Improving Mental Health Outcomes in Nottingham City CCG.

1. Improving Mental Health Outcomes in Nottingham City CCG. Presentation for Mental health PLT Nov/Dec 2015 Dr Safiy Karim, MBA, MPH, MMedSci(Ed), FRCGP GP locum and CCG – clinical mental health lead Former chairman of Robin Hood cluster

2. Aims & Objectives • AIM – To consider the emerging new pathways in children and adult mental health • Objectives • 1. To help GPs form a management plan for behavioural & emotional problems for children & YP • 2. Better care and management in the community for patients in crisis reducing pressures in A&E, NUH • 3. Refresh on managing psychosis and Subs. Misuse • 4. Provide healthcare resources & signposts

3. What are the areas of focus for Mental health in the City?

4. Joint Strategic Needs Assessment 2011NOTTINGHAM CITY POP 320,000 • 46,000 adults with a common mental health problem such as depression or anxiety (23,000 requiring treatment). Recorded depression prevalence in practices ranged from 0.7 to 21.5. • 2,834 adults with severe mental health problems such as psychosis and bipolar disorder • 3,015 people with dementia • 6,086 adults with a learning disability (1392 classed as moderate/severe /profound) • Approximately 7,000 children and young people est. mhd

5. Commissioning of Mental health Pathways (Evolving Scene) Commissioning of the mental pathway will change significantly following the Governments reforms of the NHS via the Five year Forward View where mental health will have an increased influence • Public Health England and local authorities lead on efforts to prevent mental ill-health • Clinical Commissioning Groups (CCGs) plan and buy mental health services in the local area • Public Health lead on commissioning substance misuse services and NHS England lead on commissioning forensic services and others like in-patient eating disorders. • Health and Wellbeing Boards play an important role in bringing together representatives of all the different organisations in the local area (the local authority, CCGs, national commissioners, patients) to set coherent local strategies. Bringing all these groups together effectively is crucial in ensuring mental health services are well coordinated in the local area. • Strategic Clinical Networks and Clinical Senates are the ‘engines of change’ in the new system and will work across all bodies in their area to promote collaboration and service improvement. • The patient voice in decision making will be organised by Healthwatch England. Patients can get involved through their Local Healthwatch organisations, which have a place on Health and Wellbeing Boards, to have their say on local health priorities.

6. Mental Health Access Targets – April 2016 • Improved Access to Psychological Therapies (15%) • 75% treated within 6 weeks/95% within 18 weeks • First Episode Psychosis • 50% of people experiencing a first episode of psychosis will be treated with a NICE approved package within 2 weeks • Liaison Psychiatry • include a specific focus on liaison mental health services, as well as the quality and treatment for physical conditions

7. SK after 1st s. Children & YP • Face to face and on-line counselling (Xenzone Ltd – KOOTH.com) (10-25), • Early intervention and prevention service • Self-Harm Awareness and Resource Project (SHARP) NCC, Training packages • Harmless (via City Council) mental health training • Eating Disorders in Student Services • ED for children & YP.

8. KOOTH.com Nottingham City F2F Section 1 Period 01 April to 30 June 2015 SECTION 1: REFERRALS • We had 123 referrals in this Quarter, which breaks down to; • April: 40 • May: 37 • June: 46 • This totals 409 referrals in the last 12 months, with 62% of the those being the last 6 months. • Just over 21% of these were self-referrals, with over 65% being from schools. Out of 123 referrals, the source of referrals was; SCHOOL 81 SELF 26 COLLEGE 5 CAMHS 3 GP 2 SOCIAL WORKER 2 PARENT 2 FAMILY SUPPORT 2 Big Wood and Bulwell Academy continue to refer more young people than other schools

9. KOOTH.com Nottingham City F2F Section 1 Period 01 April to 30 June 2015 Referrals by Ethnicity From 123 referrals, 75 were White British. This equates to 61% of referrals being White British, and 39% being from BAME groups. The percentage from BAME groups has increased from 29.5% to 39% this quarter, and the diversity of different groups has also expanded. This is a significant increase in the percentage of BAME groups accessing f2f counselling this quarter. 61 % White British 39% BME Groups Out of 123 referrals, 75 were White British, 8 were White & Black Caribbean, 7 were Any other Mixed Race, 6 were Pakistani, 6 were Any other White, 4 were Any other Black, 3 were White Irish, 3 were Any Other, 2 were African, 2 were White & Black African, 2 were Any other Asian, 1 was White & Asian, and 1 was Chinese.

10. KOOTH.com Nottingham City F2F Section 1 Period 01 April to 30 June 2015 Referrals by Age NUMBER YP AGE (YEARS) We can see that the peak age is 15 this quarter, with 77.24% of referrals in the age bracket of 11-15 years, and 69% of referrals in the age bracket of 12-15 years. We have seen in increase in referrals for the age group 17-18, particularly for 17 year olds. 17% of referrals were ages 16-18.

11. KOOTH.com Nottingham City F2F Section 5 Period 01 April to 30 June 2015 • SCHOOLS WE ARE COUNSELLING IN: • Bulwell Academy • Big Wood (Oak Wood) • Farnborough • Nottingham Girls’ Academy • NUSA • NUAST • Djanogly Academy • Nottingham Academy • Top Valley Academy • Woodlands • Ellis Guilford • Fernwood • Nottingham Free School • Nottingham High School • Nottingham High School for Girls • Equip Education (Alternative) • Catch 22 (Alternative College) • NCN • Bluecoat Beechdale • SCHOOLS WE HAVE PREVIOUSLY BEEN COUNSELLING IN: • Berridge Primary • Trinity School • Bluecoat • Djanogly Northgate • Arnold View Primary • East Leake Academy • Nethergate • Carlton Academy • Redhill Academy • St Peter’s CofE Primary • Haydn Primary • Jubilee Primary • Southwark Primary

12. Eating Disorders – Complaint • In consulting Room • Observe, Ask, Measure, Involve, Act • SPA, priority to better referrals • FBC, ESR, U&E (Na <130, K,2.5), h elec creatinine, Ca, Mg, Ph • Urine output • ECG –prolonged QT (heart is a muscle) • BP (80-90)/(40/50) • Pulse 40-50 • Stand or sit-up without arms • Rate of wt loss • BMI 15-17.5 • Ask • Mot. Change • Cause. Consequence • Co-morb • Social support

13. Aft Crisis …… • IAPT • The new Citywide special ‘PSO’ • Something about MHSOP etc. in pack • One research project which will resource practices for referring screened patients • One research project that may lead to health care for mental illness being delivered in a different format (Healthwatch obs.)

14. Death rates of people known to secondary mental health services compared to the wider population (Nottingham and Nottinghamshire). (Calculated by Nottingham City Public Health)

15. National Audit of Schizophrenia2014 (2nd audit) Summary of Local Findings, November 2014 • Improving the Physical health of people with mental health issues: • National CQUIN - Cardio Metabolic Assessment and Treatment for Patients with Psychoses and communication with GPs (Physform). • RHc  Citywide Pilot for practices re patients on CPA or sig mental illness

16. IAPT referrals in Nottingham City CCGs, highs and lows

18. Helping Urgent Care Users Cope with Distress about Physical Complaints Do you manage the care of patients who struggle to cope with distress or suffer considerable anxiety about physical complaints? Then you might want to help with this study now! “Process to refer is very easy and referral criteria very easy to understand”  (GP taking part) • This study is about people who seek same day primary or secondary care who are distressed and anxious about their health. They may or may not have one or more long-term physical conditions. • Randomised Control Trial, portfolio adopted by the Clinical Research Network. It compares video/telephone delivered psychological treatments versus usual care. • Previous research has shown that such treatment might work in reducing attendance for up to five years but also a reluctance on behalf of these patients to use current mental health services including IAPT. • All patients followed every 3 months for 12 months receiving more support than usual and a chance to reflect. • We aim to find out if this intervention reduces distress, cuts down on same day contacts and is cost effective. • All primary care does is identify appropriate patients and introduce the study to them, the research team do the rest. • The practice receives £75 per patient for any recruited patients. Please refer now by telephone on 0115 8231425 or e-mail urgentcaretrial@nottingham.ac.uk The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM) is a partnership between Nottinghamshire Healthcare and the Universities of Nottingham and Leicester. www.clahrc-em.nihr.ac.uk

19. Internet Support for Anxiety and Depression Study (I-SAD) Do you manage patients with anxiety and depression who have access to the internet and could do with more information and support when ever they require it over the next 6 months? • From April 2016 this study is aiming to recruit 2,000 adults with mild to moderate depression or anxiety in Nottinghamshire. • The person enrols themselves for free on the study internet website (currently being commissioned) and you don’t need to do anything else. • It does not matter if they are already receiving treatment or not. • Everyone scoring 10-20 on the PHQ-9, a self-rated measure of depression, or >10 on the GAD-7, a measure of anxiety will receive additional information or support from Big White Wall or NHS Moodzone immediately following randomisation. Big White Wall, 24/7 on line safeguarded contact with other people with depression and anxiety + information and courses NHS Moodzone 24/7 on line information on anxiety/depression Who can we support by the internet? Is it clinically and cost effective? Assessments at baseline, 3, 6, 12 and 26 weeks on mental well-being, depression, anxiety , function, quality of life, social support and costs. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM) is a partnership between Nottinghamshire Healthcare and the Universities of Nottingham and Leicester. www.clahrc-em.nihr.ac.uk

20. Aims & Objectives • AIM – To consider the emerging new pathways in children and adult mental health • Objectives • 1. To help GPs form a management plan for behavioural & emotional problems for children & YP • 2. Better care and management in the community for patients in crisis reducing pressures in A&E, NUH • 3. Refresh on managing psychosis and Subs. Misuse • 4. Provide healthcare resources & signposts