Challenge for the NHS and local councils and communities Dr Geraldine Strathdee, National Clinical Director for Mental Health. @DrG_NHS 17 November 2014
Local champions : this discussion • Developing positive mental health in our society • The myths we are busting about mental health • The cost to people & communities of NOT tackling the cause & addressing mental ill health • The cost to people and communities of NOT providing help until it is very late • Giving you some key facts and ammunition! • What support as leaders do you need from us • Your questions & discussion ……..
Mental health: the basis of a humane and wealthy society
If you as local champions arm your self with the facts and get influencing commissioning, you can make a huge difference to your communities
The myths we are busting about MH in England • Mental health just happens or not! You can’t learn it! – No, it’s NOT. Like physical, academic or creative achievement, It can be taught & learnt. • Mental health is a long term condition – No, it’s NOT ! Its so often in England an untreated acute condition • M ental health is all too complex & scary! – No it’s NOT! Its the people we all know with depression/anxiety, eating disorders, perinatal depression, OCD, alcohol, psychosis episodes etc. Mentally ill people don ’ t want to work That’s so NOT true. They can and do want to work . But they cant do it if they cant get our very cost effective, treatments to get well first • Mental health has no evidence based treatments – No it’s NOT! We have over 100 NICE guidelines , HTAs, Quality standards etc – We have highly powered, robust, cost effective treatments if given early – The neurobiology & science & economics are not understood • Mental health has no data to help commission locally appropriate services – NO, we now have the Mental health intelligence network like caner or CVD – (http://fingertips.phe.org.uk/profile-group/mental-health/profile/severe-mental-illness/data) – We have robust economic cost evaluations for every single mental health condition
The national mental health strategy Three areas to focus on for overarching national vision Ta ckling causes, building health literacy & prevention in individuals and communities 1 . Addressing common mental health conditions & integrating physical and mental health in: 2 . • Primary care, • Acute ( physical focus) trusts • Community providers, • Social care 3 . The complex specialist population
In your communities, how much social wealth is lost due to NOT tackling the causes of mental ill health and providing providing early access Do you know this for your city? See how London did it .. The report is available to download from – www.london.gov.uk/mentalhealth
Tackling causes 1 Building health literacy Prevention Employment Transport hub related : Family friendly, productive practices, Preventing isolation in older people Creating wealth Reducing avoidable suicides and Can every large, medium & small employer be a Reducing detentions positive employer? What can GPs and CCGs do ? Schools: Fire chiefs 4 Rs : reading , writing, ‘arithmetic & Resilience 70% of avoidable fires, Building resilience , addressing dyslexia domestic accidents, & RTAs Training school nurses & form tutors Engaging school governors Police commissioners Commissioning parenting College students : & Adult education Safer neighborhoods Alcohol Building resilience & Physical & mental health literacy in future leaders
A few ‘heavy hitters’ in prevention • Aim for zero physical, sexual, emotional abuse of children in England & your community • Support people to get ‘good’ employment as that promotes positive mental health • Tackle bullying early & dyslexia in schools • Support parenting, relationship building, resilience training
Why is prevention & early intervention crucial Key age range for onset • Roughly half of all lifetime mental disorders start by the mid-teens and three- quarters by the mid-20s. • Later onsets are mostly secondary conditions. • Severe disorders are typically preceded by less severe disorders that are seldom brought to clinical attention” Kessler et al, Current Opinion Psychiatry, 2007
Investing in prevention and early intervention Is your area, & your taxpayers aware that not investing in evidence based care is losing the local economy money For each £ spent you save • £8 from early interventions for parents of children with conduct disorder • £84 from school-based social and emotional learning programmes • £14 from school-based interventions to reduce bullying • £10 from work-based mental health promotion (after 1 year) • £5 from early diagnosis and treatment of depression at work • £18 from early intervention for psychosis • £10 from early intervention for pre-psychosis • £12 from screening and brief interventions in primary care for alcohol misuse • £4 from debt advice services
The national mental health strategy Three areas to focus on for overarching national vision Addressing common mental health conditions & integrating physical and mental health in: 2 • Primary care, • Acute ( physical focus) trusts • Community providers, • Social care The complex specialist population 3 .
THE KEY FACTS about access to treatment: Parity and Human Rights: improving Information, access and waiting times to evidence based, outcome measured care, & advancing person centric new treatment methods Mental health problems are estimated 26% of adults with mental illness to be the commonest cause of receive care premature death Largest proportion of the disease 92% of people with diabetes receive burden in the UK (22.8%), larger than care cardiovascular disease (16.2%) or % in By condition…. cancer (15.9%) treatment People with psychosis die 14-20 years earlier of untreated illness Anxiety and depression 24 PTSD 28 Depression associated with 50% Psychosis 80 increased mortality from all disease ADHD 34 Eating disorders 25 59% triple amputees can be treated to Alcohol dependence 23 get back into employment Drug dependence 14 7% SMI get evidence based care to get paid work…….
Supporting employment: Mental health perspective • Mental ill health is common across the world and prevalence and incidence increases in economic recession( Marmot, 2012), so England can expect more • Mental ill health accounts for 30% - 50% of the daily of GPs and primary care but • Less than 40% of GPs are given any access to post graduate training in mental health & less than 1% of practice nurses who lead the reviews of those with Long term conditions The current model of primary care in England is • GP as gatekeeper for almost all assessments and care • The skill mix in the primary care team is predominantly physical health focused & trained i.e. doctors, physical trained nurses, etc • Only 40% of GPs, and less than 1% of practice nurses & < 5% of health visitors and < 5% of midwives, who provide the care for people with Long term conditions have any post graduate MH training ( and some have no undergraduate training) • 30-50% of the daily work of primary care is people with mental ill health , often those with co occurring LTCs, So we have a major mismatch between demand and supply • It is arguable if we can make the transformational changes in employment support needed with the current model of care and investment in primary care MH and • The current monocular physical health focus in long term conditions which impact adversely on health and employment outcomes
Focus on Mental Health and Work (1) • Mental illness costs the UK economy £70 - £100bn per year – 4.5% of GDP (OECD estimate) • Since 2009, the number of working days lost to ‘stress, depression and anxiety’ has increased by 23% • Since 2009, the number of working days lost to ‘severe mental illness’ has doubled • 60-70% of people with common mental disorders (such as depression and anxiety) are in work but this can be seen as a risk factor for future employment difficulties • Co-morbidity of mental disorder and physical disorder is common; of the 15 million people in England with a long- term (physical) condition, 30% also have mental illness. 18% • In 2013, almost 41% of Employment and Support Allowance recipients had a ‘mental or behavioural disorder ’ as their primary condition : 23% 46% Source: Data & figures from the Annual Report of the Chief Medical Offi2013 – Chapter 10, ‘Mental health and work’, (Max Henderson, Ira Madan); Labour Force Survey, 2013; and OECD, 2014, ‘Mental Health and Work, UK’.
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