Parity: Innovation in Practice

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Robyn Ferguson
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1 Parity: Innovation in Practice Karen Turner Director of Mental Health 11 February 2016

2 Why does parity matter? 1:4 adults experience at least one diagnosable mental health problem a year 1:10 children and young people have a diagnosable mental health problem People with severe and prolonged mental illness die at least years earlier than others. This must be one of the greatest inequalities in England. 2

3 Why does parity matter? (2) People with long term conditions suffer more complications if they also have mental health problems 3

4 Why does parity matter? (3) One in five mothers suffers from depression, anxiety of in some case psychosis during pregnancy Suicide is the second leading cause of maternal death Not only the mother but her child can be affected The costs can be as much as 10,000 per birth 4

5 Why does parity matter? (4) One in five older people living in the community and 40% of those in care homes are affected by depression People in marginalised groups are at greater risk Nine out of ten people in prison have a mental health or substance abuse problem, and Suicide is rising. 5

6 The commitment Mandate objective: to put mental health on a par with physical health, and close the health gap between people with mental health problems and the population as a whole. By March 2015, we expect measurable progress towards achieving true parity of esteem, where everyone who needs it has timely access to evidence based services. 6

7 What progress have we made? Securing new funds: 1.25bn for children and young people 2015/2020 This includes 75m for new perinatal services November SR HMT committed additional 600m to mental health PM speech 11 January 2016 announced: 290m for perinatal mental healthcare 247m for liaison mental health in A&E 400m community crisis care as an alternative to acute admission Funding for MH Taskforce to be confirmed in full 7

8 What progress have we made? (2) Children and young people: Guidance for community eating disorder services issued. New access standard to be introduced. 123 Local Transformation Plans fully assured and financial allocations made New CYP IAPT collaborative recruited in the Midlands National dataset collection from January 2016 data Extending the current change programme to train existing and new staff in the NHS, Voluntary and Social Care. Adding to in evidence based, outcomes focussed interventions for depression, anxiety, self harm, behaviour and eating disorders to include counselling, 0-5, Learning Disability and Autistic Spectrum Disorder, combined medication and prescribing 8

9 Wessex CYPMH Services 2013/14 An outline for the Wessex SCN Children s Mental Health Service is presented below. Data was taken from the 2015 Local Transformation Plans and compares Wessex to the England Average in Mental Health Prevalence, Expenditure and Referrals. Wessex data should be read with caution as the sample sizes of CCGs and population are much lower compared to other SCNs Thames Wessex Valley 9 CCGs 19.7% Population aged 0-17 years 9.6% estimated 5-16 year olds with mental health condition Approximate 5-16 year olds with a diagnosable Mental Health per 1000 children Approximate Annual total CYPMH expenditure per general population 000s 2013/14 Approximate Annual Total CYPMH Referrals per general population 2013/14 9

10 What progress have we made? (3) Access and waiting times: early intervention in psychosis The standard: From 1 April 2016, 50% of people experiencing a first episode of psychosis treated with a NICE-approved package of care within two weeks of referral. Both elements of the standard will be measured the wait from referral to treatment and whether the treatment accessed is NICE concordant. 40m recurrent funding Regional preparedness programmes South Dataset requirements defined, with NICE-recommended interventions and outcomes tools. Mental Health Services Dataset collection from 1 Jan 2016 Interim monitoring of RTT through NHS England Unify Dec 2015 data submitted Workforce - 5m identified nationally to support training this year for EIP staff in CBT for psychosis and family interventions National clinical audit to provide baseline assessment of NICE concordance reporting April 2016 Tripartite working together to assess and support preparedness 10

11 What progress have we made? (4) Access and waiting times IAPT: Stepped care psychological therapy services established in all CCGs Self referral supported Approx 15% local prevalence seen in services Some 60% have a course of treatment (c 530,000 per year) Outcomes recorded in 97% of cases (pre IAPT, 38%) 11

12 IAPT So Far Recovery rate: 45% (range 19%** to 69%) (A third of CCGs now exceed 50%) Reliable Improvement: 61% (range 24% to 73%) Reliable deterioration: 6% (range 3% to 11%) Problem descriptor: 68%* (range <1% to 100%) Reducing variability must be one of the next goals. Notes: * up from 62% in 2013/14. ** data completeness issues, true low probably 30% Source 3 rd Annual HSCIC Report and latest quarterly data 12

13 Wait Times to First Treatment Average wait: 32 days Wait less than 4 weeks: 66.9% Wait less than 8 weeks: 85.9% Wait more than 13 weeks: 7.1% 13

14 IAPT IST in Wessex Well-established tripartite working between SCN, DCO team and IST Significant focus on resolving data quality issues Two data workshops delivered Successful resolution of patient opt-out issues Full review of IAPT services in Fareham & Gosport CCG, North Hampshire CCG, West Hampshire CCG and South Eastern Hampshire CCG (9 th February) April recovery workshop scheduled, bringing together local and national best practice 14

15 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 IAPT Outcomes Headline 60% Recovery Rate 50% 40% 30% 20% 10% 0% Wessex South Region National Source HSCIC IAPT data 15

16 IAPT Outcomes Variation 80% Recovery and Reliable Improvement 70% 60% 50% 40% 30% 20% 10% 0% Recovery Reliable Improvement Source HSCIC October 2015 IAPT data 16

17 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Access Headline 20% Access Rate 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Wessex South Region National Source HSCIC IAPT data 17

18 Annualised Access Access Variation 25% 20% 15% 10% 5% 0% Source HSCIC October 2015 IAPT data 18

19 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Waiting Times Headline 95% Patients Completing Treatment Who Received First Treatment Within Six Weeks 90% 85% 80% 75% 70% Wessex South Region National Source HSCIC IAPT data 19

20 Waiting Times To Second Treatment 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Isle of Wight Southampton Dorset England West Hampshire South Eastern Hampshire North East Hampshire and Farnham North Hampshire Portsmouth Fareham and Gosport Over 28 Days Over 90 Days Source HSCIC October 2015 IAPT data 20

21 Next steps The launch of the 5 Year Forward View for Mental Health by the Independent Taskforce Recommendations + new funds direct delivery: A 7 day NHS - supporting people experiencing a mental health crisis An integrated mental and physical health service Promoting good mental health helping people lead better lives. Major cross-cutting focus on inequalities 21

22 Next Steps: a 7 day NHS Access to crisis/emergency services for mental health, as for physical health Community based mental health crisis response 24/7 across England People experiencing a first episode of psychosis should have access to NICE concordant treatment with 60% seen within 2 weeks by 2020 Increased mental health liaison services for emergency and urgent care 24/7 22

23 Next Steps: an integrated mental and physical health service Targeting the physical health needs of those with severe mental health problems Increase access to evidence based psychological therapies to 25%, focusing on those with long term physical conditions and those unemployed Increase evidence based perinatal services for an additional 30,000 women Increase access to services for an additional 70,000 children and young people. 23

24 Next Steps: promoting good mental health Focus on vulnerable children and young people Support people with mental health problems to find and stay in work: Increase access to psychological therapies for those with anxiety and depression, coupled with employment advice Increase access to IPS for people with severe mental illness Focus on challenging stigma in communities Putting in place integrated care pathways across the criminal justice system and expanding liaison and diversion services across England Addressing housing as a critical component of good mental health care 24

25 Funds invest in what works Data relentless focus on improving data quality and availability Sustainability and transformation planning: Target need New models Users and carers Strong relationships with other ALBS Ourselves! Our tool kit 25

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