Current and Future Demand

Current and Future Demand for Social Care Services for Adults of Working Age with Mental Ill Health 

Population Needs Data

West Sussex’s Joint Mental Health and Wellbeing Needs (JSNA) published in September 2024, gives a full breakdown of the determinants of mental health for the population of West Sussex. Full and detailed information can be found on the Public Mental Health Needs Assessment 2024 page on the West Sussex JSNA website. This also includes detailed data around mental health prevalence broken down by Boroughs and Districts.

It is most helpful to look at the executive summary and full documents on this web-link but some key relevant facts for the market from this needs assessment are:

• There are rising rates of mental ill-health in West Sussex. In 2022/23 there were 9,050 people with severe mental illness on GP registers, a 5% increase of 490 - higher than population growth.
• There was a 22% increase between February 2023 and February 2024 of adults in contact with secondary mental health services.
• There are high rates of hospital admission for intentional self-harm and rising suicide rate (above England average for this).
• The highest rates of secondary mental health hospital admission are for ages 20-25.
• Waiting times, access to neurodivergence assessment and support, crisis support and support for parents and carers were the top mental health and wellbeing challenges identified by a survey of staff in GP practices (2024).

Use of and Demand for Services and Trends Around This

The total number of individuals with care packages funded by the mental health pooled budget contracted by West Sussex County Council has increased by 42% from 2019 (546) to 2024 (776). Table 3, below, illustrates this growth:

Each number in Table 3 is a snapshot figure taken from a day in first week of January of that year.

Although costs have increased significantly (see the section 'Where We Are Now and What We Know - Budgets and Funding' ), the numbers of these placed in residential and nursing care services has remained fairly stable as Table 4, below, illustrates:

Each number in Table 4 is a snapshot figure taken from a day in first week of January of that year.

The significant increase has, therefore, been individuals with mental ill health being contracted to receive community support packages, mostly contracted using Lots 1 – 3 of the Supported Living Framework as Table 5, below, illustrates. Costs have also increased for these services (see the section 'Where We Are Now and What We Know - Budgets and Funding' )

Each number in Table 5 is a snapshot figure taken from a day in first week of January of that year.

Tables 6 and 6A, below, further illustrates trends around the ages of individuals in receipt of individual care packages funded by the mental health Pooled Budget up to the age of 65.

Each number in Tables 6 and 6A is a snapshot figure taken from a day in first week in January of that year.

This age trend data shows us that the % of individuals getting non- residential support packages who are under 40 years of age has increased from 31% in 2019 to 37% in 2024 and the number of those over 40 years of age has seen a small equivalent decline. There are also small increases in number of younger people going into residential placements. However, as the numbers are low this may not be statistically significant and in addition, may reflect availability of services rather than demand.

Waiting for Services

There are a number of complex factors which can delay an individual who has been assessed as eligible for and requiring a service actually getting this service. Some delays are linked to Council, NHS and provider processes and work is currently being undertaken, working in partnership with all parties, to ensure that these system delays are minimised. For others, the delay is caused by lack of suitable service provision. In July 2024 there were a total of 41 individuals waiting where lack of supply was identified as the primary issue. (18 individuals waiting because of a lack of suitable supported living services and 16 individuals waiting for appropriate residential care. In addition, a further 7 individuals waiting for Extra Care provision.)

Placement Breakdowns

Whilst specific data is not currently available, intelligence from Council and NHS operational staff and providers in West Sussex suggest that placement breakdown is a significant issue in West Sussex which not only impacts very negatively on outcomes for individuals but also the system as a whole. West Sussex stakeholders have reviewed work done by East Sussex County Council (2023) and also Sussex Partnership NHS Foundation Trust and Sussex University (January 2024) and concluded that their findings reflect the situation also being experienced in West Sussex including:

• Challenges navigating and accessing community mental health and crisis support led to poor outcomes for patients and unnecessary placement breakdowns.
• Absence of provider staff having appropriate specialist training, both generic and patient bespoke and including around managing risks. This not only reduced the complexity of needs that services could accept, but also affected how risks were managed in services which increased placement breakdown.
• A lack of confidence in clinical services, a sense of “dump and run”, and some providers looking to move away from mental health provision/market because of this.
• Specific issues and concerns managing patients with dual diagnosis.

West Sussex County Council and providers have, therefore, been involved in early discussions around the possibility of piloting a new clinical service across Sussex which will aim to support placement retention and reduce placement breakdowns.

Individuals in Mental Health Hospitals Ready for Discharge

The West Sussex Public Mental Health Needs Assessment (2024 -Part of the Joint Strategic Needs Assessment) found that in December 2023 there were a total of 3,757 bed days of adults under the age of 65 years. Of these 1,137 were delayed, this is 30% of the total occupied bed days. Looking at the longer term, it is evident that overall occupied bed days have declined, but delayed bed days have increased. The increase in delayed bed days precedes the pandemic, reduced during the pandemic and have risen since.

In terms of the reason for delays, the monthly Sussex Partnership NHS Foundation Trust Integrated Performance Report (reported to SPFT Board of Director monthly meetings) have noted the continued challenge of a shortage of social care commissioned accommodation and care which can support complexity.

In addition, intelligence from Council and NHS operational staff and providers in West Sussex suggest that there are also some additional system and process issues which can affect timely discharge, including around planning and funding transition arrangements between hospital and supported living or residential services.