The NHS is 70

1. The NHS is 70 A Manchester Metropolitan University Celebration #NHS70

2. Exhibitors Self Help - Improving Mental Healthselfhelpservices.org.uk/ Manchester Movement Unitmmu.ac.uk/movement Faculty of Health, Psychology and Social Care #NHS70

3. Engage with us online Tweet us @MMUHPSC using the hashtag #NHS70 #NHS70

4. Joy Duxbury Professor of Mental Health Nursing at Manchester Met University A nurse by background, Joy has worked in academia since 1995 and was made a professor in 2011. Joy’s research focuses on mental health, risk and social injustice. This includes the promotion of therapeutic and trauma informed approaches in acute mental health inpatient, forensic and criminal justice services (including the prison and police service). #NHS70

5. Malcolm Rae, OBE FRCN, RMN, RGN Trustee Chair for State of Mind Malcolm has extensive experience working in a range of Mental Health specialties. Former Director of Nursing in both Wigan and Salford.Currently, Malcolm is largely employed as an Independent Investigator into serious untoward incidents, in particular, suicide and homicides in both inpatient and community settings. #NHS70

7. 4th July 2018 SPORT AND MENTAL HEALTH THE CHALLENGES AND OPPORTUNITIES Malcolm Rae OBE FRCN Chair of Trustees State of Mind sport #NHS70

8. Challenging social constraints preventing men from seeking help when they need it Last year there were over 6,000 suicides in the UK, of which 76%, or 4,623, were male (ONS) Suicide currently stands as the biggest single killer of men aged under 45 in this country (ONS) Highest at risk group middle aged men #NHS70

9. Terry Newton #NHS70

10. State of Mind Sport aims To promote an increased awareness of mental fitness, wellbeing and resilience in rugby league players, fans, and communities Tackle stigma, signpost to support, encourage early access and prevent suicide #NHS70

11. Sport speaks many languages #NHS70

12. Non-stigmatizing language Help a mate Mental fitness sessions tailored to the audience Feel good, play better #NHS70

13. Bill Clinton “We should not be ashamed of mental illness, but we should be ashamed of the stigma associated with it” #NHS70

14. Applying sporting values and characteristics • Inform leadership and practice • Influence care and recovery plans • Goal setting - team work • Motivation - self and others • Handle disappointments and adversity • Engender optimism and hope • Guide and support to reach potential #NHS70

15. Benefits of engaging in sport and recreational activities • Improves social wellbeing, enables connections with others and friendships • Prevents isolation and withdrawal – meaningful activity improves self-confidence and esteem • Combining with physical exercise and activities has the potential to improve fitness, strength, mood and reduce stress • Enables reaching vulnerable individuals and at risk groups to promote health, wellbeing and resilience #NHS70

16. What we do • Offload programme • Dedicated round • Deliver awareness and resilience building sessions • Time to Move • Boot room project • Influence policy #NHS70

17. Dr Prathiba ChitsabesanConsultant Child and Adolescent Psychiatrist, Pennine Care NHS Foundation Trust and NHS England Prathiba is a Consultant in Child and Adolescent Psychiatry working in a large mental health and community trust (Pennine Care NHS Foundation Trust). Lead consultant since 2005, she became Clinical Director in 2015 and continues to work clinically within a community child and adolescent mental health service in South Manchester. #NHS70

18. Founding Principles of the NHS #NHS70

19. Background and Context • NHS • Challenges • Service user needs are changing • Preferences are changing • Increasing treatment options • Increasing service pressures • Gaps • Health and wellbeing • Care and quality • Funding and efficiency #NHS70

20. Background and Context • Five Year Forward View (NHSE, 2014) • Focus on prevention and public health • Service users to gain better control over their care e.g personal budgets • Break down barriers in how care is provided: • Physical and mental health • Health and social care budgets • Primary and secondary care #NHS70

21. Mental Health • 2011 - No Health Without Mental Health • 2014 - Closing the Gap; Priorities for Essential Change in Mental Health • 2015 - Future in Mind • 2016 - Five Year Forward View for Mental Health • 2017 - Stepping Forward: Mental Health Workforce Strategy #NHS70

22. CYP Mental Health 0-25s Thrive • Economics of investment • - CYP MH spend was 7% of total NHS MH spend (2016/17) • Getting it wrong is expensive • Low costs of intervening early • Infrastructure/resources • High numbers of referrals • Variable waiting times (2-48 weeks to first appointment, 9 weeks average wait) • Workforce capacity Tiered system Varied approaches Step care models Integrated pathways • Systems • There are many varied approaches • Various commissioners CCGs LAs Various commissioners NHSE Schools MoJ

23. It’s a whole system… #NHS70

24. Five Year Forward View • 70,000 more children and young people accessing CYP MH services • 1,700 newly qualified therapists working in CYP MH services • 3,400 existing CYP MH therapists trained in evidence based treatments • Improved Crisis Care for all ages, including places of safety • 95% of those in need of eating disorder services seen within 1 week for urgent cases & 4 weeks for routine cases • Improved access to and use of Inpatient Care, having the right number and geographical distribution of beds to match local demand with capacity, and an overall reduction in bed usage #NHS70

25. Challenges Data • Transparency and accountability Workforce • Managing change • Nature of the work • Increasing service pressure and expectations • Providing person-centered care • Feeling valued and supported Requires • Investment in workforce • Leadership #NHS70

26. Future Opportunities and Developments Policy and funding • Green paper • New 10-year MH Plan Commissioning • Collaborative (integrated care systems) Service delivery • Partnership working with agencies and third/voluntary sector • Shared ownership, language and outcomes Research and innovation • Digital solutions/new models of care/new treatments/early intervention • Link to quality improvement and implementation It’s a journey.. #NHS70

27. Thank you for listening #NHS70

28. Dr Alina HainesResearch Fellow, Manchester Metropolitan University Alina has extensive experience of conducting research with vulnerable populations with complex needs, accessing mental health services and/or in contact with the criminal justice system. Alina is currently managing an innovative health research project testing viability of machine learning in predicting suicidal risk via smartphone proxies. #NHS70

29. Digital Innovation in Mental Health Dr Alina HainesResearch Fellow Mental Health and CoercionFaculty of Health, Psychology and Social Care, Manchester Metropolitan University #NHS70

30. A Digital Health Revolution Rapid expansion in the use of mobile technology in health care delivery in the last decade – ‘mobile health (mHealth) Drivers: extraordinary rate at which society is adopting technology into everyday life; cost savings pressure (more care for less money); patient-centred care (flexible and bespoke services) (Hollis et al., 2015) mHealth technology - can improve care in a wide range of mental health conditions, e.g. mood disorders, schizophrenia, anxiety, and substance Use (Loo Gee B. et al., 2016; Harrison et al., 2011; Lindheim et al., 2015; Marsch, 2012) #NHS70

31. There’s an app for everything… First mobile software application (app) - 2008 (Donker et al., 2013)  exponential growth  more than 10,000 of apps (1/4 specific to mental health disorders) (Menon et al., 2017) #NHS70

32. The UK Journey to Digital Innovation • Australia and the US – leaders in the field • Public-health organisations are convinced by the mHealth concept (Espie, 2016), e.g. WHO recommends the use of digital or mobile health technologies to promote self-care (WHO, 2013) • UK government initiatives to promote digital health – ‘No Health without Mental Health’ (2011) and ‘Digital First’ (2012), ‘Personalised Health and Care 2020: Using Data and Technology to Transform Outcomes for Patients and Citizens’ (2014) - technology flagged as having potential to significantly improve health and reduce health care costs • Industry commissioned to develop e-therapies/mHealth interventions – BUT limited evidence base, lack of guidance (accreditation system) and formalised approaches to mHealth developments #NHS70

33. Evidence Gap Challenges • Research not evolving at the same pace as the technology - the use of apps in mental health settings remains largely unsupported by evidence, i.e. small number of studies, weak methodologies (e.g. small samples, risk of bias, unknown efficacy in the long term), and lack of independent evaluation • E.g. a review of mobile health applications for the most prevalent conditions by the WHO (2013) identified that, of the 1,500 depression related apps on the market, only a small proportion have been research tested (32 published papers, i.e. 2%) • Competing priorities (costs towards efficacy research vs costs towards app developing and marketing) (Leigh and Flatt, 2015); a timing mismatch (danger of technology becoming obsolete by the time it collects sufficient data in order to detect a significant treatment effect; further impeded by a lack of approved guidelines) (Espie, 2016) #NHS70

34. The Way Forward • Digital health technology will change the face of mental health in the years to come, as it has the potential to improve service users’ lives – but careful consideration should be given to address its shortfalls and enable healthcare providers to embed them within routine clinical practice • Concern: the speed of digital mental health innovation and consumer access has by far exceeded the speed of (government) regulation, quality assurance and scientific evaluation possible risk of harm to service users, especially with the use of unregulated apps (Hill et al., 2017) • The use of evidence based content and quality standard in app development and evaluation – essential (McClelland & Fitzgerald, 2018) • More research evaluating the effectiveness of MH apps, incl. health economic analysis; consider using more pragmatic, less expensive, observational approaches (rather than RCTs) as primary paradigms to evaluate effectiveness (Nicholas et al., 2016) • Appropriate routine training for clinicians and practitioners to bring them up to speed re technology applications and risks, including ethics, confidentiality and patient safety #NHS70

35. What Next at Manchester Metropolitan Uni? • SWiM (Strength within Me) – an innovative mHealth research project testing viability of machine learning in predicting suicidal risk via smartphone proxies (SWiM App, Fitbit, iPhone use, Facebook) • Build on this experience to develop similar digital technologies with applications in different mental health settings, e.g. community settings and/or addiction services • Multidisciplinary across departments collaboration (e.g. Substance Use and Addictive Behaviour Group and the Division of Computer Science and Information Systems) and industry • A.Haines@mmu.ac.uk #NHS70

36. Rita LongNHS Service User At 39 years of age Rita received a diagnosis of Bipolar Disorder. She was told by her consultant psychiatrist that because of her ‘condition’ she would never work in a stimulating job again or travel long haul. Subsequently, Rita has worked as a ‘Service User Researcher’ at the Spectrum Centre for Mental Health Research at Lancaster University, published 7 academic papers and regularly works on strategic funding bids for national mental health projects. #NHS70

37. Resources • Beyond the Usual Suspects Peter Beresford • 4PI Standards NSUN • Co-Production Cath Roper, Flick Grey, Emma Cadogan • INVOLVE https://www.involve.org.uk/

38. Why?Patient and Public Involvement (PPI) • It’s the right thing to do ‘No decision about me without me’ • Understand the relative topic from the inside • Ensure research is anchored in the priorities of people for whom the research is intended • Provide novel ideas and perspectives • Challenge perceived wisdom • Help to cut through obstacles to engagement in research • Describe and disseminate findings in accessible

39. Positives • Researchers benefit from lived experience knowledge and expertise • Research is based on what the target recipients feel is relevant and beneficial • Research is kept focused and on track • SU offer an independent view of what should happen • SU have an opportunity to make a contribution that will benefit others • Recovery opportunities

40. Challenges • Human Resources– Understanding the nature of individual needs to support managers and service users • Occupational Health—Training OH staff in mental health issues e.g. not being over cautious • Balancing needs of the role with researchers needs e.g. time away from the workplace • Career progression within SU role • How do we reimburse people for their contribution when they are in receipt of benefits • Turnover of senior service user staff made consistency a challenge • Highlights limitations of constituting a SURG system per project • Boundaries PPI and clinicians/researchers/SUR Social media

41. PPI Models • SURG • Focus Groups • Advisory Panel • Crown dancing/singing • Plays • Training—staff/students • Conferences • SPECTRUM Connect—(2 way) • Networking—Support Groups/Charities • Service User Researchers • Informal conversations • Skype • Reading/critiquing information

42. Two way process • ‘It’s the highlight of my month’ (member of the Advisory panel) • ‘I really want to help others. I don’t want others to go through what I did’ (member of the advisory panel) • ‘He feels so good that he can do some thing like this’ (carer of a member of the Advisory Panel) Thanks for listening

43. Your panellists Joy Duxbury Professor of Mental Health, Manchester Met University Malcolm RaeTrustee Chair for State of Mind Dr Prathiba ChitsabesanConsultant Child and Adolescent Psychiatrist and CAMHS Strategic Lead, Pennine Care NHS Foundation Trust Dr Alina HainesResearch Fellow, Manchester Metropolitan University Rita LongNHS Service User #NHS70