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Delivering on Mental Health and Wellbeing Roundtable 13 th April 2016. Agenda. Chair’s welcome Professor Paul Corrigan. Professor Paul Corrigan, chair for the day, welcomed speakers and participants.
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Delivering on Mental Health and Wellbeing Roundtable 13th April 2016
Chair’s welcome Professor Paul Corrigan Professor Paul Corrigan, chair for the day, welcomed speakers and participants. There is a strong case for change: The moral, social and economic case for change is here: The social and financial consequences resulting from mental health issues are becoming more evident in our society …and we now need to move from theory to practice: We know a fair bit about what works, but making it happen is difficult and bringing it to scale even more so The Link Between Physical and Mental Health… We cannot ignore the link between mental and physical health. - 46% of people with mental health problem also have a long term condition. An example of mental health resulting in wider health inequalitiesis through smoking - an issue that is highlighted in a Guardian article published on the morning of the roundtable: ‘We need a strategy to help people with mental health problems quit smoking’
The transformation challenge Paul Farmer • We are just starting to understand the significant figure of unmet need • Mental health is not a medical issue – it is a biopsychosocial issue • But it is linked: mental health costs drive physical health costs up by 50% • Higher public interest in mental health has led to an increase in media attention. This, in turn, has prompted an increase in political attention. • There is fresh thinking in the community and society is not prepared to leave mental health behind now. This is hugely important in making delivery happen. ‘How do you take really good policy and well intended recommendations and make a difference in people’s minds?’
The transformation challenge Paul Farmer 4 key priorities for change A 7 day NHS – right care, right time, right quality An integrated approach to mental & physical health care Promoting good mental health & preventing poor mental health ‘Hardwiring’ mental health across the NHS • 3 steps to service transformation • 1. Local planning • Establish strong local leadership • Integrate commissioning for prevention and quality • Promote a co-ordinated approach to innovation and research • 2. Transparency of Information • Improve data and transparency • Promote equalities and reduce health inequalities • 3. Mind set shift across system • Update the regulatory framework • Establish comprehensive access pathways and standards • Produce and deliver on a multi-disciplinary workforce plan • Reform payment and incentives ‘There is nothing worse than a report ending up on the shelf’
Getting it right together: Co-producing mental health & wellbeing by Alison Faulkner • We are making progress on better mental health services, but there is still a long way to go. It is crucial we follow a ‘what matters to you’ approach. • Services and co-production: • A huge weight is placed on medical evidence but the same weight is not given to social evidence • Services are often based on systems rather than the needs of the individual; MH services need to move away from being broken down by department delivering the care– what mechanisms need to be in place to help this shift? • We talk about co-production, but we don’t embed this in practice: service user stories are powerful but these often are not translated into shaping service delivery… we need to move beyond the rhetoric, have clarity of what it means and what we can expect. To make this happen, we need to address the fact that attitudes and behaviours of frontline staff still aren’t changing fast enough as yet. ‘I’ve had experiences of professionals and projects trying to deliver a service when it wasn’t something that service users were actually asking for. Often we are not asking the right questions of the right people.’
Making it happen: Practical steps to foster co-production We need to shift the way we approach co-production to focus on what works best for those we want to co-produce with; build an equal partnership of commissioners, providers, users and carers. We need to co-produce an approach to co-production!’ • When to co-produce: • Co-production works best when co-designed at commissioning level • Co-production should start with service users/frontline staff , not in boards • In terms of co-production we are good at using the word but not at the real delivery – often there is no distinction made between “consultation” and listening • How to co-produce • The skills and experience of all those involved need to be used effectively – both professionals and service users • We need to provide incentives to get the right people around the table • Service users need to be consistently in the design of services – at every stage and across all settings and levels • Create safe spaces for service users and promote peer support services more effectively • Engage people in the process who don’t have an identified mental health issues • Challenges • Mental health experience is extremely diverse – one group cannot speak for everyone and good mental health and wellbeing is far more than just the absence of mental illness • How do we get in touch with people that aren’t heard? • Service user needs are dramatically different at different user level groups when it comes to mental health • Difficult to sustain co-production in a project when it involves children and adolescents with mental health issues ‘Co-production – we’re good at using the word but often not good at delivering it’ “I’ve found that often services/projects often seem focused on acute provision rather than prevention”
Making it happen: Practical steps to foster co-production “Previously we’ve looked at Social inclusion and the impact this has on Mental Health but that seems to have dropped off the agenda’ Commissioner • Experience vs medicine: • Choices need to be backed up by evidence • Currently there is more of a focus on choice when service users want good quality existing services • Skills: • The right skills are require to effectively facilitate conversations and to effectively show how input is implemented (the key is feedback!) • Support is required for effective co-design and engagement - we need to provide system with the right tools and training to engage properly. • Culture and behavioural change: • “Change needs to come from those who will benefit from it” • A better focus on awareness and engagement is required • Professionals should share the power with service users • Effective integration with mental health with physical health is required ‘We need to value people to encourage them to get involved in co-production of services, even something like a paid for lunch can make people feel valued for their time.’ Practical Steps: A clear approach and method to co-production needs to be defined, working with those we are aiming to co-produce with. Use existing evidence to develop approach and methodology. Coproduction works best when service users are presented with menu-based choices backed by practical evidence and community knowledge instead of open choices Training is required to ensure all those involved, both service users and professionals have the right skills and support to co-produce effectively
Strengthening prevention: A commissioner’s perspective by Toni Camp • We need to commissioners to define a proportionate way of evidencing impact of preventative services • We need to rely less on hospital based care and more on community outreach services • What services should we commission and how do we show that these are the right services to deliver the desired outcomes? • What is it that will get more value from the same amount of money? • How can we address the significant gaps in prevention and intervention around housing for people with mental health challenges? ‘Individuals with a history of dual diagnosis and resultant chaotic lifestyles lack stable accommodation best suited to meet their needs and support recovery.’
Making it happen: Practical steps to prevent poor mental health Commissioners need to embed mental health support in all services and policy – everybody needs to be an advocate. • We need to normalise access to help: • There needs to be a whole population approach to addressing stigma. • Access to universal support, for example in through schools/GPs etc. is required as these settings are often nervous about mental health because they don’t have the same knowledge as specialists. • At present, mental health is considered a life sentence, not episodic, and this perception needs to be addressed. • We need to de-medicalise mental health issues: • Universal need and risk assessments are required to maintain improved service user records. • Certain life situations, such as bereavement or trauma, are natural to affect a person and their wellbeing. We need to have more community based support to provide help and assistance through relationship building rather than treat everyone through mental health services. Sometimes these services can be more detrimental for the service user than advantageous. • Relationships: • We should focus on relationships, rather than services, as these are key to keeping well. Everyone should have someone to talk to and that should be a priority for everyone. How do you prove the value in the upfront cost associated with early intervention? Sometimes you need to spend to save. Cost associated with services governs the service user pathway
Making it happen: Practical steps to prevent poor mental health • Services: • The system is characterised by multiple ‘hand offs’ – passing people to the ‘right’ professional which leads to more paperwork, multiple assessments, time lag, increased costs, negative experience for service user • The role of health and wellbeing boards requires a higher profile to address the current issues • Flexible, targeted, and personalised care is required to stop service users moving backwards/forwards in their journey • Thinking outside the box is the key - due to the lack of funding, more radical solutions have been implemented which have ended up making significant improvements • More community based support is require to support people through relationship building • There is a need to rely less on hospital based care, and to focus in commissioning outreach and flexible services. • Integration of services/supporting services: • The role of housing in keeping people stable is critical and needs to be utilised more effectively to support people • Through building skills in the voluntary sector we can better support people and services • Systematic support to GPs around tackling mental health is required • Systems STILL don’t speak to one another, we need to address supporting functions such as IT to crack integrated care ‘Often in Mental Health services once people are discharged from acute services they no longer get support and are simply referred back to their GP’ ‘In my area they wanted to shift funds more towards personalisation however this resulted in services being decommissioned and many service users deemed no longer eligible to access services that still remained.’
Making it happen: Practical steps to prevent poor mental health • Timing of support: • Provide support before a crisis – more low level and consistent interventions are required. • More opportunity for people to flag as soon as they feel unwell is required as earlier help will reduce cost in the long term • Role of leaders: • The right leadership is required to promote skills and set tone • More leadership openness/accountability across organisations is required • The workforce must feel safe to talk about local solutions • Local level responsibility: • More focus on preventative approaches and identifying people at risk in communities will reduce cost and increased need in the long run • We need to harness local knowledge and resources, taking a strengths and assets based approach • One issue is that many services are provided by voluntary sector who don’t always have the capacity to evaluate their services to show their value to commissioners. • The workforce must feel safe to take risks and support local solutions • We need to build on community based support and responses – treat the loss of loved ones as normal life experiences and don’t treat it as a medical problem needing mental health treatment ‘I’m aware of a diabetes clinic that has a Mental Health check-up as part of its assessment’ Practical Steps: A focus on mental health needs to be embedded in all commissioned services and policy Leadership needs to focus on driving openness and accountability across organisations Effective evaluation of services needs to be driven from both a commissioner and a provider perspective
Resilience and wellbeing for our children and young people By Ollie Smith • Children see things differently from adults, and often adults are a great source of anxiety and distress for children so that should be a starting point when thinking about services. • Challenges: • Language and framing – physical health is ‘health’, mental health is ‘mental health’ – how do we change this wo we all consider being healthy to involve a combination of the two? • Leadership and roles – It is often considered to be the role of the health service, but who’s role is it to play the advocate for mental health? • Strategy or tactic – What interventions are appropriate for children? Strategic thinking or individual tactics? • We can build resilience for our children in 5 key ways: • Supporting them to develop resilience and coping skills • Support for parents • Support for schools • Support for GPs and other health professionals • Using technology to improve the reach of wellbeing support • Providing the appropriate support is essential to prevention. However, prevention is not always the cure.
Making it happen Practical steps to build resilience • We need to educate children and society in the same way we approach physical health, to appreciate many different facets of ‘good health’. • Linked services: • The educational health care system is not aligned and standardised • There is a need to also look at wider social factors such as diet, housing and relationships etc. and how these feed into supporting mental health and wellbeing. • Workforce: • A focus on leadership is required to bring all the systems and organisations together around mental health. • Understanding: • Research needs to be carried out to see if SEN schools are successful in reducing the number of children who need mental health services once an adult – and if not, how that can be incorporated in other school curriculums to enable early diagnosis and prevention • Mental health is everyone’s responsibility – not just parents, schools etc. – we should think about how we all contribute to other’s mental health in wider society but there is a continuing fear of mental illness even on the part of many professionals • Supporting children and young people to develop their own personal resilience and coping skills: • ‘The key is to reduce the stigma by encouraging us to talk about mental health’ • ‘In my school you don’t feel ashamed, or as though you have to hide it, if you are going to see the counsellor its just something some of us do’ ‘Mental health is all of our responsibility’
Making it happen Practical steps to build resilience • Supporting parents to better support their children • Targeted support for parents from birth is required, delivered in a way that works for them, to truly support emotional wellbeing and resilience in our children • Increasing support for schools to develop whole school approaches to wellbeing • The focus on and support provided for emotional wellbeing varies dramatically within borough • Investment in programmes that focus on sustainability through building capacity within schools through training of staff rather that add on services • Supporting GPs and other professionals to better support and promote mental wellbeing • GPs and other professionals need better access to training and advice • Using digital technology to improve the reach of wellbeing support, and increase self-efficacy • There is a wide range of online resources and programmes that should be used more effectively to support, or as an alternative to, interventions and other approaches. Practical Steps: Investment should focus on supporting, training and building capacity within the current workforce, rather than piecemeal commissioning of add on services Strategic planning is required to agree the right balance between investment in prevention and intervention Educate children early to challenge the stigma associated with mental health
A call for action Key messages from the discussion • Build a holistic definition of health which encompasses both physical and mental health • Take a practical focus to change and work on the principle of evolution rather than pure innovation, changing small things quickly to create areas that are “change-ready” and build momentum • Enable and empower citizens and frontline professionals to take a leading role in organisational and system change recognising that the key is people change not organisational change • Focus services around the needs of individuals and integrate services around people • Recognise the power of peer support anddevelop genuine support networks and “safe spaces” between peers on the same journey, across organisational and geographical divides See more from the day by visiting our ‘Storify’and stay connected on twitter #bettermentalhealthnow
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