Modernising Mental Health

1. Modernising Mental Health Engagement Events, July 2011

2. Objectives of this event • The purpose of this event is to help us understand your views and future priorities regarding mental health services in Bristol as we move towards achieving modernisation by April 2013

3. Reasons for this Event NHS Bristol is committed to providing safe, effective, high quality and sustainable mental health services that support the needs of our multicultural services users. In spring 2011 NHS Bristol commissioned an initial scoping exercise to assess the level of satisfaction with the current provision of mental health services in the City This scoping exercise revealed a strong desire and belief among GPs, service users and other stakeholders, that mental health services could be improved and modernised. Today’s event is aimed at hearing what you think.

4. “In Principle” – what we mean In response to the findings of the scoping exercise, and the desire to improve mental health services, the PCT Board made a decision in principle to re-commission certain services currently provided by Avon and Wiltshire Partnership Trust and Turning Point from 2013. Services will be re-commissioned as part of the normal commissioning cycle No decision has been made as to how this re-commissioning will be undertaken: we want to know what you think first.

5. The services we are talking about NHS funded mental health services for: • adults of working age • older people • Community and inpatient support • Primary and secondary care Linked to but not directly affected: • Social Care Services • Children’s Services • Learning Disability Services • Most Voluntary/3rd Sector Services • Specialist Commissioned Services (e.g., forensic services)

6. The National Context • The Economic Climate – need for value for money • The Coalition Government & White Paper • No Health Without Mental Health document • Talking Therapies: a four-year plan of action • Clinical/GP Commissioning • Payment By results/Outcome Focus - Loosening of some targets and requirements to enable innovation

7. Bristol -The changing Demographics The current population of Bristol is estimated as 433,078 This has grown by 11% between 2001-2009 (4.5% nationally) Population expected to rise to 548,100 by 2026 30% of children in Bristol’s schools are of a Black and Minority Ethnic heritage (BME) Increasingly diverse and ‘young’ population - Yet aging population: greater demand on dementia services There are clear links between mental health need and deprivation – Bristol has areas of significant deprivation as well as wealth Bristol needs to create a mentally healthy environment for everyone

8. People in Bristol • There are estimated to be 370,000 adults over 16 years of age. • At any given time, 1 in 4 of these people at some point in their life will experience some form of mental distress. This equates to approximately 90,000 people • More than half of these people will require mental health support (primary and secondary care) – circa 55,000 people • More than half of those who access mental health support will have more than one condition – circa 30,000 people

9. Co-morbidity (multiple diagnoses) adults with functional conditions Around 30,000 (or 8% of over 16s) of Bristol residents are estimated to have more than one mental health condition in 2010, rising to 32,000 by 2015. Some of the most common of these include: • Psychotic disorder • Anti-social personality disorder • Panic disorder/Phobia/Anxiety • Depressive episode • Borderline personality disorder • Obsessive Compulsive Disorder • Post Traumatic Stress Disorder

10. Dementia – and organic conditions There are different types of dementia, affecting all ages, ethnicities and classes Nationally there are approximately 750,000 people with dementia and this number is expected to double in the next 30 years (NDS) In Bristol it is calculated there are up to 5,921 people living with a form of dementia (based on 2008 JSNA, POPPI figures) Only 1,767 (23%) of these are known to GP services (Bristol Dementia strategy 2010) By 2028 it is expected that this number will increase to 7,895 people (33% increase) Bristol has a Dementia Strategy supported by a multi-agency partnership which is leading this work

11. Tiers of support

12. Changes already underway • Reducing bed numbers and moving towards community based/primary care focused services • Improving links between health, social care and 3rd sector agencies • New pathways for dementia care • Crisis house for men – 2012 • Increased ‘Talking Therapies’

13. Best Practice for Mental Health An effective mental health programme should include: An integrated strategy to support population mental well-being An effective promotion, prevention and early intervention programme for children and young people A targeted prevention and early intervention programme addressing high risk groups and key risk factors An effective primary mental health service Access to effective specialist mental health treatments Well resourced community and voluntary sectors providing network of non – stigmatised support for recovery, inclusion and well being.

14. Wrestling with key questions Does Bristol need its own model of service delivery given it is more urban and diverse than the surrounding rural areas? Ageless services, what are they and how do we achieve them? Should the priority of future investment be towards primary and preventative services or targeted towards those people in the greatest need? Have the specialist teams introduced over the past decade been a success? Where should the distinction be between social care, primary and secondary mental health care?

15. What will happen next? Engagement and involvement process throughout July and August Collation and presentation of findings – (including clinical evidence report and ‘what we heard’ during the stakeholder engagement process) at an Open Conference on the 5th October 2011. Development of final report for presentation at the Board of the three clustered local PCT’s on 23rd November 2011 We welcome submissions of local evidence (contact details final slide)

16. www.avon.nhs.uk/mhsurvey

17. Thank You! For further information or to share your views please contact Sally Whitley on 0117 900 2623 or sally.whitley@bristol.nhs.uk To submit further clinical or best practice evidence to the Clinical Reference Group, please contact Christina Gray via christina.gray@bristol.nhs.uk

18. Coffee & Tea Break

19. Listening to you • Question 1: Which mental health services in Bristol are working well and which ones are not? • What examples do you have for each? • Task: Capture • Your thoughts – general small group discussion • Your priorities – rate and agree priorities

20. Listening to you • Question 2: What positive developments would you like to see in the provision of mental health services? • Task: Capture • Your thoughts – general small group discussion • Your priorities – rate and agree priorities

21. Listening to you Question 3: Which three positive changes do you feel would most improve mental health services in Bristol? • Task: Capture • Your thoughts – general small group discussion • Your priorities – rate and agree priorities

22. Listening to you • Question 4: Which three positive changes do you feel would most support people deliver mental health services in Bristol? • Task: Capture • Your thoughts – general small group discussion • Your priorities – rate and agree priorities