Urgent & Emergency Mental Health Care in the Five Year Forward View for Mental Health Prof Tim Kendall National Clinical Director for Mental Health, NHS England Consultant Psychiatrist for Homeless, Sheffield Mental Health Crisis Care Concordat 3rd National Summit Kia Oval, 25 October 2016

5YFVMH: over-arching themes Reduce our dependence on institutional solutions to people’s (mental) health problems – and make them high quality when we do use them Create more/better alternatives to institutional care – primary, community and home care/treatment – acute, crisis and non-acute Integrate mental health care into the health service at all levels and in all places Help children and young people – prevention, secondary prevention, early intervention Timely access to what works – and focus on what has the chance to produce lasting change (work, psychological therapies, self management)

Five Year Forward View for Mental Health The report in a nutshell: 20,000+ people engaged Designed for and with the NHS Arms’ Length Bodies All ages (building on Future in Mind) Three key themes in the strategy: High quality 7-day services for people in crisis Integration of physical and mental health care Prevention and early intervention Plus ‘hard wiring the system’ to support good mental health care across the NHS wherever people need it Focus on targeting inequalities 58 recommendations for the NHS and system partners £1bn additional NHS investment by 2020/21 to help an extra 1 million people of all ages Recommendations for NHS accepted in full and endorsed by government Simon Stevens: “Putting mental and physical health on an equal footing will require major improvements in 7 day mental health crisis care, a large increase in psychological treatments, and a more integrated approach to how services are delivered. That’s what today's taskforce report calls for, and it's what the NHS is now committed to pursuing.” Prime Minister: “The Taskforce has set out how we can work towards putting mental and physical healthcare on an equal footing and I am committed to making sure that happens.”

“A Billion for a million” by 2020/21 70,000 more children will access evidence based mental health care interventions – from 25% to 33% of CYP Intensive home treatment will be available in every part of England as an alternative to hospital ALL acute hospital have all-age 24/7 mental health liaison services, and at least 50% of acute hospitals are meeting the ‘core 24’ service standard At least 30,000 more women each year can access evidence-based specialist perinatal mental health care 10% reduction in suicide and all areas to have multi-agency suicide prevention plans in place by 2017, Increase access to evidence-based psychological therapies to reach 25% of need, helping 600,000 more people per year to access care The number of people with SMI who can access evidence based Individual Placement and Support (IPS) will have doubled 280,000 people with SMI will have access to evidence based physical health checks and interventions 60% people experiencing a first episode of psychosis will access NICE concordant care within 2 weeks

Spending streams impact in later years 16/17 17/18 18/19 19/20 20/21 1 Promoting good mental health and helping people lead the lives they want to live Integrating Care 2 Creating a 7-day NHS for mental health (right care, right time, right place & recovery focused) 3 Hard-wiring mental health across health and social care 4 Children and young people’s mental health services transformation Suicide reduction Individual placement and support (employment) Mental health New Models of Care Community rehab/ step down Secure care transformation Specialist perinatal care Delivering evidence based psychological therapies to people of all ages with long term conditions and expanding access for adults from 15% to 25% Evidence based physical care screening and interventions for those with SMI Crisis resolution home treatment teams + Out of area treatment reduction Liaison mental health services Early intervention in Psychosis to 50% Early intervention in psychosis service improvement Liaison and Diversion STPs development and assurance STP delivery mechanism including via CCG improvement and assessment framework and regional support Key: System funding Infrastructure HEE workforce strategy Outcomes based payment approach in place 5 year data plan

Mental Health Task Force – crisis and acute recommendations (1/2) By 2020/21 24/7 community crisis response across all areas that are adequately resourced to offer intensive home treatment, backed by investment in CRHTTs. Equivalent model to be developed for CYP Recommendation 18: By 2020/21, no acute hospital is without all-age mental health liaison services in emergency departments and inpatient wards At least 50 per cent of acute hospitals are meeting the ‘core 24’ service standard as a minimum by 2020/21.

Mental Health Task Force – Crisis and Acute Care recommendations (continued, 2/2) Introduce standards for acute mental health care, with the expectation that care is provided in the least restrictive way and as close to home as possible. Eliminate the practice of sending people out of area for acute inpatient care as a result of local acute bed pressures by no later than 2020/21. Recommendation 13: Introduce a range of access and quality standards across mental health. This includes: 2016 - crisis care (under development) 2016/17 – acute mental health care (starting)

Determine workforce needs Agree outcomes measures Preparatory work (16/17) Find the money Develop guidance (standards) for timely access to NICE recommended care (E-B Treatment Pathways) Determine workforce needs Agree outcomes measures Develop national networks Incentivise the right treatment and care Guide the money to the front line (publish and be damned!)

Spending Review – Headlines for Crisis & Acute Care “By 2020, there should be 24-hour access to mental health crisis care, 7 days a week, 365 days a year – a ‘7 Day NHS for people’s mental health’.” Substantial new funds for crisis resolution and home treatment teams (CRHTTs) to deliver 24/7 treatment in communities and homes as a safe and effective alternative to hospitals (over 4 years from 2017/18); New money for liaison mental health services in every hospital emergency department (over 4 years from 2017/18); Capital funding for Health Based Places of Safety in 2016-18 (non-recurrent)

New investment in urgent and emergency mental health care: CYP (2016/17) new money invested this year to pump prime investment in the eight UEC vanguards to rapidly test and evaluate different models to CYP crisis care, and generate an evidence and consensus on what works (2016/17) non-recurrent new funds issued to CCGs on 26th September to improve waiting times including to accelerate plans for crisis and home treatment  

24/7 UEC mental health liaison in acute hospitals Develop the guidance: implementation guides (including EBTPs, standards, workforce and data requirements) for UE and acute Care 24/7 UEC mental health liaison in acute hospitals 24/7 ‘blue light’ UEC mental health response 24/7 community UEC mental health response 24/7 UEC response for children and young people Acute mental health care pathway

Plans for CYP urgent & emergency mental health care All areas asked to invest and develop CYP crisis care as part of their Local Transformation Plans, in Future in Mind NHS England has commissioned an evidence-based treatment pathway project for CYP crisis/liaison Some examples of potential models include: Model 1: Collaboration between a number of specialist community mental health services Model 2: Hub and spoke model: collaboration between children and young people’s specialist tier 3 and tier 4 community and inpatient mental health services Model 3: Integrated CYP mental health and social care Model 4: All-age integrated liaison and crisis mental health intervention Plans for CYP urgent & emergency mental health care

Focus needed on urgent & emergency mental health care for older adults - prevention Older adults integral part of patient cohort seen by liaison services _ LTCs often with anxiety/depression - Help people with LTC and MH problem into IAPT for CBT The majority of the financial and clinical benefits of liaison services are accrued through assessment and treatment of older adults However, recent Age UK report highlighted concerns about crisis provision for older adults – Crisis not often needed OOHs, but must have access to crisis teams Crisis and liaison teams should have access to older adult clinical expertise, or such expertise embedded

BAME communities: action required We must ensure that inequalities in access, experience and outcomes are effectively addressed Pronounced inequalities experienced by BAME groups have led to significant overrepresentation in crisis and acute settings People from black, Asian and minority ethnic groups living in the UK are more likely to: be diagnosed with mental health problems be admitted to hospital, whilst remaining underrepresented in primary care MH present in crisis come into contact with the police when in crisis enter the mental health system via the courts or the police be detained under the Mental Health Act. experience a poor outcome from treatment  disengage from mainstream mental health services, leading to social exclusion and a deterioration in their mental health.  We need to do much more. As a first national step, NHS England & NCCMH have established a BAME reference group to help advise on our crisis & acute care pathways

National quality assessment and improvement scheme (with CCQI) Products to underpin implementation (all these basics in the implementation guides) Referral to treatment pathway, including response times and NICE quality standards (implementation guides) National quality assessment and improvement scheme (with CCQI) National baseline audit and gap analysis Workforce analysis and workforce calculator (with HEE) Changes to national datasets (MHSDS) (with NHS Digital)

Patient reported experience measure: adapted from NICE service user experience guideline – key quality measure   Statement Please circle one number 1 If I experience a mental health crisis again, I feel optimistic that care will be effective. 2 3 4 5 During the treatment for my crisis, I was treated with empathy, dignity and respect. During the treatment for my crisis, I felt actively involved in shared decision-making and supported in self-management. I feel confident that the views of service users are used to monitor and improve the performance of liaison mental health services. I can access liaison mental health services when I need them. 6 During the treatment for my crisis, I understood the assessment process, diagnosis and treatment options, and received emotional support for any sensitive issues. 7 During the treatment for my crisis, I jointly developed a care plan with mental health and social care professionals, and was given a copy with an agreed date to review it. 8 When I accessed crisis support with the liaison mental health service, I had a comprehensive assessment, undertaken by a professional competent in crisis working. 9 The liaison mental health team considered the support and care needs of my family or carers when I was in crisis. Where needs were identified, they ensured that they were met when it was safe and practicable to do so.

System levers and incentives CCG Improvement and Assessment Framework – Crisis and OAPs prominent Development of Sustainability and Transformation plans – including crisis and acute mental health NHS Planning Guidance Proposed CQUIN on A&E + mental health needs Quality Premium on OAPs New payment models being developed for mental health National Medical Directors Network for MH Changes to national datasets – measuring what we want MH Dashboard – serious about transparency

Mental health dashboard to be published (CCG improvement and assessment framework) very soon Access Quality Outcomes Investment Health promotion Is everyone who needs access getting access? Is care provided of the right quality, at the right time and in the right place? Is that care effective and delivering the outcomes that people want to see? Is there the right level of investment? Integration 7 day services Hard-Wiring

Thank you! and Any questions?