Margi Butler, Head of Commissioning – Mental Health & Learning Disability, Warrington CCG

Shaping the way for the Mental Health Partnership Board

Why should commissioners strive to achieve parity between physical and mental health?

“Crisis can happen at any time - two o’clock in the morning, Christmas Day - and people need help when it happens. I don’t know what I would have done if crisis care hadn’t been available to me when I needed it. You wouldn’t say to somebody with a broken leg or a heart attack that they have to wait to see a doctor during office hours. It should be exactly the same with mental health. We really need to close this gap and start seeing mental health as important, and in need of the same amount of care, thought and urgency, as physical health.”

Expert by experience

Parity of Esteem programme – NHSE, 2013

The current design of our health system doesn’t ensure ‘whole-care’ packages• Most people with Serious Mental illness don’t receive

physical health checks• We run a national programme of health checks within

school, but we only check physical health• There are significant delays in diagnostic treatment for

people with learning disabilities• National audit of schizophrenia – only 29% of service

users getting proper metabolic monitoring

The VisionWhat Parity will mean to me:

My family and I all have access to services which enable us to maintain both our mental and physical wellbeing.

If I become unwell I use services which assess and treat mental health disorders or conditions on a par with physical health illnesses.

“Person centred, coordinated care”

What it looks like: person centred coordinated care and my outcomes

Call to Action and PoE…

• Focussing effort and resources on improving clinical services and health outcomes

• 3 areas identified as initial priorities for urgent focus :

IAPT Improving diagnosis and support for people

with Dementia Improving awareness and focus on the duties

within the Mental Capacity Act

How will this happen?

• Mental Health Focus and Delivery Group formed on a task and finish basis

• The group brings together a range of representatives from across the system in order to provide clinical and managerial leadership supporting delivery at a local, regional and national level.

Warrington’s response…

• Cross-reference with CtG and Achieving PoE• CQUIN for physical health • Psychiatric liaison service • Review of Primary Care Mental Health

services • Member of Cheshire & Mersey Strategic

Clinical Network • Much more to be done though!

Closing the Gap; priorities for essential change in mental health – DH, Feb 2014• Supports “No health without mental health”, 2011

(long term change)

• CtG seeks to bridge the gap - “where people can expect to see and experience fastest change”

• It identifies 25 aspects of mental health care and support where government – along with health and social care leaders, academics and a range of representative organisations – expect to see tangible changes in the next couple of years

Increasing access to mental health services (12)

• High-quality mental health services with an emphasis on recovery should be commissioned in all areas, reflecting local need

• We will lead an information revolution around mental health and wellbeing

• We will, for the first time, establish clear waiting time limits for mental health services

• We will tackle inequalities around access to mental health services

• Over 900,000 people will benefit from psychological therapies every year

• There will be improved access to psychological therapies for children and young people across the whole of England

Increasing access to mental health services

• The most effective services will get the most funding • Adults will be given the right to make choices about the mental

health care they receive • 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

• 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

• Poor quality services will be identified sooner and action taken to improve care and where necessary protect patients

• Carers will be better supported and more closely involved in decisions about mental health service provision

Integrating physical and mental health care (3)

• Mental health care and physical health care will be better integrated at every level

• We will change the way frontline health services respond to self-harm

• 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 (3)

• We will offer better support to new mothers to minimise the risks and impacts of postnatal depression

• Schools will be supported to identify mental health problems sooner

• 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 (7)

• People with mental health problems will live healthier lives and longer lives • More people with mental health problems will live in homes that support

recovery • 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

• Anyone with a mental health problem who is a victim of crime will be offered enhanced support

• We will support employers to help more people with mental health problems to remain in or move into work

• 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

• We will stamp out discrimination around mental health

Warrington’s Response

• Observation…. many cross-cutting themes• Good work already underway in many

areas• Local position statement to be developed

and gaps identified• Event to look at the gaps and prioritise

them against local need.

Mental Health Crisis Care Concordat, DH and Home Office, 2014

• A joint statement about how public services should work together to respond to people who are in mental health crisis.

• Sets out the principles and good practice that should be followed by health staff, police officers and approved mental health professionals when working together to help people in a mental health crisis.

• It follows the refreshed Mandate for NHS England, which includes a new requirement for the NHS that “every community has plans to ensure no one in mental health crisis will be turned away from health services”.

The Concordat is arranged around:

• Access to support before crisis point• Urgent and emergency access to crisis

care• The right quality of treatment and care

when in crisis• Recovery and staying well and preventing

future crises

The Concordat

• Expected that local partnerships of Health, LA and Criminal Justice will agree and commit to local Mental Health Crisis Declarations.

• These will consist of commitments and actions at a local level that will deliver services that meet the principle of the national Concordat.

Warrington’s Response

• Attended a meeting with Cheshire Constabulary to consider a Cheshire-wide approach

• Self-assessment (actions to enable delivery of shared goals) is about to be undertaken

• Operation Emblem, Psychiatric Liaison, CJLT, Offender HNA

All leave cancelled for 2014/15!

Useful links

www.gov.uk/government/publications/mental-health-priorities-for-change

www.gov.uk/government/publications/mental-health-crisis-care-agreement

www.gov.uk/government/speeches/achieving-parity-of-esteem-between-mental-and-physical-health