1. Parity of Esteem & Mental Health Services Pat Drohan Patient Engagement, Experience & Equality Lead Amanda Derbyshire Support, Time and Recovery Worker and Trainee Assistant Practitioner

2. Parity of Esteem When compared with physical healthcare, mental healthcare is characterised by equal: Access to the most effective and safest care / treatment; Efforts to improve the quality of care; Allocation of time, effort and resources on a basis commensurate with need; Status within healthcare education and practice; High aspirations for service users; and Status in the measurement of health outcomes. Royal College of Psychiatrists

3. Amanda Derbyshire Establishing and refining the physical health and well-being pathway as detailed in the NICE Guidelines for Schizophrenia (2014) and managing long term physical health conditions

4. Introduction Background Rationale –Research evidencing the importance of the physical health care needs of individuals with a severe mental health illness Pilot Study My role in implementing change to improve: –Service users’ physical health, wellbeing and self care –Team unity by using a multi-disciplinary team approach –Links with primary and secondary care services Future Developments

5. Background Rationale The Mental Health Strategy (2011) states that having a mental health problem increases the risk of physical ill health. Individuals suffering with mental illness like Schizophrenia, die on average 20 years earlier than the general population (Rethink, Lethal discrimination, 2013) and experience up to three times more physical health problems. Less than 30% of individuals with Schizophrenia receive annual comprehensive physical health screenings. The mortality gap is widening and will continue to do so if this population do not receive the same benefits of care, as the general population (Brown et al, 2010).

6. Pilot Study Pilot Study – AQuA Project – (2013) –Don’t Just Screen Intervene, –Lester cardio-metabolic tool (RSPHYSC, 2014) –Adhering to NICE Guidelines Schizophrenia (2013) –Lethal Discrimination (Rethink 2013) Base Line Audit (finding the starting point) –Liaised with GP surgeries and worked with care co- ordinators to compile service users physical health records. –Input data into a Survey Monkey –Only 6% of service users had received a baseline comprehensive screening –Falling to 3% at the two-year stage of treatment

7. Lester Cardiometabolic Tool (RSPHYSC, 2014)

8. Implementing Change Physical Health Lead Role established –Dedicated time Establishing Steering Group –Primary and Secondary Care links –Public Health –Service users representatives Enhanced Clinical Skills through training Developed Health and Well-being Clinics –Clinical setting –Home visits - incorporating local Wellbeing nurses –Liaison and communication links with team, GPs and Wellbeing nurses

9. Implementing Change Database Development –No I.T. infrastructure available –Created own using evidence based, best practice guidelines. –Became a live document (April 2013) –Outlook appointment reminder Produced Educational DVD and GP Leaflet Re-Audit (six months after implementation) –Comprehensive physical health screenings improved to 95% –Unmet and underlying physical health problems have been identified and interventions have been put into place British Journal of Medical Practitioners article …cont.

10. Audit Results Baseline Audit Re-Audit Baseline6%66% 3 months5%72% 12 months6%77% 24 months3%95%

11. Case Studies Pre Audit –Ad-hoc screenings –Results missing and not recorded –No interventions in place –Referrals not followed up –GP liaison inconsistent Post Audit –Full comprehensive baseline screening –Follow up screenings completed –All results recorded comprehensively –Co-ordination with GPs/wellbeing nurses –Intervention plans initiated immediately –Weekly follow up appointments and screenings

12. What are people saying…. “The service Amanda offers has opened my eyes and really helped me to understand the importance of my physical health and the need to stop smoking” Service User “Partnership working helps us to achieve our targets and ensures that service users needs are met and data is shared without duplication” Wellbeing Nurse in Primary Care

13. Future Developing an Early Intervention Outcomes Dashboard Academic Research –Links with Liverpool John Moores University Access to services standard for Early Intervention – NICE approved care package Early Intervention Service - New Role Development - Physical Health Clinic in partnership with primary and secondary care Developing a service user-led Health and Wellbeing Group

14. Conclusion All service users now receive baseline comprehensive physical health screenings and are monitored regularly throughout their care. A multi-disciplinary team approach used to work together and promote physical health –Working proactively to ensure physical and mental health run concurrently, addressing inequalities and examining the wider determinants of health to embed the importance of protecting and improving the nation’s health. Data is stored electronically and is shared between primary and secondary care services to enable integration of services

15. GP Leaflet

16. University Project

17. Draft Dashboard

18. Video Link https://www.youtube.com/watch?feature=pla yer_embedded&v=x3zgM46Ne6w#t=62

19. Later Life and Memory Service (LLAMS) Who are LLAMS? LLAMS help and support older people who are experiencing mental health difficulties like anxiety or depression. We also help with memory problems and Dementia.

20. Later Life and Memory Service (LLAMS) Borough20122014201620182020 % Increase from 2012 Halton1,2291,2561,3141,4211,51823.5% St Helens2,0812,1342,2242,3662,50620.4% Warrington2,1552,3212,4502,6412,83731.6% Knowsley1,5941,6991,8051,9171,966 23.3% Wigan3,2593,4433,6373,9184,12326.5% Total10,31810,85311,43012,26312,950 Projected Prevalence of Dementia

21. LLAMS Care Philosophy Rapid and Early Assessment and Diagnosis Holistic (all round) Patient and Carer support to live well close to home High Quality Specialist and Intensive In-Patient support Locally Based Borough Community Teams CMHT Assessment Memory Team Memory Team In-Patient Care Post Diagnostic Support Local Authority Acute Care 3 rd Sector Primary Care

22. LLAMS community redesign A single community service 4 key service functions Improved throughput, capacity and speed of response Began May 2013

23. 1 Years’ Experience in Wigan Waiting Time reduction > 9 Months to 3 Months referral to Diagnosis Increased Diagnosis Rates by 15% Full year effect on in-patient unit – 23% reduction in occupancy: 84% to 65% – 10 day reduction in average occupancy 53 to 43 days

24. Building on Strengths Oct/Nov 2011 Model of Care Presented to PCT’s, OSC’s March to September 2012 Community Pathway Piloted in Wigan Borough September 2012 to March 2013 Pilot results and change plans presented to CCG’s and OSC’s Redesign Steering groups established May 2013 ’Go Live’ of Community Pathway in remaining Boroughs Before ChangesAfter Changes Waiting Time up to 1 year Assessment to Diagnosis - up to 9 months Multiple teams In Patient Occupancy (Wigan) 84% LOS 53 days Waiting Time 24 hrs (Urgent) and 10 days (Routine) Assessment to Diagnosis at 3 Months Integrated Teams Carers Assessments In Patient Occupancy (Wigan) 65% LOS 43 Days

25. Any Questions?