Mental Health & Wellbeing Programme

Mental Health & Wellbeing Programme Programmed update to the UCLP Board of Directors March 2012

Table of contents 1. Projects timeline 2. Creating Europe s leading mental health programme 3. Adolescent mental health 4. Cross-AHSS collaboration to improve the cardiovascular health of patients with depression 5. Improving the care of people with dementia in general hospital beds 6. Developing a partnership-wide, pathway-specific outcome system to support the delivery of improved value in mental health care 7. The Psychological Interventions Research Centre (PIRC) 8. Addressing the information challenge in mental health care 9. Revolutionizing the role of IT, information and financial support services to deliver better patient care 10. Projects overview

1. Projects timeline : Reduce Incidents 2012 2013 2014 2015 2016 Prevention ( 3) Increase life expectancy and quality of life CVD risk ( 4) Cancer Deliver better value care Dementia ( 5) Whole pathway outcomes ( 6) Talking therapies ( 7) Education and Training ( 7) Enablers Informatics ( 8-9) Research

2. Creating Europe s leading mental health programme Improve patient outcomes at scale in the context of increasing resource challenges Programme projects (ongoing) BEH- MHT We have successfully created an MH partnership across northcentral and northeast London. The partnership includes five mental health trusts, two acute hospitals, and two universities. Together, we serve a population of over 2 million. C&I ELFT NELFT Our high-level objectives are to drive quality and value across the partnership by standardizing care pathways, protocols, and outcomes. We also aim to reform and revitalize psychiatric training. Overall success will be demonstrated by improving patient outcomes in the context of ever-increasing resource challenges. T&P UCL, GOSH, NHNN QMUL The scale of our partnership gives us unprecedented access to populations, creating extraordinary opportunities to evaluate and deliver care improvements. The cross-disciplinary collaborations that we are forming also have the potential significantly to impact population health. At the same time, we hope to encourage diffusion of our work through local ownership. Senior representatives from all the partner organizations, along with UCLP directors and UCL researchers, sit on the programme s executive. This group has responsibility for directing and overseeing our work, including the projects below. Maintaining partner buy-in and securing further resources for our projects are key measures of success. 2.1 million local population 800 million annual revenue 300 PIs working in areas relevant to mental health 35+ million in mental health research grants across 40+ trials 20+ masters programmes with significant mental health components

3. Adolescent mental health Healthy brain network organization Understand the mechanisms underlying mental health disorders Identify directions for research into prevention 5.4 million strategic Wellcome Trust strategic award (Q2 2012) Accelerated longitudinal study (2012 2015) Pilot cross-sectional data (Q4 2012) A strategic award from the Wellcome Trust will enable collaboration between UCLP and Cambridge University Health Partners to study brain development in relation to the emergence of major mental health problems during adolescence and early adulthood. This collaborative study will incorporate an accelerated longitudinal study of a large community sample of adolescents to provide normative data concerning the development of neural networks against which abnormal development can be compared using several adolescent clinical samples currently in treatment as part of randomised control trials of psychological therapies (START, IMPACT, REDIT) in both these regions. There is a strong initiative from the CAMHS community to focus research in child and adolescent mental health around UCLP and a well-attended meeting of researchers and clinicians has already taken place. It is our hope that the IAPT initiative, which has recently been extended to children and young people, will be coordinated locally from within UCLP and provide a focus for further integration around the improvement of quality of care offered to families in the direction of increasing evidence- based, service-user-focused, collaborative delivery of interventions. Schizophrenic brain network organization Proof of concept: brain functional networks in schizophrenia are less economically wired, less modular and less clustered we will test the developmental hypothesis that this emerges as a consequence of atypical connectivity occurring through the post pubertal adolescent years.

4. Cross-AHSS collaboration to improve the cardiovascular health of patients with depression First major trial of CVD prevention in CMHD Improve collaboration between MH and 1 care services Demonstrate the value of the AHSS model Intervention manuals (March 2012) Pilot data (April 2012) Phase II trial application (May 2012) Phase II trial (Q1 2013) Phase II trial results (beginning Q3 2013) UCLP MH is leading a project to improve the CV health of patients with depression who enter IAPT services by bringing together MH researchers and their colleagues in cardiology. The project is a collaboration between UCLP, Cambridge UHP, King s HP, Manchester AHSC and the University of Oxford. KHP MAHSC UCLP CUHP Oxford The project board includes David Clark, IAPT National Clinical Advisor; John Deanfield, Director of the Centre for Cardiovascular Prevention & Outcomes and British Heart Foundation Chair of Congenital Heart Disease; Andrew Steptoe, Director of the Institute of Epidemiology &Health Care at UCL and British Heart Foundation Chair of Psychology; André Tylee, IAPT national advisor on long-term conditions; and Steve Pilling, Director of the National Collaborating Centre for MH, who co-developed NICE guidelines for depression and depression with chronic physical health problems. Depression is second only to lifetime smoking in the risk that it confers for CVD. Addressing this comorbidity is therefore a high-priority for population health. Over 250,000 people, most of them with depressive symptoms, were referred to IAPT services from April to September 2011. This provides huge scope for developing and evaluating interventions aimed at improving the CV outcomes of depressed patients. IAPT services Cardio- Mental logy health Primary care

5. Improving the care of people with dementia in general hospital beds Improve the quality of acute hospital dementia care Reduce length of stay by people with dementia Make significant cost savings 14 12 Pilot data on LOS reductions and cost savings (Q1 2012) Standardized outcome measures (Q2 2012) Cross-partnership diffusion programme (Q3-4 2012) Report on LOS reductions, cost savings and other outcomes (Q1-2 2013) 10 8 6 Q3-4 2010 Q3-4 2011 By fostering collaboration across UCLP, this initiative aims significantly to improve the diagnosis, management and care of people with dementia, thereby reducing length of stay in acute hospital beds and making significant cost savings. We are achieving this by designing and implementing an agreed programme of quality improvement based on clinical evidence, national standards, and a consensus of good practice. 4 2 0 UCLH RFH To this end, we held a one-day conference to agree a UCLP-wide dementia strategy. Over 90 people attended the meeting, including participants from 5 acute NHS Trusts (BHR, UCLH, NMH, RFH, WXUH), 5 mental health/community NHS Trusts (CANDI, ELFT, NEPFT, NELFT, BEHMHT), and primary care including the London areas of Haringey, Havering, Islington, and Enfield. Together, we identified four priorities for improving dementia care: 1. Involving families/carers 2. Managing delirium 3. Education and training 4. Joined-up working We have subsequently held two steering group meetings to further this agenda. Pilot projects are going forward across the partnership in each of the priority areas. Next steps are to audit outcomes and to spread innovations across the partnership. 1400 1200 1000 800 600 400 200 0 2011 cost savings (000's of ) RFH UCLH

6. Partnership-wide, pathway-specific outcomes systems Improve quality and lower cost across the partnership Measure and improve patient-centred outcomes, key clinical indicators & patient experience Promote outcomes transparency Standardize outcomes and measurement Partnership-wide quality and safety forum for senior leaders (February 2012) Co-selection of measures (CAMHS: Q2-3 2012; Psychosis: Q3-4 2012) Creation and piloting of minimum measure sets (CAMHS: Q4 2012; Psychosis Q1 2013) Pilot data (CAMHS: Q3 2013; Psychosis: Q4 2013) Strategic Leadership Group Pete Sudbury (BEH MD) Sylvia Tang (C&I MD) David Osborn (C&I/UCL) Stefan Priebe (ELFT RD/QMUL) Alex Horne (NELFT MD) Trudie Rossouw (NELFT AMD) Matthew Patrick (T&P CEO) Paul Farmer (MIND CEO) Miranda Wolpert (CORC/AFC) Marta Buszewicz (GP) Together, the partner trusts identified a need to develop a standard system of patient-centred outcomes. This must support measurement and transparency across two broad domains: quality and cost. Peter Fonagy (UCLP MH) James Mountford (UCLP) Tony Lezard (UCLP) Malcolm Finn (Accountancy) To this end, we have created a multidisciplinary strategic leadership group focusing on value in mental health. This group comprises the clinical leadership of our partner trusts (MDs and CEO); experts in IT, accountancy, health economics, and outcomes measurement; and the chief executive of MIND, the UK s leading mental health charity and user group. The leadership group has obtained support from The Health Foundation to review and develop care pathways for CAMHS and acute psychosis across the partner mental health trusts. In its first phase, the project is establishing collaborative networks of patients and clinical-team leads to identify meaningful clinical outcomes and measures that can form an outcomes framework for each service. In addition to these service-specific projects, we are working to spread innovation and best practice through a partnership-wide mental health quality and safety forum, led by one of the Trust CEOs. CAMHS workstream Matthew Patrick (T&P) Eric Karas (BEH) Rafik Rafaat (ELFT) Trudie Rossouw (NELFT) Rob Senior (T&P) Miranda Wolpert (CORC/AFC) James Mountford (UCLP) Psychosis workstream David Osborn (C&I/UCL) Emma Crampin (BEH) Sylvia Tang (C&I) Stefan Priebe (ELFT) Vaughan Williams (NELFT) James Mountford (UCLP)

7. The Psychological Interventions Research Centre (PIRC) Implement the bench to bedside translational agenda Deliver trainings in all IAPT-approved psychological therapies Work with commissioners to design and implement psychological therapies services Audit and accredit psychological therapies practitioners Training Service & research design (delivery date) Pilot research survey (Q4 2011) Training & service design (on-going from Q1 2012) Hire project manager (Q2 2012) Fully functional research database (Q3 2012) Establish audit & assessment programme (Q4 2012) Research proposals from workstreams (Q2 2013) PIRC aims to implement the bench to bedside translational agenda in psychological therapies. It will have three main areas of activity: 1. Training: PIRC will deliver trainings for all IAPT-approved psychological therapies. The goal is to train all IAPT workers across UCLP and beyond. 2. Service design: PIRC will work with local commissioning groups to help them design and implement IAPT and other psychological therapies services. The goal is to develop a model that can be replicated across London and the NHS. 3. Audit and accreditation: PIRC will serve as a national accrediting body for IAPT-approved psychological therapies practitioners, services and training programmes. In addition, PIRC has initiated two joint workstreams, focusing on mechanisms and implementation respectively. These workstreams bring together senior clinicians and researchers from across the partnership to explore research opportunities aimed at developing and implementing evidence-based psychological therapies. To support this work, PIRC has developed and will maintain a UCLP-wide database of psychological research. The objective is to identify priority areas for future research (such as mechanisms), build on UCLP s established track record, and generate further research grants. Audit & assessment Studies 57 UCLP-led studies 45 Total participants 16,900 Total funding 49,150,000 Funding within UCLP 34,350,000

8. Addressing the information challenge in mental health care Increase awareness of available data Turn data into intelligence Use intelligence to drive quality improvements Expert workgroup established (January 2012) Map of available MH data (Q2 2012) Development of intelligence tools (Q3 2012) Pilot study of intelligence tools (Q4 2012) Preliminary pilot data (Q2 2013) Roll-out of tools based on pilot success (Q3 2013) Benchmarking Clubs SHAs DoH NHS Confed EEQO CQC NHS IC There is an urgent need to increase mental health professionals, service managers and new commissioners awareness of available mental health data in order to enable them to use these data to make step-changes in the quality of patient care and service research. Services send a great amount of data upstream, but they are not routinely scrutinizing their own performance in the context of their local and national peers, nor connecting data across silos within the system (e.g., across primary, social, community and mental health providers). Academics UCLP MH data expert workshop Providers To address this challenge, UCLPartners Mental Health, together with Geraldine Strathdee (National Mental Health Clinical Advisor to the Care Quality Commission and Associate Medical Director for Mental Health at NHS London), is undertaking a project to create a better path from national mental health data sets to local decision making and routine care delivery. Ultimately, our goal is to drive care-quality improvements and increase the efficiency with which limited mental health resources are deployed. Next Steps - Intelligence map - Intelligence tools Our first step was to ensure that our core team, including senior staff from UCLPartners and our partner trusts, has a thorough understanding of the data that are available. To this end, we held a one-day workshop on mental health data accessibility and interpretation to co-create solutions together with national MH data experts. We are now working to develop these solutions and eventually diffuse them throughout the partnership.

9. Revolutionizing the role of IT, information and financial support services to deliver better patient care Relevant, reliable, timely performance information will guide care decisions across the partnership Integrate clinical, IT & informatics and financial services to deliver better value Create a step-change in patient experience and NHS job satisfaction Funding application submitted (February 2012) Pilot project begins (Q4 2012) Pilot data (Q3 2013) Diffusion programme (from Q4 2013) Clinicians Finance IT & information Patients For patients, well informed clinical decision-making and reliable care implementation can be lifeor-death matters. Relevant, reliable, timely, well-presented performance information connected across silos must therefore guide every care-decision made in UCLP MH. To address this, we are establishing a pilot project in BEH to incorporate IT & information services and financial services specialists into service-line operational management groups and clinical teams with significant needs for information and IT solutions. Operational management groups Clinical teams Supported by our strategic leadership group (see above) and leaders in BEH, these frontline professionals will develop solutions that: (1) foster mutual understanding between clinicians and support services; (2) identify priority areas of intervention (e.g. conditions or service lines) and meaningful outcomes; (3) enable information systems to track performance on these outcomes; (4) develop methods for presenting and reviewing performance information, identifying opportunities and making improvements; and (5) specify changes needed to align incentives to support quality improvement. Uniquely, work in BEH will be led by the T&P CEO. The trust will be an action learning system, with two-way idea-flow: solutions generated by the frontline collaboration will spread across partner trusts via a cross-trust Project Board. Feedback from the network will enhance the solutions. Success in BEH alone would make information-driven outcome improvements possible for most of the 10,000 referrals received yearly by the trust. Spreading this innovation across UCLP MH would reach the specialist MH providers for a population of over 2m, and create a step-change in work-satisfaction for hundreds of IT/IS, FS, clinical and managerial professionals. Foster mutual understanding Identify priority intervention areas Improve performance tracking Routinely review performance Specify changes and align incentives

10. Projects overview 2011 2012 2013 2014 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2. Europe's leading MH programme On going 3. Adolescent MH A B B, C B 4. CVD & depression A B, C D E 5. Dementia A B C D 6. Partnership-wide A B B, C C, D D, E D, E E, F G outcomes 7. PIRC A B B, C B, D B, E B B, F B 8. MH information challenge A B C D E F 9. IT/IS, FS & clinical integration A B C D Adolescent MH A. Strategic award B. Longitudinal study C. Pilot cross-sectional data PIRC A. Pilot research survey B. Training and service design C. Hire project manager D. Research database functional E. Establish audit & assessment F. Research proposals CVD & depression A. Intervention manuals B. Pilot data C. Phase II trial application D. Phase II trial E. Phase II results MH information challenge A. Workgroup established B. Map of available data C. Develop tools D. Pilot tools E. Pilot data F. Roll-out of tools Dementia A. Pilot data B. Standardized measures C. Diffusion programme D. Cost-savings report IT/IS, FS & clinical integration A. Funding application B. Pilot begins C. Pilot data D. Diffusion programme Partnership-wide outcomes A. Quality and safety forum B. Measures co-selection (CAMHS) C. Measures co-selection (psychosis) D. Pilot minimum measure sets (CAMHS) E. Pilot minimum measure sets (psychosis) F. Pilot data (CAMHS) G. Pilot data (psychosis)