Adult Care, Housing and Public Health Market Position Statement: Adult Care Market and Demand

Mental Ill-Health

Demographic

 According to the Office for Health Improvement and Disparities in 2017 there was an estimated 18.6% (39,582) prevalence of common mental health disorders for the population in Rotherham aged 16 and over and a prevalence 11.6% (59,286) of people over the age of 65 over.  These estimates compare poorly against estimates for England at 16.9% and 10.2% respectively. 

In 2019/20 Q2 there were:

  • 60 per 100,000 population (aged 18+) subject to the mental health act
  • 815 people subject to the Care Programm Approach

Table 4. Predictions of Mental Ill Health prevalence from the Office for Health Improvement and Disparities

The number of people in Rotherham aged 18-64 predicted to have: 2025 2030 Increase
A common mental health disorded  29,751 29,937 +0.6%
A borderline personality or anti social personality disorder  8,998 9,047 +0.5%
A Psychotic disorder  1,098 1,105 +0.6%
Two or more psychiatric disorders 11,304 11,378 +0.6%

People Receiving Support

The Council currently supports 357 people who have a primary need of mental health. 214of which are aged 64 and under.  This indicates an approximate 9% increase since January 2022.  A review of the care and support provision for people experiencing mental ill health in Rotherham was undertaken in 2020 and this indicated that the market in Rotherham  was undeveloped and reliant there was a  reliance on the residential care model. There is a requirement to create a quality care and support market which is responsive to individual needs to achieve the best possible outcomes.

The types of services people experiencing mental ill-health require may include:

  • community outreach to enable people with mental ill-health to live independently in their own home,
  • supported living, designed specifically to enable people to live as independently as possible,
  • crisis intervention support,and
  • residential and nursing care home provision.

In 2023 a Mental Health Recovery – Flexible Purchasing System (FPS) was established.  The FPS will comprise of a number of separate lots.  Each lot will specify a community service with the principle of mental health recovery at its core. The community services in scope include supported living, day opportunities and preventative services.  Lot 1 of the FPS specifies supported living services has been established and is open for applications.

The table below illustrates the services which are provided, current levels of dependency on the service, future expectations in terms of demand and an indication of future commissioning intentions.

Table 5. Mental ill-Health. (Cohort snapshot June 2023)

Support Service Type Existing Cohort (No) Predicted Demand for future Cohort Commissioning Intentions Summary
Total number of people eligible for Council support with a primary need of mental health. 357 Increase In line with demographic change the Council will continue to engage with the market to manage demand appropriately. The Council will continue to support people living with mental ill-health to remain at home in the community for as long as appropriate.
Personal Budgets
Direct Payment – Using a service provider 141 Increase The Council supports the use of direct payments for more flexible and personalised solutions.
Direct Payment – Employing a Personal Assistant 8 Increase The Council welcomes the use of personal budgets to employ personal assistants.
Care Services
Home Care and Support Services 61 Increase The Council has appointed one  specialist regulated mental health home care and support provider to the Home Care and Support (Domiciliary Care) Flexible Purchasing System and invites other specialist mental health providers to apply  
Care Homes
Residential Care 83 Decrease The Council will continue to support people living with mental ill-health to remain at home in the community for as long as appropriate and will increase diverse support provision by introducing alternative models to residential care such as supported living. The Council will explore the reprovision of some services to expand suitability and potential to progress to supported living.
Residential EMI 23 Increase
Nursing Care 16 Increase
Nursing Care EMI 13 Increase
Other Accommodation
Supported Living 10 Increase The Council will continue to develop an offer of alternatives to bed based provision and will develop specialist mental health supported living provision.
Extra Care Housing <5* Increase
Day Opportunities
Day Opportunities <5* Neutral The Council will continue to develop a range of alternatives to building based day opportunities.**

* numbers less than five have been suppressed to reduce personal identification. **An In-house day opportunities service supports in the region of 78 people, the majority of which are not eligible under the Care Act 2014.

Residential and Nursing Care Homes

There are three care homes owned by two proprietors providing specialist mental health support in Rotherham, two provide social care provision (45 beds) and one provides nursing care (20 beds). There are 135 people with a primary mental health need who are living in residential care and around 21% of this population require nursing care. Of the total population 40% are under  the age of 67 years, and 16%  are situated in care homes located outside of Rotherham.

Mental Health Housing Related Support

Three housing related support accommodation-based services are accessed by people with a primary mental health need in Rotherham. Collectively they offer twenty units of accommodation as self-contained apartments. The associated services aim to support people onto greater independence and move into settled accommodation.

People living in the service are tenants on assured short hold tenancies for a maximum of two years. People benefiting from the service are subject to the Care Programme Approach (CPA) i.e., experience paranoid schizophrenia, bi-polar affective disorder, psychosis, personality disorder etc.

The lack of recovery focused community support to enable people to live independently means; people are at risk of failing to sustain tenancies and experience mental health relapses. Length of stay going beyond the two- year maximum also results in the service being congested and impedes access for those requiring this type of “step down” support and move on.

Please see the Housing Related Support Section for more information.

Commissioning Intentions Summary

The Council seeks more suitable provision in the Borough. A programme of commissioning and procurement activity is underway to create a high standard care and support market which has the relevant capacity and capability to meet the needs of people with mental ill health. The services to be developed will have a strong focus on mental health recovery, enabling and independent living.

  • The Council invites domiciliary care providers with a mental health specialism to join Tier 2 of the Home Care and Support Service FPS.
  • The Council invites suitably qualified supported living providers, with a mental health specialism, to join the Mental Health Recovery Service as a supported living accommodation-based service provider.
  • The Council intends to continue to promote the use of personal budgets for specialist mental health provision and increase the support from personal assistants.
  • The Council is keen to expand the amount of specialist mental ill-health providers to ensure services meet the needs of the people accessing services in addition to existing low level community mental health provision.
  • There is a requirement for cost-effective alternatives to traditional forms of support for people who require mental health recovery support i.e. long, and short term supported living (24-hour services), floating support services.
  • The Council is keen to expand specific mental ill-health provision for long term dispersed accommodation to ensure move on from temporary short-term accommodation is facilitated.

Current Service provisions for supporting people with mental ill health

Figure 4. Map of the current service provision supporting people with mental ill health.