Phil Sculthorpe

2. Phil Sculthorpe A career history segueing through…. • Bedside nursing • Hospital management • Project management • Planning/commissioning of health services • Service improvement 3 abiding passions: • Improving performance through better • measurement of need and delivery • Wife & 2 daughters • Rock and roll

3. Mental health: some English perspectives

4. England N. Ireland (missing) God’s country Scotland (missing) Wales (missing) London (National Govt.) New World (missing)

5. Statistics 400 miles top to bottom 300 miles coast to coast 49.2 million people 87% of UK population 1:8 Black or ethnic minority Health spend 8.3% GDP Regional variations 150+ local administrations

6. Adults 16 – 74 years 4% psychotic disorder 16% neurotic disorder 8.6 suicides per 100,000 Hospital spend £4.6billion (13.1% of health spend) Compulsory detention: 88 per 100,000 Local gvt. Spend £815million (5.4% total PSS spend) 11% detentions from the CJstce system 10% have used illicit drugs Over 900,000 adults claim sickness benefit due to mental health 26% report hazardous drinking pattern in last year Less than ¼ of adults with long term mh problem in work

7. The way forward • Continue to build the science base • Overcome stigma • Improve public awareness of effective treatment • Ensure the supply of mental health services and providers • Ensure delivery of state-of-the-art treatments • Tailor treatment to age, gender, race, and culture • Facilitate entry into treatment • Reduce financial barriers to treatment

8. MH ‘care’ systems Nat Govt Benefits Home Office DoH Other Depts Targets Policy in relation to Education; Social Services; Social Inclusion etc Prisons Local Authorities Health Authority commission Social Services PCT’s Schools Trusts

9. Health system Nat Govt Healthcare Commission DoH Targets Inspection Health Authority Service improvement Private & not for profit sector NIMHE commission PCT’s Trusts

10. Key policy dates 1948 – NHS created 1983 – MH Act 1990 – Community Care 1991 – Care Programme Approach 1994 – Amendment to MH Act 1998 – “Community Care has failed” 1999 – National Service Framework 2000 – NHS Plan 2001 – Modernisation Agency ? – New MH Act ? – Payment by results . Conservative administrations . Labour administrations

11. NIMHE Regionally-based Structured Positive Practice exchange Local delivery within a national framework System mediation Policy review Managed networks Technical ‘how to’ guidance Collaboratives Process mapping & service redesign Commissioner support Service Mapping

12. Primary care ¼ of routine GP appointments mh related 90% of mh care stays in primary care 30-50% depression unrecognised New graduate workers Primary care MH model Seemingly difficult to articulate Yet anti-depressant scripts increasing GPs unable to ‘prescribe’ Social care

13. Hospital services New service models Av. LOS: 18/19 days Access Av. Occupancy: 91% Inpatient suicide Gender issues Dual diagnosis Ethnicity issues Staff issues Restraint policies

14. Social Inclusion MH costs UK £77billion per year Only 24% long term mh sufferers in work 75% of tabloid editorials about mh link it with violence ‘Benefits trap’ 2/3 of young male suicides are unemployed 50% coverage uses highly stigmatising language 6 – 17,000 children care for an Adult with mh problems Public tolerance declining

15. Mental health & the judicial system 90% of prisoners have a mh problem Secure provision rising Dangerous People with Severe PD 30% have history of self-harm Suicide x7 national average Sexual predators In-reach MH workers Proposed new MH Act

16. Care Services Improvement Partnership • Commonalities: • Customers • Carers • Service provision Build on NIMHE Client specific programmes & cross-client programmes Actively cross health and social care boundaries Went live 1st April