mental health strategy for …...this commissioning strategy covers mental health services for...

Adult Mental Health

Commissioning Strategy

for

Buckinghamshire

2015-18

Adult Mental Health Commissioning Strategy for Buckinghamshire 2015-18 v9 1

CONTENTS

Introduction 2

Vision 5

National drivers 6

Why is mental health a priority? 9

The position in Buckinghamshire 12

- Local population demographics and need 12

- Current spend 13

- Current services 13

- What is Buckinghamshire doing well at? 14

- What are the gaps? 15

Themes for Action in Buckinghamshire 17

- Theme One 17

- Theme Two 18

- Theme Three 18

- Theme Four 19

Taking forward the Mental Health Strategy for

Buckinghamshire 20

- Leadership 20

- Governance 20

Action Plan for 2015/16 21

Appendix 1- definitions 24

Appendix 2 – key national statistics 27

Appendix 3 – parity of esteem 28


1. Introduction

This Adult Mental Health Commissioning Strategy for Buckinghamshire (‘the Commissioning

Strategy’) 2015-18 has been developed by the Buckinghamshire commissioning organisations

(Aylesbury Vale Clinical Commissioning Group, Buckinghamshire County Council and

Chiltern Clinical Commissioning Group) with input from a small group of mental health

service users from the Mental Health Partnership Board. In addition, an engagement

process was carried out in early 2015, giving a wide range of mental health stakeholders

(including service users, carers, clinicians and other staff) the opportunity to see the general

direction of services being proposed and offering a mechanism to provide feedback, through

submitting their comments and views on earlier draft versions. This commissioning strategy

has taken into account the views expressed.

The commissioning of mental health services in Buckinghamshire is complex in structure

with a variety of players being involved on a day-to-day basis. The County Council

commissions children and young peoples’ mental health services on behalf of all partners;

adult and older adult mental health services are commissioned by the Joint Commissioning

Unit in the County Council including on behalf of the two Clinical Commissioning Groups;

specialised commissioning through the regional arrangement of NHS England holds the

responsibility for commissioning a number of mental health services including forensic

secure mental health, CAMHS Tier 4, eating disorders and others.

This commissioning strategy covers mental health services for adults aged 18-65. It is

informed by the national drivers for change, the analysis of current local need and projected

need in Buckinghamshire for the future and input from those at the forefront of mental

health provision – the service users. Although it is a strategy for the whole county of

Buckinghamshire, there remain geographical and demographical differences between the two

Clinical Commissioning Group areas, between locality wards, between urban and rural

settings and between affluent areas and pockets of relative-deprivation.

Of course, services for people in this age group should not be seen in isolation, hence the

commissioning strategy should be considered alongside Buckinghamshire’s Dementia

Strategy, Children and Young Peoples Mental Health business plan, Buckinghamshire Autism

Strategy and the Suicide Prevention Strategy.


The most recent strategic needs assessment for mental health - the Joint Strategic Needs

Assessment1 (2013) for Buckinghamshire shows:

• There are over 40,000 adults (aged 16-64) with a common mental health problem

(12.7 per cent of the 16-64 population, compared to 15 per cent in the region).

• There are over 900 adults (aged 16-64) managing a psychotic mental illness living in

private households.

• Around a third of people with a long term condition also exhibit a mental health

problem such as depression or anxiety.

Mental health is defined by the World Health Organisation as a “state of wellbeing in which

the individual realises his or her own abilities, can cope with the normal stresses of life, can work

productively and fruitfully, and is able to make a contribution to his or her community.” [WHO,

2005]

Mental health is fundamental to our physical health, our relationships, our education and our

work. There is no health without mental health. Mental health problems impact on

individuals, families, communities and society as a whole, with immense associated social and

financial costs and they contribute to perpetuating cycles of inequality through generations.

Mental illness is an important cause of social inequality as well as a consequence. Mental

health problems contribute a higher percentage of total disability adjusted life years in the

UK than any other chronic illness. Recent estimates put the full cost of mental health

problems in England at £105.2 billion, and mental illness accounts for about 13 per cent of

total National Health Service (NHS) spend. Over the course of this commissioning strategy

it is our commitment that people who use mental health services are responded to with the

same priority as those with a physical health need.

The causes and influences of mental health problems are wide ranging and interacting.

Often they occur because of adverse events in our lives, and other circumstances, such as

poverty, unemployment, levels of supportive networks, levels of education and the broader

social environment interact and affect how resilient we are in coping with these challenges.

1 Buckinghamshire County Council (2013), Joint Strategic Needs Assessment


Good quality personalised treatment and care is vital for people of all ages with mental

health problems and achieving equal status for mental and physical healthcare is a key

national driver. However, it has been estimated that even if all those with mental illness

were given the best available treatment, the total burden of disability across the population

would still be considerable, demonstrating the importance of wider supportive networks in

enabling people to live full and meaningful lives. Since mental illness is under-diagnosed, and

treatment is only part of an effective response, this highlights the need to address the wider

risk factors for poor mental health and increase the protective factors.

As well as enhancing these protective factors for mental health, there is a good evidence

base for a number of interventions that improve mental wellbeing. Improving mental health

and wellbeing is associated with significant impacts for individuals and society, including

better physical health, longer life expectancy, reduced inequalities, healthier lifestyles,

improved academic achievement, enhanced community participation, reduced sickness

absence and improved productivity as well as reduced costs from welfare, health and social

care.


2. Vision

For everyone in Buckinghamshire, we will:

• work together to ensure there is ‘parity of esteem’

giving equal status to mental health and physical

health,

• promote positive mental health and wellbeing,

• take steps to reduce mental ill-health and its impact,

to enhance quality of life,

• intervene early and offer support when people

become unwell,

• address the stigma associated with mental illness.


3. National Drivers

Our local commissioning strategy will deliver and build upon the national mental health

strategy, No health without mental health which describes the outcomes that health

and social care organisations should seek to achieve along with recommendations for action

(https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213761/dh_1

24058.pdf).

The outcomes are as follows:

• More people will have good mental health

• More people with mental health problems will recover

• More people with mental health problems will have good physical health

• More people will have a positive experience of care and support

• Fewer people will suffer avoidable harm

• Fewer people will experience stigma and discrimination

There are three national outcomes frameworks that include specific indicators for mental

health. These are the Public Health Outcomes Framework2 the NHS Outcomes

Framework3 and the Adult Social Care Outcomes Framework4

In 2012 the Government published Preventing Suicide in England5 which aims to

reduce the suicide rate in England and to better support those bereaved or affected by

suicide.

Closing the gap: priorities for essential change in mental health6 was published in

early 2014 to support the delivery of ‘No health without mental health’ and the national

‘Suicide prevention strategy’.

Also in 2014, the Government published the Mental Health Crisis Care Concordat:

improving outcomes for people experiencing mental health crisis7 . This outlines

2 HM Government (2012), Public health outcomes framework 3 HM Government (2012), NHS outcomes framework 4 HM Government (2012), Adult social care outcomes framework 5 HM Government (2012), Preventing suicide in England 6 Department of Health (2014), Closing the gap: priorities for essential change in mental health 7 HM Government (2014), Mental health crisis care concordat: improving outcomes for people experiencing mental health crisis

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213761/dh_124058.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213761/dh_124058.pdf


a vision for health, social care and emergency services to work together to deliver a high

quality response when people of all ages with mental health problems urgently need help.

The Care Act Chapter 238 makes provision to reform the law relating to:

• care and support for adults and the law relating to support for carers

• to make provision about safeguarding adults from abuse or neglect

• to make provision about care standards

• to establish and make provision about Health Education England

• to establish and make provision about the Health Research Authority

• to make provision about integrating care and support with health services

Most importantly the Health and Social Care Act9 requires the NHS, local authority

including social care services to deliver ‘parity of esteem’ between mental and physical

health by providing a holistic, whole-person approach to every individual, whatever their

needs. A parity approach gives equal status to mental health and physical healthcare,

meaning that the standards of care for people with mental health problems are at least as

good as those for people with physical health problems.

Whole person care: from rhetoric to reality10 identifies the following implications in

achieving parity of care:

• equal access to the most effective and safe care and treatment

• equal efforts to improve care

• equal allocation of time, effort and resources in relation to need

• equal status within healthcare education and practice

• equally high aspirations of service users

• equal status to the measurement of health outcomes

8 HM Government (2014), Care Act chapter 23 9 HM Government (2012), Health and social care Act 10 Royal College of Psychiatrists (2013), Whole person care: from rhetoric to reality


Public mental health priorities: investing in the evidence11 looks at the concept of

‘mental wellbeing’ and says that the assumption that increasing well-being improves mental

health and reduces the prevalence of mental illness in the population, gives rise to

problematic conclusions because there is no consensus definition of the term ‘well-being’.

The most recent publication has been The Five Year Forward View and

Commissioning Mental Health Services in 2015 and Beyond12. The Thames Valley

Strategic Clinical Network has recommended a number of areas contained in ‘The Five Year

Forward View’ as: to maintain the stability of core services and to build on the excellent

improvements to mental health provisions in recent years. In addition: building further on

system integration (health system and public service sector); self-management (promotion

and enabling); improving mental health services in primary care; CAMHS (joint strategy for

local authority and CCGs); and perinatal mental health services. In addition there has been

recent national guidance on Access and Waiting Times13. This guidance follows the

October 2014 publication of Improving Access to Mental Health Services by 202014.

Improvements towards meeting the first standards came into effect from 1 April 2015 for

achievement by 1 April 2016 and are focussed in three areas where timely access to

evidence-based care is of particular importance in improving longer term mental health,

physical health and recover-focussed outcomes, and in reducing the distress experienced by

individuals and their families.

11 Chief Medical Officer (2014), Annual report, public mental health priorities: investing in the evidence 12 NHS England (2015), The Five Year Forward View and Commissioning Mental Health Services in 2015 and Beyond 13 NHS England (2015), Guidance to support the introduction of access and waiting time standards for mental health services in 2015/16 14 NHS England (2014), Improving access to mental health services by 2020.


4. Why is Mental Health a priority?

Mental health problems are common, disabling and costly.

• Mental health problems represents up to 23 per cent of the total burden of ill health

(includes dementia and substance misuse) in the UK and is the largest single cause of

disability compared to 16 per cent each for cardiovascular disease and cancer)15

• At least one in four people will experience a mental health problem and almost half

of all adults will experience at least one episode of depression during their lifetime16

• At any one time one in six people will suffer from a CMD, like depression or anxiety

which can be wide-ranging in severity17.

• Mental health problems can affect approximately 10 per cent of children aged

between five and sixteen18

• People with mental health problems have poor physical health outcomes and

research show that they die younger (up to 20 years younger for people with

schizophrenia)19

• Around 30 per cent of people with a long-term physical health condition will also

have a mental health problem, and of those with a mental health problem, around 45

per cent will also have a long-term physical health condition20

• Mental health problems are responsible for more sickness absence than any other

illness21

• Mental, emotional or psychological problems, many of which fall short of diagnosable

mental health conditions, together account for more disability than all physical health

problems put together22

15 World Health Organisation. The Global Burden of Disease: 2004. Update 16 Andrews G, Poulton R, Skoog I. Lifetime risk of depression: restricted to a minority or waiting for most? Br J Psychiatry 2005; 187:495-6 17 McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R. Adult psychiatric morbidity in England, 2007: Results of a household survey. United Kingdom: Health and Social Information Centre, Social Care Statistics;2009 18Green, H., McGinnity, A., Meltzer, H., Ford, T. & Goodman, R. (2004). Mental Health of Children and Young People in Great Britain, 2004. Office for National Statistics.) 19 De Hert, M. et al. Physical illness in patients with severe mental disorders. World Psychiatry 20 The Kings Fund (2012) Long-term conditions and mental health. The cost of co-morbidities. Available online: http://www.kingsfund.org.uk/publications/long-term-conditions-and-mental-health 21 Hussey L, Carder M, Money A, Turner S and Agius RM. Comparison of work-related ill-health data from different GB sources. Occup Med (Lond) 2013: 63(1): 30-37 22 Stewart-Brown S, Layte R. Emotional health problems are the most important cause of disability in adults of working age. Journal of Epidemiology and Community Health 1997; 51: 672-5.


• Mental health problems are under diagnosed and under treated - only a minority of

people with clinically recognisable mental health conditions in the UK receive and

treatment23

• Mental health problems represent the largest single cost to the NHS (13 per cent of

current spending)24

• Mental health conditions costs England approximately £105 billion each year once its

impact on work, crime and violence has been taken into account25

• Protection against mental health conditions by reducing risk factors and increasing

protective factors is important because treatment for mental health conditions is

only partially effective. It has been estimated that if all those with mental health

conditions were given the best available treatment, the total burden of mental health

conditions would reduce by only 28 per cent 26

• By 2026, the number of people in England who experience a mental health problem

is projected to increase by 14 per cent from 8.65 million in 2007 to 9.88 million27,

however this does not take account of the current economic climate which is likely

to increase prevalence.

Mental health problems: Cause and consequence of social inequality

Mental health problems are an important cause of social inequality, violence and

unemployment as well as a consequence. Mental health problems in childhood and

adolescence can result in:

• Reduce educational achievement and employability2829 and also

• Increase the risk of impaired relationships, drug and alcohol misuse, violence and

crime3031.

23 McManus S, Meltzer H, Traolach B, Bebbington P, Jenkins R. Adult Psychiatric morbidity in England 2007 results of a household Survey. Health and Social information Centre-Social Care statistics.2007 24 The London School of Economics and Political Science. (2012) How Mental Health Loses Out In The NHS. A report by the Centre of Economic Performance Mental Health Policy. http://cep.lse.ac.uk/pubs/download/special/cepsp26.pdf 25 Centre for Mental Health. The Economic and Social Costs of Mental Health Problems in 2009/10, London: Centre for Mental Health: 2010. 26 Andrews G, Issakidis C, Sanderson K, Corry J, Lapsley H. Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders. British Journal of Psychiatry 2004; 184:526-33. 27 McCrone P et al (2008) Paying the price. The cost of mental health care in England to 2026. London. The King’s Fund. 28NICE. Promoting children’s social and emotional well-being in primary education. HN 12, 2008 29 NICE. Promoting young people’s social and emotional well-being in secondary education. PH20 2009. 30 Fergusson DM, Horwood LJ, Ridder EM. Show me the child at seven: the consequences of conduct


The experience of mental health problems further exacerbates social inequalities because of

its impact on employment and housing status. Half of all mental health conditions start by

the age of 143233 and 75 per cent by mid 20s34.

Low income35, debt36, violence37, stressful life events38 and unemployment3940 are key risk

factors for mental health problems. The two-way relationship between mental health

conditions and social inequality can prove difficult to unravel.

problems in childhood for psychosocial functioning in adulthood. Journal of Child Psychol olgy2005; 46(8):837-49 31 Richards M, Abbott R. Childhood mental health and life chances in post-war Britain. Insights from three national birth cohort studies. MRC unit for life long health and ageing. 2009 32 Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. . Lifetime prevalence and age of- onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 2005; 62(6):593-602. 33 Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R. Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective longitudinal cohort. Arch Gen Psychiatry 2003; 60(7):709-17 34 Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S , Ustun TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 2007; 20(4):359-64. 35 McManus S, Meltzer H, Brugha T, Babbington P, Jenkins R. Adult psychiatric morbidity in England, 2007. Results of a household survey. Health and Social information Centre, Social Care Statistics.Uk 36 Jenkins R, Bhugra D, Bebbington P, Brugha T, Farell M, Coid J, et al. Debt, income and mental disorder in the general population. Psychol Med. 2008; 38(10):1485-93. 37 McCrone P, Dhanasiri S, Patel A, Knapp M, Lowton-Smith S. Paying the price. The cost of mental health care in England to 2026. London: The King’s Fund; 2008. 38 Melzer D, Fryers T, Jenkins R, Brugha T. Social inequalities and the distribution of common mental disorders. Hove: Psychology Press, Maudsley Monograph; 2004. 39 Healthcare Commission, Care Services Improvement Partnership, National Institute for Mental Health in England and Mental Health Services Act Commission. Count me in 2008: results of the 2008 national census of inpatients in mental health and learning disability services in England and Wales. Commission for Health care Audit and Inspection; 2008. 40 Higgins A, Barker P, Begley CM. Sexual health education for people with mental health problems: what can we learn from literature? J Psychiatry Ment Health Nurs 2006; 13: 687-97


5. The position in Buckinghamshire

It is recognised that mental health is more than the absence of illness; it is intimately

connected with physical health and forms an integral part of health.

A key message is that the organisational and conceptual division between physical and

mental health is a barrier to the improvement of health more generally.

There are ample opportunities for mental illness prevention, and treatment and recovery

from common mental disorders for which there is a sufficient evidence base to make a real

and sustained public health impact. It is now generally accepted in policy, voluntary sector

and some research circles that improving wellbeing will improve mental health and reduce

the prevalence of mental illness in the population. We should invest in opportunities to

promote, prevent and treat rather than being side-tracked by approaches to population-

based wellbeing which currently go well beyond existing evidence.

Local population demographics and level of need

There are a number of sources of data available and it is sometimes difficult to find

agreement on levels of population need. However, for this commissioning strategy we have

used the PANSI data for Buckinghamshire41, which shows:

1. Population

• Total (all ages) population in 2014 was 518,500, increasing to 579,600 in 2030

• Total (18-64) population in 2014 was 305,600, increasing to 314,000 in 2030

• An increase of 12 per cent in the population size (2014-2030) for all adults

• An increase of three per cent in the population size (2014-2030) for 18-64 year olds

2. Common Mental Disorders (18-64 year olds)

• 49,315 individuals in 2014 rising to 50,617 in 2030 (increase of 2.5 per cent in

Buckinghamshire compared to an increase of three per cent in England)

41 Institute of Public Care (2014), PANSI – projecting adult needs and service information


3. Psychotic Disorders (18-64 year olds)

• 1,226 individuals in 2014 rising to 1,258 in 2030 (increase of 2.5 per cent in

Buckinghamshire compared to an increase of three per cent in England)

4. Two or more psychiatric disorders (18-64 year olds)

• 22,019 individuals in 2014 rising to 22,619 in 2030 (increase of three per cent in

Buckinghamshire compared to an increase of 3.5 per cent in England)

We can therefore surmise that the local demographics and levels of mental health need

in Buckinghamshire approximately reflect the national England average, indicating a slight

increase in need over the period from 2015 to 2030.

Current Buckinghamshire mental health spend on adults (over 18 years old)

Commissioning organisation Amount in £1,000s a. Aylesbury Vale CCG 29,215 b. Chiltern CCG 41,639 c. Buckinghamshire CCGs total (a+b) 70,854 d. Buckinghamshire County Council 16,019

Buckinghamshire total (c+d) 86,873

Current services

Services for those with mental illness in Buckinghamshire are delivered by a mixture of

primary care and statutory and third sector provider organisations. In addition, care is

often provided on an informal basis by family members.

The treatment of common mental health problems is largely provided by GP practices and

the Healthy Minds service (part of Oxford Health NHS Foundation Trust) which offers

therapies in line with the governments ‘Increasing Access to Psychological Therapies’

agenda. People can access this service either by referral or self-referral.


Secondary mental health services are provided by Oxford Health NHS Foundation Trust

(www.oxfordhealth.nhs.uk) which can be accessed by referral from a GP or other

professional. In-patient treatment for the whole of Buckinghamshire is provided at The

Whiteleaf Centre in Aylesbury, including provision for adults acute admission and

rehabilitation, as well as designated places of safety for those in need of crisis support.

Current community service provision for adults with mental health problems includes the

following teams:

• early intervention in psychosis teams support those aged 16-35 presenting for the

first time with a psychosis

• adult mental health teams; covering the functions previously providing crisis

resolution and home treatment and assertive outreach in addition to general

community mental health services

• complex needs services for those with personality disorders

• psychiatric in-reach and liaison services (PIRLS) to the acute hospitals

• local authority employed Approved Mental Health Professionals (AMHPs) located in

community teams providing statutory mental health assessments

• Voluntary and independent sector provide advocacy services, accommodation and

support, day opportunities, carer services and service user-led organisation.

What is Buckinghamshire doing well at?

Of note, we currently have some excellent and recently-developed services, for example:

• The Whiteleaf Centre – a state-of-the-art purpose-built psychiatric hospital in

Aylesbury. This continues to have a positive impact through the provision of

improved ward environments, increased nurse-to-patient ratios providing better

levels of care and treatment, and a reduction in the number of patients having to be

placed in out-of-county treatment facilities.

• Round the clock adult mental health teams in the community with single points of

access providing extended hours care and support. These services are ahead of

many other mental health systems.

http://www.oxfordhealth.nhs.uk/


• Integrated and coordinated Psychological Therapy services – IAPT – Healthy Minds.

This service is now a national leader, regularly attaining over 60 per cent recovery

rates.

• PIRLS – psychiatric service in-reaching to the acute hospitals providing assessment

and support for those with mental health problems. This has provided quick mental

health responses to people attending the ‘Emergency Department’ and to those

admitted to general wards with complex physical and mental health issues.

• Crisis Care Concordat – providing leadership and focus on crisis and emergency

care across agencies. This now sees the Buckinghamshire agencies (health, social

care, police, ambulance) committing to increasingly work together to provide crisis

services to those in urgent need.

• Accommodation and community support services providing a range of services. The

latest local market position statement42 shows that there is an appropriate level of

provision in both supported living and residential care beds. Over the last five years

we have seen positive changes in maintaining the level of nursing care provision,

reducing residential care provision and the related increase in supported living and

extra care.

• Direct payments and social care personal budgets for people to manage their own

care. In the last two years we have seen people reduce their attendance at

traditional day services and choose to take up the offer of direct payments that

enable them to have greater flexibility in their support in the community (2014-15

has seen a 85 per cent increase in the value of direct payments and 49 per cent

decrease in the spend on traditional day care)

What are the gaps?

The available data shows that the mental health need in the adult population in

Buckinghamshire will remain mostly unchanged over the period until 2030.

The availability, quality and performance of local mental health services are regularly

monitored – provider contracts are actively managed by the commissioning organisations.

This gives a useful insight into where service areas are working well and where there are

42 Buckinghamshire County Council (2015) Market Position Statement – specialised housing for vulnerable adults


emerging issues. In addition, both locally and nationally, there is a desire to improve mental

health services so that mental health is supported equally as physical health. As a result, a

number of issues and gaps have begun to emerge. These will be addressed during the time

of this commissioning strategy.

From this information we know we should pay better attention to:

• Disparity of esteem (mental health is not afforded sufficient priority as physical

health). We need to do more to incorporate mental health care in the physical

health pathway and conversely to do more to improve the physical health of those

with severe and enduring mental illness

• Waiting times for accessing mental health care as they currently lag behind those for

physical health care

• Improve crisis response for those who have immediate and urgent mental health

needs (too many mental health patients held in police custody)

• Perinatal support and treatment (currently RAG-rated as ‘red’ for NICE compliant

services)

• Improve assessment and support for people living with ADHD

• Improve assessment and support for people living with autism with a mental health

need

• Involve service users and carers more in the development of services

• Transitions from children’s mental health services to adult mental health services is

currently complex and doesn’t prepare young people adequately

• Helping people help themselves, through developing prevention services to aid

people to seek help early so that they do not become increasingly mentally unwell,

or so that they can support themselves and each other in their recovery.


6. Themes for action in Buckinghamshire

Improving the mental health and wellbeing of people in Buckinghamshire has been

prioritised by the Buckinghamshire County Council, Aylesbury Vale Clinical Commissioning

Group and Chiltern Clinical Commissioning Group.

Our focus for this commissioning strategy is on the continuation and development of quality

services with better and timely access so that we can close the identified gaps and ensure

that we have NICE-compliant services in place.

The Buckinghamshire Themes for Action: THEME 1

Improving mental wellbeing, reducing stigma and moving to achieving parity for

mental health

- including physical and mental health promotion and mental illness

prevention, lifestyle advice and planning for older age

“My physical health needs have often been ignored due to the mental health problems I have

suffered… it’s all too often put down as being ‘all in the mind’…..it is great news to hear that

people with mental health needs need to be given the same level of care and priority as those with

physical health needs” (feedback quote received during engagement; Anon.)

“As someone who has ongoing mental health issues from anxiety and depression and on high doses

of medication, I am really pleased that Buckinghamshire is going to do something about the stigma

of anyone having mental health issues and getting people with mental health issues well again”

(feedback quote received during engagement; Anon.)

We intend to:

• Improve the physical health of those with severe and enduring mental illnesses

• Work closely with Public Health to ensure that mental health and emotional

wellbeing is included in physical lifestyle advice

• Improve access to psychological support and treatment for those with long term

physical conditions and co-morbid mental ill-health


• Working to increase the investment in mental health services

THEME 2

Intervening early with support in primary and community care

- Including self-management, community engagement, workplace support

- Commitment to reducing local health and social care inequalities

“I think families of people with mental health problems need to be more involved with their care

and support and be given the back-up needed by agencies which has been lacking in some

areas……. Families do not know what to do when someone becomes ill. They don’t know who to

go to or what to say to their loved one” (feedback quote received during engagement; Anon.)

“Very positive that the new strategy includes perinatal mental health and transition from CAMHS to

adults” (feedback quote received during engagement; Anon.)

We intend to:

• Introduce a new perinatal mental health service

• Review transitions planning for young people to ensure that this commences earlier

in the pathway

• Improving the equity of access to psychological therapies for those who are deaf and

hard-of-hearing with common mental health problems

• Further develop psychological therapy services to meet shorter waiting times

THEME 3

Managing mental ill-health and moving to recovery

- Including assessment, support and treatment and supporting recovery

through a range of integrated treatment options with choice where

appropriate

“I am really pleased to see that more consideration will be given to how mental health can support

people living with ADHD and Autism…..these people, especially young people in transition, ‘fall

through the gap’ and aren’t adequately catered for in terms of their needs being met” (feedback

quote received during engagement; Anon.)


We intend to:

• Develop urgent response services for those with a severe mental illness who are in

urgent need

• Support providers to be more proactive in the development of models that enhance

recovery

• Work in a more coordinated way with the police, ambulance service, A&E and

mental health services

• Increase the availability of early intervention services for those presenting with

psychoses for the first time.

• Provide an ADHD assessment service to work alongside the autism support service.

• Offer choice to people to access mental health services

THEME 4

Service user inclusion and involvement

“Work towards a more integrated approach from those delivering services….make a new

partnership with service users and the public” (feedback quote received during engagement;

Anon.)

We intend to:

• Increase patient and public involvement in the co-commissioning and development of

services in a way that is meaningful and acceptable

• Encourage the development of a ‘recovery college’ approach to enable peer-led

support


7. Taking forward the Adult Mental Health commissioning

strategy for Buckinghamshire

Leadership

Improving mental health is ‘everyone’s business’, but clear leadership needs to be

demonstrated by partner organisations.

There is a need to agree a clear way forward to ensure this strategy is implemented,

including the development and delivery of detailed action plans for each of the strategic

priorities.

Further strategic work will include ensuring that this commissioning strategy is monitored

fully and is linked with agreed suitable targets for assessing progress.

Governance

This strategy is owned by the Buckinghamshire Health and Wellbeing Board and will be

monitored through the Adult Joint Executive Team in Buckinghamshire.

In addition the priorities will form part of the agenda for engagement through the

Buckinghamshire Mental Health Partnership Board, where service user and carer

representation sits.


Action Plan for 2015/16

The action plan is for the first year of this commissioning strategy. The intention is that the

action plan will be updated annually with new actions each year to continue the

developments required to commission and provide quality adult mental health services

across Buckinghamshire.

The Action Plan supports the delivery of the four Themes:

THEME 1 - Improving mental wellbeing, reducing stigma and moving to

achieving parity for mental health

THEME 2 - Intervening early with support in primary and community care

THEME 3 - Managing mental ill-health and moving to recovery

THEME 4 - Service user inclusion and involvement

Development Intention

Commissioning Outcome

Action Required Theme

Increase the parity of esteem between mental health and physical health

Peoples mental health needs will receive the same level of attention as peoples physical health needs

Ensure that the increased NHS resource is fully utilised on mental health services; this will be used in the improvement and development of services to include: early intervention in psychosis, perinatal support, ADHD and autism assessment and support, transitions planning for young people

Theme 1 and 2

Improve the physical health of people with severe and enduring mental illness

Reduction in the gap in physical health outcomes between those with mental illnesses and others in the community

Clinician will ensure that people receive advice, health checks and support to improve their health outcomes

Theme 1, 2 and 3

Adopt waiting time targets

People will have the shortest possible wait to receive an

New investment will be used to achieve and maintain the

Theme 1 and 3


assessment of their needs and access to treatment

waiting time targets for assessment and treatment in both primary care and secondary services

Improve responses for people in a crisis situation

People in a crisis will receive a joined-up service that safeguards them and those around them

The Crisis Care Concordat will ensure that agencies work positively together through the Crisis Care Concordat Action Plan. Reduce the number of people in a mental health crisis being transported inappropriately. Reduce the number of people detained under S135/136 Mental Health Act through ‘street triage’. Provision of a quality psychiatric in-reach service linking mental health and acute hospital services.

Theme 3

Adopt choice for mental health services

People requiring mental health services will be offered choice in accessing services

Commissioners and providers will state the expectation for choice of services and have a clear and understandable process for its promotion

Theme 2 and 3

Promote prevention

People will be able to have the support they require to enable them to look after their own mental health, where possible without the need for intervention

Public Health will ensure that mental health and emotional wellbeing is included in physical lifestyle advice. The Prevention Matters service will look to develop more community support services and help people to access

Theme 2 and 4


these. Increase service user participation and involvement in services

People are encouraged to be involved in the development of new approaches to service delivery

New resources will be committed to the development of a ‘recovery college’ in Buckinghamshire

Theme 3 and 4

Support the stability in the local mental health system

Local mental health providers will have the confidence that they are delivering the right services at the right time

Commissioners will work with providers on the maintenance of current services and the development of new approaches through a robust contract performance framework

Theme 3


Appendix 1

Definitions:

What is good mental health?

Mental health is not just the absence of a mental health condition, but the foundation for

wellbeing and effective functioning of individuals and communities. It is defined as ‘a state of

wellbeing in which every individual realizes his or her own potential, can cope with the normal

stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his

community. Where health is a state of complete physical, mental and social wellbeing and not

merely the absence of disease or infirmity.’43

What is mental wellbeing?

Mental wellbeing is a ‘dynamic state’, in which the individual is able to develop their

potential, work productively and creatively, build strong and positive relationships with

others, and contribute to their community. It is enhanced when an individual is able to fulfil

their personal and social goals and achieve a sense of purpose in society.’44

The New Economics Foundation (NEF) describe wellbeing as conceptualising people’s

subjective experience and feeling, where it is the interaction between one’s circumstances,

activities and psychological resources (sometimes also called ‘mental capital’) that matter.

The NEF concepts of wellbeing include:

• Personal wellbeing = positive functioning, vitality, resilience and self-esteem, life

satisfaction and emotional wellbeing

• Social wellbeing = supportive relationships, trust and belonging

• Wellbeing at work = job security, job satisfaction, work-life balance satisfaction,

working conditions and emotional experience at work.

Mental wellbeing is a fundamental component of good health. Mental health problems are

hugely costly to the individual and to society, and lack of mental wellbeing underpins many

physical diseases, unhealthy lifestyles and social inequalities in health. Therefore, mental

health and wellbeing are fundamental to the quality of life and productivity of all of us, as

43 World Health Organisation (2008), Mental health, strengthening our response. Online at www.who.org 44 Government Office for Science (2008) Foresight report on mental capital and wellbeing


well as our family, community and nation. Good mental health enables us to experience life

as meaningful, creative and active citizens.

Good mental health and wellbeing has many benefits, which include45:

• Better physical health

• Reductions in health damaging behaviour

• Greater educational achievement

• Improved productivity

• Higher incomes

• Reduced absenteeism

• Less crime

• More participation in community life

• Improved overall functioning

• Reduced premature mortality.

What is mental ill health?

Mental Illness is generally categorised into Common Mental Disorders (CMD) and Severe

Mental Illness (SMI).

What is a common mental health disorder (CMD)46?

Common mental health disorders are those which tend to occur most often. People with

CMD have more severe reactions to emotional experiences than the average person. For

example, this may mean developing depression rather than feeling low, or having panic

attacks rather than experiencing feelings of mild anxiety. This includes conditions such as

depression, anxiety disorders, obsessive compulsive disorders and post-traumatic stress

disorder. In the past common mental health disorders were called ‘neurotic conditions’.

What is a severe mental health illness (SMI)?

Severe mental health problems are less common. They disrupt a person’s perception of

reality, their thoughts and judgement, and affect their ability to think clearly. People affected

may see, hear, smell or feel things that nobody else can. This includes conditions such as

45 Department of Health (2011) No health without mental health 46 Definitions adapted from the Mental Health Foundation www.mentalhealth.org.uk

http://www.mentalhealth.org.uk/


schizophrenia and bipolar disorder (formerly known as manic depression); paranoia and

hallucinations. Severe mental health illness may be referred to as psychotic conditions.

What is public mental health?

Public mental health is about improving mental health and wellbeing and preventing mental

health problems through the organised efforts and informed choices of society,

organisations, public and private, communities and individuals.

Public mental health aims to improve the mental wellbeing and reduce the burden of mental

health problems across the whole population. This can be achieved through:

• Assessing the risk factors and understanding the level of mental health problems and

what works to help us have good mental wellbeing

• Delivering appropriate evidence based interventions that promote emotional

wellbeing and prevent mental health problems

• Ensuring those people at ‘higher risk’ of mental health problems and poor emotional

wellbeing have access to mental health treatments early and are prioritised for

services in proportion to their needs.

Latest evidence suggests taking a population level approach is needed to promote wellbeing

that enables individuals to function in families, communities and society. A population

approach recognises the importance of good mental wellbeing in childhood and adolescence

for positive mental wellbeing in adulthood and old age. The more people there are in a

community who have high levels of emotional and social wellbeing, the more resilient a

community is to support those with acute mental health problems.

The New Economics Foundation (NEF) was commissioned by the Government's

Foresight Project on Mental Capital and Wellbeing to develop a set of evidence-based

actions to improve personal wellbeing47 From this report The Five Ways of Wellbeing48

was developed which sets out the evidenced-based actions which promote well-being.

47 Mental capital and wellbeing (2008) The Foresight Report 48 New Economics Foundation (2008), Five ways to wellbeing


Appendix 2

Key national statistics

Adults49:

• Most adults with mental illness experience their first episode of mental illness before

the age of 16.

• Adversity in childhood increases the likelihood of mental illness in adulthood, e.g.

non-consensual intercourse before the age of 16 increases the odds of psychosis in

adulthood 10-fold.

• People with extensive experience of physical and sexual abuse both as a child and as

an adult are 15 times more likely to have multiple mental disorders than people

without such experiences.

• In England, about one person in six (17.6 per cent) aged 16-64 had a common mental

disorder (such as anxiety or depression) in the past week.

• Common mental disorders are more likely in women (21.5 per cent) than men (13.5

per cent) of working age. This pattern is also true of eating disorders.

• Drug dependence (5.4 per cent of men; 2.8 per cent of women), alcohol dependence

(9.3 per cent of men; 3.6 per cent of women) and problem gambling (0.8 per cent of

men; 0.2 per cent of women) are more common in men than women.

• Common mental disorders tend to be highest in midlife, among particular black and

minority ethnic (BME) groups and those living in low-income households.

• Psychotic disorders also arise more commonly in BME communities.

• People living in cold homes and those who are in debt have higher odds of mental

illness, even after controlling for low income.

• Common mental disorders are twice as frequent in carers who are caring more than

20 hours a week than in the general population.

• In 2007, a quarter (24 per cent) of people with common mental disorders were in

receipt of some kind of mental health medication or therapy – 76 per cent were not.

49 Life course: adults’ mental health (2013) Chapter 7, Annual report of the Chief Medical Officer


Appendix 3

Parity of Esteem50

Mental health’s time has come. No longer is it good enough for mental health to be the

poor relative of physical health. No longer is it acceptable for there to be no parity of

esteem. It is time to stop the short term approach of simply treating the problem when it

presents and become more proactive about prevention and early intervention. That means

working with schools, colleges and universities, employers, transport, police, health and

social care, local authorities and community organisations to raise the profile and priority of

good mental health and early action if there are signs of difficulties in any individual. It is time

to stop accepting second best in mental health services and work with those who have lived

experience to design better services together.

It is time to shift care into the communities where people live by increasing primary care

mental health services and supporting specialist care - absolutely essential for many who

have episodic crises or enduring severe mental illness - in moving to community

environments with close links to primary care. We all need specialists to be freer to

respond when there is need. It is time to act and do what the evidence shows.

Mental health and wellbeing are central to the work of GPs, and high quality primary care is

critically important for the health of local communities. Indeed we are, in many ways, at a

moment of real possibility in relation to mental health. Increasingly, a body of ideas is being

shared that together represent a coherent direction of travel. Care and support moving

further out of hospital towards home; moving from prescription to partnership in working

with empowered citizens and patients; seeing the development of resilience and health

promoting communities as key ingredients for real population health; working towards

holistic approaches that bridge the mind-body divide that we have artificially created.

50 NHS England (2014) www.england.nhs.uk/ourwork Parity of Esteem

mental health strategy for …...this commissioning strategy covers mental health services for...

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