1. Introduction to Mental Health
Getting it right for patients and carers
Phil Moore
KVA
February 2015

2. CCG’s role in commissioning MH
Leadership
‘CCG chairs, for example, cannot deliver without developing the influencing, engaging and participative leadership skills these challenging roles require: simply providing the medical perspective on safety, quality and change is no longer an option.1’
‘Distributed leadership … is especially appropriate where tasks are more complex and highly interdependent – as in healthcare2.’
Service transformation
A requirement to do things very differently (e.g. primary care MH, crisis care)
Integration across the pathway (e.g. diabetes, liaison psychiatry)
Service quality
Safety, effectiveness and experience – parity of esteem
Access – a challenge we are keen to meet
The money
Even with additional investment money must be used differently & more efficiently
Shift need to deliver more in the community working closely with primary care3
1 Kate Wilson - How to be an effective clinical leader, HSJ, 26th June 2013
2 Clinical Leadership Competency Framework, NHS Leadership Academy, 2011;
3 A commissioner’s guide to primary care mental health, London Strategic Clinical Networks, July 2014

3. The past 2 years for mental health
Identified as a priority through the JSNA and placed prominently in the JHWS
Joint commissioning established with the borough and with SW London CCGs
Effective quality reviews and performance reviews established on a monthly basis that report into the CCG’s Integrated Governance Committee and thence to Governing Body for assurance
Mental health commissioning mandate developed to hold commissioning to account through HWBB
Evidence of work to engage users and carers in co-production
Action plans developed to address key areas of underperformance (primarily IAPT and dementia) with evidence of good progress towards targets
Kingston CCG led on a mental health consultation across SW London
A mental health planning board established that engages with third sector and providers
Voluntary organisations have had frequent input to clinical commissioners
Recent report to HWBB against the mandate
DPH report on mental health recently published identifying current successes and future action
JSNA – Joint Strategic Needs Assessment JHWS – Joint Health & Wellbeing Strategy HWBB – Health & Wellbeing Board DPH – Director of Public Health

4. What are we addressing? Parity of esteem
Embed parity of esteem in our plans
Already doing much of the above in a variety of areas of physical health
It is time to give mental health an equal footing
and in the process improve the physical health and life expectancy of those with mental health conditions
Examples
Re-tendering diabetes as a whole pathway
Using all elements of provision from tier 1 to tier 4
With a requirement for general practice to be engaged
Including the mental health elements of care
Access targets as in physical health
Current consultation on inpatient facilities
Challenge
How will we measure parity of esteem?

5. What are we addressing? Crisis care Crisis intervention needs
Crisis Care Concordat1
Access to support before crisis point – 24/7 and taken seriously.
Urgent and emergency access to crisis care –same urgency as physical
Quality of treatment and care when in crisis –dignity & respect, therapeutic environment
Recovery and staying well – preventing future crises
What will it look like
Easier and quicker access for GPs, patients and carers
Improved liaison psychiatry service at Kingston Hospital covering A&E, inpatients, perinatal & children
Fewer silos
More peer engagement in delivery
A culture of ‘yes’ not ‘no’
Improving home treatment teams and community mental health services
1 Mental Health Crisis Care Concordat Improving outcomes for people experiencing mental health crisis, February 2014

6. What are we addressing?
Physical health, prevention and early intervention
The stolen years
Significantly reduced life expectancy for those with serious mental health problems
Multiple reasons that we need to address
Embed physical health care in the mental health susytem and mental health care in the physical care system
Build resilience
This needs to start with pregnant mums and run through primary school, secondary school, the workplace right into helping reduce the risk of dementia
’30% of GP patients have a mental health issue; 30% of those have stress related to employment – not unemployment – must work with employers1’
Get in early
Evidence that intervening in behavioural problems in primary school will reduce serious mental health issues in adulthood by a third
Includes building healthy family life ‘Everyone in secure mental health units has had something awful happen in childhood or adolescence.’
Early intervention in psychosis
1 Dr Geraldine Strathdee – National Clinical Director for Mental Health

7. What are we addressing? Psychological therapies
Improving access to psychological therapies (IAPT)
Much work has gone on to improve these services and we are almost at target
We have ambition to extend and improve access to these as a means of intervening earlier and building resilience
We want to improve
The timescales in which people are seen
The recovery rate
The use of the service – overcoming some of the prejudices

8. What are we addressing? Children and young people’s services
A complete redesign is underway
Better linkage and flow between the various tiers of service
A single point of access for professionals and patients/carers
Specialist community teams for children and young people with eating disorders (NHE England led)
We are looking hard at theTHRIVE model
A very different approach to children and young people that has been piloted by the Tavistock …

9. The THRIVE Model
Attempts at drawing a clearer distinction than before between:
treatment and support
self-management and intervention
We use the term to reflect our core commitment to young people “thriving” and to represent our commitment to provision that is Timely, Helpful, Respectful, Innovative, Values-based and Efficient.

10. What are we addressing? Dementia serivces
A complete redesign is underway
Much more care will be undertaken by community services
A new community memory service is being commissioned
Greater involvement of the voluntary sector
A complete review of diagnostic coding in general practice has helped us identify more people with significant memory problems
Building a dementia friendly community
Work is starting to engage with employers and community groups
A plan is being developed

11. What are we addressing? Primary Care Mental Health
Primary care is already delivering much mental health care
90 per cent of people with a common mental disorder are cared for entirely within the primary care sector1. Often for less than 10% of the mental health budget.
Specialist mental health services are over-stretched: access is sometimes limited and waiting times tend to be long.
And there is much more potential
Primary Care Mental Health can take on more of the stable mental health conditions with easy access to advice and support from specialist colleagues2.
Primary mental health care is defined3 as:
first line interventions that are provided as an integral part of general health care, and
mental health care that is provided by primary care workers who are skilled, able and supported to provide mental health services.
1 Gask L, Lester H, Kendrick T and Peveler R. (2009) Primary care mental health. London: Royal College of Psychiatrists, vol 4: no 1 (Mar 2012)
2 A commissioner’s guide to primary care mental health, London Strategic Clinical Networks, July 2014
3 Funk, M, Ivbijaro, G, Integrating mental health into primary care: A global perspective, (2008) World Health Organization

12. Education and training
Prepare by getting the necessary education and training of primary care clinicians underway
Train a further 48 clinicians in suicide prevention
Give the general GP population opportunities for general mental health updating
One GP per 10,000 patients undertaking mental health diploma
University accredited mental health course for mental health commissioners, social workers and some practice managers
Course for nurse practitioners and practice nurses
Provide mental health awareness raising for practice staff

13. What is effective commissioning?
Coproduction
Risk of just being a buzz word
Real value if we can get it right (users sitting on panel in procurement process)
Improving mental health
Resilience and early intervention vital for sustainability
Needs to start with perinatal care through primary school and on up
Improving services
Incentivise providers to get it right first time
Incentivise care by primary care with rapid and easy access to support and advice
Parity of esteem
Define how we measure it and add it to contractual KPIs
Embed it with equality and diversity assessments
Enhancing recovery
Keep the focus on recovery
Embed in care plans

14. Thank you
Phil Moore