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Mental health over the next 5 years : Priorities and

programmes

DDr. Geraldine Strathdee, National Clinical Director for Mental

Health .@DrG_NHS

Open Forum Manchester March 2016

This talk:

• Mental health over the next 5 years: priorities and programmes

• The changing understanding about mental health in the past 3 years

• The Prime Ministers Life Chances strategy and the Mental health Taskforce

• International and national insights from Devolutions, vanguards, local transformations

• The challenges and opportunities for implementation going forward

• Leaders fit for the future: be determined to get the basics right, innovate, family friendly

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National context: Prime Minister announced MH as a national priority, Life Chances Jan 11th

5 Year Forward view & taskforce: Lifespan approach based on HMT deep dive economics

Being Born well Best early

yearsLiving and working

wellGrowing older

wellDying well

Building Positive mental health

in individuals & communities

Prevention of mental ill health

Improving access to

Integrated

Timely Effective care for all new patients

Transformation

of services to

deliver value, better outcomes, quality & personalized Right Care & integration

Integrating physical, social, mental health care for individuals and communities

Literacy : The major growing national and international social movement

for mental health literacy: getting in control of your life & society

• The busting of the 5 great myths about mental health

• 8 million people hit on NHS Choices mental health website

• Time to Change, NHS Choices, Media, Daily Mail. Whole City digital platforms

• 8 page supplement on mental health stories in the Daily Mail

• 500,000 people in Citizens UK agreed to prioritize mental health

• The Crisis Concordat: 22 front line community agency whole system partnerships

• The social movement 330, 000 committed MH leaders & @Wes

• The international movement : 150 countries have MH as a top sustainability goal

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NHS | Presentation to [XXXX Company] | [Type Date]5

NHS Choices information & self management:

2. Prevention: High impact prevention programmes to commission & provide New era in public services, public health, patient self management & clinical stratification & economic modeling tools

Parenting & relationships programmes & perinatal Life Chances strategy

• The ‘statin” of good mental health now at pregnancy clinics, primary care & adult education

Zero Child abuse: Ambition for England : sexual, physical, emotional

Schools: Resilience embedded in the school culture & curriculum, early identification though school nurse and form tutor

training, & Governors for well being & resilience

Employers: Positive productive employment practice, jobs , Health & Safety employment standards

Alcohol: Strategy needed asap to save £20 billion for the NHS, Police, Local government

Prioritizing opportunities for prevention in the highest risk groups & reengineering spend

CYP: Leaving care CYP , adopted children, those who have suffered abuse

Top 10% :Frequent crisis, admissions, detentions, stable accommodation, transitions

Integrated mind/body care: integrate psychological therapy into pathways in primary & acute services

Empowered patients & clinicians: Hope and optimism and skilled therapies for recovery and life chances

CQUiN results 2015/16: physical care shows Big improvement in

(Assessment + Intervention) for 32, 000 inpatients

Inpatient ward setting Number audited

CQUIN

Performance

Acute inpatient 3166 46.34%

CAMHS ward 77 64.94%

High dependency/rehabilitation ward 573 68.06%

Low secure unit 698 63.32%

Medium or high secure unit 640 74.53%

Older adults ward 419 48.69%

Other 129 67.44%

PICU 266 60.53%

Grand Total 5968 54.93%

Open Data network new data

Nov 2015

https://www.thersa.org/discover/public

ations-and-articles/reports/getting-

the-message-on-mental-health/

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World cities are testing practical ways forward: London,

New York, Manchester, Birmingham international

For the 16 mental health care pathways we have commissioned

Biopsychosoical integrated care

Using every proven implementation strategy to built in sustainability and continuous quality

improvement and gathering and publishing PROMs, PREMs, CROMs

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Right Time

Right Care NICE standards for the common crisis conditions & services & pathways

✓ Information

✓ Physical health

✓ Medication

✓ Psychological therapies

✓Right suicide prevention

✓ Rehabilitation &

Recovery care plans for training/ employment

✓ Right carer and social

network

✓ Crisis & relapse

prevention

✓ Maximizing digital

potential

Right Outcomes

Right Team

✓ PROMs

✓ PREMs

✓ CROMs

✓ Employment

Right team

- Compassionate,

- Coaching,

- Coproduction

- Recovery focus

- Multi disciplinary/ agency

Right implementation & Continuous Quality improvement

✓ Commissioning guidance

✓ Baseline national audit

✓Regional implementation teams

✓ Workforce plans

✓ Data collection plans

✓Clinical dashboards for teams

✓ Accreditation networks

✓Digital Maturity plans

✓ 5 ALB & Regulation

✓ Big Data & innovation plans

The 5YFV road map for integrated pathways

Primary care mental health : Vanguards progressing towards integrated care P

AC

S a

nd

MC

Ps

Prevention in High risk groups

Self assessment and self management

Common conditions

Repeat attenders & MUS

Long term & severe mental illness

• Psychosis: Enhanced psychosis outreach

services +3rd sector

• MUS: Collaborative care for MUS medically

unexplained symptoms e.g. Tavy/Hackney

• LTCs: Integrated physical & mental treatment in

groups for LTCs

• Common: direct access psychological

therapies for depression & anxiety

• CYP: Intermountain primary care CYP model

• Perinatal: Integrated perinatal community

teams in reaching to acute clinics & PC

• Eating Disorders: community teams

• Registration: e Chat from New Zealand

• Prevention :Pan city on line digital platforms

Acute care : transforming acute care and care homes & achieving integration through liaison mental health teams & care pathways

in A/E 24/7:

Productivity gains

Reductions in 4 hour wait breaches

Admissions by 40% into acute hospital wards & care homes:

Repeated Attendances for self harm and other conditions

Acute delirium assessment ward

for people with dementia

Productivity gains

80% go back home with a well organized personal health care package

and are not admitted into a care home

Acute wards where 40%

patients have Mental illness

Productivity gains

Increases the discharge rates

Reduces LOS

Reduces expensive unnecessary investigations and operations

LTC clinics in acute care & primary care where 40-70% have

untreated depression &

anxiety

70% people with liver disease, 40% people with cardiac disease, 40% with long disease, 60% with irritable bowel syndrome, 80% in pain clinics

Patients get treatment and

Repeat OPCs are reduced

Unnecessary diagnostics are avoided

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Liaison mental health teams: 4 components of productive care

Cancer & Diabetes: the evidence & best practice case examples of integrated care

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Diabetes integrated care

: http://www.slcsn.nhs.uk/scn/mental-health/mh-physical-care-diabetes-082014.pdf

Cancer integrated care: http://www.londonscn.nhs.uk/publication/psychological-support-for-

people-living-with-cancer/

Why do we need integrated care?

Integrated care systems: Chris Hilton

Daily GP advice line

Integrated Care Programme

Monthly multidisciplinary care

planning groups for patients with

long term conditions

Integrated mental health in

Intermediate Care team

(Consultant and RMNs)

Whole systems

integrationPlanning model of care for

Early Adopter projects and

future Local Hospital

Primary care

education and

supervision

Palliative Care Hospice

and Community Pilot

HIV Mental

Health

assessments

Community dementia

Liaison nurse

Integrated long term

condition

psychotherapy

services

Support for Primary

Care Mental Health

Workers

IAPT & Clinical

Psychology

Interfaces

Outpatient clinics

for MUS/LTC

Digital is key to increasing access, safety, effectiveness &

integrated care & sustainability of NHS & workforce

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Electronic care records

Safer, quicker, 21st century

✓ Interoperability of records between sectors

• Primary, MHT, acute, community social care, SU

✓Functionality

• E prescribing, monitoring

reminders, GASS

• On line diagnostics order & see results

• Clinician decision support templates e.g.Bradford, lithium

• Skyp/ tele consultations

• Text reminders

• On line Outcomes tools PROM PREM. CROM

•✓Freeing time to care

• Digital dictation

Efficient safe care

Faster, safer, community care

✓SCR one click for

medicines reconciliation

✓Directory of Services / Mobile app.

✓Capacity Management system to reduce junior

doc & nurse time spent finding acute, PICU, CAMHS Tier4 beds/ OATS

✓Remote access tablets to

access records from the community

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Innovation, SU in control

A care plan by any other name

✓Apps for fitness and literacy

✓Big Data to self manage & stop relapse

✓Self Management apps

✓ Psychosis avatars

✓ Interactive digital treatment sessions

✓On line city platforms & white label

digital therapies

✓Sim City to show case what can be done

Continuous Quality improvement:• Clinical team digital dashboards

• Touch screen in wards and teams every day

Transforming healthcare : focus on Integration of care internationally

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• Integrated clinical care:

• history taking & assessment at registration & in consultations

• Treatments, care plans and care pathways

• Integrated NICE guidelines, NICE Quality Standards, NICE indicators

• Integrated ONE ‘open access’ record

• Digital Maturity for people & their clinicians to access their own integrated care record

• Integrated virtual & live case conferencs for frequent attenders, admissions, detentions

• Workforce Integration

• Integrated teams: skillmix of ‘physical’ or ‘mental’ staff or ‘alliance pathways’

• Workforce training at undergrad, post grad and CPD

• Integrated payment & incentive systems & continuous improvement supports

• National clinical audits & Inquiries, National confidential inquiries, research, genome

• Integrated payment tariffs, CQUINs, and incentive systems for primary, acute, MH

Leaders:

• Communication strategy:

• Our communication strategy has won the hearts and minds of government, the public

and 10 million people in England & stigma is now reducing

• We need that hope and optimism communicated to our families and staff

• Leaders:

• We have an army of fabulous people in every, single sector & agency

• Vision & Intelligence on ‘what good looks like’ :

• We have the genius, creativity & innovative spirit we would expect in our MH world

that embraces difference, diversity, ‘thinking outside the box’ & now a spirit of collaboration

• Data: Its our Achilles heel as a healthcare system & especially in mental health

• We have 60% of what we need, but virtually no-one that knows how to use it,

• Our clinicians spend 52% time gathering data but almost none is fed back

• Evidence based implementation plans, sharing & continuous QI:

• Money: % OECD spend on healthcare & % of spend on mental health