CARE PATHWAYS BETWEEN PHYSICAL AND MENTAL HEALTH Dr Hugh Griffiths National Clinical Director for Mental Health

INTRODUCTION The clinical background Where the policy fits What is being planned strategically What we are planning for today

THE CLINICAL BACKGROUND - LTCs There is a strong link between physical long term conditions and psychological distress/disorder Co-morbidity increases health care consumption, and self perceived patient need Psychological treatment improves outcomes and reduces health care consumption NICE recommends the use of psychological interventions in people with LTCs

THE CLINICAL BACKGROUND - MUS People with medically unexplained symptoms have significant psychological distress People with MUS have increased use of health care resources MUS cost the NHS £3 billion (08/09) Psychological treatments help people with MUS There is no NICE guideline for MUS

POLICY CONTEXT Equity and Excellence White Paper - Towards GP Led commissioning & PbR tariffs Quality Innovation Productivity & Prevention (QIPP) agenda Mental Health strategy – 2010 IAPT and talking therapies

THE CONTEXT IS RAPIDLY EVOLVING, COMPLEX, AND INCLUDES: White Paper Public Health Social Care Carers a new Public Health Service, with a White Paper in December 2010; a new Vision for Social Care, with ambitions for greater independence and choice for users of social care. The strategy will include personalisation, prevention and re-ablement; and a refocused carers strategy to be published in April 2011 bold reforms to the NHS as set out in the White Paper Equity and excellence: Liberating the NHS;

Equity and Excellence NHS White Paper GP led commissioning - Joint work with the RCGP and RC Psychiatrists, including ADAS and NHS Confederation -Details remain unclear PbR Development of mental health PbR tariffs -Development of care clusters -Moving towards outcome based tariffs

IAPT Development of outcome based tariff Development of other talking therapies Increase access to: Children and adolescents People with physical health problems People with severe and enduring mental illness

Quality, Innovation, Productivity and Prevention (QIPP) Five deal broadly with how we commission care, covering long-term conditions, right care, safe care, urgent care and end of life care. Five deal with how we run, staff and supply our organisations, covering productive care (staff productivity), non-clinical procurement, medicines use and procurement, efficient back office functions and pathology rationalisation. Two enabling workstreams covering primary care commissioning and contracting and the role of digital technology in delivering quality and productivity improvement. 12 NATIONAL QIPP WORKSTREAMS

Quality, Innovation, Productivity and Prevention (QIPP) Three Mental Health work streams: -Acute Care Pathway, OATs & Physical and mental health Physical & MH to develop, support and disseminate high quality, innovative and productive care for people with MUS & physical LTCs and MH issues Establish & disseminate common evidence base, case studies & business case data

MENTAL HEALTH STRATEGY THEMES Patient choice and control (personalisation) Outcomes and quality Reducing inequality and tackling stigma Improving efficiency (QIPP) in the context of a challenging financial climate

More people will recover, more quickly Potential outcomes Fewer people developing mental illness, improved well-being More people will make self-defined recovery Improved life expectancy & reduced suicide for people with severe mental illness More people with a positive experience of care Fewer people will suffer avoidable harm MENTAL HEALTH STRATEGY

A CROSS-GOVERNMENT MENTAL HEALTH STRATEGY Key messages for a cross government mental health strategy good mental health is essential for everyone Improving public mental health and well-being, with prevention and early intervention, can cut the £77bn annual cost of mental ill health people with mental ill-health are likely to have better outcomes if they have real, well-informed choices over their care a twin-track approach will improve outcomes for people with mental ill-health and build resilience and well-being to prevent mental ill-health in the whole community The importance of mainstreaming mental health a Concordat with key stakeholders

MOVING FORWARD Time of change Focus on quality and cost-efficiencies Strategies and plans in development Critical 3-6 months to shape future service delivery

Introduction Dr Alan Cohen National Primary Care Advisor, IAPT

QIPP Quality –improved outcomes, from a range of interventions Innovation – Developing an integrated approach to providing psychological care for people with LTCs Productivity –Using scarce health care resources better Prevention –Minimising the impact of the disorder, through primary, secondary and tertiary prevention.

A word from our Sponsor… Multi-morbidity is a key focus Mental illness is part of DH LTC approach Involve GP groups now A multi morbidity approach will make you attractive to commissioners Prevention is central –Working with L.A.s as they will lead on public health –Commissioning health children programmes essential for an even earlier prevention approach

Putting it in Perspective MUS 5.75 million 11.5% Depression and Anxiety 7.5 million 15% of adult population LTCs 30 million 60% 10% of people with MUS also have depression and anxiety 0.5 million 15% of people with LTCs also have depression and anxiety 4.5 million 60% of people with MUS also have a LTC 3.45 million

Putting it in Perspective For a practice of 10,000 people –There are 690 people with MUS and LTCs –There are 900 people with Depression and LTCs –There are 100 people with MUS and Depression

Putting it in Perspective Providing psychological treatments for people with MUS could save £60m in a three year period For diabetes alone –There are about 450,000 people with co-morbid depression and diabetes –Access to collaborative care could bring savings of up to £250m in a three year period For a practice of 10,000 –MUS savings of £4,000 per year –Diabetes savings of £16,600 per year

Putting it in Perspective It is attractive to commissioners It is attractive to people who need the service

WHAT DO WE WANT FROM YOU? Your experience – how can we best use examples of innovative and high quality to move forward? Examples of programme evaluations and costings Products that we can disseminate, based on these programmes Advice on developing care pathways that cut across current silos of care

Thank you