Mental Health Services 2015 & Beyond Dr Nick Broughton

Broadmoor Hospital

Points to cover Case for change – humanitarian & economic Situation now The way forward

“Apart perhaps from global warming, there is no other major problem which is so neglected worldwide” “Thrive – the power of evidence-based psychological therapies” Richard Layard & David Clark

Mental health: the basis of a humane and wealthy society

By condition…. % in treatment Anxiety and depression24 PTSD28 Psychosis80 ADHD34 Eating disorders25 Alcohol dependence23 Drug dependence14 Largest proportion of the disease burden in the UK (22.8%), larger than cardiovascular disease (16.2%) or cancer (15.9%) People with psychosis die years earlier than the general population Depression associated with 50% increased mortality from all disease 59% triple amputees can be treated to get back into employment 7% SMI in paid work

The Statistics 1 in 6 suffer from depression or anxiety 1/3 of families include someone who is mentally ill Mental illness accounts for 40% of all illness 75% never get treatment As many people kill themselves as die from war & homicide 7% of British teenagers have tried to kill or harm themselves 10% 5-16 year olds suffer from a serious mental health problem 50% of serious mental illnesses begin in childhood 4.6 million living with long term physical & mental health problems

Economic cost to Britain of Mental Illness Cost to economyCost to taxpayers Unemployment, absenteeism & presenteeism 42 Crime21 Physical healthcare 11 Total74 (% of national income)

Integrated physical & mental health care for long term conditions Co-morbid MH problems are associated with a 45-75% increase in service costs per patient Between 12% and 18% of all expenditure on long-term conditions is linked to poor mental health and wellbeing If a person with a LTC has an untreated MH condition they cannot recover as well and they die earlier

NHS Landscape post 2012 CEO: Simon Stevens 5000 staff 24 National Clinical Directors NHS England 27 nationally 3 in London Local Area Teams 211 nationally 32 in London Clinical Commissioning Groups

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 NHSE direct commissioned services CCG commissioned services Local authority commissioned Commissioning the beds Commissioning the teams The Mental Health System

No Health Without Mental Health Government strategy set out six key objectives: 1.More people will have good mental health 2.More people with mental health problems will recover 3.More people with mental health problems will have good physical health 4.More people will have a positive experience of care and support 5.Fewer people will suffer avoidable harm 6.Fewer people will experience stigma and discrimination

Increasing political support “This government has made improving mental health services a bigger priority than ever before, and we’re determined that mental health is treated with as much importance as physical health in the NHS ” Rt Hon Norman Lamb MP, 16 September 2014

London Health Board: MH priorities Mental Health & Employment The development of more effective support to ensure that talent is not lost from the London workforce because of mental illness Adolescent Resilience Working with schools & across all agencies to support adolescents to improve their resilience, so improving education outcomes & mental wellbeing Digital Mental Wellbeing Supporting the joint commissioning of a digital wellbeing service to all 6 million adults in London to enable them to develop & maintain emotional resilience

Call for commitment to parity of esteem Ensure fair funding for mental health services Give children a good start in life Improve physical health care for people with mental health problems Improve the lives for people with mental health problems Enable better access to mental health services

The way forward Promote good mental health: Neighbourhoods, communities, schools (the 4 Rs), building resilience, addressing dyslexia, training school nurses & form tutors, engaging school governors Prevention and early intervention: –Parenting programmes –Early intervention in psychosis –Students against depression

Effective treatment Timely access to help when it’s needed: –Perinatal mental health support –Psychological therapy –Crisis care –Liaison psychiatry –Diversion

Support recovery ‘Job, home, family and friends’ Employment and education Action to tackle stigma & discrimination Support with housing, benefits, debt, etc Peer support Support for carers

The Role of the Third Sector Addressing stigma Identifying need & gaps in service provision Research – MH research underfunded Innovation – developing new service models Collaboration with public sector Co-production & co-design