5 Ways to achieve parity in mental health

1. 5 Ways to achieve parity in mental health Karen Turner Director of Mental Health, NHS England (karen.turner34@nhs.net) 9th December 2015

2. Mental Health • Common mental illness accounts for a half of all morbidity in the working age population. • It accounts for a half of all disability, and reduces the productivity of employed people with mental illness by at least 20%. • Improving mental health is the most significant thing the NHS can do to increase our national income and productivity.

3. The IAPT Argument (Depression Report 2006) Much current service provision focuses on psychosis which deserves attention but affects 1% of population at any one time. Many more people suffer from anxiety and depression (approx.15% at any one time. 6 million people). Economic cost is huge (lost output £17 billion pa, of which £9 billion is a direct cost to the Exchequer). Effective psychological treatments exist. NICE Guidance recommends CBT for depression and ALL anxiety disorders plus some other treatments for individual conditions (EMDR for PTSD, Interpersonal Psychotherapy, Couples therapy, Counselling & Brief Dynamic Therapy for some levels of depression). Less than 5% of people with anxiety disorders or depression receive an evidence based psychological treatment. Patients show a 2:1 preference for psychological therapies versus medication Increased provision would largely pay for itself

4. Start Point & Planning Assumptions – Addressing 15% of Prevalence

5. NHS Mandate – 2015/16 3.9 ………..extending and ensuring more open access to the Improving Access to Psychological Therapies (IAPT) programme, in particular for children and young people, and for those out of work, and to continue planning for country wide service transformation of children and young people’s IAPT. NHS England will work with stakeholders to ensure implementation is at all times inline with the best available evidence. NHS England will maintain the commitments that at least 15% of adults with relevant disorders will have timely access to IAPT services, with a recovery rate of 50%. In addition, NHS England will ensure that by March 2016, 75% of people referred to the IAPT programme begin treatment within 6 weeks of referral, and 95% begin treatment within 18 weeks of referral.

6. 1. Workforce • NICE-recommended evidence based therapies delivered by practitioners trained under an IAPT accredited training course. • Therapists receive regular (weekly) case supervision (in addition to clinical supervision) and are managed as a team with training in NICE concordant care available to all staff. • Therapy is delivered in the most cost-efficient manner, utilising stepped-care when appropriate.

7. 1. Workforce

8. 2. Outcome Measures • High quality commissioning with a focus on outcomes providing enough resource to ensure that services are able to provide NICE approved and evidence based therapies to clients   • A key characteristic of an IAPT service is the effort individual therapists put into demonstrating the outcomes that are delivered. • Routine outcomes measurement is central to improving service quality - and accountability. • It ensures the person having therapy and the clinician offering it have up-to-date information on an individual's progress, which is of therapeutic value in itself.

9. Access & Waiting Times

10. Recovery & Reliable Improvement

11. 3. Long Term Conditions • Having a mental health problem increases the physical healthcare costs of a LTC by 50% on average • When people with co-morbid physical and mental health conditions receive psychological therapy, the savings on physical healthcare costs exceed the cost of the psychological therapy. • Requirement for partnerships between IAPT services and physical health services. • This includes placing psychological therapists in physical health settings e.g. diabetes clinics, CHD clinics etc.

12. 4. Employment • Employment has always been considered an important outcome in IAPT, and for many patients it is a key mechanism of recovery. • 48% of ESA claimants have mental/behavioural disorders as their primary condition. • IAPT will work with job centres to insure that, once awarded ESA, such people are automatically referred directly to IAPT for assessment and treatment. • Strong evidence suggests that even programmes with no focus on employment generate sufficient savings to cover their cost. If we provide more employment support, there will be even more savings. • Aim to have, in each IAPT team, one employment support worker for every eight therapists.

13. 5. Keep Innovating • Extending choice among NICE recommended psychological therapies. • When patients have a preference between different evidence-based treatments they usually have a better outcome when they receive their preference. i.e. couples therapy for depression • Take advantage of the digital revolution • Provide internet based cognitive behavioural therapy (iCBT). Similar results to face-to-face and at a considerable saving • Use learning from extensive IAPT database to enhance outcomes • i.e. Identify key features of top performing services and reorganise other services to improve access, recovery, waiting times • Through deep dives, consultancy, workshops