on leave. Sue Turner confirmed that 1 clinician had been on study leave, but had kept in touch with discussions and had accepted the decision on his return.

The Overview and Scrutiny Manager drew attention to the Commissioning strategy and questioned what would be reported to the Committee in March 2010. Patrick Nyarumbu, Senior PPI Manager at NHS Birmingham East and North, advised that the Primary Care Trust wanted to continue dialogue on the strategy and had established stakeholder panels. He noted concern that the Strategic Health Authority (NHS West Midlands) had signed off the plan for the strategy, but that information had not been provided to this Committee, and he confirmed that the Primary Care Trust would share with the Committee details of the discussions that had taken place with stakeholders. Sue Turner advised also that she had intended to submit a summary of the responses received to the consultation to the March 2010 of the Committee. The Link Officer accepted that the situation regarding the Personality Disorders Service involved not only Birmingham services and he was concerned that it was not clear what the overall service arrangements would be.

Jane Collier advised that Tier 1 and 2 commissioning strategies were in place and that an outline strategy had been prepared for Tier 3. The Link Officer suggested that the Main House residential service would be viable only with input from outside of the City. Sue Turner confirmed that there was a need for clarity on the national and regional strategies, which was beyond the Birmingham remit.

RESOLVED:-
That the report be noted.


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