Transcript Document

Commissioning Guidance
for
Public Mental Health and
Well-being
Karen Newbigging
22nd October 2009
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Communities, Rights and Inclusion
Overview
Why is this important?
Making the case for mental well-being
Overview of the guidance: content and
process
Next steps
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The mental wealth of nations
Nature 23 October 2008
Mental capital
+
“Mental capital encompasses both
cognitive and emotional resources.
It includes people’s cognitive
ability; their flexibility and efficiency
at learning and their ‘emotional
intelligence’ or social skills and
resilience in the face of stress. It
captures a key dimension of
the elements that establish how
well an individual is able to
contribute to society and to
experience a high quality of life.”
Mental well-being
“Mental well-being is a dynamic
state that refers to an individuals
ability to develop their potential,
work productively and creatively,
build strong and positive
relationships with others and
contribute to their community.”
Policy focus across
government on quality of life
and wellbeing: population
health, prevention and early
intervention alongside
emphasis on
decentralisation, community
responsibility and social
justice
The case for mental wellbeing
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Increased quality of life and overall wellbeing
Improved educational attainment and outcomes
Safer communities with less crime
Reduced health inequalities – both physical and mental health
related and lower health care utilisation
 Improved productivity and employment retention
 Reduced sickness absence from work
 Reduced levels of poor mental health and mental illness
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1. Economic case
2. Moral or
communitarian
case
Economic Case
 Early intervention with Conduct and Emotional Disorders. Total value of
benefits of prevention from treating a one year cohort of children with conduct disorder is estimated at £5.2 billion.
 Promote good mental health as well as social & emotional skills in
childhood (especially those with conduct disorders). Estimated lifetime benefit of
£115,000 per case of child with conduct disorder. Cost savings for mental health promotion are £75,000 per case. Total value of
benefits of prevention of promoting positive mental health in a one year cohort of UK children is £23.25 billion.
 Early Intervention is cost effective in reducing the risk of reoffending: Every £1 spent on a prevention programme for those at risk of offending saves £5.
 Later targeted parenting programmes with children with emotional
and conduct disorders. Programmes cost £600-4000 but a total cost of a child with conduct disorder is
£70,000 by 28 years of age.
 Family Intervention Programme: Cost of programme £8-20,000 compared to costs, if no
intervention, of £250-350,000.
 Refer and treat alcohol misuse problems in perpetrators of
violence across health and CJS systems. Alcohol is a key risk factor for carry out and
being a victim of violence and abuse. For every £1 spent on treatment, the public sector saves £6.
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Purpose of the guidance
The guidance is designed:
to enable local health and local authority
commissioners, and their partners, to
make decisions about mental health
improvement strategies to suit local
circumstances
commissioned by the National
Mental Health Development Unit
New Horizons: Twin aims
Improving the mental health and
wellbeing of the population
Improving the quality and accessibility of
services for people with poor mental
health (mental illness)
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Paradigm Shift! Towards a whole
system approach to well-being
 Mental health is an essential component of general health
 Mental well-being is more than absence of mental illness.
 Mental well-being is a key social asset of economic significance as a
resource for long-term social and economic prosperity.
 Wellbeing is the other side of the coin of personalisation – an
opportunity for greater personal responsibility in health and social care.
 Mental wellbeing and physical illness are connected with long-term
health conditions, particularly CHD, CVD, hypertension, diabetes,
obesity
 Addressing mental wellbeing is key to local action to tackle health
inequalities
 Responsibility for promoting mental well-being extends across all
disciplines and government departments
Improving public mental health and
well-being
General public
People vulnerable
to poor mental
health
What?
Practitioners
Intervention
processes
Improving public mental health and
well-being
General public
People vulnerable
to poor mental
health
What?
How?
Local Strategic
Partnerships, Local
Authorities and
Primary Care
Trusts
Practitioners
Intervention
processes
Implementation
processes
Adapted from: Blase & Fixsen (2005): Measuring the Fidelity of Implementation.
National Implementation Research Network
The key challenge
is commissioning
for sustainable
long-term
development to
build individual
and community
resilience
Two levels of guidance prepared to date
1. Strategic Guidance for Boards and senior
staff of PCTs and Local Authorities
Making the case and starters for ten
2. Technical (detailed) Guidance for
commissioning managers in health and local
authorities (social care, education,
regeneration, community development etc.)
Detailed and practical to include tools, resources and
positive practice examples
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Overview of guidance
 Meaning of mental well-being
 Values and principles underpinning the approach
 Business case for public mental health and well-being
 Key messages from the relevant policy documents
 Opportunities to link public mental health agenda with others
 ‘Basic buys’ for commissioning mental health improvement
 Practical tools: decision tool, monitoring and evaluation
Key documents that underpin the
guidance
 Every Child Matters
 The NHS Next Stage Review
 Working for a Healthier Tomorrow
 Putting People First
 Commissioning Framework for Health and WellBeing
 World Class Commissioning competencies etc
 Flourishing People, Connected Communities.
 New Horizons: towards a shared vision for mental
health
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Whole system approach
Develop a whole system approach with
interventions in all domains according
to
Robust evidence for interventions
Local priorities and values (established through
the JSNA and LSP processes)
Continued development and learning
from promising practice and action
A practical decision
Good practice in commissioning
tool to enable
commissioners to
prioritise
investment
Identifying local priorities
JSNA
Turning inputs into outcomes using Joint
Strategic Needs assessment (JSNA)
Using:
Analytical data on demography, social context
and epidemiology
Local views and community engagement
Reflecting and contributing to
commissioning plans and LSP/LAA targets
Draft Guidance:
Domains for outcomes and evidenced based
interventions
Children and
adolescents
Adults up to 65
Safe sustainable
communities
Groups with specific
vulnerabilities
Older adults 55+
Objectives
Rationale and
key evidence
Achievable
outcomes
Commissioning
intervention
Working with or
through other
agencies
Life course domains in the draft
guidance
 Develop safe sustainable connected communities;
 Child and adolescent years (incorporates ‘Build resilience
and safe and secure base’ and ‘Ensure a positive start in life’)
 Adults (incorporates ‘Integrate physical and mental health and
wellbeing’)
 Older People (incorporates ‘Promote meaning and purpose’)
 Vulnerable groups (includes mental illness prevention and
wellbeing for people living with the effects of disability)
Criteria for the ‘Basic Buys’
• Maximise cost effective health gain
– Effect size
– Burden of disease
– Population benefit
• Wider social gains
• Education, employment, community safety,
• Feasibility and achievability
• Not the last word on evidence!
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Examples of the ‘Basic Buys’
• Universal screening for perinatal mental health
problems and targeted interventions for women at
risk of postnatal depression including home visiting
and support
• Targeted early interventions for common parenting
problems
• Healthy Schools approaches including social and
emotional learning programmes to strengthen self
esteem
• Social prescribing to increase opportunities for social
contact and participation
• Improving wellbeing for people living with the
consequences of mental health problems
Timeframe
Phase 1: Draft guidance was prepared during
the spring and early summer 2009
Phase 2:
 Review of the evidence base continues
 Further work on the New Horizons vision and
programme of action (to be published early
December)
 Rigorous field testing of the guidance during the
autumn with key stakeholders and a leadership
group
 Possible development of a web based tool
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Publication in March 2010
In conclusion..
Addressing mental health and well-being will
achieve two different objectives simultaneously:
 Improve health, reduce health and social services
interventions, and assist in wider social gains
 Assist those who have mental health
problems and prevent such problems
occurring
Interested in field
testing and
developing the
guidance?
[email protected]
[email protected];
International School for Communities Rights and
Inclusion, University of Central Lancashire
Tel: 01772 892780
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Communities, Rights and Inclusion