Mental Health Implementation Board

15 August 2007

Mental Health Implementation Board

15 August 2007Alex McMahon and Denise Coia

Background

Delivering for Mental Health – 5/12/2006 LDP/trajectories for targets in place – April First implementation visits – April/May Report back to CEs – July

Overview Good energy, with Boards using DfMH to drive

service improvement Top teams at review meetings (though some

interesting gaps) Need to improve evidence gathering to better

assess and benchmark progress Generally good progress, but CAMHS challenging

Commitments with Boards

3 – Depression 4 – Psychological Therapies 5 – Physical Health 8 – Crisis Standards 9 – Acute Inpatient Forums

Depression Most areas seem to know what they know Standardised tools generally being used (but we don’t

know much about coverage across GP practices) Some therapies in place in some places (more to come as

part of ICP implementation) Some areas using stepped care approach Action on CHD/diabetes co-morbidity less evident Most areas have plans, but many unresolved issues and

question over pace of change

Psychological Therapies Generally good information about staff trained to deliver

therapies, but poor information about therapies being delivered

Local planning arrangements mostly in place NHS NES developing plans to significantly increase

number of trained staff (with appropriate supervision) Improvement Collaborative will focus on redesign to

ensure skills are used Action point for HD – set baseline for commitment

Physical Health Evidence of good progress, But some Boards flagging

need for support and guidance (consultant adviser in place) Very different approaches being taken (GP; day hospital;

secondary services; etc.) Some Boards moving beyond the commitment to match

interventions to assessed needs Some Boards taking approach into inpatient settings Consultations September to November 2007

Crisis Standards

Lots of activity – crisis response; OOH provision, IHTT; etc.

Coverage – geography and time – issues, particularly in rural areas

But delivery not being benchmarked against standards – need for guidance from HD?

Acute Inpatient Forums No forums in place yet, but discussions underway and

local models being developed No significant problems identified with regard to 2009

timescale Issues with respect to Orkney and Shetland and their use of

mainland facilities Main challenge will be in demonstrating added value Similar issues – staff engagement, environment, activity,

privacy – raised for continuing care wards by MWC report

Commitments with HD 1 – Cultures and Behaviours 2 – Peer Support Workers 6 – ICPs for 5 Diagnoses (NHS QIS) 7 – Suicide Training for Frontline Staff 12 – CPA for Restricted Patients 13 – MH/Substance abuse co-morbidity

Support Programme

Leadership Programme – 24 April Benchmarking Project – August Collaborative – launch September (has

slipped)

CAMHS Leadership and accountability not clear Significant gaps in intensive community responses Risks in respect of funding sources Ongoing discussion about service model for

specialist services ? Need for clearer statement of necessary service

elements

New Challenges

Possible revised commitment to 10% reduction by [2009] in anti-depressant prescribing

Dementia now a higher priority Focus on health improvement and public

health approaches

Next Steps Board specific letter to each NHS CE Further work on how we gather and present

evidence Focus on HEAT targets for Annual Reviews Next visits in October/November Guidance on Substance Misuse and on Physical

health- December / January

Mental Health Implementation Board

15 August 2007

MENTAL HEALTH and SUBSTANCE MISUSE

Peter Rice,Consultant Psychiatrist, NHS Tayside andChair, Mental Health and Substance Misuse Group

THE MENTAL HEALTH and SUBSTANCE MISUSE GROUP

- To improve the awareness of co-occurring mental health and substance misuse problems and

- To improve support and service provision for people who have both mental health and substance misuse problems.

- Our goal is to enable individuals to improve their life chances and live to their potential.

MENTAL HEALTH AND SUBSTANCE MISUSE GROUP

Dr Peter Rice (Chair): Consultant Psychiatrist, Tayside Alcohol Problems Service, NHS TaysideDr Alex Baldacchino: Director, Centre for Addiction Research and Education Scotland, University of DundeeDr Seonaid Anderson, Specialist Registrar, NHS Grampian (from December 2006)Dr Stephen Bell: Consultant Clinical Psychologist and Neuropsychologist, NHS GrampianDr David Blaney: Director of Postgraduate GP Education, NHS Education ScotlandJim Carroll: Clydebank Addiction Team Dr Fiona Clunie, Consultant Psychiatrist (Rehabilitation), NHS Lothian and Chair of Rehabilitation Sub Group,Dr Denise Coia: Psychiatric Adviser, Scottish Executive Health DepartmentFrank Fallan: Voices of Experience (VoX) (from January 2007)Dr Andrew Fraser: Director of Health Care, Scottish Prison ServiceEllen Hair: Planning and Commissioning Officer, Mental Health Services, Edinburgh an (ADSW) Dr Audrey Hillman: Consultant Psychiatrist (Mental Health and Substance Misuse), Inverclyde CommunityHealth Partnership, NHS Greater Glasgow and Clyde Dr Charles Lind: Consultant Psychiatrist (Substance Misuse), NHS Ayrshire & ArranChris Lock: Voices of Experience mental health service user representation (to November 2006)Dr Tom MacEwan: Consultant Psychiatrist (Old Age Psychiatry), NHS GrampianMike McCarron: Association of Alcohol and Drug Action Teams, National Substance Use Liaison OfficerLorraine McGrath: Scottish Association for Mental HealthDr Debbie Mountain: Consultant Psychiatrist (Rehabilitation), NHS Lothian and Chair of Rehabilitation Sub GroupDr Donald Mowat: Consultant and Clinical Director in Old Age Psychiatry, NHS GrampianKaren Norrie: Addictions Adviser, Scottish Prison ServiceBarbara O’Donnell: National Alcohol Liaison Officer, Alcohol Focus ScotlandChris Park: Acting Service Manager – Alcohol and ARBD, Inverclyde Council Dougie Paterson: National Operations Manager, Choose Life (from October 2006)Jacqui Pollock: Carers Scotland and also representing Princess Royal Trust of Carers and Coalition of Carers in Scotland Eunice Reed: Consultant Clinical Psychologist (Substance Misuse), NHS LothianGail Reid: Secondary Services Manager, Glasgow Addiction Services, NHS Greater Glasgow and ClydeLinda Reid: Senior Mental Health Liaison Officer, Scottish Executive Health DepartmentMarion Shawcross: Mental Welfare Commission for ScotlandAddie Stevenson: Director of Children and Family Services, Aberlour Child Care TrustClive Travers: Head of Mental Health, North Community Health Care Partnership, NHS Greater Glasgow and Clyde Alan Wilson: Al-Anon (from November 2006)

- “Individuals with substance misuse-related issues often did not have sufficiently severe mental health problems to be eligible for attention from community mental health teams which prioritised severe and enduring mental illness.” (CARES report) and

- “Despite high prevalence rates of drug misuse, only a small number (less than 5%) of mental health patients exhibited patterns of drug use that would have been likely to satisfy eligibility criteria for statutory drug treatment programmes in their areas mainly because they were not opiate users.” (Department of Health 2004)

THE NATURE OF THE GAP

PROMOTION, PREVENTION & COMMUNICATIONS

- Promotion and prevention policy, strategy and delivery for addressing substance misuse and mental health problems and illness should be part of and integral to broader promotion and prevention action.

- These promotion/prevention strategies and actions should also highlight and target those populations most at risk and the interventions that are most effective in minimising risk and promoting protective factors.

SUICIDE PREVENTION

of UK suicides in contact with services:

- 27% have “dual diagnosis”

- 50% have a history of alcohol problems

- 37% have a history of drug problems

- 13% of Scottish drug overdose deaths “intentional”

SUICIDE PREVENTION

- Substance misuse services should be involved in and provide training in suicide risk assessment and prevention in line with commitment 7 in Delivering for Mental Health.

- Drug Related Death Monitoring Groups and Choose Life and Suicide Prevention Groups should work together.

- NHS boards should establish a mechanism to monitor alcohol related suicide trends.

STIGMA

- Identified as a major issue in user consultation

- Scottish research work with staff indicates problems

- Training and supervision programmes improve staff expectations and attitudes

RESEARCH and MONITORING

- To continuously monitor the epidemiology of co-morbid mental health and substance misuse issues in Scotland

- To evaluate of current practice to ascertain efficiency and effectiveness - To study the impact of parental co-morbidity on children

- To understand the prevalence, type and impact of co-morbidity present in the prison, psychiatric and general practice populations

IDENTIFICATION

- All substance misuse and mental health agencies should have assessment processes which identify

co-morbidity systematically to match care appropriate to level of need

- We have suggested validated tools to identify co-morbidity

- Recognise the training needs for services to use these

SERVICE PLANNING AND DELIVERY

- Improve public awareness of the relationship between substance use, misuse and mental health as part of stepped care approach.

- Substance misuse services should develop knowledge, skills and capacity in psychological treatments for

substance misuse and to meet the mental health needs of their client group.

- NHS mental health services should have the lead coordinating responsibility for care for those whose mental health needs are severe and enduring and whose

needs are best met within specialist care, for instance, by integrated care pathways.

TRAINING

- A training strategy should be developed by NHS boards and partner agencies, including NHS Education Scotland

- The Alcohol and Drugs Workforce Development Strategy Group should include mental health competencies within their remit

- Other accreditation bodies should consider the needs for skills development in co-morbidity in their criteria

ALCOHOL RELATED BRAIN DAMAGE (ARBD)

- Limited data, but major concern by housing agencies

- Improve identification and stepped approach to

assessment

- Improve prevention by population and high risk

approaches

- Development of cognitive impairment complex and

multi-factorial

- Care needs best met alongside other forms of cognitive

impairment and brain injury

- Need for strategic review of services for younger people

with cognitive impairment and brain injury

SPECIAL CONSIDERATIONS

Older People- Demographic trends- Lack of research on effectiveness

Children and Young People- Impact of parental problems- Services for younger people

Learning Disability- Distinct needs for health promotion and services

Trauma and Abuse Survivors- Staff competencies- Stepped care approach

PROCESS AND PROGRESS

4 August 2006 First Meeting of Group.

May/June 2007 Late Draft Discussions with: - NHS Health Scotland

- Health Improvement - Mental Health Division - Public Health and Substance Misuse Division

Involvement of Scottish government Ministers

21 June Consultation draft circulated at Event George Hotel, 200 attendees Presentations, facilitated groups, conference report

21 June Formal Consultation launched

13 September Consultation ends

10 December Report Launch

Mental Health Implementation Board

15 August 2007