Transcript Document

Suicide Prevention
’
National & Local Programmes
Dr Geraldine Strathdee
National Clinical Director
Mental Health
1 NHS | Presentation to [XXXX Company] | [Type Date]
Suicide prevention:
national and local programmes
The National Mental Health Strategy is working to :
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Identify and prevent the causes of mental ill health
Focus on high risk groups
Crisis care: improvements
Primary care mental health at scale
Acute trust MH services
Specialist mental health services
I am very keen to hear what you are doing that others across the
country need to know about. What challenges are you facing and as
leaders what would you like to do to help?
Mental health:
the basis of a humane and wealthy society
The mental health system
Three segments for our overarching national vision
Tackling causes, building health literacy &
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prevention in individuals and communities
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3.
Primary, community, acute, & social integrated
care provision
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
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
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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
Employment
Family friendly, productive practices,
Creating wealth
Can every large, medium & small employer be a
positive employer? What can GPs and CCGs do?
Prevention
Transport hub related
Preventing isolation in older
people
Reducing avoidable suicides
and Reducing detentions
Schools
Fire chiefs
4 Rs: reading , writing, ‘arithmetic & Resilience
70% of avoidable fires,
domestic accidents, & RTAs
Building resilience , addressing dyslexia
Training school nurses & form tutors
Engaging school governors
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:
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Unemployed, relationship challenges, substance misusers,
repeated self harm, isolated, 20-45 yr-old men
Update on national employment support programmes
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Substance misuse: alcohol programmes
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IAPT, IPS, Quality premiums for CCGs Personalization, social
impact bonds, support for GPs to refer to employment
programmes
New public health campaign on alcohol
Primary care enhanced scheme for alcohol and depression / anxiety
Self harm
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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 4th year for MH in primary care
RCGP new initiatives
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
– See ¾ in year and 45% in month before suicide
Supporting hard pressed primary care : the basics
– Clinicians decision support templates
– Annual checks : zero exclusion of SMI
– Family and 3rd sector outreach
Primary care at scale initiatives
– integrated ‘Living well’ care stroke, diabetes, pain, COPD, bariatric surgery care
– Named workers in primary care
– Federated effective suicide prevention programmes which have been successful in
Seattle, Canada, New Zealand, Australia, Denmark, and Hungary.
Population based focus based on local need
– Enhanced SMI care in inner cities ?
– Enhanced MUS 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
Suicide prevention:
national and local programmes
3. Crisis care: improvements
– The national transformational model and innovations
(http://www.crisiscareconcordat.org.uk/)
– The Information revolution (e.g. NMHIN, best practice website,
NHS Choices & 111)
– Improving access & best practice in suicide risk assessment and
management e.g. tele-triage Victoria state assessment tools:
– Street triage by mental health professionals with police & paid
for jointly by transport industry and NHS England embedded in
transport hubs
– Local initiatives: suicide ‘points’, e.g. bridges; CALM; ‘Talk to
your neighbour’
MY Ask:
• Is your team/service on NHS Choices?
• Do you have brilliant examples of user voice? Local action?
Reducing avoidable admissions
Commissioning the Care Pathway of Mental Crisis Service
Alternatives to Hospital beds
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Liaison mental health
teams
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Crisis Home Treatment Teams
Trained tele-triage and telehealth to increase access
Single number to access crisis
care
Accessible information to prevent crises and get help early
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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 and can it be amended to add a brief Suicide risk assessment which reduced suicide
5. Information sharing protocols
6. Good practice examples of 111 MH: what can we
learn e.g. Isle of Wight
7. Training: what awareness do 111 staff need in mental health
What lessons can we learn from the triage pilots with British transport police hubs & police street triage
8. MH Pilots to place mental health trained staff in 111: What lessons
can we learn from the
triage pilots with British transport police hubs & police street triage
New focus on high risk groups with long term physical ill-health
Integrated physical and mental health care: Long term conditions
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International research finds that comorbid MH problems are associated
with a 45-75% increase in service costs
per patient (after controlling for severity of
physical illness)
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.
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
Therefore it makes no logical, ethical, or
business sense not to include
psychological
180%
160%
% increase in annual per patient costs
(excluding costs of MH care)
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140%
120%
100%
80%
Depression
Anxiety
60%
40%
20%
0%
New Recovery guidance from NHSE Commissioning & Monitor
Tariffs need to include mental health recovery care to get Value
Mental health policy & partnerships:
‘policy’ focus on implementation
Care pathway
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• 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.
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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
Intensive rehabilitation
closed unit for complex
dual diagnosis
24/7 Assertive outreach /rehabilitation &
recovery team
Open rehabilitation units
Locally authority Residential
rehabilitation
Supported accommodation with care package
24/7 Assertive outreach /rehabilitation &
recovery team
Rehabilitation / recovery team
Rehabilitation / recovery team
CMHT/ Enhanced primary
care SMI with 3rd sector
outreach
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
CMHT/ Enhanced primary
care SMI with 3rd sector
outreach