Draft Milton Keynes Mental Health Strategy

Transcription

1 Draft Milton Keynes Mental Health Strategy January

2 Contents Foreword 3 1. Introduction and vision 4 2. National context No health without mental health Recovery and social inclusion Personalisation in health and social care Finance 6 3. The local picture Adult Mental Health Needs Assessment key points Local Services Strategic Priorities for the next 3 years More people will have good mental health More people with mental health problems will recover More people with mental health problems will have good physical health More people will have a positive experience of care and support Fewer people will suffer avoidable harm Fewer people will experience stigma and discrimination How will we know we have made a difference? Appendix A 19 Mental Health Dashboard Community Mental Health Profile Milton Keynes Glossary References 23 2

3 Foreword The Milton Keynes Mental Health Strategy is being developed in consultation with a wide range of stakeholders including service users and carers adopting a partnership approach to improving mental health and wellbeing in Milton Keynes. The strategy highlights the strategic priorities for the next three years in line with the national strategy No Health without Mental Health and the local Health and Wellbeing strategy. These range from prevention through to early interventions and specialist mental health services. 3

4 1. Introduction and vision Mental health and wellbeing affects everyone in Milton Keynes and it affects one in four people. There will be people who have not experienced a degree of mental distress at some time but have a friend or relative that has. The aim of this strategy is to support the people of Milton Keynes to have good mental health and wellbeing. This will be done through Prevention - promoting measures that help prevent mental ill health in the first place Early Intervention - supporting early intervention when people do become unwell Stepped care - ensuring that people receive the right care at the right time and that there are clear care pathways where people can easily step up and down according to their needs Good quality services - that safe, caring, person-centred and help people recover to the best of their ability This strategy is primarily concerned with tackling mental ill health and promoting wellbeing in adults. Separate strategies exist or are being developed that are interdependent with the mental health strategy such as homelessness, learning disability, autism, children and young people, dementia, older people, substance misuse and carers. Joint priorities to take those issues which cut across a number of strategies will be further developed as part of the strategy implementation work. 4

5 2. National Context 2.1 No Health without Mental Health The national strategy for mental health, No Health without Mental Health: A cross-government mental health outcomes strategy for people of all ages (DH 2011), shows why tackling mental illness and promoting mental wellbeing is essential not only for individuals and their families but to society as a whole: At least one in four people will experience a mental health problem at some point in their life and one in six adults has a mental health problem at any one time. Almost half of all adults will experience at least one episode of depression during their lifetime. One in ten new mothers experiences postnatal depression. Mental ill health represents up to 23% of ill health in the UK and is the largest single cause of disability. People with severe mental illnesses die on average 20 years earlier than the general population NHS spent around 11% of its budget on Mental Health, almost double the spent on cancer The aims of the national mental health strategy are to prevent mental ill health, intervene early when it occurs and improve the quality of life for people with mental health problems and their families. The strategy focuses on six key themes: More people will have good mental health More people with mental health problems will recover More people with mental health problems will have good physical health More people will have a positive experience of care and support Fewer people will suffer avoidable harm Fewer people will experience stigma and discrimination In this strategy we will detail how we plan to deliver against each of these key themes 2.2 Recovery and social inclusion In mental health, recovery does not always refer to the process of complete recovery from a mental health problem in the way that we may recover from a physical health problem. Recovery emphasises the importance of a meaningful, valued and satisfying life whether in the presence or absence of symptoms. There is a strong link between the recovery process and social inclusion. A key role for services is to support people to regain their place in the 5

6 communities where they live and take part in mainstream activities and opportunities along with everyone else. Important factors on the road to recovery include: Good relationships Financial security Satisfying work Personal growth The right living environment Developing one s own cultural or spiritual perspectives Developing resilience to possible adversity or stress in the future There is a growing body of evidence that demonstrates that taking part in social, educational, training, volunteering and employment opportunities can support the process of individual recovery. 2.3 Personalisation in health and social care Personalisation and recovery are part of a common agenda for change in mental health systems. Both are centred on self-determination and reclaiming the rights of full citizenship for people with a lived experience of mental health problems. Central to personalisation are Personal Budgets (PBs) in social care and Personal Health Budgets (PHBs) in the NHS. PBs and PHBs give individuals and their carers greater say over the way in which their health and social care needs are met. PHBs are due to be rolled out national within the lifetime of this strategy. The national PHB pilot programme which ran in 26 sites across the country from 2009 to 2012 tested out mental health PHBs in areas such as early intervention, assertive outreach, high-cost residential placements, psychological therapy services, older people s mental health services and in community mental health teams. The independent PHB evaluation found that PHBs are cost-effective for mental health and that they improve people s health-related quality of life and psychological well-being and also reduce indirect NHS costs compared to traditional service delivery. In the long term, the intention is that anyone who chooses to have a PB and a PHB should have the right to an integrated assessment across the NHS and social care, an integrated support plan, a single individual budget and an integrated review. 2.4 Finance This strategy must be delivered in the face of significant financial challenge. The NHS has been required to deliver 20bn of efficiency savings, known as Quality, Innovation, Productivity and Prevention (QIPP), nationally between 2010 and 2015 to meet the increasing demand on health services, in particular from an ageing population and the costs of new technology. 6

7 The QIPP target for the NHS in Milton Keynes was 104m to be delivered by 2014/15. In the same timeframe Milton Keynes Council needed to save more than 40m. As well as providing services within financial constraints there is an expectation that services will increasingly move from block contracts to more flexible arrangements incorporating payment by results for meeting individual mental health needs in conjunction with personal health and social care budgets. 7

8 3. The local picture This strategy builds on a wide range of local information and evidence including the local JSNA and a recent Milton Keynes adult mental health needs assessment. The Milton Keynes Health and Wellbeing Strategy has designated mental health as one its strategic priorities (Improve Wellbeing) and states its intention to improve access to, and quality of, mental health promotion and services. 3.1 Adult Mental Health Needs Assessment key points Mental health problems (such as depression, anxiety, phobias and obsessive compulsive disorder) are very common with a prevalence rate in adults in England of 17.6%, with half having symptoms severe enough to require treatment. Estimates of the current and future prevalence in Milton Keynes are shown in table 1. All estimates are based on ONS 2012 population figures and MKC population projections. Table 1: Five Year Projection of main Mental Health Disorders (all persons year olds) Mental health - all people People aged predicted to have a common mental disorder (depression anxiety) People aged predicted to have a borderline personality disorder People aged predicted to have an antisocial personality disorder People aged predicted to have psychotic disorder People aged predicted to have two or more psychiatric disorders 26,292 27, ,746 12,248 Source: (Based on National Prevalence of 17.6% of year olds; applied to year olds) The above shows that the total number of people with a common mental health problem will increase moderately by approximately 4.2% over the next 6 years. It is slightly higher than the predicted overall growth for England. The rise of those with borderline and antisocial personality disorder is also moderate, with growth expected to be approximately 4.4% in both categories. For those with schizophrenia, bi-polar and other psychoses growth is in the 8

9 region of 4.3% and this is replicated in the figures for growth in those with two or more psychiatric disorders. Inpatient admissions There were 510 mental hospital admissions in 2012/13 which compares to 612 in 2011/12. The vast majority of admissions (462) were to the local acute inpatient unit the Campbell Centre where the median length of stay was 12 days. The crude rate of access to NHS inpatient care ( ) per 100 mental health service users for Milton Keynes was 8.47 compared to England average of 6.61 and is significantly higher. This means that a relatively high proportion of patients with serious mental health problems are admitted. The bed occupancy rate in 2012/13 has also been high. The average length of stay of all 510 admissions in 2012/13 by all providers was 33 days, heavily influenced by a few patients with very long length of stay. The most common diagnosis on admission in 2012/13 are for reaction to severe stress, schizophrenia and specific personality disorders but as 73% of admissions had no recorded diagnosis these figures should be taken as an indication only. There is a weak correlation between increased admissions from areas with a higher deprivation score over the three year period April 2010 to March This is In line with expectation and the national picture. 9

10 Older People s Mental Health Old age is a major risk factor for mental health problems that can significantly impact on quality of life. There are a number of conditions that older people are more likely to experience, particularly as this group are prone to social isolation, financial difficulty, chronic physical health problems and loss. The main mental health problems for older people are depression, anxiety and dementia. The total number of older people with depression is estimated to be around 6,800. Table 4: Estimated Number of over 65s with depression in Milton Keynes Percentage Number Age Women Men Women Men % 28% 1,309 1, % 20% % 24% % 27% % 39% % 43% Total 3,704 3, Source: Projection Older People Population Information, Generalised Anxiety Disorder is a common mental health problem in later life, with predicted prevalence rates of 2-4% among older people living in the community, which equates to 380 to 760 people in Milton Keynes. However many more show symptoms of anxiety, 10-24%, which equates to 1,900 to 4,600 in Milton Keynes. The predicted numbers of people with dementia in Milton Keynes will increase from the current 2076 to 3250 in Only around 42% of this number has been diagnosed in Milton Keynes and across the country. (Dementia is addressed in a separate Milton Keynes Dementia Strategy) Health inequalities Mental illness is known to be higher in more deprived populations but this is not always demonstrable in Milton Keynes. The prevalence of depression in Milton Keynes is 5.4% (11,076 patients,) compared to the England average of 5.8%. There is no correlation between the GP surgery Index of Multiple Deprivation (IMD) score and the level of diagnosed depression in the GP surgeries. This may suggest that either patients are not accessing some practices for depression symptoms for a variety of reasons or there is 10

11 variation in diagnostic practice among GPs. There is also large variation in prevalence ranging from 1.4% to 9.9%. The current NHS Milton Keynes prevalence for schizophrenia, bi-polar disorder and other psychoses is recorded as five cases per 1,000 population (0.6% of total population, 1,632 patients) which is significantly lower than the national prevalence of 0.8%. The prevalence varies fairly widely across GP surgeries from 12.8 (Grove surgery, Netherfield) to 2.9 (Neath Hill Health Centre) patients per 1000 registered patients and increases with practice deprivation score. Physical health In general the physical health of people with chronic mental health problems is poor and this is reflected in shorter life expectancy than the general population. Much of this is due to cardiovascular disease as well as its modifiable risk factors, namely smoking, diabetes, hypertension, and high cholesterol. This is compounded by high rates of unhealthy lifestyles and the potential side effects of some psychotropic medications. This underlines the need to consider physical conditions alongside mental health in all parts of the mental health system and emphasises the need for support with healthy lifestyles such as smoking cessation, alcohol consumption, healthy eating and physical activity. Suicide and self-harm For the period the suicide and injury undetermined rate in Milton Keynes was similar to the England rate, and was lower than the rate, in line with national size of reduction. However the number of suicides in England increased from 2010 to 2011 amongst both the general population and mental health patients. In Milton Keynes there were 13 and 19 deaths in 2011 and 2012 respectively which is similar to previous years. The admission rate for self-harm in Milton Keynes (190.5/100,000) is slightly below the national average for England (207.9/100,000) and for children below 18 years the rate is much lower (68.0/100,000 aged 0-17) than the England average (115.50/100,000). This rate has been static for the period The self-harm admission rate for the two year period for all ages varied by practice between 3.51/1000 population (Wolverton Health Centre) to 0.54/1000 population (Cobbs Garden, Olney) and increasing rates with higher practice deprivation scores. The peak is in the age group but high numbers are also seen in age group Needs Assessment Summary There will be an increasing number of people with mental health problems in Milton Keynes due to population growth and changing socio-demographic features of the population. 11

12 Planning assumptions about future capacity will need to take into account the predicted rise, but in doing so will need to reflect the changing patterns of service delivery needed to ensure delivery of population mental health and wellbeing. Milton Keynes has relative low levels of patients with serious mental illness who are managed predominantly in secondary care but a relatively high proportion of these patients are admitted as inpatients. The suicide and self-harm rates are average or low and static. There are indications that not all people in need are accessing primary care services while there is evidence for inequalities in mental health problems similar to the national picture. Although the premature mortality of people with serious mental illness is low there is much scope for improvement of the management of physical health of people with mental illness in all care settings. Most of the current funding is spent in secondary care and there are very few preventive and early intervention programmes. The large numbers of people with common mental problems such as anxiety and depression suggest the need to build capacity in primary care mental health as treatment options in primary care are limited and no stepped care model exists. There are gaps in local specialist service for eating disorders, Attention Deficit Hyperactivity Disorder (ADHD) and complex personality disorders. 3.2 Local Services At present there is a pooled budget between MK Clinical Commissioning Group and Milton Keynes Council to jointly commission and provide health and social care services for people with mental health problems. Commissioned services for people with mental health problems in Milton Keynes are provided predominately through the NHS secondary mental health services. These were provided by a local NHS community and mental health trust Milton Keynes Community Health Services (MK CHS) until April 2013 when the organisation was acquired by Central North West London Foundation Trust (CNWL) and became CNWL MK. In addition to the above complementary services such as housing and employment support, independent living skills and counselling services are commissioned from the voluntary sector. The proportion of funding allocated to non-statutory services is very low with the voluntary sector receiving approximately 3% of the overall health and social care mental health budget. NHS Milton Keynes has spent 178 per weighted patient population per year in the year which is lower than the average spending of England ( 212) and its average ONS peers ( 185). It is also lower than its spent of 191. Budget is predominantly used by secondary care and Secure and High Dependency Services and more than its ONS peers. Although Milton Keynes mental health expenditure per weighted population is in the 12

13 bottom 20% of CCGs the expenditure per known person with a mental health problem is high compared to ONS peers. This indicates a need to shift resources to address unmet needs and in particular fund more preventative interventions if planned across the whole mental health economy incorporating secondary mental health services, primary care, voluntary and independent sector. 13

14 4. Strategic Priorities for the next 3 years The strategic priorities do not only apply to statutory mental health services but across the whole mental health system in Milton Keynes including primary care, the voluntary and independent sector and in conjunction with service users and carers. To improve mental health and wellbeing in Milton Keynes there needs to be a greater focus on prevention, early intervention, keeping people well in the community and supporting recovery. 4.1 More people will have good mental health More people of all ages and backgrounds will have better wellbeing and good mental health Services will be accessible to all regardless of age, gender, sexuality, disability, culture and ethnicity and provided to people according to their needs We need to improve the data on who is accessing services and engage with those groups that are under-represented to identify what prevents people from accessing the services they need and how these barriers can be overcome A plan to address the broader determinants of poor mental health will be developed including: Young people Not in Education, Employment or Training (NEETs) Crime and violence People living in poverty Unemployment Substance misuse Workplace interventions are not only beneficial to individual wellbeing but can be cost effective from the perspectives of both business and the health service, reducing sickness absence which subsequently benefits productivity and performance and enhancing work morale and efficiency. We will: Map mental wellbeing activities at the workplace in Milton Keynes and develop a strategy to promote mental wellbeing in the workplace. Ensure Milton Keynes workplaces are exemplars of healthy working environments with the Council and NHS taking the lead. Methods for changing behaviour need to be aligned with cultures, learning styles and social contexts. 14

15 4.2 More people with mental health problems will recover More people who develop mental health problems will have a good quality of life greater ability to manage their own lives, stronger social relationships, a greater sense of purpose, the skills they need for living and working, improved chances in education, better employment rates and a suitable and stable place to live An important aspect of recovery is that it is not something that paid professionals and carers can simply do to or for people but requires a complete change in approach. We will: Strengthen service user involvement as developing more recovery focused approaches needs a high level of involvement of service users in the development of policy, strategy and the commissioning and provision of services Develop a Recovery College model locally which can support service users, carers and staff from statutory and voluntary organisations with putting recovery into practice Ensure that all services that are commissioned to provide mental health care have an emphasis on recovery and outcome measures In partnership with voluntary organisations, Department of Work and Pensions (DWP) and employers help people with mental health problems prepare for work, find work and stay in work Develop person-centred packages of care, including the use of health and social care personal budgets, to more effectively meet individual needs and deliver agreed outcomes Improve support to carers through better identification and assessment of carers, improved information, advice and support ensuring that carers are listened to and that patient confidentiality does not become a barrier to carer involvement Work in partnership with housing and the voluntary sector to ensure that no resident of Milton Keynes is homeless because of their mental health problems Commission a range of high quality supported housing to bridge the gap between hospital and living independently in the community. 4.3 More people with mental health problems will have good physical health Fewer people with mental health problems will die prematurely, more people with mental health problems will have better physical health and more people with physical ill health will have better mental health The management of physical health needs and access to behaviour change services, in particular smoking cessation services, needs to improve. We will: Ensure that the physical health needs of adults with mental health problems are reviewed and addressed. Specific issues to be 15

16 addressed are smoking, alcohol, obesity, physical activity, and regular monitoring of long term physical conditions. People from BME groups and people living in deprived areas need to be prioritised to reduce health inequalities. 4.4 More people will have a positive experience of care and support Care and support, wherever it takes place, should offer access to timely, evidence-based interventions and approaches that give people the greatest choice and control over their own lives, in the least restrictive environment and should ensure that people s human rights are protected to provide the best possible outcomes for people as well as making the best use of resources it is essential that people received the interventions they require early and at an appropriate level. We will: Develop a stepped care model locally with clear pathways and access points, enabling people to easily step up and down according to their needs, and providing clear information and advice on services Improve mental health support within primary care to ensure that people can be effectively supported by primary care staff where this is appropriate and secondary mental health services are targeted at those most in need Improve access to primary care by using innovative approaches such as running primary care services such as offering flexible appointments and outreach Commission services that allow for seamless transition from Child and Adolescent Mental Health Services (CAMHS) to adult mental health services. This applies in particular to areas of self-harm, eating disorders, ADHD and substance misuse Develop alternatives to admission for acute care including 24/7 intensive supported housing and crisis beds Develop a community eating disorder service in Milton Keynes and agree an appropriate care pathway including transitional pathway from CAMHS and pathway into regional inpatient beds Develop improved care pathways around dual diagnosis to address current unmet need and ensure clear relationships between substance misuse services, Milton Keynes Hospital and secondary mental health services Commission community services which better meet the needs of people with complex needs/ personality disorders that reduce the need for inpatient care 4.5 Fewer people will suffer avoidable harm People receiving care and support should have confidence that the services they use are of the highest quality and at least as safe as any other public service 16

17 4.5.1 Commission mental health awareness training for front line staff to identify and signpost individuals, in particular those at risk of selfharm and suicide Ensure that inpatient services meet and maintain all statutory and clinical standards and over the lifetime of this strategy aim for an enhanced level of quality standards to be agreed in conjunction with service users, carers and local stakeholders 4.6 Fewer people will experience stigma and discrimination Public understanding of mental health will improve and, as a result, negative attitudes and behaviours to people with mental health problems will decrease Raise awareness of stigma and discrimination locally through tailored campaigns and activities Frontline workers, across the full range of services, are trained to understand mental health and the principles of recovery All organisations challenge negative reporting, and encourage positive reporting, of mental health issues in the local media. 17

18 5. How will we know we have made a difference? The Department of Health has published a mental health dashboard (see appendix A) that is aligned to the strategy No Health without Mental Health. This provides a good framework for the priorities to be addressed to improve the mental health of populations and will be used alongside local data, performance indicators, patient surveys and feedback from service users, carers and stakeholders locally to measure progress. Many indicators are also included in the Community mental health profile Milton Keynes 2013 (see appendix A). A plan and timetable for implementing the strategic priorities will be developed and will report to the Mental Health Partnership Board which has a wide membership of service users, carers and stakeholders and the Mental Health Programme Board which makes commissioning recommendations to MK CCG. 18

19 6. Appendix A Mental Health Dashboard

20 Community Mental Health Profile Milton Keynes

21 21

22 7. Glossary ADHD ASD CAF CCG CAMHS CNWL ONS SMI Attention Deficit Hyperactivity Disorder Autistic Spectrum Disorders Common Assessment Framework Clinical Commissioning Group Child and Adolescent Mental Health Services Central North West London Foundation Trust Office of National Statistics Serious Mental Illness 22

23 8. References Department of Health (2012), No Health without mental health: implementation framework /No-Health-Without-Mental-Health-Implementation-Framework-Reportaccessible-version.pdf Department of Health (2013), 'No health without mental health': mental health dashboard 1 Joint Strategic Needs Assessment, Executive Summary 2012/13, JSNA% %20Executive%20Summary.pdf Milton Keynes Joint Strategic Needs Assessment(2013), People with mental health problems 1 Haest I, (2013), Milton Keynes Adult Mental Health Needs Assessment 1 Milton Keynes Joint Health and Wellbeing Strategy 23

24 Available in audio, large print, Braille and other languages Tel Milton Keynes Council Joint Commissioning Civic Offices 1Saxon Gate East Central Milton Keynes MK9 3EJ T E tracey.chapman@miltonkeynes.gov.uk W 24