New fron)ers for preven)on and integrated care and intelligence "Bringing together physical and mental health- A new Fron8er for integrated care" and its implica8ons for training. Sept 23 Bristol 14:30-15:10 Na8onal Clinical Lead, Mental Health Intelligence Network Dr. Geraldine Strathdee: @DrG_NHS
The world of the future for trainees & supervisers as ci-zens, clinicians and academics An overview of the life course na8onal & global mental health policy, & the implica8ons for clinical leaders: Primary, secondary and ter8ary preven8on strategies: what this means for trainees and educa8onal supervisers Integrated preven8on & care: how is it being achieved in clinical prac8ce, informa8cs and data science, service development & interna8onal funding systems Why every clinical leader needs informa8on and intelligence literacy, and how to acquire such skills What support can the mental health intelligence network offer trainees and educa-on supervisers to develop their competences in informa-on, intelligence and integrated care
The fast changing world for clinical leaders as ci8zens and clinicians why informa8on & data science is increasingly important... Post Brexit defini8on of democracy: Informed ci)zens making informed choices Digital enablement Big data & ECRs The 17 year gap from discovery of evidence to rou8ne implementa8on is no longer acceptable The democra8za8on of knowledge
Modern society is developing a personalised genera)onal lifespan approach to mental & physical health in global popula)ons : the 5 the Year Forward view... Being Born well Best early years Living and working well Growing older well Dying well!. For each genera8on life course stage: focus on accessible knowledge, personal empowerment, community assets 1. Provide mental & physical health fitness knowledge in individuals & communi)es 2. Development of Peer support Carer support Self management 3. Community assets 4. Preven)on 2. When a person needs to access treatment : make it early, Integrate physical, social, mental care, focus on recovery & preven8on, 1. Early access to Right Interven)ons Acute/ Crisis care Preven)on of repeat episodes of care Recovery focused for ongoing needs Integrated, preven)on, recovery focused in Primary care Acute care Specialist community Specialist MH Social care
Providing Information: NHS Choices has spent 3 years developign the world s largest literacy libraby on information, tools & self management: 1.6 million hits a day & 413 million Spanish speaking South Americans NHS Presenta8on to [XXXX Company] [Type Date] 5
Preven8on: an update
Popula8on health & preven8on of premature deaths Note this is not tested out for mental health :
Preven)ng Adverse Childhood Experiences in future genera)ons is the highest value investment for popula)ons Poor diet (current) by 14% Binge drinking (current) by 15% Smoking (current) by 16% Early sex (before age 16) by 33% Cannabis use (life8me) by 33% Unintended teen pregnancy by 38% Violence vic)misa)on (past year) by 51% Violence perpetra)on (past year) by 52% Incarcera)on (life8me) by 53% Heroin/crack use (life8me) by 59% slide with thanks to Karen Hughes, John Moore s University
High impact preven)on programmes: Through a new era in public health, pa-ent self management & stra-fica-on Zero Child abuse: Ambi8on for England : sexual, physical, emo8onal Schools: Resilience embedded in the school culture & curriculum, early iden8fica8on though school nurse and form tutor training, & Governors for well being & resilience Employers: Posi8ve produc8ve employment prac8ce, jobs, Health & Safety employment standards Paren)ng & rela)onships programmes The sta8n of good mental health now at pregnancy clinics, primary care & adult educa8on Alcohol: costs 20 billion a year Secondary preven)on : Priori8ze those with great need for successful preven8on e.g. Leaving care CYP Top 10% Frequent crisis, admissions, deten8ons, stable accommoda8on, transi8ons Integrate mind and body preven8on & care pathways in public health, primary and acute services
Top 10% stratification principles in mental health Secondary preven)on : Priori8se those with great need for successful preven8on e.g. Leaving care CYP Top 10% Frequent crisis, admissions, deten8ons, who account for 40% resource use using root cause analysis and intensive case management, with fidelity to the proven effec8ve models Integrate mind and body preven8on & care pathways in public health, primary and acute services
Health analy)cs: using informa)on in your new consultant posts & for secondary preven)on Stra)fica)on to prevent unnecessary risk & poor outcomes & reengineer spend downstream: using data and analy8cs to iden8fy the top 10% of people so that they can have a root cause analysis review of their case and a beler coproduced care plan to help them stabilize and recover. This is the only way we can release funding rapidly to spend downstream in community care & preven8on Geo-mapping of repeat crises to put in place preven8on e.g. iden8fying cluster of self harm or suicides, or domes8c violence, or gangs Care planning that excites and is focused on recovery and QOL Top 10 % people account for 40% of resource use This is because they have repeat consulta8ons, crises, admissions, deten8ons Data analy8cs by analysts with clinical translators could transform this
Crisis care: reducing avpidable repeat episodes of care We really have to get a grip on our crisis data collec8on in 111, A/E, crisis home treatment teams, liaison services, street triage, AMHP services etc We can t go on flying blind designing crisis care in England We have to Understand the preventable causes of crisis, prevent suicide, geqng crisis care plans right to avoid repeat crises What would lead to step change in safety, dignity and pa8ent experience Model of tele triage with inbuilt suicide risk assessment tool Every DOS up to date MyDOS mobile directory available to all community workers Communicate my care advance direc3ves crisis plans accessible to all agencies
In mental health we also need rapid access to NICE treatment Modern trainees need to be Bilingual & model ourselves on.eg. Cancer specialists Geqng it Right for Cancer care means... ü Chemotherapy : 2-3 medicines ü Radiotherapy: ü Surgery ü Lifestyle ü Rehabilita8on prostheses Geqng it Right for Psychosis care means..
Trainees developing big data science & informa8cs competencies Why every clinical leader needs informa8on and intelligence literacy, and how to acquire such skills How can we help you to see and understand & use the new discipline of informa8cs and data science How can service development & interna8onal funding systems use the data for preven8on Advocacy competencies: Why every clinical needs needs to require access to their own data they spend 35-52% of their 8me entering..
Start by understanding your own community Please take 10 minutes to look at your Local Authority and CCG and STP area on finger8ps mental health intelligence network hlp:// finger8ps.phe.org.uk/profile-group/mental-health See, for where you and your family live, and where you work The social determinants of health and illness The incidence and prevalence the number and types of people at highest risk to priori8ze for preven8on the level of access, quality, spend on provision of services in primary care, CCG community care, CCG inpa8ent care, NHSE England specialized care and social care
Structured into 6 domains hlp://finger8ps.phe.org.uk/profile-group/mental-health/profile/severe-mental-illness 16
Structured into 6 domains hlp://finger8ps.phe.org.uk/profile-group/mental-health/profile/severe-mental-illness 17
Current Post code lolery for rates of care, deaths, recovery The use of CPA for ppl with psychosis : Size of varia)on 3.8% to 94.4% across CCGs are on CPA The average for England is 51.8% 82 CCGs which have significantly lower % of people on CPA than the England average 4 CCGs had counts below 5 (Corby, Guildford and Waverley, Surrey Heath, Isle of Wight) 83% of people with psychosis on CPA for 12 months had a review (range 11% to 100%) Employment outcomes range from 1% to 18.5%
Let s end the mental health Bermuda triangle... To stop the unnecesssary suffering & 20 years premature deaths to stop you spending 35-50% of your )me entering data to fill th black hole
The world of the future for trainees & supervisers as ci-zens and clinicians and academics What support can the mental health intelligence network offer trainees and educa3on supervisers to develop competences in informa3on, intelligence and integrated care Can we help you get your knowledge of the communi3es you live and work in and can uniquely influence for good, to the same level of cri3cal appraisal competencies as your knowledge of research methods
Can trainees help design a... MENTAL HEALTH GLOBAL EXEMPLAR DIGITAL SYSTEM Mental health clinicians need to act for parity in clinical care digital support we need the same level of tech at work as we use at home and our family increasingly use Parity in Electronic care records Empower people & their clinicians Interoperability essen)al for integrated care : Primary, acute, social care, ECRs Func)onality Remote access in community E prescribing, monitoring, GASS On line diagnos8cs Clinician decision support tools Skyp/ tele/ zoom consulta8ons Text care plan & OPC reminders Online Outcomes PROMs PREMs. CROMs Free )me to care Digital dicta8on DOS & Capacity management tools Clinical team dashboards for clinicians End the MH data Bermuda Triangle Clinical Dashboards in vivo : Give every clinical team back its data on a clinical dashboard so they can have con-nuous improvement Service Users: give access to their records & self monitoring data & care plans Con8nuous Quality improvement: Clinical team digital dashboards Touch screen in wards and teams every day Respect our SUs skills & ac3va3on Give them informa3on tools Apps for mind/body fitness and literacy Big Data to self manage & stop relapse Self Management apps On-line peer and clinician moderated wellbeing networks, improving outcomes and preventing relapse Psychosis avatars Interactive digital treatment sessions On line city platforms & white label digital therapies Sim City to showcase what can be done 2
Contact the Mental Health Intelligence Network Contact us with feedback at: - Simran Sandhu (Programme Manager) Simran.Sandhu@phe.gov.uk - Cam Lugton (Programme Lead) Cam.Lugton@phe.gov.uk Visit our exis)ng finger)ps profiles: - hlp://finger8ps.phe.org.uk/profile-group/mental-health/ - Or Google mental health finger8ps