Volition Trustees
08.01.15
jenny.thornton@nhs.net
Leeds Mental Health Framework
2014 -17
OUR VISION
Leeds is a city that values people’s mental wellbeing
equally with their physical health.
“Our Ambition is for people to be confident that others will
respond to our mental health needs without prejudice or
discrimination and with a positive and hopeful approach to our
future recovery, wellbeing and ability”.
“No health without mental health”
2011
More people
will have good
mental health
More people
with mental
health
problems will
have good
physical health
Fewer people
will experience
stigma and
discrimination
Mental
Health
Framework
More people
with mental
health
problems will
recover
Fewer people
will suffer
avoidable harm
More people
will have a
positive
experience of
care and
support
Public Mental Health - a conceptual model derived
from the WHO framework .
Annual Report of the CMO 2013.
Mental illness
prevention
Mental health
promotion
Treatment,
recovery and
rehabilitation
Closing the Gap:
Priorities for Essential Change in Mental Health.
The “What”
• Aims to bridge the gap between our long-term
ambition within No Health Without Mental Health and
shorter-term action. It seeks to show how changes in
local service planning and delivery will make a
difference, in the next two or three years, to the lives
of people with mental health problems.
• 25 areas where people can expect to see, and
experience, the fastest changes.
These are the priorities for action
• To reduce the damaging impact of
mental illness and improve
mental wellbeing.
25 Priorities for Action
Increasing access to mental health services
1. High-quality mental health services with an emphasis
on recovery should be commissioned in all areas,
reflecting local need
2. We will lead an information revolution around
mental health and wellbeing
3. We will, for the first time, establish clear waiting time
limits for mental health services
4. We will tackle inequalities around access to mental
health services
5. Over 900,000 people will benefit from psychological
therapies every year
6. There will be improved access to psychological therapies
for children and young people across the whole of England
7. The most effective services will get the most funding
8. Adults will be given the right to make choices about the
mental health care they receive
9. We will radically reduce the use of all restrictive practices
and take action to end the use of high risk restraint,
including face down restraint and holding people on the
floor
10. We will use the Friends and Family Test to allow all patients
to comment on their experience of mental health services –
including children’s mental health services
11. Poor quality services will be identified sooner and action
taken to improve care and where necessary protect patients
12. Carers will be better supported and more closely involved
in decisions about mental health service provision
Integrating physical and mental health care
13. Mental health care and physical health care will be better
integrated at every level
14. We will change the way frontline health services respond
to self-harm
15. No-one experiencing a mental health crisis should ever be
turned away from services
Starting early to promote mental wellbeing and prevent
mental health problems
16. We will offer better support to new mothers to minimise
the risks and impacts of postnatal depression
17. Schools will be supported to identify mental health
problems sooner
18. We will end the cliff-edge of lost support as children and
young people with mental health needs reach the age of
18
Improving the quality of life of people with mental health problems
19. People with mental health problems will live healthier lives
and longer lives
20. More people with mental health problems will live in homes
that support recovery
21. We will introduce a national liaison and diversion service so
that the mental health needs of offenders will be identified
sooner and appropriate support provided
22. Anyone with a mental health problem who is a victim of
crime will be offered enhanced support
23. We will support employers to help more people with mental
health problems to remain in or move into work
24. We will develop new approaches to help people with mental
health problems who are unemployed to move into work and
seek to support them during periods when they are unable to
work
25. We will stamp out discrimination around mental health
Why do we need the Mental Health Framework now?
The NHS Mandate sets out five “domains” four of which have indicators
related specifically to mental health
Domain 1
Preventing people from dying prematurely
Reducing premature death in people with serious mental
illness
Indicator: Excess under 75 mortality rates in adults with
serious mental illness (PFOF)
Domain 2
Enhancing quality of life for people with long term conditions
Enhancing quality of life for people with mental illness
Indicator: employment of people with mental illness (ASCOF,
PHOF)
Adult Social Care Outcomes Framework: People are able to find
employment when they want, maintain a family and social life
and contribute to community, avoid loneliness and isolation
Indicator – number of people in contact with secondary mental
health service living independently, with or without support
PHOF 1.6
Domain 3
Helping people to recovery from episodes of ill health and
following injury
Access to psychological therapies
Indicator – number of people entering therapy, recovery rate,
BME access and over 65 recovery rates CCG OF
Domain 4
Ensuring people have a positive experience of care
Improving experience of healthcare for people with mental
illness
Indicator – patient experience of community mental health
services
Friends & Family Test indicator in development - to be
introduced in mental health
Feedback from consultation events in 2013 with service
users, carers, clinicians and service providers
identified that there is still work to do in ensuring effective
joined up working arrangements between statutory and all
voluntary sector providers to deliver continuity of care.
The main issues with the current system are:
• It is not easy to understand to
anyone outside of it
• There is no central point of
information that describes it well
• Specialist advice is not easy to
access if you are outside the
service
• There is inconsistency of care
management
• The wait for talking therapies is
too long
• It is not consistently “outcome”
focussed
We also want to engage the general public, economic, social
and commercial communities in Leeds, and secure their support
in promoting well-being and resilience .....“Mind Out for Leeds”
Local Challenges
• We need to have a clearer and more integrated mental health
service pathways for Leeds, that everyone can understand.
• We need to integrated mental health pathways into wider services
ending the perception that mental health is separate and specialist
• Demand for services is unlikely to decrease, we need to use data to
help design services that accommodate
 The needs of increasingly diverse communities
 The impact of the economic downturn in the city
 Widely different life expectancy depending on the area you live in
• Expenditure on mental health needs to be re-defined with more
partnership working
• We need to have a centralised Information resource about mental
health and mental health services in the city – making it easy for
public and professionals to navigate their way to what will help.
• We need to focus more on early intervention to prevent crises
We will deliver the mental health framework by
focussing on five Outcomes
1. Focus on keeping people well – to build
resilience and self-management
2. Mental health and physical health services
will be better integrated
3. Mental health services will be transformed to
be recovery and outcome focussed
4. We will ensure access to high quality services
informed by need
5. We will challenge Stigma and Discrimination
Process for developing the Framework
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Engagement
Listening
More engagement
Policy drivers
Local health and well-being strategy
Listening to comments on Draft versions
Version 1 agreed Oct 14
Agreeing the priorities for action
• Support from NHS Improving Quality team
Achieving Better Access to Mental
Health Services by 2020. Oct 14
Phase 1 – 2014/2015: Laying the Groundwork
• Drive the implementation of Closing the Gap,
– Improving Access to Psychological Therapies programme
– Securing nationwide sign up to the Crisis Care Concordat
– The Children and Young People’s IAPT programme
• New £40 million funding boost to kick-start delivery of the 2020
vision
• £7 million immediately in 50 new inpatient beds and in better case
management, to ensure that children with specialist inpatient
needs are cared for in appropriate settings.
• £33 million is being invested in Early Intervention Services for
Psychosis and in rapid implementation of the Crisis Care Concordat.
General Hospital Liaison and Home Treatment services
Achieving Better Access to Mental Health Services by 2020
Phase 2 – 2015/2016:
Implementing the first standards
•
In 2015/16 a further £80m will be
freed from existing budgets
•
The refreshed NHS mandate for
2015/16 will contain the commitment
that NHS England will begin planning
for countrywide service
transformation of children and
young people’s Improving Access to
Psychological Therapies. As set out in
Closing the Gap 100% roll out should
be achieved by 2018.
•
In three key areas where we have
invested this year, we have agreed
that the NHS Mandate for 2015/16
will introduce three access standards
as a crucial starting point on a
journey to parity of esteem when,
with the right will, our ambitions of
parity can be fully realised.
In 2015/16 we will introduce the following
access and waiting standards:
•
75% of people referred to the Improved
Access to Psychological Therapies
programme will be treated within 6 weeks
of referral, and 95% will be treated within
18 weeks of referral.
•
More than 50% of people experiencing a
first episode of psychosis will be treated
with a NICE approved care package within
two weeks of referral.
•
£30m targeted investment on effective
models of liaison psychiatry in more acute
hospitals. Availability of liaison psychiatry
will inform CQC inspection and therefore
contribute to ratings
The Crisis Care Concordat challenges
local areas to make sure that:
• Health-based places of safety and beds are available 24/7
in case someone experiences a mental health crisis
• Police custody should not be used because mental health
services are not available and police vehicles should also
not be used to transfer patients. We want to see the
number of occasions police cells are used as a place of
safety for people in mental health crisis halved compared
2011/12
• Timescales are put in place so police responding to mental
health crisis know how long they have to wait for a
response from health and social care workers. This will
make sure patients get suitable care as soon as possible
The Crisis Care Concordat challenges
local areas to make sure that:
• People in crisis should expect that services will share
essential ‘need to know’ information about them so they
can receive the best care possible. This may include any
history of physical violence, self-harm or drink or drug
history
• Figures suggest some black and minority ethnic groups are
detained more frequently under the Mental Health Act.
Where this is the case, it must be addressed by local
services working with local communities so that the
standards set out in the Concordat are met
• A 24-hour helpline should be available for people with
mental health problems and the crisis resolution team
should be accessible 24 hours a day, 7 days a week
No Assumptions. A Narrative for Personalised,
Co-ordinated Care and Support in Mental Health 2014.
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NICE quality standard 14 on
people’s experience of adult
mental health services
developed with people who use
and work in the services includes
the quality statement
“People using mental health
services, and their families or
carers, feel optimistic that care
will be effective”
People who use services want to
see
Joined up, preventative
approaches that do not
abandon them at key stages
Their mental and physical health
needs to be addressed together
in a whole person approach
Priority Aims in whole system change
1. INFORMATION
All members of the public, service users and professionals can easily
obtain relevant accurate information about prevention, mental health
services and how to access them.
2. DATA
All commissioners, clinicians and managers have access to timely relevant
clinical and operational data sources that are known and shared by all to
inform their decisions.
3. CHILDREN AND FAMILIES
Children and families obtain appropriate professional support early in
their lives.
4. CRISIS
Mental health crises are prevented where possible but where they do
occur service users receive timely comprehensive professional support.
5. MENTAL HEALTH IN THE COMMUNITY
Community services are recovery focussed and configured to deliver
sustainable recovery taking account of wider determinants.
Developments to support our aims
• Mental Health Crisis & Urgent care
Mapping workshop 3rd February 15
• Common Mental Health pathway meetings
• Information hub Workshop 3rd December 14
• Children and Young people JM JW meetings
• Partnership Provider event November 14
• Dual Diagnosis Network event November 14
• Data – audit of our process of developing the
Mental Health Framework November 14
Where we are now
INFORMATION
• Finance secured
• Project support secured
• Information Hub Steering
group
• Scope of work established
and interfaces with other
mhealth work-streams/links
with Public Health
• Branding/raising profile by
Dec 15
CHILDREN AND FAMILIES
• Focus on ante-natal and
peri-natal mental health
identification and
assessment.
• Developing stronger
partnership working with
Maternity /HV & MH
services
• Discussing possible scope of
work within Children and
Families clusters
• Project support required
Where we are now
CRISIS
• Service user experience report
completed by LIP
• Project support
• Project Initiation Document in
development
• Workshop to develop new MH
crisis pathway
• Agree scope of work required to
deliver Crisis Care Concordat
requirements including
Assessment of current service
configuration against
requirement to deliver a RAID
style model of service
MENTAL HEALTH IN THE
COMMUNITY
• Project support required
• Development of complex needs
enhancements to services
through innovations funding
2015-16
• Agree scope of work required to
deliver Better Access 2020
requirements that
75% of people referred to the
Improved Access to Psychological
Therapies programme will be
treated within 6 weeks of referral,
and 95% will be treated within 18
weeks of referral.
•
Achieving Better Access to Mental Health Services by 2020
Developing the Infrastructure to rebalance the system
for parity between physical and mental health
Laying the ground work for an equivalent system of access and waiting time standards,
levers and incentives, commissioning and payment models that will place mental
health services for all ages on a more level playing field with physical health.
For the current year, the infrastructure priorities for the system will be:
(a) Establishing the baseline position: carrying out analysis on the level and reliability of
information that currently exists for mental health services across care pathways, which would
help to support the work to develop access and waiting time standards.
(b) Strengthening national datasets: develop definitions and data specifications that are fit for
purpose to enable robust and consistent analysis of patient pathways and measurement of actual
waiting times.
(c) Improving data collection, reporting and assurance: assess whether there is appropriate IT
infrastructure in organisations to support data capture: improve the quality of clinical coding and
datasets; and establish national protocols for reporting and assurance.
(d) Establishing best practice waiting time benchmarks for different services, taking account of
local circumstances.
(e) Collecting data on out of area placements.
2015/16 NHS Outcomes Framework domains
Domain 1
Preventing people from dying prematurely
Outcome sought:
Reduce premature mortality in adults with
common mental health problems
Domain 2
Enhancing quality of life for people with long
term conditions
Outcome sought:
Better (health-related) quality of life for
people with mental health problems
Domain 4
Ensuring people have a positive experience of
care
Outcome sought:
Patient experience of community mental
health services
Friends & Family Test indicator to be
introduced in mental health
Raising the profile of the
Mental Health Framework
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Children’s commissioner 16th September 14
LIP 24th September 14
ZIP 15th October 14
LYPFT SUN 1st October 14
Student Mental Health 22nd October 14
Volition Trustees 8th January 15
Health & Well Being Board 4th February 15
Veteran's Mental Health February 15
South & East CCG Clinical Forum 26th February 15
ASC Head of Services 12th March 15