14/02/12 Update on the Mental Health Joint Commissioning Strategy Yasmin Sidyot Yasmin Surti Mark Wheatley Purpose of the Joint Commissioning Strategy • To set out the plans for the development of health and social care services over the next 3 years • The partners are Leicester City Council for social care and NHS Leicester City for health services • The plans are in line with One Leicester and One Healthy Leicester 1
14/02/12 Charter for Mental Health Every person in Leicester, Leicestershire and Rutland has the right to mental health services that: Make a positive difference to each person they serve. • Stop doing things that are not working. • Are guided by the individual’s views about what they need • and what helps them. • Treat everyone as a capable citizen who can make choices • and take control of their own life. • Work with respect, dignity and compassion. • Recognise that mental health services are only part of a • person’s recovery. • Recognise, respect and support the role of carers, family • and friends. • Communicate with each person in the way that is right for them. • Understand that each person has a unique culture, • life experiences and values. • Give people the information they need to make their • own decisions and choices. • Support their workers to do their jobs well. • Challenge “us and them” attitudes both within mental • health services and in the wider society. Vision & Aims Improving the wellbeing of the people of Leicester by strengthening resilience, reducing health and social barriers to good mental health and wellbeing and improving the communities within which we live. AIMS: Promote good mental health and well-being, • Improve services for people who have mental health problems. • Help people to look after their mental health and prevent them from becoming ill. • Tackle the stigma that's associated with mental ill health by focussing on whole • population mental health. Recognise that mental health and well-being is everybody’s business • Work in partnership with service users and their carers throughout the • commissioning process. Commission services of a high quality that will meet the needs of the service users. • Ensure Mental Health services are closely integrated with general health services • Develop services closer to home, where ever possible. • Develop well planned care which will aim to support people in achieving recovery. • Implement personalised care plans for people assessed as needing services. • 2
14/02/12 Inequalities in Severe Mental Illness and Self-harm Inequalities in Severe Mental Illness and Self- harm in Leicester, 2005 – 2007 Source: Leicester Health Equity Audit, 2007 Prevalence of Severe Mental Illness by Ethnic Group Prevalence of Severe Mental Illness by Ethnic Group, 2008 Source: Leicester Health Equity Audit, 2007 3
14/02/12 The priorities for the delivery of mental health care in Leicester • The development and implementation of a stepped care approach to ensure all patients have timely access to appropriate services • To continue to work in partnership to address the determinants of inequality and deprivation with are linked to mental illness • Increase support for the involvement of service users and carers in the planning, development and delivery of mental health services Mental Health Promotion • Strengthening individuals • Strengthening communities • Reducing the structural barriers to mental health and well being 4
14/02/12 Delivering Race Equality in Mental Health Care • Mental health needs of people from Black and Minority Ethnic background is affected by issues such as deprivation • BUT new communities, are likely to have high rates of mental ill health, for example major anxiety, depression or post traumatic stress disorder • People from Black/Black British ethnic backgrounds are over generally represented in mental health service use • People from Asian/Asian British ethnic backgrounds are generally under-represented in mental health service use Maternal Mental Health In pregnancy depression is most common at the end of the second • trimester Psychiatric disorder following childbirth is common and often • serious and can range from anxiety and depression to post traumatic stress and puerperal psychosis For those who have had previous mental ill health there is a risk of • relapse In Leicester it can be estimated that 150 women will have a major • perinatal depressive illness 3-5% of women who have delivered will have moderate to severe • depressive illness 1 per 1000 women who deliver will have puerperal psychosis • 5
14/02/12 Working Age Adults 16-18% of working age adults might be expected to be suffering a • common mental health disorder at any one time (29,000 – 33,000 people in Leicester) Unemployment, overcrowding, few educational qualifications are • associated with poor mental health and Leicester ranks higher than the national average on all such measures Poor quality of life resulting from physical illness is also closely associated • with mental ill health Physical ill health of those with a persistent mental illness often goes • undetected, contributing to increased morbidity and lower life expectancy The number of adults claiming Incapacity Benefit/Severe Disablement • Allowance has been increasing Number of GP consultations of people with severe mental health • problems is 13-14 annually compared with 3-4 in the general population Older People • Provision of mental health care for older people is an urgent problem • 10-16% of older people have depression • Common mental disorders are associated with disability, long term physical health problems, difficulties with activities of daily living, loneliness and isolation • Cognitive impairment related to dementia is expected to affect more than 3,000 by 2016 • Family carers of people with dementia are often old and frail themselves, with high levels of depression and physical illness, and a diminished quality of life 6
14/02/12 Suicide and self-harm • Annually there are between 25 and 30 deaths from suicide in Leicester • The highest rates are amongst those in the most deprived quintile and amongst men • History of self-harm is associated with increased risk of suicide • Whilst the suicide rate in England has shown a downward trend, the rate in Leicester has fluctuated Progress so far….. • The implementation of the mental health joint commissioning strategy has been steadily progressed despite the major infrastructure changes across both health and social care. • Mental health has been identified as a joint commissioning workstream across health and social care • currently the new reporting structures have been developed to support the management and monitoring of the implementation of the current strategy and scope development for 2013 onwards. 7
14/02/12 Improving access to psychological therapies Roll-out of IAPT across the City • The formal evaluation of the IAPT report now available – demonstrated that the service has • achieved high BME access and overall has achieved the outcomes it was set up to deliver. Areas that require further development was identified – improving access to older people • (Age Equality Agenda), supporting the wellbeing of individuals with long-term conditions. These to be addressed through the development of service and pathways. Procurement process to commence in 2012 for service to be recommissioned in 2013. • This remains a strategic priority for the Clinical Commissioning Group. • Stepped care model for psychological therapies model at steps 4 & 5 developed with the • specialist services integrated. Draft of the revised care pathway has been developed. The Stepped Care Approach • The stepped care approach more intensive treatments are generally reserved for people who do not benefit from simpler first-line treatments • Stepped care has the potential for deriving the greatest benefit from available therapeutic resources 8
14/02/12 The Stepped Care Approach Stepped Care Approach to the Management of Depression as Outlined in NICE Guidance. Source: Depression (amended): management of depression in primary and secondary care, 2007 Review and redesign of the acute mental health care pathway • Expansion of liaison psychiatry presence in the Emergency Department from 9-5 to midnight Monday – Friday and weekends presence commenced from December • Initial engagement event held in January 2012 to engage stakeholders in the draft plans for redesigning access to acute mental health care – crisis service 9
14/02/12 Supported Living People have been enabled to move on from • hospital, residential care and other schemes: • Wolsey Extra Care age designated scheme • Manor Farm flats • Orchard House referrals managed by LPT Service Manager • Glenfield Road self contained flats with on site support • Hinckley Road self contained flats with floating support • Further developments underway Transfer of staff • Current arrangements between Leicestershire Partnership NHS Trust terminating as of March 31st 2012. • The Personalisation Agenda in adult social care, the integration of community services into the Leicestershire Partnership NHS Trust and the need for the organisations to make efficiencies and savings mean that changes are necessary. • All partners committed to continuing to develop and improve integrated working and responsibilities under the Care Programme Approach. 10
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