Transcript Document

Joint Mental Health Commissioning
Strategy
‘Mainstreaming Mental Health’
Mental Health Partnership Board
Vision & Values
Values
In working towards our vision we will:
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Vision
The vision for Kirklees is
designed to enable our local
population, to maintain and
improve their mental health and
wellbeing.
For those who experience mental
health distress, our aspiration is
for them to obtain the highest
level of self sufficiency within their
communities, through the use of
valued, quality support, networks
and services
Act with integrity in the spirit of openness and
true partnership
Encourage and empower individuals to
exercise their rights to choice , respect, dignity and
independence through equality, opportunity, and
inclusion
Embrace the diversity of our local population
to facilitate their mental wellbeing
Involve and inform local people in planning
and reviewing services to meet their needs
Implement rapidly and systematically
improvements in service delivery, based on
evidenced practice through effective and
accountable leadership and management
Ensure appropriate and timely access to
services
Value and accept feedback from Individuals
and providers across Kirklees
Do what we say we will
What Works and Ways Forward
Target High Risk Groups:
People with MH problems
People with disabilities
Vulnerable Young people
Offenders
Homeless people
Disadvantaged families
Isolated older people
Travellers & asylum seekers
BME Groups
Promote
Well being
Address underlying
Risk Factors & Promote
Protective Factors
Individual Physical
Risk Factors
Social Determinants
Reduce
Risk Factors
Resilience – Life
Skills to deal with
Everyday traumas
Violence & Abuse
Reduce Risk Factors
•Smoking
•Drugs
•Alcohol
Reduce Risk Factors
•Unemployment
•Poverty & Homelessness
•Discrimination
•Family Breakdown
Access and Discrimination
Promote
Protective Factors
•Access to Creativity
•Emotional Literacy
•Relationship Skills
•Talking Therapies
Mental
Well Being
Promote Protective Factors
Physical Well Being
• Healthy Eating
•Physical Activity
Promote Protective Factors
Social Well Being
•Housing,Benefits Advice & Advocacy
•Community Activity & Social Networks
•Health settings-work, Hospitals, Prisons
Engagement with Third Sector and Citizens
Psychological
Services
Biological
Services
Environmental
Experience
Economic
Trends
Social
Integration
Recovery
Social
Services
Stepped/Tiered Approach - Prevalence & Incidence
Acute Illness Significant Risk
Treatment resistant -
Tier 1
Between 1000 – 1200 people
Tier 2
Between 1,200 – 3,000 people
Severe & enduring illness
Common & Enduring Illness
Tier 3
This is the neglected majority.
Between 5,000 – 7,000 people
Milder Disorder
Tier 4
In Primary care 40,000
Some concern ‘watchful regard’
Tier 5
In Primary care 10,000
The whole working age population
some 237,250 people.
It has been acknowledged that the science behind the numbers is not as precise as everyone would want. This is particularly significant at
Tiers 3, 4 and 5.
In Kirklees the overall adult population is predicted to rise by 3%. It has to be the case that numbers alone will not best inform what needs are.
Community resilience is problematic together with some key areas of provision. In using a
range of approaches to assess need, we can capture themes expressed by people who
experience services. In the national MIND survey of 2004 the issues below were seen as a
major or contributory cause of isolation and mental distress.
Issue
Discrimination
Isolation
Lack of confidence
A lack of close relationships
A lack of work
Lack of money
Lack of transport
Lack of supportive housing
Lack of information
Lack of support
Not feeling safe
Mentioned by
58% of people
79%
78%
74%
54%
59%
42%
42%
43%
57%
60%
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There is little education and training for work
Literacy and innumeracy are issues.
Learning “for itself” is not available
Creative arts and cultural activity is important
They want physical activity alongside recreational and sporting
activity
Volunteering needs to be an option.
They want more coping resources including self help.
Can I connect with faith-based groups?
Is there money, debt, and legal advice?
Are there opportunities for social participation?
They want an increased sense of responsibility.
Friendships and social support outside of “professional”
networks.
Access to the telephone or the internet.
Mentoring and buddying around skill development.
Access to ways to campaign.
Affordable, accessible social activity
Target Service – What does this mean for Mental Health
Now
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Focus on secondary care services
~ Small numbers
~ High cost/High risk
~ Single local provider
~ Discharge difficulties
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Limited partnership working
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Patchy investment in community based
services
~ Blocked care pathways
~ Serious gaps in prevention
~ Lack of capacity in primary care
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Too little emphasis on public service roles
in health promotion, diagnosis and
assessment, and well-being
Major unmet need
e.g. Employment
Supported Housing
Talking therapies
Advice
Responding to diversity
Carer support
BME community development
Creativity, physical activity.
Future
•Focus on integrated partnership working
~ Across NHS services
~ With social care and local government
~ With the third sector
~ With people who experience services
and their carers.
•Emphasis on health promotion and well-being,
community capacity and diversity. Responding
to the key themes of need.
•Greater investment in improved practicebased primary care services for diagnosis,
assessment, more treatment and care options
•Investment in more community-based care
management
•Changing focus on investment from
services to neighbourhoods.
•Investment in employment opportunity
•More supported housing
•Access to talking therapies and self help, and
to engage with women only provision.
•Addressing the needs of hard to reach groups
of people e.g. people with a dual diagnosis.
•A modern workforce strategy.
Desired Service Model
2010:
Current Service Model 2007:
• Recovery model established to
support people leaving hospital.
Planning for Services for Adults with Mental Health Needs
• Integrated assessment and care
Planning for Services for Adults with Mental Health Needs
management service across health
Commissioning / Service Activity
and social care.
 Service users and carers involved
Workforce planning will focus on well-being and recovery
in service planning and monitoring.
 Single point of entry via CMHT’s.
 Supporting People schemes
Specialist employment support provision will be enhanced by social Enterprise
supporting people to live
independently.
The breadth of supported accommodation will increase
 A limited range of living options
available
Break provision will be supported Carer assessments will feature as core
 Too much reliance on out of area
services
placements.
S117 situations will be reviewed annually
 PICU managed by SWYMHT + 5
additional local acute beds.
The number of Approved Social Workers will increase to 1 per 10,000 of the
 Assertive Outreach Service in place
population
 Range of specialist mental health
Carers’ Support Services available.
Capacity in primary care around ccbt, cbt and talking therapies will be enhanced
 Independent Mental Capacity
Advocacy Service in place.
 Partial early Intervention in
Day activity will have more of a focus on community linkages
Psychosis (EIP) Service in place.
April 2009
100 people using Direct Payments.
 30 people – in paid work or work
preparation.
730 bed nights of break provision available
a year.
CCBT network established in primary care.
Creative options in place
April 2010
200 people using Direct Payments.
 Out of area places down to 5.
 3 Social Enterprises established.
 60 people in paid work or work
preparation
 Day Care reframed as community
link
 Some open access provision
100% of workforce equipped with
skills to deliver well-being and
recovery
•The focus of public services will
be on well-being, rather than on
mental ill-health.
•Citizens-commissioners will be
accessing personalised services
via individualised budgets.
• More choices – the third sector
will be available and include
access to learning, leisure,
creativity, volunteering and
employment.
• There will be increased
investment in community based
solutions at the expense of more
traditional provision.
• M.H. services need to be
integrated into ‘ordinary’ services
such as libraries, G.P. surgeries,
places of work and community
groups.
•Care management will be based
on the principles of hope and
recovery and will have a
brokerage function.
•Supported living will have been
enhanced.
•The anti-stigma movement will
be stronger
April 2011
250 people using Direct Payments.
Citizen Commissioning network
established
 Supported accommodation increased by
100 units of floating support.
Dual diagnosis service in place
Brief intervention team in Primary care
established.
Strategic
Objective
Employment.
Learning &
Education.
There are
very limited
employment
pathways.
The Gap –
What is required
This is a major
gap. 35% of
service users
express positive
views about work.
A range of options
covering the
spectrum of
supports.
Mentoring/
Buddying/DDA
issues all relevant.
Focus on
mainstream
solutions
paramout.
Links required with
JC +, Worklink,
Pathways and
Mindful Employers.
Rationale – Desired
Outcomes
Commissioning
Implications
2008/9
The rationale is with
the ODPM report, the
Layard report and
what service users
say. Outcomes
include access to
money, networks,
confidence, social
participation, and exit
from services.
There are significant
economic benefits to
service users and
support services.
To procure a
specific
service with
an output of
30 work and
work
preparation
places per
annum.
Enhance
vocational
strategy
group
(CERT).
Commissioning
Implications
2009/10
To increase
capacity to
60 places.
Commissioning
Implications
2010/2011
To increase
capacity to
90 places.