‘No Health without Mental Health ’ Progress

Dr Geraldine Strathdee National Clinical Director Mental Health

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NHS | Presentation to [XXXX Company] | [Type Date]

A Vision for Change:

• • • • • • More people will have good mental health More people with mental health problems will recover More people with mental health problems will have good physical health More people will have a positive experience of care and support Fewer people will suffer avoidable harm Fewer people will experience stigma and discrimination NHS | Presentation to [XXXX Company] | [Type Date] 2

Mental health:

the basis of a humane and wealthy society

The mental health system Three segments for our overarching national vision 1

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Ta ckling causes, building health literacy & prevention in individuals and communities 2

. Primary, community, acute, & social integrated care provision

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. The complex specialist population

Building collaborative , resilient communities for England through the knowledge that the Mental health intelligence network can bring you and your partners

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The Mental Health Intelligence Programme

please look at Fingertips ( http://www.yhpho.org.uk/mhdnin ) and find out about your community

The mental health intelligence network can now show you for every CCG and every Local Authority in England:

– About your community - the risks and strengths factors for mental health – The prevalence of mental ill health & suicide – The high risk groups to target for early intervention – The rates of identification in primary care mental health • The extent of IAPT services; the recommended NICE evidence treatment • Medication prescribing, rates of assessment of high risk groups – Secondary care services : the levels of • • Access, waiting times, standards, quality, outcomes, spend Soon to add rates of NICE recommended practice – The crisis pathway & much more

The Mental Health Intelligence Programme

please look at Fingertips ( http://www.yhpho.org.uk/mhdnin ) and find out about your community

MY ask of mental health leaders : Can you please look at your CCG/ LA area and tell us • What's helpful • • • What you notice about your area What can we add in terms of quantitative data that would be useful We plan to add factsheets, references, what good looks like so that there is a pathway that says: we have the data , now how to we apply that new knowledge to out in place practice to reduce suicide Can you help: • What best practice factsheets, training programmes, service development • tools can you give us for the WGLL site , Would you like to organize a 1 day course in mental health intelligence leadership

‘ Thinking’ Communities are calculating the cost of NOT addressing mental health

The report is available to download from – www.london.gov.uk/mentalhealth

Tackling causes Building health literacy Prevention

Employment

Family friendly, productive practices, Creating wealth Can every large, medium & small employer be a positive employer? What can GPs and CCGs do ?

Schools:

4 Rs: reading , writing, ‘arithmetic & Resilience

Building resilience , addressing dyslexia Training school nurses & form tutors Engaging school governors

Transport hub related

Preventing isolation in older people Reducing avoidable suicides and Reducing detentions

Fire chiefs

70% of avoidable fires, domestic accidents, & RTAs College students: Building resilience & Physical & mental health literacy in future leaders Police commissioners Commissioning parenting Safer neighborhoods Alcohol

Suicide prevention:

national and local programmes

Focus on high risk groups including:

– unemployed, relationship challenges, substance misuse, repeated self harm – Update on national employment support programmes • IAPT, IPS, Quality premiums for CCGs Personalization, social impact bonds, support for GPs to refer to employment programmes – Substance misuse: alcohol programmes – New public health campaign on alcohol – Primary care enhanced scheme for alcohol and depression / anxiety – Self harm • • • New service specification Liaison mental health services ? A national self harm CQUIN?

Mental health policy & partnerships: the parity & integration revolution

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New era in primary, acute, community & social integrated care for common ‘conditions’

What’s new: the incredible level of innovation focus on

implementation & culture of sharing ‘best’

Primary care innovations

learning from the best of international primary care MH leaders & role modeling collaborative partnerships

Workforce : HEE Mandate for a 4 th RCGP new initiatives year for MH in primary care Registration & annual checks:

– – – include 1 min self completion behavioural health assessment

Primary care team skillmix

30% of the work; ? % of staff with NICE training psychological health training

Supporting hard pressed primary care : the basics

Clinicians decision support templates – Annual checks : zero exclusion of SMI – Family and 3 rd sector outreach

Primary care at scale initiatives

– integrated ‘Living well’ care stroke, diabetes, pain, COPD, bariatric surgery care –

Population based focus based on local need

– Named workers in primary care Enhanced SMI care in inner cities ?

– Enhanced MUS care – Enhanced SMI care – Alliance commissioning models

New and very exciting era in primary care & integrated acute & community mental health • • • • London Strategic clinical network & London CCG MH leaders 70+ case studies of primary care mental health integrated physical and MH recovery care, integrated public health approaches, all securing evaluation support now Reference : Primary care mental health guide: – http://bit.ly/mhpricare

Check out the primary care at scale federated models of suicide prevention in Seattle, Scandinavia, Hungary Check out Sheila Hardy: Train the Trainer for practice nurses and building a community of practice between practice nurses and mental health nurses MY ask of leaders

If you know of others, please let us know about good practice Can you run a primary care at scale master class or federated programme Can you lobby for research funds in England to do this and lest include alcohol so we are the best in the world

Reducing avoidable admissions Commissioning the Care Pathway of Mental Crisis Service Alternatives to Hospital beds Liaison mental health teams Crisis Home Treatment Teams Trained tele-triage and tele health to increase access Single number to access crisis care

Accessible information to prevent crises and get help early

£ £ £ £ £ £

Can you help with any of these steps

1. Leadership: Who is the national MH 111 lead & names of the local leads 2. Governance arrangements for national and local oversight & planning

3..Directory of Services : is there a specification of MH local services for DOS

4. Crisis Assessment for MH: What is the current assessment for people in mental health crisis & can a brief suicide risk assessment which reduced suicide be added?

5. Information sharing protocols 6. Good practice examples of 111 MH: what can we learn e.g.Isle of Wight?

7. Training: in mental health awareness - what do 111 staff need? 8. MH Pilots to place mental health trained staff in 111 :

New focus on high risk groups with long term physical ill-health Integrated physical and mental health care: Long term conditions • • • • International research finds that co-

morbid MH problems are associated with a 45-75% increase in service costs

per patient (

after controlling for severity of physical illness

) 180% 160% 140% Between 12% and 18% of all expenditure on long-term conditions is linked to poor mental health and wellbeing – at least £1 in every £8 spent on long-term conditions.

120% 100% 80% Depression If a person with a LTC has an untreated MH condition they cannot recover as well and they die earlier, are more disabled, cant adhere to treatment plans, use more healthcare, are poorer 60% 40% 20% Therefore it makes no logical, ethical, or business sense not to include 0% psychological New Recovery guidance from NHSE Commissioning & Monitor

Tariffs need to include mental health recovery care to get Value

Anxiety

Mental health policy & partnerships: ‘policy’ focus on implementation

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Care pathway

• whole person, whole pathway approaches • Disseminating ‘best’ for the specialist

population:

What’s new: the focus on Implementation & culture of sharing

‘best’

Early Intervention Psychosis : new national focus -

Current services:

Standard care means that duration of untreated psychosis is between 8 months & 2.5 years with lifelong poor outcomes - 29% receive Cardio metabolic assessment & only 25% receive treatment At least 34% do not have NICE psychological therapies 16% of medicines prescribed do not adhere to guidelines. The Variation ranges from 0-70% across England

Future services:

- Early intervention psychosis teams with treatment in the first critical 8 weeks -full NICE compliance -home based care -recovery to employment -maintain 70% recovery from first episode

Mental health system of care:

what can be done to build personalized, recovery orientated care & reduce suicide at every level The beds High secure beds Medium secure beds The teams 24/7 Assertive outreach/ community forensic team Low secure beds 24/7 Assertive outreach /rehabilitation & recovery team Intensive rehabilitation closed unit for complex dual diagnosis 24/7 Assertive outreach /rehabilitation & recovery team Open rehabilitation units Rehabilitation / recovery team Locally authority Residential rehabilitation Rehabilitation / recovery team Supported accommodation with care package Own tenancy plus personalized budget Design Principle :It is vital to understand that in mental health our ‘technology’ and ‘care model design principle’ is that in order to provide safe, NICE concordant , efficient services, we need proven effective care teams to link with beds. In mental health we are expert at using case managers to triage all admissions & work early on the discharge plans.

CMHT/ Enhanced primary care SMI with 3 rd sector outreach CMHT/ Enhanced primary care SMI with 3 rd sector outreach