1. National Mental Health Intelligence Network (NMHIN) & Mind Using data to improve crisis care planning at the local level Cam Lugton, Programme Lead NMHIN Russell Plunkett, Intelligence Analyst NMHIN 25th October 2016

2. Overview Why use data on mental health crisis care?
Who are the NMHIN? How will we help?
What crisis care data is available now?
When will we address the data gaps?

3. Understanding crisis care
Which data driven questions help us understand crisis care need and response?
Answers to these questions will help us to:
Ensure areas have timely local data on which to base their prevention plans
Ensure people in crisis get the right help, in the right place, the first time around
Prevent avoidable repeat crises, admissions and detentions
Commission and provide the right, effective, high quality services
Plan the workforce to meet needs 24/7
Train staff in each crisis response agency with the key competencies required
Identify populations with the greatest crisis care need, and respond to them
The Key Questions:
Who is at risk of crisis?
Who is presenting in crisis at each service?
Why do they present and are the causes preventable?
Are they new or known to services?
When do they present?
Where are they referred from?
Are they on a mental health act section?
What services and intervention do they receive?
Data contributes to the intelligence that enables every area to plan services well

4. What are the common causes and impact of mental health crises
Mental health crisis presentations
Dementia
Delirium
Alcohol dependence
Psychosis relapse
Self harm & suicide
PTSD
Physical illness with mental health complications
Legal highs
Impact of mental health crises
>40% 4 hour breaches in A/E
Avoidable frequent attenders
Suicide
40% avoidable admissions
Longer length of stays
Avoidable diagnostics
Greater complications
Higher costs
What are the preventable causes & triggers?
Housing crisis
Finance/ debt
Relationship breakdown
Crime related
Gangs
Bullying: cyber or person
Employment or bullying stress & related depression
Data sources: HSCIC MHMDS & linked HES/MHMDS and UCLP AHSN deep dives

5. The National Mental Health Intelligence Network

6. Introduction to the NMHIN
The NMHIN is a cross-system network:
Chaired by NCD, Leadership Group includes NHSE, NHSD, DH, PHE, NHSI, 3rd Sector and Clinical Expertise
NMHIN purpose:
Develop relevant and timely intelligence tools
Take a strategic lead across the system on the innovative development of information for improvement, and embed our products in local systems
Our main products:
Data profiling tools
Intelligence reports and briefings

8. Crisis Care Profile
Note catalogue:
Availability, geographies etc

9. Crisis Care Data Catalogue
The crisis care data catalogue lists all data in relation to mental health crisis care, and details its availability and where it can be accessed. CLICK HERE TO ACCESS:
NMHIN - Stakeholder Event, 1st June 2015

10. Using the Crisis Care Profiling Tool

11. Data within the crisis care profile
Socio-economic and demographic data on who is at risk of crisis.
Prevalence and incidence data for mental health conditions
Domain 1: Understanding Need
What support/services are available to someone before they reach crisis point: IAPT, drug and alcohol services.
Access to NHS 111 (gender/age of caller, time of call and where advised to go)
Domain 2: Access to support Before Crisis Point
Travel to place of care (ambulance data)
Attendances at A&E, MH Trust admissions
Domain 3: Urgent and emergency access to crisis care
If a crisis plan is in place. Treatment completion rates
Patients with SMI getting physical health checks
Emergency readmissions, repeat detentions under MHA, satisfaction with social care
Domain 4: Quality of treatment and care when in crisis
IAPT recovery rates, employment & housing status, excess mortality rates, follow-up after discharge
Domain 5: Recovery and staying well / preventing future crisis

12. Understanding Need
Socioeconomic deprivation: overall IMD score (2015)
Statistically significant relationship to 64.5% of indicators at lowest geography
Clustered around urban centres & coastal
Younger populations
Significant relationship with 20 out of 31 indicators at the lowest geography level – big influence on crisis care

13. Understanding Need
Impact of financial difficulty & socioeconomic factors on MH crisis
Socioeconomic deprivation: overall IMD score (2015) /
Number of people with SMI known to GPs (% of register)
Insolvency rate per 10,000 /
Suicide age-standardised rate per 100,000
Use fingertips to provision services – higher social deprivation and financial difficulties

14. Understanding Need: Children
Use fingertips to provision services – higher social deprivation and financial difficulties

15. Understanding Need: Adults
Use fingertips to provision services – higher social deprivation and financial difficulties

16. Key Gaps in Data Police Use of S136 Contact with A&E
Expecting the Annual Data Return in Q2 of 2017/18
Contact with A&E
RCEM are updating ED dataset to improve validity of indicators – expected 2017/18
Work to link two existing databases to get better A&E data is ongoing to create insightful indicators – expected 2017/18
Crisis Resolution Home Treatment Teams
MHSDS to report number of people contacted by CRHTTs – expected 2017/18
Data being collated from Health Education England, NHS Benchmarking & CCG IAF to create outcomes indicators expected in Q2 of 2017/18
Liaison Psychiatry
NCCMH ABA Developing a dataset for Liaison Psychiatry services
Mental Health Tele-Triage
Data not reported nationally, it is recommended that metrics be developed for trusts and CCGs to report usage
Street Triage
Data not reported nationally, organisations are recommending a national reporting mechanism for use of street triage
Crisis Lines
Diverse providers with differing geographies – investigations ongoing as to whether the data is sufficient to create robust indicators

17. Local Area Data Evaluation
25th October 2016
mind.org.uk

18. How are Concordat local areas using data to inform their planning?

19. Local Area Data Evaluation
Three areas with unique practice
Fifteen stakeholders interviewed
14 hours of audio transcribed
mind.org.uk

20. “ ”

21. Case Studies mind.org.uk People’s Parliament - Sandwell
Cross-boundary working - Healthy London Partnership
Lean Process Mapping
- Devon
mind.org.uk

22. Recommendations – 1 mind.org.uk Review how SU feedback is gathered
National reporting mechanism for multi-agency projects – Street Triage
Develop new indicators from national datasets …
mind.org.uk

23. Recommendations – 2 mind.org.uk
Technical support should be provided to local areas for metric development
Data Training should be made available to all stakeholders in the planning process
Information sharing protocol to be agreed …
mind.org.uk

24. Recommendations – 3 mind.org.uk
Local area plans should be publically available
Statistical modelling of Crisis
Further evaluations of local area data requirements & Lived Experience of Crisis
mind.org.uk

25. “I have likened emergency mental health care to a crazy bus journey in which, at the moment, people are focusing on immaculately tended perfect bus stops. Actually, if you’re travelling that journey, you’re much more interested in the journey from bus stop one to bus stop two, not that the first bus stop is a perfect bus stop…
there is a need for a very different way of thinking about the quality of people’s experience in which the journey and the interrelation between elements of that journey, is everybody’s responsibility, not just their own tiny, little silo of it.”

26. Service user journey map Experience of services
National data
Local knowledge
Service user journey map
Local data
Experience of services
mind.org.uk

27. Contact us Contact us with any further feedback at:
Cam Lugton (Programme Lead NMHDNIN) –
Russell Plunkett (Intelligence Analyst) -
Simran Sandhu (Programme Manager) –
Visit our existing fingertips profiles:
Or Google ‘mental health fingertips’