Mental Health Implementation Board

1. Mental Health Implementation Board 15 August 2007

2. Mental Health Implementation Board15 August 2007 Alex McMahon and Denise Coia

3. Background • Delivering for Mental Health – 5/12/2006 • LDP/trajectories for targets in place – April • First implementation visits – April/May • Report back to CEs – July

4. Overview • Good energy, with Boards using DfMH to drive service improvement • Top teams at review meetings (though some interesting gaps) • Need to improve evidence gathering to better assess and benchmark progress • Generally good progress, but CAMHS challenging

5. Commitments with Boards • 3 – Depression • 4 – Psychological Therapies • 5 – Physical Health • 8 – Crisis Standards • 9 – Acute Inpatient Forums

6. Depression • Most areas seem to know what they know • Standardised tools generally being used (but we don’t know much about coverage across GP practices) • Some therapies in place in some places (more to come as part of ICP implementation) • Some areas using stepped care approach • Action on CHD/diabetes co-morbidity less evident • Most areas have plans, but many unresolved issues and question over pace of change

7. Psychological Therapies • Generally good information about staff trained to deliver therapies, but poor information about therapies being delivered • Local planning arrangements mostly in place • NHS NES developing plans to significantly increase number of trained staff (with appropriate supervision) • Improvement Collaborative will focus on redesign to ensure skills are used • Action point for HD – set baseline for commitment

8. Physical Health • Evidence of good progress, But some Boards flagging need for support and guidance (consultant adviser in place) • Very different approaches being taken (GP; day hospital; secondary services; etc.) • Some Boards moving beyond the commitment to match interventions to assessed needs • Some Boards taking approach into inpatient settings • Consultations September to November 2007

9. Crisis Standards • Lots of activity – crisis response; OOH provision, IHTT; etc. • Coverage – geography and time – issues, particularly in rural areas • But delivery not being benchmarked against standards – need for guidance from HD?

10. Acute Inpatient Forums • No forums in place yet, but discussions underway and local models being developed • No significant problems identified with regard to 2009 timescale • Issues with respect to Orkney and Shetland and their use of mainland facilities • Main challenge will be in demonstrating added value • Similar issues – staff engagement, environment, activity, privacy – raised for continuing care wards by MWC report

11. Commitments with HD • 1 – Cultures and Behaviours • 2 – Peer Support Workers • 6 – ICPs for 5 Diagnoses (NHS QIS) • 7 – Suicide Training for Frontline Staff • 12 – CPA for Restricted Patients • 13 – MH/Substance abuse co-morbidity

12. Support Programme • Leadership Programme – 24 April • Benchmarking Project – August • Collaborative – launch September (has slipped)

13. CAMHS • Leadership and accountability not clear • Significant gaps in intensive community responses • Risks in respect of funding sources • Ongoing discussion about service model for specialist services • ? Need for clearer statement of necessary service elements

14. New Challenges • Possible revised commitment to 10% reduction by [2009] in anti-depressant prescribing • Dementia now a higher priority • Focus on health improvement and public health approaches

15. Next Steps • Board specific letter to each NHS CE • Further work on how we gather and present evidence • Focus on HEAT targets for Annual Reviews • Next visits in October/November • Guidance on Substance Misuse and on Physical health- December / January

16. Mental Health Implementation Board 15 August 2007

17. MENTAL HEALTH and SUBSTANCE MISUSE Peter Rice, Consultant Psychiatrist, NHS Tayside and Chair, Mental Health and Substance Misuse Group

19. THE MENTAL HEALTH and SUBSTANCE MISUSE GROUP • To improve the awareness of co-occurring mental health and substance misuse problems and • To improve support and service provision for people who have both mental health and substance misuse problems. • Our goal is to enable individuals to improve their life chances and live to their potential.

20. MENTAL HEALTH AND SUBSTANCE MISUSE GROUP Dr Peter Rice (Chair): Consultant Psychiatrist, Tayside Alcohol Problems Service, NHS Tayside Dr Alex Baldacchino: Director, Centre for Addiction Research and Education Scotland, University of Dundee Dr Seonaid Anderson, Specialist Registrar, NHS Grampian (from December 2006) Dr Stephen Bell: Consultant Clinical Psychologist and Neuropsychologist, NHS Grampian Dr David Blaney: Director of Postgraduate GP Education, NHS Education Scotland Jim Carroll: Clydebank Addiction Team Dr Fiona Clunie, Consultant Psychiatrist (Rehabilitation), NHS Lothian and Chair of Rehabilitation Sub Group, Dr Denise Coia: Psychiatric Adviser, Scottish Executive Health Department Frank Fallan: Voices of Experience (VoX) (from January 2007) Dr Andrew Fraser: Director of Health Care, Scottish Prison Service Ellen Hair: Planning and Commissioning Officer, Mental Health Services, Edinburgh an (ADSW) Dr Audrey Hillman: Consultant Psychiatrist (Mental Health and Substance Misuse), Inverclyde Community Health Partnership, NHS Greater Glasgow and Clyde Dr Charles Lind: Consultant Psychiatrist (Substance Misuse), NHS Ayrshire & Arran Chris Lock: Voices of Experience mental health service user representation (to November 2006) Dr Tom MacEwan: Consultant Psychiatrist (Old Age Psychiatry), NHS Grampian Mike McCarron: Association of Alcohol and Drug Action Teams, National Substance Use Liaison Officer Lorraine McGrath: Scottish Association for Mental Health Dr Debbie Mountain: Consultant Psychiatrist (Rehabilitation), NHS Lothian and Chair of Rehabilitation Sub Group Dr Donald Mowat: Consultant and Clinical Director in Old Age Psychiatry, NHS Grampian Karen Norrie: Addictions Adviser, Scottish Prison Service Barbara O’Donnell: National Alcohol Liaison Officer, Alcohol Focus Scotland Chris Park: Acting Service Manager – Alcohol and ARBD, Inverclyde Council Dougie Paterson: National Operations Manager, Choose Life (from October 2006) Jacqui Pollock: Carers Scotland and also representing Princess Royal Trust of Carers and Coalition of Carers in Scotland Eunice Reed: Consultant Clinical Psychologist (Substance Misuse), NHS Lothian Gail Reid: Secondary Services Manager, Glasgow Addiction Services, NHS Greater Glasgow and Clyde Linda Reid: Senior Mental Health Liaison Officer, Scottish Executive Health Department Marion Shawcross: Mental Welfare Commission for Scotland Addie Stevenson: Director of Children and Family Services, Aberlour Child Care Trust Clive Travers: Head of Mental Health, North Community Health Care Partnership, NHS Greater Glasgow and Clyde Alan Wilson: Al-Anon (from November 2006)

21. THE NATURE OF THE GAP • “Individuals with substance misuse-related issues often did not have sufficiently severe mental health problems to be eligible for attention from community mental health teams which prioritised severe and enduring mental illness.” (CARES report) and • “Despite high prevalence rates of drug misuse, only a small number (less than 5%) of mental health patients exhibited patterns of drug use that would have been likely to satisfy eligibility criteria for statutory drug treatment programmes in their areas mainly because they were not opiate users.” (Department of Health 2004)

22. PROMOTION, PREVENTION & COMMUNICATIONS • Promotion and prevention policy, strategy and delivery for addressing substance misuse and mental health problems and illness should be part of and integral to broader promotion and prevention action. • These promotion/prevention strategies and actions should also highlight and target those populations most at risk and the interventions that are most effective in minimising risk and promoting protective factors.

23. SUICIDE PREVENTION • of UK suicides in contact with services: • 27% have “dual diagnosis” • 50% have a history of alcohol problems • 37% have a history of drug problems • 13% of Scottish drug overdose deaths “intentional”

24. SUICIDE PREVENTION • Substance misuse services should be involved in and provide training in suicide risk assessment and prevention in line with commitment 7 in Delivering for Mental Health. • Drug Related Death Monitoring Groups and Choose Life and Suicide Prevention Groups should work together. • NHS boards should establish a mechanism to monitor alcohol related suicide trends.

25. STIGMA • Identified as a major issue in user consultation • Scottish research work with staff indicates problems • Training and supervision programmes improve staff expectations and attitudes

26. RESEARCH and MONITORING • To continuously monitor the epidemiology of co-morbid mental health and substance misuse issues in Scotland • To evaluate of current practice to ascertain efficiency and effectiveness • To study the impact of parental co-morbidity on children • To understand the prevalence, type and impact of co-morbidity present in the prison, psychiatric and general practice populations

27. IDENTIFICATION • All substance misuse and mental health agencies should have assessment processes which identify co-morbidity systematically to match care appropriate to level of need • We have suggested validated tools to identify co-morbidity • Recognise the training needs for services to use these

28. SERVICE PLANNING AND DELIVERY • Improve public awareness of the relationship between substance use, misuse and mental health as part of stepped care approach. • Substance misuse services should develop knowledge, skills and capacity in psychological treatments for substance misuse and to meet the mental health needs of their client group. • NHS mental health services should have the lead coordinating responsibility for care for those whose mental health needs are severe and enduring and whose needs are best met within specialist care, for instance, by integrated care pathways.

29. TRAINING • A training strategy should be developed by NHS boards and partner agencies, including NHS Education Scotland • The Alcohol and Drugs Workforce Development Strategy Group should include mental health competencies within their remit • Other accreditation bodies should consider the needs for skills development in co-morbidity in their criteria

30. ALCOHOL RELATED BRAIN DAMAGE (ARBD) • Limited data, but major concern by housing agencies • Improve identification and stepped approach to assessment • Improve prevention by population and high risk approaches • Development of cognitive impairment complex and multi-factorial • Care needs best met alongside other forms of cognitive impairment and brain injury • Need for strategic review of services for younger people with cognitive impairment and brain injury

31. SPECIAL CONSIDERATIONS • Older People • - Demographic trends • - Lack of research on effectiveness • Children and Young People • Impact of parental problems • Services for younger people • Learning Disability • Distinct needs for health promotion and services • Trauma and Abuse Survivors • Staff competencies • Stepped care approach

32. PROCESS AND PROGRESS • 4 August 2006 First Meeting of Group. • May/June 2007 Late Draft Discussions with: • - NHS Health Scotland • - Health Improvement • - Mental Health Division • - Public Health and Substance Misuse Division • Involvement of Scottish government Ministers • 21 June Consultation draft circulated at Event • George Hotel, 200 attendees • Presentations, facilitated groups, conference report • 21 June Formal Consultation launched • 13 September Consultation ends • 10 December Report Launch

34. Mental Health Implementation Board 15 August 2007