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Mental Health Services 2015 & Beyond Dr Nick Broughton Broadmoor Hospital Points to cover • Case for change – humanitarian & economic • Situation now • The way forward “Apart perhaps from global warming, there is no other major problem which is so neglected worldwide” “Thrive – the power of evidence-based psychological therapies” Richard Layard & David Clark Mental health: the basis of a humane and wealthy society Largest proportion of the disease burden in the UK (22.8%), larger than cardiovascular disease (16.2%) or cancer (15.9%) People with psychosis die 14-20 years earlier than the general population % in By condition…. treatment Depression associated with 50% increased mortality from Anxiety and depression 24 all disease PTSD 28 Psychosis 59% triple amputees can 80 be treated to get back into ADHDemployment 34 SMI in paid work 25 Eating7% disorders Alcohol dependence 23 Drug dependence 14 The Statistics • • • • • • • • • 1 in 6 suffer from depression or anxiety 1/3 of families include someone who is mentally ill Mental illness accounts for 40% of all illness 75% never get treatment As many people kill themselves as die from war & homicide 7% of British teenagers have tried to kill or harm themselves 10% 5-16 year olds suffer from a serious mental health problem 50% of serious mental illnesses begin in childhood 4.6 million living with long term physical & mental health problems Economic cost to Britain of Mental Illness Cost to economy Cost to taxpayers Unemployment, absenteeism & presenteeism 4 2 Crime 2 1 Physical healthcare 1 1 Total 7 4 (% of national income) Integrated physical & mental health care for long term conditions 180% • • Co-morbid MH problems are associated with a 45-75% increase in service costs per patient Between 12% and 18% of all expenditure on long-term conditions is linked to poor mental health and wellbeing If a person with a LTC has an untreated MH condition they cannot recover as well and they die earlier 160% % increase in annual per patient costs (excluding costs of MH care) • 140% 120% 100% 80% Depression Anxiety 60% 40% 20% 0% NHS Landscape post 2012 NHS England • CEO: Simon Stevens • 5000 staff • 24 National Clinical Directors Local Area Teams • 27 nationally • 3 in London Clinical Commissioning Groups • 211 nationally • 32 in London The Mental Health System Commissioning the beds NHSE direct commissioned services CCG commissioned services High secure beds Commissioning the teams Medium secure beds 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 Locally authority Residential rehabilitation Local authority commissioned Supported accommodation with care package Own tenancy plus personalized budget Rehabilitation / recovery team Rehabilitation / recovery team CMHT/ Enhanced primary care SMI with 3rd sector outreach CMHT/ Enhanced primary care SMI with 3rd sector outreach No Health Without Mental Health - 2011 • Government strategy set out six key objectives: 1. More people will have good mental health 2. More people with mental health problems will recover 3. More people with mental health problems will have good physical health 4. More people will have a positive experience of care and support 5. Fewer people will suffer avoidable harm 6. Fewer people will experience stigma and discrimination Increasing political support • “This government has made improving mental health services a bigger priority than ever before, and we’re determined that mental health is treated with as much importance as physical health in the NHS” Rt Hon Norman Lamb MP, 16 September 2014 London Health Board: MH priorities • Mental Health & Employment The development of more effective support to ensure that talent is not lost from the London workforce because of mental illness • Adolescent Resilience Working with schools & across all agencies to support adolescents to improve their resilience, so improving education outcomes & mental wellbeing • Digital Mental Wellbeing Supporting the joint commissioning of a digital wellbeing service to all 6 million adults in London to enable them to develop & maintain emotional resilience Call for commitment to parity of esteem • Ensure fair funding for mental health services • Give children a good start in life • Improve physical health care for people with mental health problems • Improve the lives for people with mental health problems • Enable better access to mental health services The way forward • Promote good mental health: Neighbourhoods, communities, schools (the 4 Rs), building resilience, addressing dyslexia, training school nurses & form tutors, engaging school governors • Prevention and early intervention: – Parenting programmes – Early intervention in psychosis – Students against depression Effective treatment • Timely access to help when it’s needed: – – – – – Perinatal mental health support Psychological therapy Crisis care Liaison psychiatry Diversion Support recovery • • • • • • ‘Job, home, family and friends’ Employment and education Action to tackle stigma & discrimination Support with housing, benefits, debt, etc Peer support Support for carers The Role of the Third Sector • • • • Addressing stigma Identifying need & gaps in service provision Research – MH research underfunded Innovation – developing new service models • Collaboration with public sector • Co-production & co-design