Mental Health

Funding - Gaining parity?

Working across the lifespan

Perinatal Mental Health

This guidance can be accessed via the Maternity Section.

Children and Young People

Children and Young people’s Mental Health and Wellbeing

The government has pledged £1.25billion by 2020 to support improvements in children and young people’s mental health and wellbeing, along with £150million for eating disorder services

Following a Ministerial Children and Young People’s Mental Health and Wellbeing Taskforce, Future in Mind was published in March 2015, a report which established a clear and powerful consensus about change across the whole system to improve children and young people’s mental health and wellbeing.

TVSCN Offer to Support the Children & Young People Mental Health ambitions

Eating Disorders

In Autumn 2014 Government announced additional funding of £30million per year for 5 years to ensure that children and young people with an Eating Disorder (ED) get specialist help early, enabling them to be treated in their community with effective evidence based treatment. Progress in the Thames Valley to date:

Integration of Physical & Mental Health

The Five Year Forward View makes the case for three levels of integration: health and social care, primary and specialist care, and physical and mental health care. The MH Taskforce report further reinforces the importance of the third dimension – that of physical and mental health

The need to integrate mental and physical care

Mental and physical comorbidity is common:

• 80% of hospital bed days occupied by people with comorbid physical and mental illness
• 30% of general hospital inpatients have dementia and 20% have delirium
• 30% of medical outpatients have symptoms not fully explained by a medical condition and often associated with mental illness
• People with severe mental illness have almost 7 times more emergency inpatient admissions, and 3 times the rate of Accident & Emergency attendances, of which half was unrelated to mental health need, instead driven by urgent physical health care

Mental and physical comorbidity is important because it causes:

• Poorer patient experience with fragmented care
• Poorer clinical outcomes for patients through reduced treatment adherence and reduced Quality of Life
• Substantially increased healthcare costs through prolonged hospital admission and increased unplanned medical care

Evidence indicates integrated services for patients with comorbidity can:

• Improve patients’ clinical outcomes
• Reduce resource use, through reduced length of stay and re-admissions

People with severe mental illness (SMI) have a lower life expectancy of up to 25 years and poorer physical health outcomes than the general population. Evidence suggests that is caused by a combination of factors:

• lifestyle (physical inactivity, an unhealthy diet, and a high smoking  prevalence)
• physical health side effects such as psychotropic  medication eg, raised risk of obesity
• socio-economic  poverty,
• social isolation
• discrimination
• abuse, neglect, trauma,
• drug dependencies and;
• barriers to accessing physical health care (stigma, complex referral systems or ‘diagnostic overshadowing’)

Areas for Improvement

The interaction between mental and physical health has important consequences at all levels of the health and social care system. The Kings Fund report (“Bringing together physical and mental health: A new frontier for integrated care” March 2016) describes 10 areas where there is particular scope for improvement

To commission effective integration of physical and mental health care relies on a number of key changes, including the commissioning of care navigator roles to support patients through their local systems. Other changes such as simplified service processes, shared protocols and joint funding/commissioning arrangements are synonymous with good commissioning however committed strategic leadership combined with motivated, energised and well trained staff are the cultural levers to ensure this change can be delivered on.

Case Study – Care Navigators & Integrated Care

Liaison Psychiatry

National Ambition for Liaison Psychiatry

By 2020/21 all acute hospitals will have an all-age mental health liaison service in place and at least 50% of these will meet the ’Core 24’ service standard as a minimum.

It is important to note there is no single established model, however (among other operational models) one approach proposed by the Oxford AHSN is the:

Integrated psychological medicine  model (AHSN 2016)

 Key features of this approach are that it is :

• Commissioned through the medical service provider
• Designed around needs of patients with the medical provider
• Delivered as part of the medical service

The benefits of this model include:

• Better meets needs of acute hospitals, primary care services
• Integrated within medical specialties to deliver ‘whole person care’
• Provides supervision and training for clinicians to upskill medical system
• Improved accountability of care to the organisation caring for the patient
• Allows systematic management of comorbidity to reduce cost

Improving Access to Psychological Therapies (IAPT)

The Mental Health Taskforce Report gives a commitment to:

1. Expand access to IAPT services to meet 25% of need with a focus on people living with long-term physical health conditions by 2020/21
2. At least double the number of “employment advisors” in IAPT services.
3. Maintaining and developing the quality of existing IAPT service

Expansion of Access to IAPT

Most of this expansion will be achieved through developing co-located IAPT services alongside physical health services – with a focus on those people with anxiety/depression in the context of a long term condition, co-morbid mental health problem or persistent unexplained physical problem (previously known as medically unexplained symptom).

Bids to develop this integrated IAPT care model have been agreed across Oxfordshire, Buckinghamshire (x 2 CCGs), Berkshire East (x4) and Berkshire West (x4). NHS England will be reviewing plans for robust and generalizable evidence on savings and quality outcomes for these population groups.

Employment Advisors in IAPT services

It is widely recognised that there is a strong inter-relationship between employment and good mental health: work can be actively good for health, and good health means that you are more likely to be employed, and to have more choice about the sorts of work you do. However, the employment rate for people with mental health conditions remains unacceptably low: 43% of all people with mental health problems are employed compared to 79% of the general population with no health conditions.

Central funding has been made available for CCGs to support the employment of new Employment Advisors within IAPT services and all CCGs in Thames Valley have been invited to bid for the funding – key to this funding will be to build a strong evidence base to support future investment in employment support and evaluate the impact of their mental health, productivity at work and supporting people to return, remain or find work

Performance

This year’s data on IAPT performance and comparator information can be accessed at the links below.

Recovery rates – May 16

First treatment 18 weeks finished Course

First treatment 6 weeks finished course

Best Practice – Are your services optimal?

The evidence base for what makes a high quality IAPT service is growing.  The Royal Colleges of Psychiatrists, General Practitioners, Physicians and the British Psychological Society suggests that high quality IAPT services have a number of key characteristics

Prevention of Mental Illness (including Suicide)

Mental Health Taskforce has identified Prevention of Mental Illness as a top priority. Areas of improvement include;

• Targeted support for new mothers and babies
• Mental health promotion within schools and workplaces
• Self-management of mental health
• Ensuring good overall physical and mental health and wellbeing,
• Early intervention to stop mental health problems escalating

The Five Year Forward View recommends by 2020;

Thames Valley Performance

Most areas of the Thames Valley are below the England average on suicide. However, the rate of suicide in Thames Valley has remained more or less stationary in the last few years. This suggests considerable room for improvement in reducing the incidence of suicide in the region.

TVSCN are committed to reducing suicide year on year. Suicide has a significant impact on society and is a major cause of death and disability (Zalsman et al 2016). Suicide is a complex issue involving an interaction of genetic, psychological, social, and cultural risk factors, combined with experiences of trauma and loss (Zalsman et al 2016) and as such TVSCN recommend a multi-agency, regional approach to suicide prevention.

Although the evidence to support individual suicide prevention interventions remains limited there is strong evidence that restricting access to lethal means is associated with a reduction in suicide (Zalman et al 2016). Furthermore, evidence suggests that a tailored preventive approach targeting specific risk groups e.g. psychiatric patients, children and adolescents, older people, and ethnic minorities is effective (Zalman et al 2016)

National data shows that suicide currently stands as the biggest single killer of men aged under 45 in this country (ONS 2015). Nearly 4 times as many men aged 20 to 34 died as a result of suicide and injury or poisoning of undetermined intent than women (ONS 2015). Data available for Thames Valley presents a similar picture.

Work underway in Thames Valley

Early Intervention in Psychosis

EIP as key priority for the NHS

From 1 April 2016 a new national standard for EIP services was introduced. The delivery of this standard is one of the national commitments for 2016/17 in both the Mandate and the NHS Planning Round.

More than 50% of people experiencing first episode psychosis should be treated with a NICE-approved care package within two weeks of referral.

Following the recommendations of the Mental Health Taskforce, NHS England has committed to ensuring that  by 2020/21, the standard will be extended so that:

At least 60% of people experiencing first episode psychosis are treated with a NICE-approved care package within two weeks of referral.

The EIP Implementation Guide for Commissioners and Providers can be accessed here

Thames Valley Performance

Current Thames Valley Performance on EIP access standards (click to access data)

Average investment per patient (Thames Valley & MK)

Duration of Untreated psychosis <90 days

Care Coordinators – Thames Valley

Best Practice – Oxford AHSN EIP Preparedness Programme

Dementia

Bold Transformation for Dementia care in England – High quality care focussed on Wellbeing pathway

Thames Valley priorities for Dementia – 2016/17

Dementia Diagnosis Rates (DDR) – August 15 – July 16

As can be seen, wide variation still exists in dementia diagnosis rates across the Thames Valley and Milton Keynes CCGs

Post Diagnostic Support

People with dementia and their carers feedback;

• that support ideally needs to be from a single person and,
• the advice needs to be bespoke, and response needs to be timely.

Dementia advisors play a key information sharing role in this and a three step approach of support is recommended (ABC model);

• Advice and information provided in a timely and prompt manner
• Bespoke information available when needed
• Complex clinical care provided by Admiral nurses (dementia specialist nursing provided by Dementia UK)

Primary Care and Community support for those people with or who support those with Dementia

Professor Alistair Burns (National Clinical Director for Dementia) breaks this down to the 5 P’s:

Dementia Friendly Practices

In November 2014 TVSCN and Health Education England launched a joint scheme inviting local GP practices to bid for funding to support them to become “dementia friendly”.

The Pilot review and links to resources can be accessed by clicking here

The practices were tasked with improving both their physical environment, management processes, staff awareness and training to ensure patients and carers receive the care and attention they require when visiting the practice, using SPACE principles

Dr Sian Roberts (GP project Lead – John Hampden Surgery) notes; “I am passionate about identifying our patients with dementia. Being diagnosed in a timely way will enable patients to access the right treatments and find the best source of support, as well as being able to make decisions about the future. In doing so, patients can “live well” with dementia and maintain a good quality of life”

The key message from Dementia Friendly Practices pilot is to “focus on the quality, the outcomes will follow”

The pilot outcomes, harnessed with leading evidence from our colleagues in Hampshire CCGs shows the quality improvements can have a positive effect on patients, as well as aiding constitutional standards.

Dementia Friendly Communities

Dementia Friendly Communities is a community based programme aiming to facilitate the creation of dementia-friendly communities across the UK.

Everyone, from governments and health boards to the local corner shop and hairdresser, share part of the responsibility for ensuring that people with dementia feel understood, valued and able to contribute to their community.

More information can be accessed through the Alzheimer’s Society webpages