17 July 2017

For immediate publication

One month on from Grenfell Tower fire: alongside the community - an update

CNWL Chief Executive, Claire Murdoch, said: "Today we think of all the victims and bereaved in the community around Grenfell Tower; even now no one can fully grasp the horror and suffering this community is trying to come to terms with. Amidst all the pain it has been very humbling for us in the NHS to work with this community, to be alongside them, helping where we can and responding to their needs, how they want them; we are particularly grateful for all the members of the community who volunteered to help, all the community and faith organisations who have made the health intervention work better."

"Many staff in primary, community and hospital services have lived and worked in the area for a long time, they have lost friends or patients and have been moved and humbled by the spirit of the people they are now caring for and supporting."

"We are determined to be alongside, for as long as the community need us."

Current provision - summary

The health response team situated at the Westway Assistance Centre has changed to reflect the current level of need.   Our health outreach team is visiting patients in their place of residence or at another place of their choosing e.g. a local community centre.

Our Westway and outreach teams can respond to emotional, mental health and physical health need and liaise with other services and signpost into routine GP services and more specialist services including mental health as required. 

Through the NHS 111 service GP appointments are also available if needed at the St Charles Centre for Health and Wellbeing Integrated Care Centre, Exmoor Street, London W10 6DZ.

The first port of call for physical, emotional or mental health needs for any resident should be their own GP. The GP will provide the all-important continuity of care for the patient and is able to signpost to more specialist services. Local GP practices are well placed to support people with emotional and mental health needs.

Dedicated support is also available for those who have more specific needs.  Those requiring an urgent mental health response should call 0800 0234 650. Health visitors are also contacting all displaced families with young children and Child and Adolescent Mental Health Services (CAMHS) have been reaching out to talk directly to children, young people and to parents who have concerns about their children.

Service update

There is a single point of access for all adult and child mental health support- call 0800 0234 650.

This update describes the health response to the community's needs; we are acting urgently but also with sensitivity, alongside the community.

NHS organisations very speedily pulled together the overall health intervention alongside the GPs of the area.

The NHS is free at the point of need and the need is great; all providers have responded accordingly - from Central, North and West London NHS Foundation Trust (CNWL) who have provided emotional and psychological support, Central London Community Healthcare NHS Trust (CLCH) District Nurses and Health and Social Care Assistants from My Care My Way and London Central and West Unscheduled Care Collaborative (LCW) who run the NHS 111 and GP out of hours service to West London Clinical Commissioning Group providing ongoing support and leadership.

Work with our colleagues in hospitals continues but the emphasis has shifted to the community where we have about 641 documented sessions with people, of which 225 were principally mental health.

The focus of the NHS work, both at the Westway Centre and outreach, has been to address immediate need and reduce the potential isolation that people may experience when they are displaced from their homes and living in hotels. 

The support has ranged from physical care, e.g. prescription writing, dressings, support for people with diabetes and mental health care, offering a space and time to talk, access and referral to specialist psychological and mental health services, as well as liaison, signposting and guiding people through the numerous  services available at the Westway and in the local area. The Single Point of Access has taken 98 calls from the area and also handled 60 email referrals to mental health services from local GPs. 

The NHS mobilisation has been considerable but would not have been as effective had we not been able to work alongside the community organisations and many individuals from the area. They have been guides for the NHS and have taken us to the people who were worried or so distrustful they were unlikely seek help for themselves. 

The NHS will treat all who need help. The Red Cross first responders have been outstanding as have been:

• Al Manaar Muslim Cultural Heritage Centre

• The Notting Hill Methodist church

• The Rugby Portobello Trust

• Latymer Christian Centre

• The Harrow Club

• The Clement James Centre.

The Doctors of the World organisation are working in the area and we liaise with them for their expertise and assistance in supporting undocumented migrants.

All these organisations can rely on the NHS to support them, the people who have seen so much and done so much for the community.

This community work will be the guiding light for the future with the community saying how it should be delivered; we will listen.

We have been on the ground since the morning of the disaster. We had a walk-in desk at the Westway; but from the outset we worked with all community organisations to ask them did they want a visible NHS presence, how to contact us if they did, and if there was anything we could immediately help with - both physical and mental health.

We're still at Westway, with a walk-in desk open from 10am till 8pm (with the Council, DWP and others like the food bank). Though the numbers are now relatively small, we think it provides an accessible presence and people know we are there. At Westway, there are two CNWL mental health workers and two from CLCH on physical health; these staff assess anyone who comes for help. They also help people see local GPs and make appointments.

The outreach team is based at St Charles hospital and they have been going door to door in the blocks immediately surrounding the tower.  RBKC gave us lists of tenants and where their hotel or temporary accommodation was and we visited them. We've reached a large number of people in this phase and have persevered to find displaced people as they are moved from place to place. CAMHS have also been part of the team knocking on doors. The Outreach team has visited over 1,000 addresses, about half with meaningful conversations. Many involved emotional issues and were long; the other half did not want to talk. Some of this is out distrust, but some is simply not wishing to talk.

On every visit we offer information and advice, giving out the trauma leaflets and Single Point of Access details and following up or offering full mental health assessments if necessary. 

CAMHS have been at Westway to talk directly to children and young people and parents who have concerns about their children.  

We follow-up people to check on symptoms they may be experiencing.          

Trauma Treatment

Mental health staff from CNWL are working closely with local GPs to assess and treat those affected by the fire. 

Training and advice has been given so that GPs are able to identify symptoms of PTSD and other reactions to trauma and how to refer-on for treatment. 

For patients in need of psychological treatment, CNWL staff make sure there is a seamless interface between the GP and mental health teams, with the patient at the centre of all decisions. 

The treatment programme is as follows:

• Patients who are most severely affected are seen immediately.

• Patients whose symptoms are less severe are being contacted and offered an appointment within a week of the referral being received (including self-referrals). 

• The appointment is face to face or can be offered over the telephone if the patient prefers.

• Those who need immediate treatment are entered into treatment at this stage.  

• Many patients who are distressed will recover over a four to six week period without treatment. After first contact patients who are likely to improve without intervention are monitored regularly. 

• At the end of that period those requiring treatment will be entered into treatment. 

• Patients who show signs of getting worse over the waiting period are also entered into treatment without waiting for the four to six week period to elapse.

Schools  

Child and Adolescent Mental Health Services initial response to the fire has been two fold; at Westway to talk directly to children, young people and to parents who have concerns about their children, and also part of the outreach team knocking on doors in hotels and in the surrounding area checking in on how people are coping. 

Our other approach has been to work closely with school nursing, the local authority, and educational psychology to create teams of support around local schools where the vast majority of children are getting help and support.  

Educational Psychologists, our in-house clinical team and CAMHS link workers have been supporting all schools. The service provides key contact details to Head teachers and SENCOs, helping schools' senior management to think about how to respond, sharing materials for communication with affected families, running parent meetings and providing specialist support and advice for students, providing other avenues of support for schools. 

Referrals to CAMHS for those affected by the Grenfell Tower Fire are rising, as we expected.  

However, at this time our advice remains to refer on to CAMHS those children and young people who continue to experience distress or ongoing symptoms and are not responding to a universal offer of initial advice and support from parents/carers and other trusted adults. 

Clinically symptoms of PTSD/severe distress begin to show after four to six weeks - round about now, which also coincides with school holidays.

Referrals - for young people as well as adults - relating to Grenfell can be made through the SPA (0800 0234 650).

Schools and the Summer Break 

We recognise that the summer period will be particularly critical period of time. There is wide ranging support for young people to engage in positive activities alongside providing emotional well-being support.

The Local Authority has already planned a wide range of summer school programmes - including Fit4Sport, EPIC, Rugby Portobello Trust as well as a range of voluntary sector providers who deliver childcare and youth services in the borough.  

The details of these programmes will be published online in the ‘Summer in the City' guide due shortly

All programmes will either signpost or provide access on-site for specialist counselling support and advice for children, young people and their families (including Place2Be and kooth). 

A working partnership group has been established to oversee the local mental health and wellbeing response for children, families and adults. As well as coordinating the immediate crisis response, this group are developing the wider support offer over the summer period and beyond. 

Many children involved in a major disaster will suffer significant distress. In most cases this distress is part of a natural human response to disaster. It is not an indication of a mental health problem. However, some children may experience longer-lasting effects that may interfere with their abilities to function in their day-to-day lives. 

However we need a graduated response which supports existing community infrastructure to provide a range of meaningful activities, ensuring there is increased capacity for listening services and more specialist mental health services for those who need it.

Place2Be are working with local schools who have identified a need for some additional counselling capacity now and over the summer break and Place2Be will be working to provide counselling and support to children young people and parents over the summer break.

Kooth.com - is an online counselling service - this will be introduced to specific schools before the break for the summer. The Local Authority will be working with as many affected schools as possible to ensure that young people are aware and able to access this service over the school break.

Additional CAMHS will be around to provide advice, support and treatment to all the community.All schools are being asked to compile a list of vulnerable children to ensure support is in place for them and their families over the summer. For those children where the need or risk is felt to be more immediate, a single point of access for CNWL for adult and child mental health support has been established as part of the Screen and Treat programme; call 0800 0234 650.

For more details:

Contact Senior Communications Officer Jeremy Dunning on 0203 214 5756 or email jeremy.dunning@nhs.net

Central and North West London NHS Foundation Trust
Stephenson House, 75 Hampstead Road, London NW1 2PL
Tel: 020 3214 5756 e-mail:communications.cnwl@nhs.net