www.nmhdu.org.uk ISSUE 4 OCTOBER 2010 • WELCOME • OCTOBER SPOTLIGHT • THEMED FOCUS • • • • • Quality and productivity in mental health (QIPP) Mental health and the QIPP agenda – some facts and figures Acute Care Pathways Out of Area Placements Mental/physical interface Welcome to the latest edition of the National Mental Health Development Unit (NMHDU) news briefing on programme developments and related policy and practice news. If you would like to know more about our work, contact Alison Cooley or Tony Jameson-Allen. For more information go to our website. Click here to subscribe or unsubscribe to future editions. • POLICY AND PRACTICE Key developments: OCTOBER SPOTLIGHT Ian McPherson, NMHDU Director "The National Mental Health Development Unit is working alongside policy colleagues to inform and shape the new mental health strategy, which the Minister for Care Services announced earlier in September. While no-one can credibly underestimate the scale of the challenges ahead, it is possible to implement real, measurable improvements in mental health care provision and in the wellbeing of communities, families and individuals, if we take an evidence-based, whole systems approach to the task. The NMHDU is working closely with key partners, such as the NHS Confederation and ADASS to give local commissioners and providers a strong, well evidenced case for driving cost-efficiency in a way that improves outcomes in the lives, hopes, and expectations of the end user. With this issue in mind, this edition of our stakeholder briefing focuses on the work we are doing with DH and our partners to promote QIPP (Quality, Innovation, Productivity and Prevention) in the mental health system. The NMHDU is committed to providing a vital bridge between policy and practice and has an ambitious work programme that runs to March 2011. While our funding arrangements and future are subject to review and to the major changes across the public sector, key mental health stakeholders are in discussions with the DH about what type of policy implementation function would be required, and could be achieved, beyond March 2011. The outcome of those discussions are expected to become clearer towards the end of this calendar year. In the meantime, we welcome your continued interest and involvement to ensure we achieve the goals we have committed to in our current work programme." • • • • • • • • • NMHDU series of evidence factsheets available Royal Colleges join forces to meet the commissioning challenge Triangle of Care guidance launched Dual diagnosis programme final report and training resources published The role of local government in promoting wellbeing Users try out personal mental health budgets Equalities programme develops new resources Let’s Respect toolkit Developing financial capability • EVENTS > SPOTLINE continued 1 www.nmhdu.org.uk ISSUE 4 OCTOBER 2010 • WELCOME • OCTOBER SPOTLIGHT • THEMED FOCUS • • • • • Quality and productivity in mental health (QIPP) Mental health and the QIPP agenda – some facts and figures Acute Care Pathways Out of Area Placements Mental/physical interface SPOTLIGHT continued Intention to launch new mental health strategy announced Care services minister Paul Burstow plans to launch a new mental health strategy towards the end of this year. The strategy is expected to maintain New Horizons’ lifespan approach and emphasis on promoting mental health and wellbeing and the important contribution to mental health of factors such as employment and housing. It will also continue to support the development of talking-based therapies across the NHS. Paul Burstow has signalled a new, equal emphasis on mental health outcomes in assessing quality of NHS and social care. The new strategy will expect patients’ mental health to be considered alongside their physical health outcomes following NHS treatment. "The fact is we can no longer accept that curing someone of cancer, then leaving them to struggle with depression afterwards, is a true mark of success," he told Community Care magazine. "The NHS should deal with the full parameters of a patient's recovery, including helping them return to work and get their life back after illness. That's what the new outcomes framework should deliver." The full report is available on the NMHDU website. • POLICY AND PRACTICE Key developments: • • • • • • • • • NMHDU series of evidence factsheets available Royal Colleges join forces to meet the commissioning challenge Triangle of Care guidance launched Dual diagnosis programme final report and training resources published The role of local government in promoting wellbeing Users try out personal mental health budgets Equalities programme develops new resources Let’s Respect toolkit Developing financial capability • EVENTS 2 www.nmhdu.org.uk ISSUE 4 OCTOBER 2010 • WELCOME • OCTOBER SPOTLIGHT • THEMED FOCUS • • • • • Quality and productivity in mental health (QIPP) Mental health and the QIPP agenda – some facts and figures Acute Care Pathways Out of Area Placements Mental/physical interface THEMED FOCUS Quality and productivity in mental health (QIPP) Mental health accounts for around 13.8% of England's health budget . One in six of the population has some form of common mental health problem at any one time2 and up to one in 100 people live with a serious mental illness2. Mental health has a successful track record in redesigning services to improve quality and productivity, particularly in the adult mental health sector. However there remain areas of significant variation in quality across the country, including awareness of the links between mental health and physical health. 1 The programme is supported by Dr Hugh Griffiths, the Department of Health’s Interim National Clinical Director, and is managed by Jim Symington, NMHDU Deputy Director. A central focus of NMHDU activity is enabling the key stakeholders to work together at national and local level to achieve improvements in these three areas. The three projects are already working towards a number of products, including guidance on best practice and evidence-based outcomes, implementation toolkits for regional/ local commissioners and providers, benchmarking information for SHAs, commissioners and providers, and joint NHS Confederation / NMHDU / ADASS briefing materials. Mental health and the QIPP agenda – some facts and figures • • Mental health problems account for 23% of all lost years of healthy life in high-income countries3. Mental illness represents the single largest cause of disability in the UK. NHS, social and informal care costs £22.5 billion per annum in England4. • POLICY AND PRACTICE Key developments: • • • • • • • • • NMHDU series of evidence factsheets available Royal Colleges join forces to meet the commissioning challenge Triangle of Care guidance launched Dual diagnosis programme final report and training resources published The role of local government in promoting wellbeing Users try out personal mental health budgets Equalities programme develops new resources Let’s Respect toolkit Developing financial capability In coordinated work with partners in DH, the SHAs, the NHS Confederation and the Audit Commission, NMHDU has developed a potential national Mental Health QIPP workstream to support the national Quality, Innovation, Productivity and Prevention (QIPP) initiative. The workstream comprises three projects: • acute care pathways – to reduce variations across the country in mental health bed day usage so that all areas move closer to the upper quartile of national performance. This will be achieved by improving use of evidence based interventions to reduce admissions, lengths of stay and delayed discharges • out of area placements, including medium secure services – to reduce the numbers of people with mental ill health and related conditions placed outside their PCT area and to improve the outcomes where these placements are used • physical and mental health – to reduce the inappropriate use of primary and acute hospital services by people with medically unexplained symptoms (MUS) and people with long-term physical health conditions and co-morbid mental health issues by use of evidence-based psychological treatments. • EVENTS > PRACTICE AND POLICY continued 3 www.nmhdu.org.uk ISSUE 4 OCTOBER 2010 • WELCOME • OCTOBER SPOTLIGHT • THEMED FOCUS • • • • • Quality and productivity in mental health (QIPP) Mental health and the QIPP agenda – some facts and figures Acute Care Pathways Out of Area Placements Mental/physical interface THEMED FOCUS Acute Care Pathways • Improved early intervention and home treatment could yield significant savings (some through reduced acute hospital admissions, shorter lengths of hospital stay, and less use of high-cost intensive interventions5. • Crisis teams reduce length of stay and hospital costs and cost up to an estimated £600 less per crisis admission6. Out of Area Placements • Out of area placements cost the NHS and local authorities in England an estimated £356 million a year7. • Out of area placements cost 65% more than in-borough placements – and 22% residential and nursing care placements for people with mental health problems are out of area8. Mental/physical interface • 11% of adult health care costs in the UK are attributable to physical symptoms caused or exacerbated by mental health problems. Between 20% and 30% of consultations in primary care are with people who are experiencing medically unexplained symptoms and have no clear diagnosis9. • Cognitive therapy can reduce use of GP and secondary care services and prescriptions for antidepressant medication – saving an estimated 9%– 53% in costs, especially when it is available in primary care10. • Patients with a physical illness are at three to four times greater risk of developing a mental illness. Up to 28% of patients admitted to acute hospital may also have a diagnosable mental illness11. References: 1. Mental Health Strategies (2008). The 2007/08 national survey of investment in adult mental health services. London: Department of Health 2. ONS 2000. Psychiatric morbidity among adults living in private households in Great Britain. 3. World Health Organisation (2004). The World Health Report 2004: Changing History. WHO. 4. McCrone P, Dhanasiri S, Patel A et al (2008). Paying the price: the cost of mental health care in England to 2026. London: King’s Fund. 5. NHS West Midlands (2010). QIPP workstream (early intervention and community teams). Version 2. Birmingham: NHS West Midlands. 6. National Audit Office (2007). Helping people through mental health crisis: the role of Crisis resolution and home treatment services. London: National Audit Office. 7. Mental Health Strategies (2005). Out of area treatments 2004/5 – a market out of control? London: Mental Health Strategies 8. Royal College of Psychiatrists (2009) New Horizons consultation response. London: RCPsych. 9. Improving Access to Psychological Therapies (2008). Medically unexplained symptoms: positive practice guide. London: Department of Health. 10. Cited in Department of Health (2009). Quality and productivity examples: psychological management of long term conditions, including medically unexplained symptoms. London: Department of Health www.library.nhs.uk/qipp/ViewResource. aspx?resID=330623&tabID=289 11. NHS Confederation (2009). Healthy mind, healthy body. London: NHS Confederation. • POLICY AND PRACTICE Key developments: • • • • • • • • • NMHDU series of evidence factsheets available Royal Colleges join forces to meet the commissioning challenge Triangle of Care guidance launched Dual diagnosis programme final report and training resources published The role of local government in promoting wellbeing Users try out personal mental health budgets Equalities programme develops new resources Let’s Respect toolkit Developing financial capability • EVENTS 4 www.nmhdu.org.uk ISSUE 4 OCTOBER 2010 • WELCOME • OCTOBER SPOTLIGHT • THEMED FOCUS • • • • • Quality and productivity in mental health (QIPP) Mental health and the QIPP agenda – some facts and figures Acute Care Pathways Out of Area Placements Mental/physical interface POLICY AND PRACTICE Key programme developments NMHDU series of evidence factsheets available NMHDU has produced a series of evidence factsheets on a range of mental health related area such as employment, stigma and discrimination, public mental health and wellbeing, housing and equalities, to highlight the hard-hitting features, impact and consequences of mental ill health and wellbeing in the UK. These are available to download on the DH and NMHDU websites. Royal Colleges join forces to meet the commissioning challenge With an eye to the radical changes heralded by the Government NHS White Paper, NMHDU’s mental health commissioning programme, in partnership with the NHS Confederation, is supporting an unprecedented coming together of the Royal College of Psychiatrists and the Royal College of General Practitioners to discuss the future commissioning of mental health services. The two Royal Colleges met at a seminar on 14 September at which service users were also present and which was attended by Dinesh Bhugra, president of the RCPsych, and Clare Gerada, chair elect of the RCGP. The aim of the seminar was to agree the fundamental values and principles that should underpin commissioning for mental health. A full report on the seminar will be available later in October. The Royal Colleges have agreed to continue to work together on GP-led commissioning for mental health. The hope is that this initiative at national level will provide a model for similar discussions and joint working between GPs and mental health professionals at regional and local level. Triangle of Care guidance launched New best practice guidance to ensure carers are involved as equal partners in the care planning and treatment of people with mental health problems has been published jointly by NMHDU with The Princess Royal Trust for Carers. The Triangle of Care – Carers Included: A Best Practice Guide in Acute Mental Health Care is aimed at acute services, inpatient and crisis resolution home treatment (CRHT) staff and their managers, and also to inform carers, service users and carer groups. The guide was developed by carers and staff to improve carer engagement in acute inpatient and home treatment services. It is one of the practical outputs of the Acute Care Declaration, launched in June 2009 with the aim to bring together all the key stakeholders to work to improve acute mental health services. For further information on related programme areas go to the NMHDU website. • POLICY AND PRACTICE Key developments: • • • • • • • • • NMHDU series of evidence factsheets available Royal Colleges join forces to meet the commissioning challenge Triangle of Care guidance launched Dual diagnosis programme final report and training resources published The role of local government in promoting wellbeing Users try out personal mental health budgets Equalities programme develops new resources Let’s Respect toolkit Developing financial capability • EVENTS > POLICY AND PRACTICE continued 5 www.nmhdu.org.uk ISSUE 4 OCTOBER 2010 • WELCOME • OCTOBER SPOTLIGHT • THEMED FOCUS • • • • • Quality and productivity in mental health (QIPP) Mental health and the QIPP agenda – some facts and figures Acute Care Pathways Out of Area Placements Mental/physical interface POLICY AND PRACTICE continued Dual diagnosis programme final report and training resources published The NMHDU’s dual diagnosis programme, which concluded its five-year programme of work earlier in the year, has published a final report summarising the programme’s achievements. The report notes in particular the valuable involvement of users and carers in motivating and contributing to the work, and the support of the PROGRESS group of nurse consultants who worked to ensure that services for people with dual diagnosis and their carers and families remain at the forefront of clinical policy and practice at local and national levels. Responsibility for developing dual diagnosis strategies and improvements passes to the regional SHAs, and to commissioners and providers at local level. The wealth of guidance and good practice produced over the last five years will continue to be available on the NMHDU website and the Progress dual diagnosis website. The Dual diagnosis team training resource, recently published, is a bespoke compendium of training materials for clinical care teams working with people with this diagnosis. The training resource is designed to meet the needs of the workforce more generally by helping to integrate clinical knowledge and skills in dealing with mental health and substance use. It is also intended to raise awareness and understanding of the particular issues facing this client group across a range of care settings and help people to work together in clinical practice to improve outcomes. Go to the NMHDU website to download the resource. An online awareness raising resource, produced for the NMHDU Improving Care Pathways programme by the PROGRESS group of consultant nurses and Coventry University has also been published. The aim of the resource is to promote awareness of the issues faced by people who have both mental health and drug and alcohol use problems and their care and treatment needs. The course can be accessed from the University of Coventry website. The role of local government in promoting wellbeing A key report on The Role of Local Government in Promoting Wellbeing will be published later this month. The report was commissioned jointly by the NMHDU Wellbeing and Population Mental Health Programme and the Healthy Communities Programme within Local Government Improvement and Development. It was written by the New Economics Foundation (nef), with contributions from leading experts and agencies working across the UK on wellbeing, public health and health improvement. The report highlights the importance of wellbeing for local government, showcases what local government is already doing in some parts of the country, and sets out what the potential challenges and opportunities are and why this is a good time to be thinking in more depth about the future role of local government in wellbeing and wider public health and health improvement. The report will be available through NMHDU website. > POLICY AND PRACTICE continued • POLICY AND PRACTICE Key developments: • • • • • • • • • NMHDU series of evidence factsheets available Royal Colleges join forces to meet the commissioning challenge Triangle of Care guidance launched Dual diagnosis programme final report and training resources published The role of local government in promoting wellbeing Users try out personal mental health budgets Equalities programme develops new resources Let’s Respect toolkit Developing financial capability • EVENTS 6 www.nmhdu.org.uk ISSUE 4 OCTOBER 2010 • WELCOME • OCTOBER SPOTLIGHT • THEMED FOCUS • • • • • Quality and productivity in mental health (QIPP) Mental health and the QIPP agenda – some facts and figures Acute Care Pathways Out of Area Placements Mental/physical interface POLICY AND PRACTICE continued Users try out personal mental health budgets People with mental health problems are, for the first time ever, now ‘buying’ their own mental health care, using the new personal health budgets (PHBs). The Coalition government has signalled its ongoing support for the use of PHBs across the NHS. A total of 63 sites are piloting the use of PHBs across the healthcare sector, approximately a third of which are mental health focused. Of these 63, 20 are being formally evaluated over three years by the University of Kent, and eight of these are mental health projects. These evaluated pilot sites are receiving £100,000 funding a year each from the Department of Health to support the development and introduction of PHBs. Go to the personal health budgets learning network for further information. So far, people have spent their PHBs on services like gym membership and personal health care assistance, although the way is now open to more ambitious uses, such as paying for residential care. NMHDU is funding a national learning set involving all 23 personal mental health budget pilot sites so that people involved in the implementation can come together to learn from each others’ successes and share good practice. Go to the NMHDU website for further information on the personalisation in mental health programme. Equalities programme develops new resources The mental health equalities programme has produced a number of new web-based resources. Spirituality and mental health NMHDU has developed a new website section on religion and belief. The page contains links to numerous resources and websites related to spirituality and mental health. To suggest other links and resources to consider including on this page, contact Hari Sewell, NMHDU programme lead. Podcast explores LGB issues Being lesbian, gay or bisexual (LGB) is not in itself a mental health problem; homosexuality was removed from the World Health Organisation International Classification of Diseases (ICD) in 1990. However, discrimination, isolation and homophobia can be very damaging to the mental health of a lesbian, gay or bisexual person. Research shows that LGB people are at significantly higher risk of mental disorder, suicidal ideation, substance misuse and deliberate self-harm than heterosexual people. In a new podcast available on the NMHDU website, mental health and social care researcher Sarah Carr discusses the experiences of LGB people in mental health services, and the stigma and assumptions she has encountered personally. The website page also contains further information to read and download. • POLICY AND PRACTICE Key developments: • • • • • • • • • NMHDU series of evidence factsheets available Royal Colleges join forces to meet the commissioning challenge Triangle of Care guidance launched Dual diagnosis programme final report and training resources published The role of local government in promoting wellbeing Users try out personal mental health budgets Equalities programme develops new resources Let’s Respect toolkit Developing financial capability • EVENTS > POLICY AND PRACTICE continued 7 www.nmhdu.org.uk ISSUE 4 OCTOBER 2010 • WELCOME • OCTOBER SPOTLIGHT • THEMED FOCUS • • • • • Quality and productivity in mental health (QIPP) Mental health and the QIPP agenda – some facts and figures Acute Care Pathways Out of Area Placements Mental/physical interface POLICY AND PRACTICE continued Let’s Respect toolkit A free toolkit to support work with older people with mental health needs is now available from NMHDU. The Let's Respect Resource Box uses powerful images and case studies to provide information and practical suggestions of how to better meet the mental health needs of older people, with a particular focus on acute care settings. The toolkit is free but you do need to pay the cost of postage. Download an order form from here. Developing financial capability The NMHDU, in partnership with the NHS Confederation, is supporting a programme that aims to tackle issue around financial capability, which is being led by the Consumer Financial Education Body (CFEB). CFEB is an independent body, created in April 2010 by the Financial Services Act 2010. It is responsible for helping consumers understand financial matters and manage their finances better. It’s well known that money problems can worsen people's mental health, and that people with mental illness are more likely to experience financial problems and debt. Research shows that improving people's ability and understanding of money matters can assist their recovery and support their mental wellbeing. CFEB is therefore working in partnership with the National Mental Health Development Unit to raise awareness of the links between money worries and mental ill-health. This is particularly important in the light of the increase in people holding individual health and social care budgets. Go to the CEBR’s website and its consumer site, Money Made Clear, for further information. • POLICY AND PRACTICE Key developments: • • • • • • • • • NMHDU series of evidence factsheets available Royal Colleges join forces to meet the commissioning challenge Triangle of Care guidance launched Dual diagnosis programme final report and training resources published The role of local government in promoting wellbeing Users try out personal mental health budgets Equalities programme develops new resources Let’s Respect toolkit Developing financial capability • EVENTS 8 www.nmhdu.org.uk ISSUE 4 OCTOBER 2010 • WELCOME • OCTOBER SPOTLIGHT • THEMED FOCUS • • • • • Quality and productivity in mental health (QIPP) Mental health and the QIPP agenda – some facts and figures Acute Care Pathways Out of Area Placements Mental/physical interface EVENTS Upcoming events with NMHDU programme involvement include: Meeting the challenge: driving quality and productivity through mental health commissioning Venue: Manchester Conference Centre Date: 20th October, 2010 Where is faith in mental health? Venue: The International Centre, Telford Date: 22nd October, 2010 Trauma and adult mental health: taking steps on the road to recovery Venue: ORT House Conference Centre, London Date: 30th November, 2010 Psychological Therapies in the NHS Venue: Savoy Place, London Date: 2-3 December, 2010 Web: Click here Further events are listed on the events section on the NMHDU site • POLICY AND PRACTICE Key developments: • • • • • • • • • NMHDU series of evidence factsheets available Royal Colleges join forces to meet the commissioning challenge Triangle of Care guidance launched Dual diagnosis programme final report and training resources published The role of local government in promoting wellbeing Users try out personal mental health budgets Equalities programme develops new resources Let’s Respect toolkit Developing financial capability • EVENTS 9