international school for communities, rights and inclusion commissioning guidance for public mental...
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International School forCommunities, Rights and Inclusion
Commissioning Guidance for
Public Mental Health and Well-being
Karen Newbigging
22nd October 2009
International School forCommunities, Rights and Inclusion
Overview
Why is this important?Making the case for mental well-beingOverview of the guidance: content and processNext steps
Policy focus across government on quality of life and wellbeing: population health, prevention and early intervention alongside emphasis on decentralisation, community responsibility and social justice
Policy focus across government on quality of life and wellbeing: population health, prevention and early intervention alongside emphasis on decentralisation, community responsibility and social justice
International School forCommunities, Rights and Inclusion
The case for mental wellbeing Increased quality of life and overall wellbeing Improved educational attainment and outcomes Safer communities with less crime Reduced health inequalities – both physical and mental health
related and lower health care utilisation Improved productivity and employment retention Reduced sickness absence from work Reduced levels of poor mental health and mental illness
1. Economic case2. Moral or
communitarian case
International School forCommunities, Rights and Inclusion
Economic Case Early intervention with Conduct and Emotional Disorders. Total value of
benefits of prevention from treating a one year cohort of children with conduct disorder is estimated at £5.2 billion.
Promote good mental health as well as social & emotional skills in childhood (especially those with conduct disorders). Estimated lifetime benefit of £115,000 per case of child with conduct disorder. Cost savings for mental health promotion are £75,000 per case. Total value of benefits of prevention of promoting positive mental health in a one year cohort of UK children is £23.25 billion.
Early Intervention is cost effective in reducing the risk of re-offending: Every £1 spent on a prevention programme for those at risk of offending saves £5.
Later targeted parenting programmes with children with emotional and conduct disorders. Programmes cost £600-4000 but a total cost of a child with conduct disorder is £70,000 by 28 years of age.
Family Intervention Programme: Cost of programme £8-20,000 compared to costs, if no intervention, of £250-350,000.
Refer and treat alcohol misuse problems in perpetrators of violence across health and CJS systems. Alcohol is a key risk factor for carry out and being a victim of violence and abuse. For every £1 spent on treatment, the public sector saves £6.
Purpose of the guidance
The guidance is designed:to enable local health and local authority commissioners, and their partners, to make decisions about mental health improvement strategies to suit local circumstances
commissioned by the National Mental Health Development Unit
International School forCommunities, Rights and Inclusion
New Horizons: Twin aims
Improving the mental health and wellbeing of the population
Improving the quality and accessibility of services for people with poor mental health (mental illness)
Paradigm Shift! Towards a whole system approach to well-being
Mental health is an essential component of general health Mental well-being is more than absence of mental illness. Mental well-being is a key social asset of economic significance as a
resource for long-term social and economic prosperity. Wellbeing is the other side of the coin of personalisation – an
opportunity for greater personal responsibility in health and social care. Mental wellbeing and physical illness are connected with long-term
health conditions, particularly CHD, CVD, hypertension, diabetes, obesity Addressing mental wellbeing is key to local action to tackle health
inequalities Responsibility for promoting mental well-being extends across all
disciplines and government departments
Improving public mental health and well-being
General publicPeople vulnerable to poor mental health
Intervention processesPractitioners
What?
Improving public mental health and well-being
General publicPeople vulnerable to poor mental health
Intervention processesPractitioners
What?
Implementation processes
Adapted from: Blase & Fixsen (2005): Measuring the Fidelity of Implementation. National Implementation Research Network
How?
Local Strategic Partnerships, Local Authorities and Primary Care Trusts
The key challenge is commissioning for sustainable long-term development to build individual and community resilience
International School forCommunities, Rights and Inclusion
Two levels of guidance prepared to date
1. Strategic Guidance for Boards and senior staff of PCTs and Local Authorities
Making the case and starters for ten
2. Technical (detailed) Guidance for commissioning managers in health and local authorities (social care, education, regeneration, community development etc.)Detailed and practical to include tools, resources and
positive practice examples
Overview of guidance
Meaning of mental well-being Values and principles underpinning the approach Business case for public mental health and well-being Key messages from the relevant policy documents Opportunities to link public mental health agenda with others ‘Basic buys’ for commissioning mental health improvement Practical tools: decision tool, monitoring and evaluation
International School forCommunities, Rights and Inclusion
Key documents that underpin the guidance Every Child Matters The NHS Next Stage Review Working for a Healthier Tomorrow Putting People First Commissioning Framework for Health and Well-Being World Class Commissioning competencies etc Flourishing People, Connected Communities. New Horizons: towards a shared vision for mental
health
Whole system approach
Develop a whole system approach with interventions in all domains according to
Robust evidence for interventionsLocal priorities and values (established through the JSNA and LSP processes)Continued development and learning from promising practice and actionGood practice in commissioning A practical
decision tool to enable commissioners to prioritise investment
Identifying local priorities
JSNATurning inputs into outcomes using Joint
Strategic Needs assessment (JSNA)Using:
Analytical data on demography, social context and epidemiology
Local views and community engagement
Reflecting and contributing to commissioning plans and LSP/LAA targets
Life course domains in the draft guidance Develop safe sustainable connected communities; Child and adolescent years (incorporates ‘Build resilience
and safe and secure base’ and ‘Ensure a positive start in life’)
Adults (incorporates ‘Integrate physical and mental health and wellbeing’)
Older People (incorporates ‘Promote meaning and purpose’)
Vulnerable groups (includes mental illness prevention and wellbeing for people living with the effects of disability)
International School forCommunities, Rights and Inclusion
Criteria for the ‘Basic Buys’
• Maximise cost effective health gain– Effect size– Burden of disease– Population benefit
• Wider social gains• Education, employment, community safety,• Feasibility and achievability• Not the last word on evidence!
Examples of the ‘Basic Buys’
• Universal screening for perinatal mental health problems and targeted interventions for women at risk of postnatal depression including home visiting and support
• Targeted early interventions for common parenting problems
• Healthy Schools approaches including social and emotional learning programmes to strengthen self esteem
• Social prescribing to increase opportunities for social contact and participation
• Improving wellbeing for people living with the consequences of mental health problems
International School forCommunities, Rights and Inclusion
TimeframePhase 1: Draft guidance was prepared during
the spring and early summer 2009Phase 2:
Review of the evidence base continues Further work on the New Horizons vision and
programme of action (to be published early December)
Rigorous field testing of the guidance during the autumn with key stakeholders and a leadership group
Possible development of a web based tool
Publication in March 2010
In conclusion..
Addressing mental health and well-being will
achieve two different objectives simultaneously: Improve health, reduce health and social services
interventions, and assist in wider social gains Assist those who have mental health problems
and prevent such problems occurring
Interested in field testing and
developing the guidance?
International School forCommunities, Rights and Inclusion
[email protected] [email protected];
International School for Communities Rights and Inclusion, University of Central Lancashire
Tel: 01772 892780