South Worcestershire Clinical Commissioning Group Redesigning Mental Health Services July 18 th 2012

Mental Health A Priority SWCCG Business Planning Event October 2011 – MH services Identified as priority for improvement

Strategy & Planning SWCCG MH Approach Redesigned MH Service Redesigned MH Service

Strategy & Planning SWCCG MH Approach Redesigned MH Service Redesigned MH Service Patient outcome centred Patient view of pathway Not about organisations Any boundaries = seamless Treatment focus = recovery Patient outcome centred Patient view of pathway Not about organisations Any boundaries = seamless Treatment focus = recovery

Strategy & Planning SWCCG MH Approach Redesigned MH Service Redesigned MH Service

National Mental Health Strategy More People Will Have good mental health through prevention and earlier intervention. Recover by being treated in primary care Have good physical and mental health addressed collaboratively in primary care. Have a positive experience of care Fewer People Will Suffer avoidable harm by reduction in admission to hospital. Experience stigma and discrimination sometimes associated with secondary care

Joint Commissioning Panel For Mental Health Written by primary care experts in consultation with patients and carers Provides guidance on commissioning good quality integrated primary mental health care Supports the delivery of the National Mental Health strategy

Strategy & Planning SWCCG MH Approach Redesigned MH Service Redesigned MH Service

What do we know about current services ?

Consultation Process – Seeking Views To Improve Local Services Patient Questionnaires [n= 140] & 3 Locality Based Patient Focus Groups – Information help patients make informed choices about their care – Patients want their GPs and practice staff to have a better understanding of mental ill health, and have an empathic approach – GPs must be at the centre of the patients’ care Mental Health Clinical Staff – 4 Locality Meetings – Variety of access points into services is confusing – The Evesham Pilot Project is creating better collaboration between services. SWCCG GP Practices – 4 Locality Groups & 32 Practices – Need a standardised, effective Single Point of Access – Direct communications between GPs and consultants needs to be improved – MH services do not work closely enough with practices

Strategy & Planning SWCCG MH Approach Redesigned MH Service Redesigned MH Service

Clinical Consultation Workshop – Ideas For Improvement Single point of access for GP referrals would be a positive move. Gateway, Counselling, IAPT and secondary care psychiatry should all work together as one team to defragment patient care. Single point of access for GP referrals would be a positive move. Gateway, Counselling, IAPT and secondary care psychiatry should all work together as one team to defragment patient care. Closer working within primary and secondary care - aim to close gap (it is possible & both want it). A great deal of consensus - SPA = one service. Do not forget people with complex needs & severe and enduring mental illness. Excellent to see commissioners go back to the coal face to seek the views of different front line personnel. Very good opportunity for staff who will be implementing the pathways to meet and discuss the real issues! Good to hear perspectives of others in different services. Useful to identify what works. Single point of access. Identified need for STR workers in primary care and access to longer term counselling. Useful to identify what works. Single point of access. Identified need for STR workers in primary care and access to longer term counselling. Very useful day - "the development of a seamless service within constraints of resources" Interesting to hear different peoples perceptions - still can't believe people don't know what IAPT is!!Promotion and education is a must. Opportunity to meet all members of the team. It would be lovely to be able to discuss with them more often as part of patient care. We should learn from the Evesham pilot and roll out the successful elements across the rest of the county.

An Opportunity? Pathways can be better Remove shared frustration Improve patient experience Improve patient outcomes By working together

Patient Views GP Views National Strategy MH Team Views Best practice guidance Workshop Ideas Proposed Pathway

In The GP Practice: Good quality information for patients and staff on self management Practice staff to be mental health aware Other practice-attached clinical staff able to screen and offer self help guidance

Mental health aware – Mental health/physical health co-morbidity – Treatment options Assessment – structured consistent assessment (incl. risk) Treatment by GP (evidence based) – watchful waiting – Self help options and signposting – Medication Referral – Opportunity for GP to consult with mental health specialists within practice – Opportunity for mental health specialists to consult with GP to discuss referral – Telephone support from psychiatrists to GPs – Single Point of Access (SPA) – structured consistent referral Support for patient – active monitoring/review Proposed Pathway - GP

Primary Care Mental Health Access via SPA Gateway Worker (qualified mental health worker), Psychological Wellbeing Practitioner, CBT therapist, counsellors – education re roles Provide assessment process in primary care (post SPA) Case management Patient support to stay in therapy Treatment options Step 2 & 3 psychological interventions Supporting step down from secondary care Consistent across S. Worcs localities – Processes – Resources

Secondary Care Mental Health Urgent same day referral & assessment service via assessment team (24/7 service) Access via SPA for all other referrals Telephone support from psychiatrists to GPs Delivering recovery based service to people with severe and complex mental illness Working with GPs to manage physical health co- morbidities Delivering timely, concise information to GPs Providing rapid access to patients in primary care with deterioration

Other Improvement Areas Promote collaboration with other services to maximise opportunities for prevention of mental ill- health and challenge stigma Develop outcome measures for recovery Regular feedback from patients and staff Communications between all parts of the pathways Electronic referral to SPA via choose & book

What Would A Good Mental Health Service Look Like? A good mental health service is: – Evidence based – Patient-centred – Based on need – Age inclusive – Capable – Integrated – Accessible – Sufficient capacity – Outcome focused – Recovery focused – Community linked – Preventative A stepped care model can offer integration of the adult mental health pathway Reference: Joint Commissioning Panel for Mental Health Guidance for Commissioners

Stepped Care Model of Care The core principle is that people are matched to an intervention that is appropriate to their level of need and preference Step 1: Self management of psychological and emotional well-being, social prescribing, peer experts and mentors, health trainers and healthy lifestyle information, as well as psychological and emotional well-being practitioners Step 2: Co-ordinated care involving the primary care team, and includes provision of low intensity therapies and links to employment support, carer support and other social support services Step 3: High intensity psychological therapies and/or medication for people with more complex needs (moderate to severe depression/anxiety disorders, psychosis, and co-morbid physical health problems Step 4: Specialist mental health care, including extended and intensive therapies with community mental health teams and other specialist services

Next Steps Redesigned MH Service Redesigned MH Service

Working Groups 1.Self help 2.Structured assessment and referral including SPA 3.Expanding psychological therapies 4.Step up/step down 5.Education and training

Working Groups 1.Self help 2.Structured assessment and referral including SPA 3.Expanding psychological therapies 4.Step up/step down 5.Education and training Need your help & contribution We will fund back fill

Next Steps Timescales: – Working groups to report through August & September – Report to CCG Board in September How to get involved in working groups: – To register your interest in taking part in one of the working groups please contact: