NHS | Presentation to [XXXX Company] | [Type Date]1 Suicide Prevention ’ National & Local Programmes Dr Geraldine Strathdee National Clinical Director Mental Health

Suicide prevention: national and local programmes The National Mental Health Strategy is working to : Identify and prevent the causes of mental ill health Focus on high risk groups Crisis care: improvements Primary care mental health at scale Acute trust MH services Specialist mental health services I am very keen to hear what you are doing that others across the country need to know about. What challenges are you facing and as leaders what would you like to do to help?

Mental health: the basis of a humane and wealthy society

The mental health system Three segments for our overarching national vision Ta ckling causes, building health literacy & prevention in individuals and communities Primary, community, acute, & social integrated care provision The complex specialist population

Building collaborative, resilient communities for England through the knowledge that the Mental health intelligence network can bring you and your partners Building collaborative, resilient communities for England through the knowledge that the Mental health intelligence network can bring you and your partners

The Mental Health Intelligence Programme please look at Fingertips ( and find out about your communityhttp:// The mental health intelligence network can now show you for every CCG and every Local Authority in England: – About your community - the risks and strengths factors for mental health – The prevalence of mental ill health & suicide – The high risk groups to target for early intervention – The rates of identification in primary care mental health The extent of IAPT services; the recommended NICE evidence treatment Medication prescribing, rates of assessment of high risk groups – Secondary care services : the levels of Access, waiting times, standards, quality, outcomes, spend Soon to add rates of NICE recommended practice – The crisis pathway & much more

The Mental Health Intelligence Programme please look at Fingertips ( and find out about your communityhttp:// MY ask of mental health leaders : Can you please look at your CCG/ LA area and tell us What's helpful What you notice about your area What can we add in terms of quantitative data that would be useful We plan to add factsheets, references, what good looks like so that there is a pathway that says: we have the data, now how to we apply that new knowledge to out in place practice to reduce suicide Can you help: What best practice factsheets, training programmes, service development tools can you give us for the WGLL site, Would you like to organize a 1 day course in mental health intelligence leadership Can you please look at your CCG/ LA area and tell us What's helpful What you notice about your area What can we add in terms of quantitative data that would be useful We plan to add factsheets, references, what good looks like so that there is a pathway that says: we have the data, now how to we apply that new knowledge to out in place practice to reduce suicide Can you help: What best practice factsheets, training programmes, service development tools can you give us for the WGLL site, Would you like to organize a 1 day course in mental health intelligence leadership

‘ Thinking’ Communities are calculating the cost of NOT addressing mental health The report is available to download from –

Tackling causes Building health literacy Prevention Employment Family friendly, productive practices, Creating wealth Can every large, medium & small employer be a positive employer? What can GPs and CCGs do ? Schools 4 Rs: reading, writing, ‘arithmetic & Resilience Building resilience, addressing dyslexia Training school nurses & form tutors Engaging school governors College students: Building resilience & physical & mental health literacy in future leaders Transport hub related Preventing isolation in older people Reducing avoidable suicides and Reducing detentions Fire chiefs 70% of avoidable fires, domestic accidents, & RTAs Fire chiefs 70% of avoidable fires, domestic accidents, & RTAs Police commissioners Commissioning parenting Safer neighborhoods Alcohol Police commissioners Commissioning parenting Safer neighborhoods Alcohol

Suicide prevention: national and local programmes Focus on high risk groups including: Unemployed, relationship challenges, substance misusers, repeated self harm, isolated, yr-old men Update on national employment support programmes – IAPT, IPS, Quality premiums for CCGs Personalization, social impact bonds, support for GPs to refer to employment programmes Substance misuse: alcohol programmes – New public health campaign on alcohol – Primary care enhanced scheme for alcohol and depression / anxiety Self harm – New service specification – Liaison mental health services – ? A national self harm CQUIN?

Mental health policy & partnerships: the parity & integration revolution ? New era in primary, acute, community & social integrated care for common ‘conditions’ 2 What’s new: the incredible level of innovation focus on implementation & culture of sharing ‘best’

Primary care innovations learning from the best of international primary care MH leaders & role modeling collaborative partnerships Workforce : HEE Mandate for a 4 th year for MH in primary care RCGP new initiatives Registration & annual checks: – include 1 min self completion behavioural health assessment Primary care team skillmix – 30% of the work; ? % of staff with NICE training psychological health training – See ¾ in year and 45% in month before suicide Supporting hard pressed primary care : the basics – Clinicians decision support templates – Annual checks : zero exclusion of SMI – Family and 3 rd sector outreach Primary care at scale initiatives – integrated ‘Living well’ care stroke, diabetes, pain, COPD, bariatric surgery care – Named workers in primary care – Federated effective suicide prevention programmes which have been successful in Seattle, Canada, New Zealand, Australia, Denmark, and Hungary. Population based focus based on local need – Enhanced SMI care in inner cities ? – Enhanced MUS care – Alliance commissioning models

New and very exciting era in primary care & integrated acute & community mental health London Strategic clinical network & London CCG MH leaders 70+ case studies of primary care mental health integrated physical and MH recovery care, integrated public health approaches, all securing evaluation support now Reference : Primary care mental health guide: – Check out the primary care at scale federated models of suicide prevention in Seattle, Scandinavia, Hungary Check out Sheila Hardy: Train the Trainer for practice nurses and building a community of practice between practice nurses and mental health nurses MY ask of leaders If you know of others, please let us know about good practice Can you run a primary care at scale master class or federated programme Can you lobby for research funds in England to do this and lest include alcohol so we are the best in the world If you know of others, please let us know about good practice Can you run a primary care at scale master class or federated programme Can you lobby for research funds in England to do this and lest include alcohol so we are the best in the world

Suicide prevention: national and local programmes 3. Crisis care: improvements – The national transformational model and innovations ( – The Information revolution (e.g. NMHIN, best practice website, NHS Choices & 111) – Improving access & best practice in suicide risk assessment and management e.g. tele-triage Victoria state assessment tools: – Street triage by mental health professionals with police & paid for jointly by transport industry and NHS England embedded in transport hubs – Local initiatives: suicide ‘points’, e.g. bridges; CALM; ‘Talk to your neighbour’ MY Ask: Is your team/service on NHS Choices? Do you have brilliant examples of user voice? Local action?

Reducing avoidable admissions Commissioning the Care Pathway of Mental Crisis Service ££££££££££££ Accessible information to prevent crises and get help early Alternatives to Hospital beds Liaison mental health teams Crisis Home Treatment Teams Trained tele-triage and tele- health to increase access Single number to access crisis care

Can you help with any of these steps? 8. MH Pilots to place mental health trained staff in 111: What lessons can we learn from the triage pilots with British transport police hubs & police street triage What lessons can we learn from the triage pilots with British transport police hubs & police street triage 7. Training: what awareness do 111 staff need in mental health 6. Good practice examples of 111 MH: what can we learn e.g. Isle of Wight 5. Information sharing protocols 4. Crisis Assessment for MH: What is the current assessment for people in mental health crisis and can it be amended to add a brief Suicide risk assessment which reduced suicide 3. Directory of Services : is there a specification of MH local services for DOS 2. Governance arrangements for national and local oversight & planning 1. Leadership: Who is the national MH 111 lead & names of the local leads

New focus on high risk groups with long term physical ill-health Integrated physical and mental health care: Long term conditions International research finds that co- morbid MH problems are associated with a 45-75% increase in service costs per patient ( after controlling for severity of physical illness ) Between 12% and 18% of all expenditure on long-term conditions is linked to poor mental health and wellbeing – at least £1 in every £8 spent on long-term conditions. If a person with a LTC has an untreated MH condition they cannot recover as well and they die earlier, are more disabled, cant adhere to treatment plans, use more healthcare, are poorer Therefore it makes no logical, ethical, or business sense not to include psychological New Recovery guidance from NHSE Commissioning & Monitor Tariffs need to include mental health recovery care to get Value

Mental health policy & partnerships: ‘policy’ focus on implementation Care pathway whole person, whole pathway approaches Disseminating ‘best’ for the specialist population: 3 What’s new: the focus on Implementation & culture of sharing ‘best’

Early Intervention Psychosis : new national focus Current services: - Standard care means that duration of untreated psychosis is between 8 months & 2.5 years with lifelong poor outcomes - 29% receive Cardio metabolic assessment & only 25% receive treatment -At least 34% do not have NICE psychological therapies -16% of medicines prescribed do not adhere to guidelines. -The Variation ranges from 0-70% across England Future services: - Early intervention psychosis teams with treatment in the first critical 8 weeks -full NICE compliance -home based care -recovery to employment -maintain 70% recovery from first episode

Mental health system of care: what can be done to build personalized, recovery orientated care & reduce suicide at every level High secure beds Medium secure beds Low secure beds Intensive rehabilitation closed unit for complex dual diagnosis Open rehabilitation units Locally authority Residential rehabilitation Supported accommodation with care package Own tenancy plus personalized budget 24/7 Assertive outreach/ community forensic team 24/7 Assertive outreach /rehabilitation & recovery team Rehabilitation / recovery team CMHT/ Enhanced primary care SMI with 3 rd sector outreach Design Principle :It is vital to understand that in mental health our ‘technology’ and ‘care model design principle’ is that in order to provide safe, NICE concordant, efficient services, we need proven effective care teams to link with beds. In mental health we are expert at using case managers to triage all admissions & work early on the discharge plans. The beds The teams