National Mental Health Programme

This presentation about the National Mental Health Programme by Dr Geraldine Strathdee, National Clinical Director of Mental Health, NHS England, was delivered at the launch of the Strategic Clinical Network for Mental Health, Dementia and Neurological Conditions Yorkshire and the Humber on 17 September 2013.

Geraldine covers:
- How common is mental ill health
- What are we trying to achieve
- What are the priorities
- Progress update
- How can we help and what can we learn from Yorkshire and Humber
- We need your leadership, your expertise and your drive!

1. Mental health strategic clinical network meeting : Yorkshire and Humber SCN Dr. Geraldine Strathdee, National Clinical director, Mental H ealth

2. Today’s discussion How common is mental ill health What are we trying to achieve What are the priorities No health without mental health’ national strategy NHS Mandate Emerging SCN priorities across the country Progress update How can we help and what can we learn from Y&H We need your leadership, your expertise and your drive! NHS | Presentation to [XXXX Company] | [Type Date] 2

3. NHS | Presentation to [XXXX Company] | [Type Date] 3 How common is mental ill health

4. How common are mental health conditions Our children 1 in 5 under the age of 15 Only 25% can access care 50% bullied, leading to: Depression Low self- esteem Suicide 1: 10 have unrecognised dyslexia, dyspraxia The workforce 1 in 6 adults at any time 1: 10 have depression Suicide is the greatest cause of male deaths < 35 yrs Work related stress affects 1.5 million 5.6 million work days lost a year Senior citizens Dementia effects 5% over 65’s 10-20% over 80 1 in 6 over 65 suffer from depression Major factors: Social isolation Physical ill- health 30% of >65s in Acute Trust beds have dementia All communities Over 300 spoken languages in UK; many cultural beliefs & mental health issues Over-representation of black people in acute inpatient & forensic care

5. The prevalence of mental health & impact on outcomes Prevalence ICD conditions Outcome impact Primary care : 30-50% of daily workload Depression & anxiety Substance misuse Children's conditions Premature mortality : 15-25 years Quality of life in LTCs Recovery from illness Patient safety Patient experience Acute care 20%-40% of A/E in 40% acute beds 50% acute LTC outpatient clinics Alcohol & drugs Depression & self harm Depression Dementia Premature Mortality Quality of life for LTCs Recovery from illness Patient safety Patient experience Prisons & offenders 70-80% especially young men ADHD, ASD Depression Substance misuse PD Premature Mortality Specialist mental heath services Psychosis Neurodevelopmental Substance misuse Personality disorders Complex multi axial Premature Mortality : 15-25 years Quality of life in LTCs Recovery from illness Patient safety Patient experience

6. D epression : think about the causes & solutions follow.. opportunities for demand management, prevention & early intervention across Value care pathways Elderly isolated & people with dementia Victims of domestic violence Alcohol and drug addictions Isolated women with small children Victims of school and employment stress and bullying Key life cycle: Divorce Retirement Redundancy Menopause Long term physically ill Dyslexia, Dysprexia ADHD, Autism, Asperger ’ s and Learning Disabilities People with schizophrenia and sight and hearing problems

7. 3. The top 10% of Mental health conditions : service redesign for prevention, earlier identification & better access & treatment for young eople The origins and causes of mental ill health The life span health & social determinants of mental health conditions Genetic & biochemical Organic brain & neurodevelopmental Societal ‘What could we do?’ ‘What should we do?’ ‘How should we do it?’ ADHD, ASD , Dyslexia, Dyspraxia Biochemical ‘causes’ C affeine, nicotine, alcohol, street drugs Neurotransmitters Endocrine disorders Life span high risk events Long term physical conditions Unemployment Adolescence Pregnancy Bereavement Migration Gang/ veteran trauma

8. What Outcomes do our service users ask us to support them achieve

9. What Outcomes do our patients ask us to achieve in partnership with them Professor Bruce Keogh, Medical Director of the NHS

10. Parity : NHS Mandate: what does it mean in practice From a London GP ………………… GPs are trying to do everything for everyone, too much of 21 st Century care is being provided through 19 th century organisational models……… Professor Michael Porter is a world authority on strategy in business, & has spent the past decade working in healthcare systems in dozens of countries . I was struck the other day when I saw a patient -  who has been off work for 3 months waiting for CBT. He is depressed and was just told to go on sick leave-  no medication, just a referral for CBT in the distant future. When I saw him , what upset me most was that if he had broken his leg, he would have been treated asap , given rehab, told to go to work on crutches and would not have just been abandoned . I want to make it impossible for mental health problems to be treated as second class illnesses - with patients with treatable conditions languishing on waiting lists or worst still with no treatment at all Clare Gerrada

11. The economic impact: 2012

12. Mental health has among the most clinically and cost effective treatments of any sector but access is low and a post code lottery

13. What are the priorities & progress No health without mental health’ national strategy NHS Mandate & Suicide prevention strategy Emerging SCN priorities across the country AHSNs LETBs New funding streams

14. Emerging System priorities ..a system based on value, equalities & shared learning

15. CCG GP Mental health leadership programme Knowledge based leadership for high impact and improving outcomes ….……a new model of leadership

16. The national care pathways priorities What do we want to commission with partners Parity for people with physical & mental health Integrated physical & mental health & social care Where every contact is a kind enabling, coaching experience

17. S tep 1: Information for Commissioning value based care pathways we have commissioned unique whole care pathway health & social care information for every CCG

18. Clinical and economic best commissioning tools

19. 2. Primary mental health care i n England internationally: they are using systems thinking around the many roles of GPs

20. International learning : Primary care mental health service organization : a ‘ stratification’ approach & federated models e.g. ‘ ( Kaeser , Scandanavia , US Vets

21. An example of a federated model Hungary Depression & suicide reduction Training, systems redesign, whole team sustainable approach Szanto et al ( 2007

22. Shared whole pathway learning Oxleas NHS Foundation Trust runs a series of free evening masterclasses on mental health and learning disability issues for primary care professionals. The aim of the series is to: Provide GPs with updates on the current evidence-based treatments for common mental health conditions Share information on new assessment tools Share best practice care pathways Topics have included depression, dementia & child & adolescent mental health issues . GP Master class series

23. AHSNs working with SCNs and LETbs 2. 5 hour Masterclass for practice nurses Masterclass developed by a practice nurse mental health expert with RMNs Train the trainer model : 1 specialist MH nurse trainer per CCG 2.5 hour master classes in each `CCG area for 20 PNs 800/1400 London practice nurses trained in 6 months New modules in depression, suicide prevention, planned NHS | Presentation to [XXXX Company] | [Type Date] 23 UCLP practice nurse master classes

24. Intermediate tier Acute and unplanned care emergin g thinking £ £ £ £ £ £

25. 5. Integrated physical and mental health care Long term conditions Mental health raises costs in all sectors C hris N aylor, Kings fund Overall, international research finds tha t co-morbid 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.

26. Co-morbidity is the norm Lancet, Barnett, Mercer et al 2012

27. 2012 publication Compendium of examples of cost effective programmes for people with physical illnesses in acute trust, primary care settings

28. The Ian Galton challenge: an integrated dementia, MH and neurological plans Dementia MH Neurology Our integrated support processes: The MH intelligence network will include dementia & neurology CCG commissioning & quality improvements x x x The SCN website: sharing intelligence & updates x x x Mandate : we are working on it as part of a shared governance agenda & the delivery of ICD dementia diagnosis and improved care and IAPT and liaison crisis services x x Particular service models and clinical pathways we are working on in an integrated way The acute and unplanned care programme : inputs to ensure care for people with dementia, self harm, relapsing psychosis & alcohol related d neurological and dementia conditions e.g. Korsakoffs and Wernicke x x x Integrated care pathways for alcohol and young onset dementia & cognitive impairment x x x Dementia DES integrated care pathways for delirium and dementia better diagnosis and assessments? Pt safety: supporting NHS E to implement patient safety for falls and medicines optimisation x x x Integrated physical and Mh care factsheet series between NCDs and MH field experts x x Medically unexplained symptoms common pathway : would love to support neurological MUS & IAPT x x Specialist commissioning group in brain injury are including MH assessment x x x ICD coding in HES and MHMDS: drive up quality in recording diagnosis and better more rapid discharge summaries? x x x Others: PQ what we are doing re ASD and Asbergers services x x

29. Many of the outcomes we achieve for people with schizophrenia and psychosis are unacceptable www.rethink.org Excess mortality – people dying 15-20 years earlier. Poor social outcomes – only 8% in employment. Overrepresentation of people with schizophrenia/psychosis in prison or amongst homeless population. Very high levels of stigma and misunderstanding. Cost to society of £11.8 billion.

30. Value based Integrated care pathways design : commissioning for 60% volume, 60% spend; top 10%

31. 3. The care of people with psychosis In 2012, the National schizophrenia Commission & National A udit of Schizophrenia found: examples of good practice Wide variation in standard National data shows changes away from demonstrated models of evidence based care The need to ‘ industrialise improvement in 5 core areas of care: Physical health Safe optimised medicines Psychological therapy Inpatient care Care plans that are personalized, empowering g

32. Key partners & network members to build synergies ( not inclusive )

33. 2012 publication Compendium of examples of cost effective programmes for people with physical illnesses in acute trust, primary care settings

34. Prevention and Early intervention (Knapp et al, 2011 ) highly effective treatments: major economic benefit For every one pound spent the savings are: Parenting interventions for families with conduct disorder : £ 8 Early diagnosis and treatment of depression at work: £ 5 in year 1 Early intervention of psychosis £18 in year 1 Screening & brief interventions in primary care for alcohol misuse £ 12 Yr 1 Employment support for those recovering from mental illness: Individual Placement Support for people with severe mental illness results in annual savings of £6,000 per client (Burns et al, 2009) Housing support services for men with enduring mental illness: annual savings: £11,000–£20,000 per client (CSED, 2010).

35. Proportion in UK with mental disorder receiving any intervention (Green et al, 2005; McManus et al, 2009) 28% of parents of children with conduct disorder 24% of adults with common mental disorder 28% of adults screening positive for PTSD 81% of adults with probable psychosis received some form of treatment compared to 85% in 2000. 65% of adults with ‘ psychotic disorder ’ in past year 14% of adults dependent on alcohol 14% of adults dependent on cannabis only 36% of adults dependent on other drugs Less than 10% of older people with depression receive adequate treatment

36. The prevalence of mental health & impact on outcomes Prevalence ICD conditions Outcome impact Primary care : 30-50% of daily workload Depression & anxiety Substance misuse Children's conditions Premature mortality : 15-25 years Quality of life in LTCs Recovery from illness Patient safety Patient experience Acute care 20%-40% of A/E in 40% acute beds 50% acute LTC outpatient clinics Alcohol & drugs Depression & self harm Depression Dementia Premature Mortality Quality of life for LTCs Recovery from illness Patient safety Patient experience Prisons & offenders 70-80% especially young men ADHD, ASD Depression Substance misuse PD Premature Mortality Specialist mental heath services Psychosis Neurodevelopmental Substance misuse Personality disorders Complex multi axial Premature Mortality : 15-25 years Quality of life in LTCs Recovery from illness Patient safety Patient experience

37. The route map to delivering the MH strategy

38. mentalhealthpartnerships.com

39. Clinician led and collaborative A portal for clinician led partnerships to support, accelerate and improve commissioning and service redesign Providing collaborative tools for networks, organisations and individuals to improve services and the health and wellbeing of communities

40. S upported and supportive Helping you to: promote and disseminate consult and engage f ind and share what works best recommend and comment network and l earn from elsewhere identify and access expertise