1. Value based system of care in England: What are the common needs people tell us they have Needs What outcomes do people tell us they want What outcomes are now being routinely measured Outcomes How do we coproduce better assessments and agree formulation and diagnos(es) with the person Assessment, formulation, diagnoses What effective care interventions can guide our practice to address those needs & deliver outcomes Effective care: NICE/SCIE What Best outcomes, Best Value care do commissioners want Commissioning What care pathways and service delivery models enable evidence based care to be delivered with Value added Home based care Care pathways What information do we have on current baseline What information do we critically need for Value Information Current leaders and the new CCGs, Area team, SCNs, AHSNs, CLARHs, health economists Leaders

2. Working together, mental health can deliver social and wealth capital for England

3. From the patient’s perspective Safety “Will I be ok?” Effectiveness “ Will it do me any good?” Experience “ Access, information & treatment experience” Efficiency Was it fast, safe, near home, back to work asap What Outcomes do our service users ask us to achieve in partnership with them Professor Bruce Keogh, Medical Director of the NHS

5. Parity and equalities: Benchmark October 2013 There is a disparity in the number of people with mental illness in contact with services, compared to physical health, yet it is a major cause of premature death & lives lived in distress and misery 26% of adults with mental illness receive care 92% of people with diabetes receive care 26% of adults with mental illness receive care 92% of people with diabetes receive care By condition…. % in treatment Anxiety and depression24 PTSD28 Psychosis80 ADHD34 Eating disorders25 Alcohol dependence23 Drug dependence14 Mental health problems are estimated to be the commonest cause of premature death Largest proportion of the disease burden in the UK (22.8%), larger than cardiovascular disease (16.2%) or cancer (15.9%) People with schizophrenia die 15-25 years earlier Depression associated with 50% increased mortality from all disease

6. Value based system of care in England What effective care interventions can guide our practice to address those needs & deliver outcomes Effective care: NICE/SCIE What Best outcomes, Best Value care do commissioners want Commissioners What care pathways and service delivery models enable evidence based care to be delivered with Value added And to increase access and self management Care pathways What information do we have on current baseline What information do we critically need for Value Economic remodelling Information Current leaders and the new CCGs, Area team, SCNs, s Leaders

7. NICE Guidelines 2013 Alcohol dependence & harmful use & clinical management clinical management Antenatal and postnatal mental health Antisocial personality disorder AnxietyAnxiety disorders Attention deficit hyperactivity disorder (ADHD) Bipolar disorder Borderline personality disorder (BPD) Dementia Depression in adults Depression in children and young people Depression with a chronic physical health problem Drug misuse: opioid detoxification Drug misuse: psychosocial interventions Eating disorders Medicines adherence Obsessive compulsive disorder (OCD) and body dismorphic disorder (BDD) Post-traumatic stress disorder (PTSD) Schizophrenia (update) Self-harm Violence When to suspect child maltreatment Completed public health guidance Brief interventions and referral for smoking cessation Interventions to reduce substance misuse among vulnerable young people Mental wellbeing and older people Needle and syringe programmes Preventing the uptake of smoking by children and young people School-based interventions on alcohol Smoking cessation services Social and emotional wellbeing in primary education Social and emotional wellbeing in secondary education Workplace interventions to promote smoking cessation Autism spectrum disorders in children and young people Delirium Identification and care pathways for common mental health disorders Psychosis with substance misuse Self-harm (longer term management) Public health guidance in development Alcohol-use disorders (prevention) Home-based approaches to promoting children's wellbeing Looked after children Personal, social and health education focusing on sex and relationships and alcohol education Pre-school approaches to promoting children's wellbeing Preventing domestic violence Quitting smoking in pregnancy and following childbirth School-based interventions to prevent smoking Autism spectrum disorders in children and young people Delirium Identification and care pathways for common mental health disorders Psychosis with substance misuse Self-harm (longer term management) Public health guidance in development Alcohol-use disorders (prevention) Home-based approaches to promoting children's wellbeing Looked after children Personal, social and health education focusing on sex and relationships and alcohol education Pre-school approaches to promoting children's wellbeing Preventing domestic violence Quitting smoking in pregnancy and following childbirth School-based interventions to prevent smoking

8. Value in mental health NICE/SCIE 1.Right information 2.Right physical health care 3.Right medication 4.Right psychological therapies 5.Right rehabilitation, training for employment 6.Right care plan addressing housing, work, healthcare, self management 7.Right crisis care 8 Mental health : Is the problem that we have no evidence or value based guidance? Mental health has over 100 NICE Health Technology appraisals, NICE guidelines, Public health related guidelines and Quality standards….. The problem is not lack of guidance The problem is that we have not focused on how we learn and disseminate from those that can and have implemented Can the FT network lead a new NHS Change model? Mental health : Is the problem that we have no evidence or value based guidance? Mental health has over 100 NICE Health Technology appraisals, NICE guidelines, Public health related guidelines and Quality standards….. The problem is not lack of guidance The problem is that we have not focused on how we learn and disseminate from those that can and have implemented Can the FT network lead a new NHS Change model?

9. 9 “Crossing the Quality Chasm” Ohio State Psychiatry Grand Rounds 12.05.2012

10. National Audit of Sschizophrenia Physical Health Significant premature mortality among those with a diagnosis of schizophrenia (M=20yrs; F=15yrs). Only 29% had all 5 risk factors monitored only 25% had treatment for elevated BP Medicines 10 fold variation among trusts in relation to adherence to safe, effective medicines practice Psychological Therapies The range of those offered psychological therapies varied from 0% to 94%.

11. What are the reasons for increased Length of stay  Comorbidities: physical ill health, substance misuse, PD  Detentions under the mental health act  Implementations of NICE/SCIE evidence based care  Workforce capacity and competence People with SMI die 15-25 years younger due to 5-12 times increased levels of un assessed and untreated COPD, Diabetes, High BP, Cancer Substance misuse is 6+ times more common in people with SMI Workforce strategies and training programmes need to be provide training in evidence based treatments  Comorbidities: physical ill health, substance misuse, PD  Detentions under the mental health act  Implementations of NICE/SCIE evidence based care  Workforce capacity and competence People with SMI die 15-25 years younger due to 5-12 times increased levels of un assessed and untreated COPD, Diabetes, High BP, Cancer Substance misuse is 6+ times more common in people with SMI Workforce strategies and training programmes need to be provide training in evidence based treatments

12. Co-morbidity is the norm Lancet, Barnett, Mercer et al 2012

13. 5. Integrated physical and mental health care Long term conditions Mental health raises costs in all sectors Chris Naylor, Kings fund Overall, international research finds that co- morbid MH problems are associated with a 45-75% increase in service costs per patient (after controlling for severity of physical illness) Between 12% and 18% of all expenditure on long- term conditions is linked to poor mental health and wellbeing – at least £1 in every £8 spent on long- term conditions.

14. Mental health has the capacity to improve England's social and wealth capital Economic remodelling programmes Unplanned care pathways Psychosis pathways Children and Young people pathways Integrated physical and mental health care pathways

15. Prevention and Early intervention (Knapp et al, 2011) highly effective treatments: major economic benefit For every one pound spent the savings are: Parenting interventions for families with conduct disorder : £8 Early diagnosis and treatment of depression at work: £5 in year 1 Early intervention of psychosis £18 in year 1 Screening & brief interventions in primary care for alcohol misuse £12 Yr 1 Employment support for those recovering from mental illness: Individual Placement Support for people with severe mental illness results in annual savings of £6,000 per client (Burns et al, 2009) Housing support services for men with enduring mental illness: annual savings: £11,000–£20,000 per client (CSED, 2010).

16. Outcomes in Mental health