Five Year Forward View for Mental Health Prof Tim Kendall National Clinical Director for Mental Health NHS England Consultant Psychiatrist for Homeless Sheffield Mental Health Crisis Care Concordat 3 ID: 717306
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Urgent & Emergency Mental Health Care in the Five Year Forward View for Mental Health
Prof Tim KendallNational Clinical Director for Mental Health, NHS EnglandConsultant Psychiatrist for Homeless, Sheffield
Mental Health Crisis Care Concordat 3
rd
National Summit
Kia Oval, 25 October 2016Slide2
5YFVMH: over-arching themes
Reduce our dependence on institutional solutions to people’s (mental) health problems – and make them high quality when we do use themCreate more/better alternatives to institutional care – primary, community and home care/treatment – acute, crisis and non-acuteIntegrate mental health care into the health service at all levels and in all placesHelp children and young people – prevention, secondary prevention, early intervention
Timely access to what works – and focus on what has the chance to produce lasting change (work, psychological therapies, self management)Slide3
The
report in a nutshell
:
20,000
+
people engaged
Designed for and with the NHS Arms’ Length BodiesAll ages (building on Future in Mind)Three key themes in the strategy: High quality 7-day services for people in crisis Integration of physical and mental health carePrevention and early interventionPlus ‘hard wiring the system’ to support good mental health care across the NHS wherever people need itFocus on targeting inequalities58 recommendations for the NHS and system partners £1bn additional NHS investment by 2020/21 to help an extra 1 million people of all agesRecommendations for NHS accepted in full and endorsed by government
Five Year Forward View for Mental Health
Prime Minister: “The Taskforce has set out how we can work towards putting mental and physical healthcare on an equal footing and I am committed to making sure that happens.”
Simon Stevens:
“Putting mental and physical health on an equal footing will require major improvements in 7 day mental health crisis care, a large increase in psychological treatments, and a more integrated approach to how services are delivered. That’s what today's taskforce report calls for, and it's what the NHS is now committed to
pursuing.”Slide4
“A Billion for a million” by 2020/21
70,000
more children
will access evidence based mental health care interventions
– from
25% to 33% of CYP
280,000 people with SMI will have access to evidence based physical health checks and interventionsIntensive home treatment will be available in every part of England as an alternative to hospitalALL acute hospital have all-age 24/7 mental health liaison services, and at least 50% of acute hospitals are meeting the ‘core 24’ service standardThe number of people with SMI who can access evidence based Individual Placement and Support (IPS) will have doubled60% people experiencing a first episode of psychosis will access NICE concordant care within 2 weeks
10% reduction in suicide
and all areas to have multi-agency suicide prevention plans in place by 2017,At
least
30,000 more women
each year
can access
evidence-based specialist
perinatal mental
health care
Increase
access to evidence-based
psychological therapies to reach 25% of need, helping 600,000
more people per year to access careSlide5
Spending streams impact in later years
16/17
17/18
18/19
19/20
20/21
1Promoting good mental health and helping people lead the lives they want to live
Integrating Care
2
Creating a 7-day NHS for mental health (right care, right time, right place & recovery focused)
3
Hard-wiring mental health across health and social care
4
Crisis resolution home treatment teams + Out of area treatment reduction
STPs development and assurance
Specialist perinatal care
Delivering evidence based psychological therapies to people of all ages with long term conditions and expanding access for adults from 15% to 25%
Suicide reduction
Outcomes based payment approach in place
HEE workforce strategy
Liaison mental health services
Evidence based physical care screening and interventions for those with SMI
Children and young people’s mental health services transformation
Community rehab/ step down
Individual placement and support (employment)
STP delivery mechanism including via CCG improvement and assessment framework and regional support
Early intervention in Psychosis to 50%
Early intervention in psychosis service improvement
Mental health New Models of Care
Liaison and Diversion
Secure care transformation
5 year data plan
Key:
System funding
InfrastructureSlide6
Recommendation 17:
By 2020/21 24/7 community crisis response across all areas that are adequately resourced to offer
intensive home treatment
, backed by investment in CRHTTs
.
E
quivalent model to be developed for CYP Recommendation 18: By 2020/21, no acute hospital is without all-age mental health liaison services in emergency departments and inpatient wardsAt least 50 per cent of acute hospitals are meeting the ‘core 24’ service standard as a minimum by 2020/21. 6Mental Health Task Force – crisis and acute recommendations (1/2)Slide7
Recommendation 22:
Introduce standards for acute mental health care
, with the expectation that care is provided in the least restrictive way and as close to home as possible.
Eliminate
the practice of sending people out of area
for acute inpatient care as a result of local acute bed pressures
by no later than 2020/21. Recommendation 13:Introduce a range of access and quality standards across mental health. This includes: 2016 - crisis care (under development) 2016/17 – acute mental health care (starting) 7Mental Health Task Force – Crisis and Acute Care recommendations (continued, 2/2)Slide8
Preparatory work (16/17)
Find the moneyDevelop guidance (standards) for timely access to NICE recommended care (E-B Treatment Pathways)Determine workforce needsAgree outcomes measuresDevelop national networks
Incentivise the right treatment and care
Guide the money to the front line (publish and be damned!)Slide9
“
By 2020, there should be 24-hour access to mental health crisis care, 7 days a week, 365 days a year – a ‘7 Day NHS for people’s mental health’.”
9
Spending Review – Headlines for Crisis & Acute Care
Substantial new funds for
crisis resolution and home treatment teams
(CRHTTs) to deliver 24/7 treatment in communities and homes as a safe and effective alternative to hospitals (over 4 years from 2017/18);New money for liaison mental health services in every hospital emergency department (over 4 years from 2017/18);Capital funding for Health Based Places of Safety in 2016-18 (non-recurrent)Slide10
New investment in urgent and emergency mental health care: CYP
(2016/17) new money invested this year to pump prime investment in the eight UEC vanguards to rapidly test and evaluate different models to CYP crisis care, and generate an evidence and consensus on what
works
(2016/17
)
non-recurrent
new funds issued to CCGs on 26th September to improve waiting times including to accelerate plans for crisis and home treatment Slide11
Develop the guidance: implementation guides (including EBTPs, standards, workforce and data requirements) for UE and acute Care
24/7 UEC mental health liaison in acute hospitals
24/7 ‘blue light’ UEC mental health response
24/7 community UEC mental health response
24/7 UEC response for children and young people
Acute mental health care pathway Slide12
12
Plans for CYP urgent & emergency mental health care
All areas asked to invest and develop CYP crisis care as part of their
Local Transformation Plans
, in
Future in Mind
NHS England has commissioned an evidence-based treatment pathway project for CYP crisis/liaisonSome examples of potential models include:Model 1: Collaboration between a number of specialist community mental health services Model 2: Hub and spoke model: collaboration between children and young people’s specialist tier 3 and tier 4 community and inpatient mental health services Model 3: Integrated CYP mental health and social careModel 4:
All-age integrated liaison and crisis mental health interventionSlide13
13
F
ocus needed on urgent & emergency mental health care for older adults - prevention
Older adults integral part of patient cohort seen by liaison services _ LTCs often with anxiety/depression -
Help people with LTC and MH problem into IAPT for CBT
The majority
of the financial and clinical benefits of liaison services are accrued through assessment and treatment of older adultsHowever, recent Age UK report highlighted concerns about crisis provision for older adults – Crisis not often needed OOHs, but must have access to crisis teamsCrisis and liaison teams should have access to older adult clinical expertise, or such expertise embeddedSlide14
14
BAME communities: action required
We must ensure that inequalities in access, experience and outcomes are effectively
addressed
Pronounced inequalities experienced by BAME groups have led to significant overrepresentation in crisis and acute
settings
People from black, Asian and minority ethnic groups living in the UK are more likely to:be diagnosed with mental health problemsbe admitted to hospital, whilst remaining underrepresented in primary care MHpresent in crisiscome into contact with the police when in crisis enter the mental health system via the courts or the policebe detained under the Mental Health Act.experience a poor outcome from treatment disengage from mainstream mental health services, leading to social exclusion and a deterioration in their mental health. We need to do much more. As a first national step, NHS England & NCCMH have established a BAME reference group to help advise on our crisis & acute care pathwaysSlide15
Products to underpin implementation (all these basics in the implementation guides)
Referral to treatment pathway, including response times and NICE quality
standards (implementation guides)
National
quality assessment and improvement scheme
(with CCQI)
National baseline audit and gap analysis Workforce analysis and workforce calculator (with HEE)Changes to national datasets (MHSDS) (with NHS Digital)Slide16
Statement
Please circle one number
1
If I experience a mental health crisis again, I feel optimistic that care will be effective.
1
23452
During the treatment for my crisis, I was treated with empathy, dignity and respect.
1
2
3
4
5
3
During the treatment for my crisis, I felt actively involved in shared decision-making and supported in self-management.
1
2
3
4
5
4
I feel confident that the views of service users are used to monitor and improve the performance of liaison mental health services.
123455I can access liaison mental health services when I need them.123456During the treatment for my crisis, I understood the assessment process, diagnosis and treatment options, and received emotional support for any sensitive issues.123457During the treatment for my crisis, I jointly developed a care plan with mental health and social care professionals, and was given a copy with an agreed date to review it.123458When I accessed crisis support with the liaison mental health service, I had a comprehensive assessment, undertaken by a professional competent in crisis working.123459
The liaison mental health team considered the support and care needs of my family or carers when I was in crisis. Where needs were identified, they ensured that they were met when it was safe and practicable to do so.12
345
16Patient reported experience measure: adapted from NICE service user experience guideline – key quality measureSlide17
17
System levers and incentives
CCG
Improvement and Assessment Framework
– Crisis and
OAPs prominent
Development of Sustainability and Transformation plans – including crisis and acute mental healthNHS Planning GuidanceProposed CQUIN on A&E + mental health needsQuality Premium on OAPsNew payment models being developed for mental healthNational Medical Directors Network for MHChanges to national datasets – measuring what we wantMH Dashboard – serious about transparencySlide18
Mental health dashboard to be published (CCG improvement and assessment framework) very soon
Access
Quality
Outcomes
Investment
Health promotion
Integration7 day servicesHard-WiringIs everyone who needs access getting access?Is care provided of the right quality, at the right time and in the right place?
Is that care effective and delivering the outcomes that people want to see?
Is there the right level of investment?Slide19
Thank you!
and Any questions?