Early Intervention in Psychosis Network 22 March 2018

Transcription

1 Yorkshire and the Humber Mental Health Network Early Intervention in Psychosis Network 22 March 2018 Stephen McGowan, EIP Clinical Lead for Y&H CN and NHSE (North) (Chair) Dr Steve Wright, Consultant Psychiatrist, TEWV (Co-Chair) Sarah Boul, Quality Improvement Manager #yhmentalhealth March

2 Yorkshire and the Humber Early Intervention in Psychosis Network Welcome! Sarah Boul, Quality Improvement Manager, Yorkshire and the Humber Clinical Networks

3 #yhmentalhealth happycoconut779

4 Yorkshire and the Humber Early Intervention in Psychosis Network National, Regional & Local Update Moggie McGowan, Co-Chair, Clinical Advisor, Y&H IRIS, Y&H Clinical Network & NHS England North

5 National & Regional Update Moggie McGowan

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7 National Update Triangulation/EIP Matrix Performance (NB UNIFY switch off and Increasing Incidence!) Quality: CCQI self-assessment results NAS NCAP Investment Training update (NB PSI)

8 NHS England Triangulation

9 National Update Triangulation/EIP Matrix Performance (NB UNIFY switch off and Increasing Incidence!) Quality: CCQI self-assessment results NAS NCAP Investment Training update (PSI)

10 Rolling Quarter Summary of Indicators - Providers Jan uar Latest Data: y EN ENGLAND Started Treatment (Rolling Quarter) Org code People started Treatment within 2 weeks % People started Treatment within People started Treatment within 6 weeks % 12 weeks % Total started EN 71.5% 93.1% 98.1% 3,086 TAD 61.9% 91.7% 95.2% 84 NHV 61.4% 93.2% 93.2% 44 RV9 96.2% 98.1% 100.0% 52 RP7 65.0% 92.5% 98.8% 80 NQL 100.0% 100.0% 100.0% 3 RXE 72.5% 100.0% 100.0% 40 TAH 41.9% 83.9% 96.8% 62 RXG 88.2% 97.6% 98.8% 85

11 FACTOR IMPACT Extending the age-range to 65 HIGHEST 14 day access target HIGH Increased demand for initial assessment HIGH Introduction of ARMS pathway HIGH Increase in substance use inc. legal highs HIGH CMHT/CAMHS capacity/transformation HIGH Increased stress and poverty in society MODERATE More migrants with traumatic experiences LOWER Cuts to local authorities LOW Fewer alternative pathways LOW Reduced substance misuse services LOW The national average increase in referral rates is 48% The national average increase in caseloads is 21% 11

12 National Update Triangulation/EIP Matrix Performance (NB UNIFY switch off and Increasing Incidence!) Quality: CCQI self-assessment results NAS NCAP Investment Training update (NB PSI)

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14 National Update Triangulation/EIP Matrix Performance (NB UNIFY switch off and Increasing Incidence!) Quality: CCQI self-assessment results NAS NCAP Investment Training update (NB PSI)

15 Year 2: Spotlight audit on EIP services The second year of the audit (2018/19) will focus on EIP services. Data collection is expected to be in October/November 2018

16 National Update Triangulation/EIP Matrix Performance (NB UNIFY switch off and Increasing Incidence!) Quality: CCQI self-assessment results NAS NCAP Investment Training update (NB PSI)

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18 Reaffirmation

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20 Deliverables for 2018/19 Each CCG must meet the Mental Health Investment Standard (MHIS) by which their 2018/19 investment in mental health rises at a faster rate than their overall programme funding. CCGs auditors will be required to validate their 2018/19 year-end position on meeting the MHIS. Ensure that 53% of patients requiring early intervention for psychosis receive NICE concordant care within two weeks. Ensure all commissioned activity is recorded and reported through the Mental Health Services Dataset. (NHS England/NHS Improvement. February 2018)

21 Additional funding for EIP announced in 5 Years Forward View CGI Baseline allocation: EIP 17/18 18/19 19/20 20/21 New Investment 11m 9m 10m 40m Recurrent increase 11m 20m 30m 70m

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23 Regional Update Local Progress 2018 deep dives Updating Regional map SOP Challenges: - ARMS - Out-Of-Hours - CYP - Outcomes 18/19 regional programme IRIS website

24 MEASURING PROGRESS ACCESS QUALITY INVESTMENT Are access and waiting time standards are being met, is data being reported reliably and do Unify and MHSDS data compare well? Are NICE approved therapies available to all that need them with good levels of take up and is the service provide in accordance with contextual (service design) requirements Is service development supported by CCG investment and Trust spending? Do staffing levels and skill mix reflect the workforce calculator and current incidence? GOOD REQUIRES IMPROVEMENT INADEQUATE

25 Y&H 17/18 TRUST ACCESS QUALITY INVESTMENT

26 Regional Update Local Progress 2018 deep dives Updating Regional map SOP Challenges: - ARMS - Out-Of-Hours - CYP - Outcomes 18/19 regional programme IRIS website

27 Summary of 2017 Deep Dive themes Shortages of CBTp practitioners in a number of teams and uncertainty about whether free training would continue to be available Similar re IPS training Meeting the physical health baseline is a challenge in many teams and most needed to improve take-up of interventions for weight gain and smoking Bringing QPR and DIALOG into use is ongoing in most teams At Risk Mental State (ARMS) interventions are in their infancy in most teams Many teams have received investment to increase their workforces and appear to have reasonable capacity now. Some haven t There are also real concerns about rising demand At most meetings we managed to get providers and commissioners to agree to a joint review of referral rates after the summer so any requirement for further funding could be fed into contracting reviews Poor appreciation of the 5YFV funding plans in most places and a great deal of interest in the IRIS illustration by CCG that had been presented elsewhere in the North Region

28 Regional Update Local Progress 2018 deep dives Updating Regional map SOP Challenges: - ARMS - Out-Of-Hours - CYP - Outcomes 18/19 regional programme IRIS website

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31 Regional Update Local Progress 2018 deep dives Updating Regional map SOP Challenges: - ARMS - Out-Of-Hours - CYP - Outcomes 18/19 regional programme IRIS website

32 Regional Update Local Progress 2018 deep dives Updating Regional map SOP Challenges: - ARMS - Out-Of-Hours - CYP - Outcomes 18/19 regional programme IRIS website

33 Regional Update Local Progress 2018 deep dives Updating Regional map SOP Challenges: - ARMS - Out-Of-Hours - CYP - Outcomes 18/19 regional programme IRIS website

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36 Yorkshire and the Humber Early Intervention in Psychosis Network David Shiers and Steve Wright In Conversation Dr David Shiers, Honorary Research Consultant, Psychosis Research Unit

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39 Yorkshire and the Humber Early Intervention in Psychosis Network Physical Health and SMI Research Update Professor Simon Gilbody, Director of Mental Health and Addictions Research Group (MHARG), University of York

40 SMOKING CESSATION FOR PEOPLE WITH SEVERE MENTAL ILL HEALTH: INSIGHTS FROM THE UK SCIMITAR TRIAL Simon Gilbody Professor of Psychological Medicine & Health Services Research University of York March 2018 On behalf of the SCIMITAR collaborative

41 Today's talk Smoking and severe mental ill health poor health, poverty and early death The SCIMITAR trial first look at the results of the pilot and overview of an ongoing trial Making mental health services more conducive to quitting rather than

42 Consequences of smoking for those with SMI Poor physical health Early death years Tobacco poverty Increasing health inequalities Stigma

43 Smoking is the single most important modifiable risk factor for early death in SMI

44 Problem People with SMI want to quit, but are not routinely encouraged to do so by people working in mental health services

45 Developing a user-centred model of care for people with SMI who smoke

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47 Bespoke Smoking Cessation the SCIMITAR model MHP with L2 smoking cessation training GP or Practice Nurse Psychiatrist/CMHT/key worker Behavioural support

48 Different from NHS Standard Treatment Programme (STP) in the following ways: Delivered by a mental health professional NRT was the mainstay of treatment Nicotine pre-loading & cut down to quit More intensive and more personalised Special attention to medication management Planning for quit attempt. What to do in place of smoking

49 SCIMITAR trial programme Pilot trial: Results in the public domain 2015 Fully powered trial Oct 2015 December 2017

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52 Who took part? 98 People with SMI Long history of smoking 27 years Heavy smokers 25/day (range 5-60) Overweight BMI - 29

53 Russell standard: CO-verified quit at 12 months 40% 12 month CO-verified quit rate 35% 30% 25% 20% 15% 10% 5% 0% Usual care Bespoke smoking cessation

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55 she understood the mental health side The nurse knows what I ve got. Whereas if you go to a normal stop smoking thing and they know you ve got mental health problems.. then it s stigma isn t it?

56 Purpose of the pilot.. Road test the intervention Learn about recruitment, randomisation and retention Established the parameters for the full trial Preliminary estimates of effect

57 STARTED IN 2015 Needed to recruit 400 participants

58 Results of SCIMITAR+ in late but some reflections on smoking and SMI

59 Recruited on time and to target Target Actual 100 0

60 Some common myths which maintain high levels of smoking mythbusting

61 Mythbusting #1 Smoking relieves stress, and people with SMI have more reason to be stressed

62 Mythbusting #2 Quitting smoking will cause relapse, deterioration in mental health, admission to hospital.it is never a good time to quit

63 Mythbusting #3 People who use mental health services just aren t interested in quitting No point asking, since nothing works Therapeutic nihilism

64 Top tips for mental health professionals Make every encounter count - VBA Be prepared to challenge common misperceptions Make every encounter count Challenge services to be responsive to smoking cessation and the needs of people who use services Know how to manage medications when people quit Go smoke free and challenge the smoking culture

65 Thanks to team-scimitar and our

66 Disclaimer The SCIMITAR trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (project number 07/41/05). The views and opinions expressed by authors do not necessarily reflect those of the National Health Service, NIHR, the NIHR Evaluation, Trials and Studies Coordinating entre, the HTA Programme, or the Department of Health.

67 Yorkshire and the Humber Early Intervention in Psychosis Network Time for a break?

68 Yorkshire and the Humber Early Intervention in Psychosis Network Introduction to the Group Discussion Dr Steve Wright, Co-Chair, Consultant Psychiatrist, TEWV & Clinical Advisor, Y&H Clinical Network

69 World Café! Select a topic of your choice from the list below; gravitate to the relevant table, discuss and nominate a scribe to make notes on the A3 sheets provided! Oral Health Physical Health Monitoring Physical Health Interventions (inc. medication) Healthy Lifestyle Smoking Misc

70 Yorkshire and the Humber Early Intervention in Psychosis Network Summary & Close Dr Steve Wright, Co-Chair, Consultant Psychiatrist, TEWV & Clinical Advisor, Y&H Clinical Network

71 Date of the Next Meeting June 2018 Specific date to be confirmed!

72 Yorkshire and the Humber Early Intervention in Psychosis Network Thank You for Attending! Don t forget to fill out your evaluation form!