Mental health strategic clinical network meeting : Yorkshire and Humber SCN

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

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]

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

4. Our children The workforce Senior citizens All communities • 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 • 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 Over 300 spoken languages in UK; many cultural beliefs & mental health issues Over-representation of black people in acute inpatient & forensic care 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 How common are mental health conditions

5. The prevalence of mental health & impact on outcomes

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

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 Organic brain & neurodevelopmental Societal Genetic & biochemical • Life span high risk events • Long term physical conditions • Unemployment • Adolescence • Pregnancy • Bereavement • Migration • Gang/ veteran trauma Biochemical ‘causes’ Caffeine, nicotine, alcohol, street drugs Neurotransmitters Endocrine disorders ADHD, ASD, Dyslexia, Dyspraxia ‘What could we do?’ ‘What should we do?’ ‘How should we do it?’

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………………… • 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 Isaw 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 GPs are trying to do everything for everyone, too much of 21st Century care is being provided through 19th century organisationalmodels……… Professor Michael Porter is a world authority on strategy in business, & has spent the past decade working in healthcare systems in dozens of countries.

11. The economic impact: 2012

12. Mental health has among the most clinically and cost effective treatments of any sectorbut 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. Parity for people with physical & mental health • Integrated physical & mental health & social care • Where every contact is a kind enabling, coaching experience The national care pathways priorities What do we want to commission with partners

17. Step 1: Information for Commissioning value based care pathwayswe 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 in 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 modelHungary Depression & suicide reduction Training, systems redesign, whole team sustainable approach Szantoet al ( 2007

22. GP Master class series 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.

23. AHSNs working with SCNs and LETbs UCLP practice nurse master classes • 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]

24. Acute and unplanned care emerging thinking £ £ £ £ £ £ Intermediate tier

25. 5. Integrated physical and mental health care Long term conditions Mental health raises costs in all sectorsChris Naylor, Kings fund • Overall, international research finds thatco-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

29. Many of the outcomes we achieve for people with schizophrenia and psychosis are unacceptable • 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. www.rethink.org

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 Audit 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, empoweringg

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: £5in year 1 Early intervention of psychosis £18 in year 1 Screening & brief interventions in primary care for alcohol misuse £12Yr 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

37. The route map to delivering the MH strategy