Lethal Discrimination Towards ‘Parity of Esteem’ in Health Improvement Service Provision for People with Serious Mental Illness. Mel Conway Consultant Public Health South Essex Partnership Trust

Overview Three to four times more likely to die if you have a serious mental illness!

Implications? Action! –Evidence based interventions Public health priority –‘Parity of esteem’ between mental and physical care Human rights disgrace –Engage emotion as well as intellect

People with serious mental illness have poorer access to health improvement services than the general population. Problem definition

Objective To prioritise reasons for poorer access and to address an access barrier to health improvement services for people with serious mental illness resident in Southend by October 2013.

Root Cause Analysis People with serious mental illness have poorer access to health improvement services than the general population Resources for physical healthcare Inadequate follow-up Attitudes and expectations SYSTEM Service Factors - STIGMA STAFF Limited skills Diagnostic overshadowing Patient Factors – ILLNESS and SELF STIGMA Awareness and understanding Engagement Reluctance to discuss physical health problems

Strategic Options Root causesStrategic OptionsEvaluative criteria TimelyResourcesPotential impact PatientsExpert patient programmesNoAdditionalMedium Patient mentoring /supportNoAdditionalMedium /High Structured educationNoAdditionalMedium Health passports /paperworkNoNeutralLow StaffStaff trainingNoNeutralLow Staff mentoringNoAdditionalMedium Performance managementNoAdditionalLow SystemNew service for MH patientsNoAdditionalHigh Integrate LA commissioned health improvement services with MH service provision YesNeutralHigh Organisational development across the health economy NoAdditionalMedium (but complex)

Implementation Exploration phase –Identifying stakeholders –Testing the idea in principle Developing the proposal –Operational procedures –Risk and training –Data collection and metrics ‘Launch’

Metrics Structure –To establish an integrated health improvement service between the independent health trainer service and SEPT by December –Measure resource available to SMI team caseload (health trainer hours). Process –Increase % HT case load with SMI in the year after introduction of the newly integrated service compared with the previous year. –Baseline; % SMI caseload that access the health trainer service. Outcome –Achieve personalised goals –Self-efficacy measure –Warwick Edinburgh Mental Wellbeing Scale

Evaluation Service established by December HT capacity – 15 new referrals per month Data on contacts –35 contacts (approx 12% of the cohort) –Uptake 40% MH cohort cf 27% general population –Duration of intervention WEMWBS –MH cohort mean 47.2 ( ) –Population reference group mean 50.7 ( )

Lessons learned Opportunism versus logical strategic determination The importance of implementation ‘Uncompromising clinical leadership’ ‘Making do with metrics’ The paradox of achieving ‘parity of esteem’ within a polarised system The paradox of self-stigma: diminished self-esteem and self efficacy versus energised

What next? Mental health topic priority in Health and Well-being Strategies Measure of premature mortality in SMI NHS outcome measure HWB strategy outcome measure Public health service commissioning Patient engagement

Supplementary slide - WEMWBS