Implementing the Government s Mental Health Strategy to Ensure Equal Parity: a ten year journey

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1 Implementing the Government s Mental Health Strategy to Ensure Equal Parity: a ten year journey Sarah McClinton, Director Mental Health, Disability and Dementia 03 March

2 .the journey continues Government policy 2010 onwards - mental health as a clear priority; What has been achieved - introducing waiting times and success of the Crisis Care Concordat; New funding; Old problems, new solutions - Crisp Report 2016; Five Year Forward View for mental health - recommendations for the NHS and cross government; The importance of attitudes - we can all play our part. 2 Enter the presentation's title using the menu option View > Header and Footer

Coalition Government Policy Feb 2011 Jan 2014 Feb 2014 Oct 2014

mental health strategy for people of all ages Closing the Gap:

Crisis Care Concordat: Improving outcomes for people

Mental Health Services by 2020 Future in Mind: Promoting,

3 Coalition Government Policy Feb 2011 Jan 2014 Feb 2014 Oct 2014 March No health without mental health: A crossgovernment mental health strategy for people of all ages Closing the Gap: Priorities for essential change in mental health Mental Health Crisis Care Concordat: Improving outcomes for people experiencing mental health crisis 3 Achieving Better Access to Mental Health Services by 2020 Future in Mind: Promoting, protecting and improving our children and young people s mental health and wellbeing

Creating better access- Access and Waiting Times Standards: For the first time legislated to enshrine parity of esteem and put into place waiting time targets.

4 Creating better access- Access and Waiting Times Standards: For the first time legislated to enshrine parity of esteem and put into place waiting time targets. Invested over 120m in order to introduce for the first time waiting times standards for mental health services from April a very significant milestone on the road to parity. Currently, data on secondary care mental health services waiting times is not collected. Data will start to be available via the new Mental Health Services Dataset from Starting with Early Intervention in Psychosis, but moving on to other mental health pathways over the coming years. 4 DH Leading the nation s health and care

Being there is a crisis - national and local partnerships support the Crisis Care Concordat: National leadership with now almost 30 signatories to Crisis Care Concordat.

5 Being there is a crisis - national and local partnerships support the Crisis Care Concordat: National leadership with now almost 30 signatories to Crisis Care Concordat. 100% sign up to local action plans - local partnerships and political leadership critical; Reduced use of police cells, Street Triage schemes have saved police time, reduced use of S136; Support for local areas through Mind, CCC website, examples of good practice; The Time Out Café and Safe Haven Project in Surrey - provides an alternative to A&E; Tile House in Camden - high quality accommodation with dedicated clinical support and personalised social integrated in a single team. Saving 443k pa. 5 DH Leading the nation s health and care

Use of Police Cells 2011/12-8667 Use of Police Cells 2012/13-7761 Use of police

detentions reduced by 54% between 2011/12 9000 8000 7000 6000 5000 4000 3000 2000

6 Use of Police Cells 2011/ Use of Police Cells 2012/ Use of police cells 2013/ Use of police cells / Use of Police Cells for s136 detentions reduced by 54% between 2011/ Enter the presentation's title using the menu option View > Header and Footer

Mental health is a continuing priority, backed by new funding 120 invested to put in place first ever waiting times standards from April 2015; 150m for eating disorders - announced in Autumn

7 Mental health is a continuing priority, backed by new funding 120 invested to put in place first ever waiting times standards from April 2015; 150m for eating disorders - announced in Autumn Statement 2014; 1.25bn for children and young people s mental health and perinatal mental health - announced in Budget, March 2015; Spending review announced mental health policy priority (alongside cancer and 7 day services): Extra 10bn for NHS over the parliament. Over 100m for joint work and health unit. 2bn social care precept and 1.5bn extra BCF and integration. Extra 1billion a year by 2020 for mental health services to support Mental Health Taskforce Report. 7 DH Leading the nation s health and care

Old problems, New solutions: Lord Crisp s Report into services and admissions to mental health

difficulties in admissions to mental health beds, examine the causes of these pressures and make

Interim report referred to the socalled bed or admission crisis which is very significantly a

services and the management of the whole system.

8 Old problems, New solutions: Lord Crisp s Report into services and admissions to mental health beds: The Task: Lord Crisp was asked to set up a Commission to review variable services and difficulties in admissions to mental health beds, examine the causes of these pressures and make recommendations for improvement. Interim report referred to the socalled bed or admission crisis which is very significantly a problem of discharges and alternatives to admission and can only be addressed through changes in services and the management of the whole system. What Lord Crisp s Report found: The final report of the Commission to review the provision of inpatient psychiatric care for adults, chaired by Nigel Crisp, was published on 8 February The Report made a number of Recommendations. 8

9 Old problems, New solutions: Lord Crisp s Report into services and admissions to mental health beds: Delayed discharges due to lack of housing, combined with pressures on social care and cuts to community mental health teams; Lack of alternatives to admission - inadequate staffing of crisis resolution home treatment teams offering a 24/7 intensive homebased service; An increase in the use of out of area placements; Lack of clear quality outcomes and transparent reporting of these; Fragmented provision and commissioning of acute services; Variability in : quality of care in inpatient units; access to evidence based therapies across the acute pathway; involvement of patients and their carers; quality of leadership and culture across organisations. 9

treatment and working in partnership with housing.

10 Examples where local areas are already making progress: In Sheffield, they have almost entirely eliminated adult acute out of area treatments and brought average bed occupancy down to 75% by redesigning the local system, including investing in intensive community treatment and working in partnership with housing. South Tyne Area has seen: 22% reduction in median length of stay; 20% reduction in total numbers of admissions; 24% reduction in bed usage. Which equates to a conservative 3.5 million reduction in bed-costs per annum for the South Tyne area. 10

Five Year Forward View for Mental Health: Summary: The Task: Independent Mental Health Taskforce was commissioned in March 2015; Scope:

all age national strategy for mental health to 2020, aligned to the Five Year Forward View (FYFV); Make comprehensive recommendations

What the Taskforce heard: Over 20,000 people identified priorities for better outcomes: Prevention and early intervention; Improved

11 Five Year Forward View for Mental Health: Summary: The Task: Independent Mental Health Taskforce was commissioned in March 2015; Scope: cross system improvement to improve treatment and outcomes for patients with poor mental health; Purpose: to develop a new five-year all age national strategy for mental health to 2020, aligned to the Five Year Forward View (FYFV); Make comprehensive recommendations with specific focus on reducing inequalities in mental health care and outcomes. What the Taskforce heard: Over 20,000 people identified priorities for better outcomes: Prevention and early intervention; Improved access to effective care in the least restrictive settings; Integrated mental and physical healthcare; Quality: experience, effectiveness and safety. The final report was published on 15 February. 11

12 NHS Five Year Forward View for Mental Health - by 2020: Creating a 7 day NHS for people in mental health crisis: Core 24 liaison mental health services to be available in half of acute hospitals across the country, all-ages 24/7 urgent and emergency response; Crisis Resolution and Home Treatment Teams (CRHTTs) available in every part of England as an alternative to hospital; At least 60% of people with first episode of psychosis to have access to a NICEapproved care package within 2 weeks of referral; At least 10% fewer people should take their own lives through investment in local multi-agency suicide reduction plans. Establish a truly integrated mental and physical health service increase access to evidence-based psychological therapies to reach 25% of need, helping 600,000 more people to access care; At least 280,000 people living with severe mental health problems should have their physical health needs in primary; 30,000 women additional women each year should have access to evidencebased specialist mental health care during the perinatal period; transformation of children and young people s (CYP) mental health to ensure that 70,000 more CYP have access to high quality care. 12

13 Mental Health Taskforce: Cross-Government Recommendations Public Health England should develop a national Prevention Concordat programme that will support all Health and Wellbeing Boards and put in place updates JSNA and joint prevention plans that include mental health and comorbid alcohol and drug misuse, parenting programs and housing. The Department of Health, Communities and Local Government, NHS England, HMT and other agencies should work with local authorities to build the evidence base for specialist housing support for vulnerable people with mental health problems and explore the case for using NHS land to make more supported housing available to this group. The Department for Work and Pensions should ensure that when it tenders the Health and Work Programme it directs funds currently used to support people on ESA to commission evidence-based health-led interventions and should also invest to ensure that qualified employment advisors are fully integrated into expanded psychological therapies. By 2020/21, NHS England and the joint unit should ensure that up to 29,000 more people per year living with mental health problems are supported to find or stay in work through increasing access to IAPT and doubling the reach of IPS. Health Education England should work with NHS England, PHE, professional bodies, charities, experts-by-experience and others to develop a costed, multi-disciplinary workforce strategy for the future shape and skill mix of the workforce required to deliver both this strategy and the workforce recommendations set out in Future in Mind. The Department of Health, Public Health England HSCIC and NHS England should develop a 5-year plan to address the need for substantially improved data across mental health services, set out responsibilities and ensuring adequate information governance. DH should support improvements in children and young people s mental health outcomes, drawing on data sources from across the whole system. The Department of Health and NHS England should require CCGs to publish data on levels of mental health spend in their Annual report and accounts. 13

Recommendations for System Enablers: Leadership: local, national and cross-

. Reforming payment and incentives to move away from unaccountable block

the NHS ALBs, independent experts, industry and experts-by-experience, should

14 Recommendations for System Enablers: Leadership: local, national and cross- Government for a mentally health society.. Reforming payment and incentives to move away from unaccountable block contracts The Chief Scientist, working with all relevant parts of government, the NHS ALBs, independent experts, industry and experts-by-experience, should publish a report a year from now setting out a 10- year Government and ALB strategy for mental health research. Lead for Equalities/Inequalities Workforce strategy and Think Ahead Comprehensive access pathways and standards for mental health (across conditions, ages and settings). 14

Changing attitudes to mental health - Time to Change Campaign: Since Time to Change began in 2007, there has been an overall 8.3% improvement in attitudes.

15 Changing attitudes to mental health - Time to Change Campaign: Since Time to Change began in 2007, there has been an overall 8.3% improvement in attitudes. More than two and a half million people (6% of the population) have improved attitudes since people have pledged to end mental health stigma 350 employers have signed up people have pledged to end mental health stigma 15 DH Leading the nation s health and care

A new mindset: the Five Year Forward View for mental health

A new mindset: the Five Year Forward View for mental health Paul Farmer Chief Executive mind.org.uk Five Year Forward View for Mental Health Simon Stevens: Putting mental and physical health on an equal