Transcript mental well

Mental Wellbeing Impact
Assessment
(MWIA)
Integrating mental well-being into
policy and practice
in times of austerity.
15th April 2011
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This workshop aims to:
• Present an overview of mental well-being and
implications for people in times of austerity
• Share work in England on the development of a
MWIA toolkit and building a national profile and
capacity to use MWIA
• Offer you a chance to ‘have a go’ with some of the
resources for MWIA
• Explore how MWIA might support your work and
any lessons we can learn from each other
What do we mean by mental health?
mental illness
Absence of
illness
Prevalence of mental illness
• Mental ill health accounts for almost 20% of
the burden of disease in the WHO European
Region
• Mental health problems affect one in four
people at some time in life.
• Nine of the ten countries with the highest rates
of suicide in the world are in the European
Region.
• Estimated 83 million people being affected
Mental Health is……
“ a state of well-being in which the individual
realises his or her own abilities, can cope
with the normal stresses of life, can work
productively and fruitfully and is able to
make a contribution to his or her
community”
(WHO, 2005)
The dual continuum
Flourishing
mental illness
Absence of
illness
Languishing
Benefits of flourishing
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Live longer
Are healthier
Use health services less
Take less days off work
Are more productive
Higher income
More likely to be in long term relationships
(Keyes, Lyubomirsky, King, Diener)
No Health without Mental Health
• Mental Health is the foundation for
individual well-being and effective
functioning of community
(WHO 2010)
• The level of mental health and well-being in
the population is a key resource for the
success of the EU as a Knowledge based
society and economy
(European Pact for mental health and well-being)
Promoting Mental Well-being
Unemployment
Poverty
Poor
education
Control
Protective
Risk factors
Resilience and
community
assets
Factors
Participation
Inequalities
Inclusion
Poor living
conditions
Individual
Community
Structural
The Development of MWIA:
MWIA was first developed by a partnership
in Lewisham and Lambeth, including South
London and Maudsley NHS Trust, to assist
those delivering and monitoring
Neighbourhood Renewal Strategy projects
to identify and measure their impact on
positive mental health and well-being –
original toolkit published April 2004
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“A pioneering methodology for reforming systems
to focus on well-being outcomes and
determinants”
•MWIA provides a structured, evidence based analysis of how
policies, proposals, programmes and projects might influence mental
health and well-being
•It focuses on mental well-being and identifies factors that are
having, or have the potential to have, a negative or positive impact
on mental well-being. Once identified, actions and indicators are
developed to maximise the positive and provide ways to measure
this impact going forward.
•Mental Well-being Impact Assessment is rooted in Health Impact
Assessment methodology and exists to build healthy public
policy
•With ever increasing policy emphasis on well-being, this tool
provides an ideal methodology for supporting system reform to a
well-being focus.
The Benefits of MWIA include:
• Engaging a range of stakeholders, including
beneficiaries, to increase awareness and understanding of
mental well-being
• Identifying potential positive and negative impacts of a
‘project’ or ‘proposal’ on mental well-being
• Developing specific indicators (measures) of
mental well-being
• Creating a set of evidence based recommendations and
actions to enhance the positive and minimise the negative
impact of a project
• Useful tool to help re-align/commission services to have a
well-being focus
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Figure 2.2: A dynamic model of mental well-being for assessing mental well-being impact
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Evidence based assessment framework:
Population Characteristics & Wider Determinants
Population characteristics include:
Age, race & ethnicity; gender; socio-economic position & class; physical
health; disability; sexuality and other population groups.
The wider determinants of mental well-being are:
• 1. Physical security e.g. housing, safety at home and in the neighbourhood
• 2. Environment e.g. green space, safe play space, quality of the built
environment
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3. Meaningful activity e.g. employment, volunteering
4. Good quality food e.g. affordable, accessible
5. Leisure e.g. arts and creativity, sport, culture
6. Education e.g. lifelong learning, pre-school
7. Financial security e.g. income, credit, assets
8. Transport e.g. affordable, accessible, sustainable
MWIA Protective Factors:
MWIA is based on 3 key protective factors which
promote and protect mental well-being.
These are:
• Enhancing control
• Increasing resilience and community assets
• Facilitating participation and promoting inclusion.
(Adapted from the Department of Health, 2001)
The 6 Stage Process of MWIA:
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Appraisal Process
Scoping
Screening
Deciding whether you carry
out an MWIA?
How will you carry out the MWIA?
•Community profiling
•Stakeholder MWIA Workshop
•Research – Literature Review
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The Report &
Recommendations
Identifying Impact
Indentifying Indicators
(www.hiagateway.or.uk and www.nmhdu.org.uk/mwia-toolkit-2010)
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Collecting, analysing & interpreting
information
Local information:
profile of local
population,
socioeconomic & other
determinants from
census, NHS, council,
police, local reports etc
Triangulation
Epidemiological
data & other
published & peer
reviewed research
evidence
Views and
experience of
interested parties
eg community &
vol groups,
decision makers,
staff, patient
groups
Capacity building and use of MWIA
in the UK
• Approximately 500 people have now been trained in most regions of
England to carry out MWIAs ranging from Screening to full MWIA
• Well over 500 MWIAs have been carried out on a wide range of
programmes including: Local Area Agreements, Timebanks, carers
projects, mental health projects, community arts projects, the
European Capital of Culture 08 (in Liverpool), the Well London and
NMHDU programme.
• A National MWIA Collaborative oversees the development and
promotion of MWIA and will now be supported by the NHS
Confederation and Local Government Improvement Development
• The former National Mental Health Development Unit funded a
national MWIA development and capacity building programme
• MWIA is becoming mainstreamed in English and UK public policy such
as ‘No health without mental health’ and guidance for local
government
Any Questions?
Over to you
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A case study to illustrate….
Stockport Healthy Lifestyles Service/s
• In process of re-commissioning service/s in
context of reduced budget and changing
demands and feedback
• Saw MWIA ‘as a tool to help us realise
active engagement from partners in provider
organisations’ and a way to focus on mental
well-being
Current Lifestyle Services
Weight
Stop Smoking Alcohol Health Health Trainer
Management
Service
Advice Service
Service
Services
Mental
Wellbeing
Services
Physical
Activity
Services
Differential access - some universal, some limited; use of varied support tools and processes
Mixed pattern of self referral and GP referral
Cross-referral pathways exist, some stronger, some less so
Most services issue specific
Current Lifestyle Service
Weight
Stop Smoking Alcohol Health Health Trainer
Management
Service
Advice Service
Service
Services
Mental
Wellbeing
Services
Physical
Activity
Services
Single Point of Access Pilot (LAP)
Referrals from General Practice managed via single pathway, services remain issue specific.
Self-referral unaffected; use of support tools and processes still varied.
Integrated Lifestyle Support Model
Limited
access
Enhanced Basic Offer
One-to-one, tailored, personal
support over several weeks to
identify priorities, plan and
carry through change.
Community-based “healthtrainer” style/ branding; all
lifestyle issues
Commissioned direct
PARiS; AOP
Walking prog; KIOFG
Self-health@ library
Phase IV Rehab
Stressbusters
Enhanced Specialist Offer
One-to-one support
over several weeks by skilled staff
able to manage complex cases and multiple
morbidities. NHS style/branding; all lifestyle issues
Universal
access
Universal Offer
Web-based tools to review lifestyle choices
and obtain tailored advice Directory of local services/
opportunities to support individual action planning
Referral Processes
Mediated
(individual assisted to access service via web)
Social care providers
Housing sector
Education providers
Community development
Neighbourhood management
Pharmacies
Direct
(service contacts client in response to professional referral)
Primary care
Self
Secondary care
Open-access to web-based service
A&E lifestyle project
Via personal computers
Mental health service
Via computers in public locations eg libraries, schools
Work Programme
Extensive promotion of service to
maximise access and uptake across
population
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MWIA of commissioning proposals
• Screened proposals using MWIA Screening
tool
• Identified needed to hear from all interested
parties
• Had already done a Community Profile and
Literature Review
• Held four workshops with range of people
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Findings
• Some positives such as offering access to
information on healthy lifestyles and other
activities including self help through web
access – helps sense of control and
participation
• Likely to be easier for wider range of people
to recommend and refer people into the
service – control, resilience
• May be cost effective as can go to one point
of access and use more community based
services - control, resilience
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BUT…. Potential negatives…
• Access for people without internet or literacy could
reduce access - increase exclusion
• Concerns that existing criteria for access to
support services is limiting as only to people from
‘deprived area’ - increase exclusion
• Concerns that benefits of group activities lost if
only 1-1 support focus – participation and
resilience
• Concern about possible division between
individual lifestyle behaviour and wider community
based activities - increase exclusion
• Need for staff training identified – feeling valued
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Recommendations
• Emphasise the need to high profile publicity
and work to help people who do not have
access to the internet
• Revise proposals to find way to balance 1-1
support with group based activities
• Make a case for area served criteria to be
changed
• Keep staff involved with the proposals as
more likely to have ownership
• Staff training to be included
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Reflections form the commissioner
• ‘Helped us realise active engagement from partners in
provider organisations’
• ‘But it has also been useful in adding depth to discussion
about the proposal and highlighting areas of concern and
link to mental well-being’
• ‘Also I think it helps me to keep a consistent emphasis on
the links between mental wellbeing and successful
behaviour change which is useful in considering the nature
of the processes and support that the service will need to
encompass’
• ‘MWIA is a useful too for co-productive commissioning and
helping understand implications for cost savings’
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Thoughts on relationship to other
Impact Assessments….
• Intended to compliment and not replace
• Intended to be used as a tool if specific interest is
mental well-being & re-alignment to a mental wellbeing focus
• The assessment framework can be integrated into
others such as HIA if wanting to strengthen
understanding & assessment of mental well-being
• Feedback is suggesting it encompasses areas
covered by Equality and Race IAs
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Future application of MWIA in context of
re-aligning to a well-being focus in
context of austerity measures:
• Informing the re-commissioning of services as part of
the efficiency drive
• Informing the re-focusing of service provision to have
a well-being focus and service improvement
• As a tool to support the understanding and importance
of mental well-being and the contribution that services
and programmes (often not part of the NHS) have to
make towards this.
• As a tool for identifying and measuring impacts and
their relationship to outcome measures.
For further information on MWIA please contact:
Anthea Cooke
Email: [email protected];
Tel: 00 +44 (0)1428 714485
OR
Tony Coggins
Email: [email protected]
Tel: 00 +44 (0)1428 203 228 1688
You can download further information on MWIA and the toolkit from:
www.hiagateway.org.uk
Any Questions and thoughts
about relationship to HIA?