Mental Health: Better, Faster and Earlier Help

Manchester4 March 2015

Mental Health, Dementia and Neurological Conditions

• Greater Manchester to control £6bn NHS budget• It is understood the councils will take control of local

NHS spending • Greater Manchester is to become the first English

region to get full control of its health spending, as part of an extension of devolved powers.

• Chancellor George Osborne said the £6bn health and social care budget would be taken over by the region's councils and health groups.

• Mr Osborne said it was a "really exciting development".

1957 Royal Commission on Mental Health Act

‘Most people are coming to regard mental illness and disability in much the same way as physical illness and disability’

Mental Health, Dementia and Neurological Conditions

What works in Healthcare?

Having a mindset of perfect care and dramatic increases or stretch goals as against incremental improvement

Zero Vision for suicide*Mindset

*Methodology* Marker

Mental Health, Dementia and Neurological Conditions

ZERO VISION FOR SUICIDE10 October 2018

South West England

Mental Health, Dementia and Neurological Conditions

TOPICSPerfect depression

Post discharge from hospitalPresentations of high risk to frontline staff

Hotspots High risk middle age men

Mental Health, Dementia and Neurological Conditions

NATURE OF INTERVENTION

IHI Breakthrough Series Collaborative model

National Suicide Prevention StrategyRegional Suicide Prevention Expertise

Follow the energy

Mental Health, Dementia and Neurological Conditions

Do safety measures reduce suicide rates?

0.

3.5

7.

10.5

14.

17.5

2003 2004 2005 2006

0-6 recommendations

7-9 recommendations

*

*Patient suicide

rate per 10,000

*

* = significant difference p<0.05

Source: National Confidential Inquiry, Lancet, 2012

The Zero Suicide Collaborative includes the following stakeholders:

People with lived experienceClinical Commissioning GroupsArea TeamsPrimary Care PhysiciansProviders Mental HealthServicesAcute Hospitals / ERThird sector organisationsSamaritansPolice serviceAmbulance serviceAcademic Health Science NetworksLocal AuthoritiesCoroner’s officePublic HealthChildrens servicesRoyal National Lifeboat InstitutePublic Health

Mental Health & Respiratory Disease

• People with mental health problems … die on average 16-25 years sooner than the general population.

• … have higher rates of respiratory, cardiovascular & infectious disease…

• Increased smoking is responsible for most of the excess mortality of people with severe mental health problems.

No Health without Mental Health

Smoking Rates & Mental Illness

Coultard, M., Farrell, M., Singleton, N. and Meltzer, H. (2000). Tobacco, alcohol and drug use and mental health. London: Stationery Office.

20% General population smoking rate 2014

Mental Health & Desire to Quit

Clearing the Air. King’s Fund 2006

Time After Stopping

20 minutesBP, HR & peripheral circulation improve

8 hours Nicotine & CO levels

Fall by 50%. PaO2 - N

24 hours All Nicotine eliminatedTaste & smell improved

48 hours CO & mucociliary clearance

normal, risk of MI falls

72 hours Breathing easier,

bronchospasm relaxesEnergy improves

2-12 weeks Circulation improves

3-9 months Cough & wheeze improve

1 year Risk of MI reduced by 50%

10 years Risk of CA bronchus

reduced by 50%. Risk of MI back to normal

15 years Risk of stroke back to

normal

Benefits of Stopping Smoking

PHE January 15The self-assessment tool breaks down the NICE guidance into four areas. The:

• systems required to implement the guidance • communication required

• training that will enable staff to successfully implement the recommendations • treatments that should be available to support staff and service users

ZERO VISION FOR SMOKING IN HEALTHCARE

11 March 2016South West England

Mental Health, Dementia and Neurological Conditions

Wider costs to the national economy in terms of welfare benefits, lost productivity at work amount to some £77 billion a year

Value in Health Care

•OUTCOME ACHIEVED RELATIVE TO COST

• Shift from volume to value

• Value defined around the patient

• Cost is total cost (not cost of individual service)

• Reducing cost may require increased spend on some services

Value based healthcare requires integration (but how much?)

USER VIEW

• Less symptom orientated

• More how do I function as a person

home

work

recreation

family/friends

Intelligent Commissioning ‘sperm to worm’

DATA

Mental Health, Dementia and Neurological Conditions

•Would you fly a plane on 2 year old

data?

A consultation on updating the NHS Constitution: Feb 15

• ‘You have the right to drugs, treatments and psychological therapies that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you’. (Annex 2, Change 7)

• Do you agree?

‘Change is the law of life. All those who look only to

the past or present are certain to miss the future’

JFK

Mental Health, Dementia and Neurological Conditions