1. Better health for Sunderland Liaison Psychiatry Event Jan 27, 2016 Commissioning for sustainable liaison services

2. Better health for Sunderland Dr. Johannes Dalhuijsen  GP in Southwick, Sunderland  SCCG Clinical Lead for Mental Health  Joint NESCN strategic lead for MH & Dementia

3. Better health for Sunderland Liaision Mental Health Service: how did this all start for us?  Sunderland Mental Health Care Transformation -Crisis intervention (IRS) -CMHT and Community Pathways -IAPT and counseling services -long term physical conditions in IAPT -inpatient services and PICU -dementia facilities (-street triage and MUS)

4. Better health for Sunderland MHC Transformation key elements  Focus on outcomes and value for patients.  Ensure excellent access. Single point.  Transparency of pathways. No gaps.  Skills up front.  Availability of clinical records at all times.  Good quality signposting.  Holistic and integrated care in community.  Scaffolding

5. Better health for Sunderland MHC Transformation key results  A wide range of acclaimed services (awards)  Excellent access  Good (short term) outcomes  Transformed SU and referrers experience  No risks identified as in ‘benefits realisation plan’  50% Beds reduction in PICU and adult wards

6. Better health for Sunderland However, gaps when into hospital.  Inpatient MH needs ummet ?Parity of esteem  A&E: MH problems obvious, but not addressed  Frequent attenders/admissions with MH a factor  Pathways discussions in network/ committees: -what to do in crises? -discontinuity of MH treatment & support pathways?  GPs forced into a dualistic approach (‘once you’re out of hospital we’ll have another look at your mental health’)

7. Better health for Sunderland Opportunity  Birmingham experience offered an established model and and economic evaluation  The hospital could do with some anabolics re MH  Ad hoc funding available

8. Better health for Sunderland Worries  We do not want liaison to contribute to A&E becoming a hub or sump for MH problems nor for it to slow down community care transformation  Birmingham experience does not reflect the quality of our own community services  The Birmingham economic evaluation seemed frail.  Stronger focus required on A&E

9. Better health for Sunderland Actions  To commission an extended liaison service per 2014  To commission an external evaluation

10. Better health for Sunderland Experiences  Major parts of the hospital are beginning to understand what mental health is about  MH needs are now being met  Positive patient experiences  Gaps in pathways plugged and loose ends tied  Work with frequent attenders well underway  Problems for GPs resolved (minor gremlins)  Balance found between follow up/support and step down/transfer to other services

11. Better health for Sunderland Evaluation  Further (external) evaluation is being finalised

12. Better health for Sunderland Next steps  Further contribute to addressing MH needs and reducing inappropriate physical health care - further expand into outpatient clinics - further contribute to MUS and complex needs  Keep seams tight/ transitions/ Children/ elderly.  Contribute to further integration of MH care with primary care and community MH services  Integrated records with hospital?  Find right level of funding to continue with essential work.

13. Better health for Sunderland Thank you.  …Questions/ answers?