Agenda - Wellbeing for Life

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Wellbeing and Health Partnership

Mental Health Strategic Board

Meeting to be held Friday 21 January. 1pm – 3pm, Carliol Room

Contact Officer: Helen Wilding, Wellbeing and Health Partnership Coordinator

Tel: 0191 211 6461 Email: [email protected]

Membership: C. Bull; G. O’Hare; J. Thompson; A. Jamson; S. Winter; D. Pickersgill; C. Drinkwater/C. Bethell; C. Wild, J. Jobson, B. Hill, A. Cameron, G. Rickett

Newcastle Hospitals Trust rep to be confirmed (1 place)

AGENDA

Time Item Lead Paper For

1. 1.00 Introductions and Apologies for Absence

2. 1.10 Joint Strategic Needs Assessments (first drafts)

- Emotional and mental wellbeing

- Adults with long term mental health needs

AJ Yesx2 Discussion

3. 2.15 Delivery Group Updates

� Discussions to date re: Delivery Group lead arrangements

� Prevention and mental health promotion

� Social inclusion and recovery group

CD/SW

CD/CB

SW

yes

yes

Discussion and Approval

4. 2.45 AOB

5. 2.50 Minutes of last meeting yes

6. 3.00 Date and Time of Next Meeting:

25 February 11am – 1pm

Consultation Draft Dec 2010

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Adults with Long Term Mental Health Needs

Joint Strategic Needs Assessment Highlighted Headings indicate JSNA Headings Adults with long term mental health needs are those with a diagnosis of a psychotic disorder and those with a mental health problem on enhanced care coordination. Psychotic disorders produce disturbances in thinking and perception that are severe enough to distort perception of reality. Symptoms include hallucinations, delusional beliefs and disorganised thinking. The main types are schizophrenia and affective psychosis such as bipolar disorders and manic depression. These groups are at increased risk for a range of physical illnesses and conditions, including coronary heart disease, diabetes, infections, respiratory disease and greater levels of obesity. They are almost twice as likely to die from coronary heart disease as the general population and four times more likely to die from respiratory disease. In many cases weight gain is a clear side effect of medication. People with a diagnosis of schizophrenia or bipolar disorder are more than twice as likely to have diabetes as other patients and also more likely to experience ischemic heart disease, stroke, hypertension and epilepsy.1 WHAT IS THE DATA

Impact of mental illness

• At any one time, approximately 5% of men and 3% of women can be assessed as having a personality disorder and over 0.4% have a psychotic disorder such as schizophrenia or bipolar affective disorders.

• Mental illness accounted for more disability adjusted life years lost per year than any other health condition in the UK and the figures for 2004 show that 20% of the total burden of disease was attributable to mental illness (including suicide), compared with 16.2% for cardiovascular diseases and 15.6% for cancer. No other condition exceeded 10%.

• No other health condition matches mental ill health in the combined extent of prevalence, persistence and breadth of impact.

• Mental illness begins early; 10% of children have a diagnosable mental health condition and 50% of lifetime mental illness is present by the age of 14.

Among adults who have long term mental health needs, 36% of men and 75% of women were shown to be obese, compared with rates of 17% in men and 22% in women amongst the general UK population. If patients who have mental health needs have cancer they have a 50% lower chance of survival. There are a range of risk factors associated with suicide including; people who have been discharged from inpatient psychiatric services within the past 4 weeks; and people with mental

1 Another group of psychoses, not included here, are organic psychoses such as dementia and

Alzheimer’s disease. These will be incorporated into the Newcastle upon Tyne JSNA on Dementia.


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health problems, especially depression, schizophrenia and personality disorders (many may not be in contact with secondary mental health services, especially people with depression).

The table below shows estimates of the current and projected numbers of adults aged 16-64 in Newcastle expected to have a psychotic disorder. One thousand four hundred and eighty adults aged 16-64 living in private households in Newcastle are estimated to have a psychotic disorder. This represents 0.7% of adults in this age group, compared to 0.71% in the region and 0.54% nationally. There are a greater number of people with psychosis among those aged 16-34 than across other age groups in Newcastle.

Estimated numbers of adults in Newcastle aged 16-64 with a Psychotic disorder (private households), by age

Age band

2009 2019 2029 2009-2029 % Change

Newcastle upon Tyne

North East

England

16-34 560 580 570 2.1% -2.4% 4.9% 35-44 460 420 510 12.0% 3.9% 9.4% 45-54 290 260 240 -18.0% -16.2% 0.2% 55-64 170 180 170 -1.4% 3.6% 17.2%

Total Psychotic Disorder

1,480 1,440 1,490 0.8% -2.4% 7.2%

Source Planning4care: Mental Health strategic needs assessment for Newcastle upon Tyne

The proportion of people with psychosis is projected to increase by 0.8% in Newcastle between 2009 and 2029, compared with a slight decrease across the region, and 7.2% increase across England. Locally, the biggest increases are likely to be seen in the 35-44 age groups. People with a Combination of Psychiatric Disorders Of people who have at least one psychiatric disorder, many have a combination of conditions that will affect the severity of their mental health problem and their likelihood of needing to access mental health services. The Adult Psychiatric Morbidity Survey 2007 identified and analysed the prevalence of six distinct groupings of people with one or more mental health disorder, five of which included a combination of conditions. This categorisation, known as psychiatric comorbidity, has the potential to link more directly to service planning, as psychiatric comorbidity is known to be associated with increased severity of symptoms, longer duration, greater functional disability and increased use of health services. Categorisation includes six clusters that describe how people group together in terms of having one or more mental health conditions.


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These six clusters are defined as: Cluster 1: Unaffected (National prevalence, all adults, 89.0%) Most people (86.8%) assigned to the ‘unaffected’ cluster were not identified with any of the conditions in the model. Of the people in this cluster who were identified with a condition (13.1%), all had just one. This was most likely to be mixed anxiety and depressive disorder (8.0%), alcohol dependency (3.0%) or drug dependency (1.3%). The proportion of people in the unaffected cluster with any other condition was less than 1%. Cluster 2: Moderate internalising (National prevalence, all adults, 5.8%) The moderate internalising cluster was composed mostly of people with a single internalising disorder. Members of this group all met the criteria or screened positive for at least one condition: two-thirds (68.2%) for only one, and one-third (30.8%) for two conditions. Most of them met the criteria for generalised anxiety disorder (59.2%). The only other conditions to affect more than 6% of the sample were panic disorder or phobia (20.9%), depressive episode (17.5%) and Post Traumatic Stress Disorder (PTSD) (15.4%). The mean number of conditions per cluster member was 1.3. Cluster 3: Cothymia (National prevalence, all adults, 2.1%) Everyone assigned to the cothymia cluster met the criteria or screened positive for two or more conditions, and about one-quarter (23.1%) were identified with three or more conditions. People in the cothymia cluster all met the criteria for mixed anxiety and depressive disorder, and all had at least one of a range of other conditions. High rates of externalising problems were observed among cluster members: 39.7% with alcohol dependency and 19.9% with drug dependency. Post Traumatic Stress Disorder (36.5%) and eating disorder (14.1%) were also highly represented in this cluster. The mean number of conditions per cluster member was 2.3. Cluster 4: Comorbid internalizing (National prevalence, all adults, 2.5%) Everyone assigned to the comorbid internalising group met the criteria or screened positive for at least two conditions: four-fifths (83.0%) had three or more conditions. These conditions covered a range of primarily internalising disorders, including: depressive episode (62.1%), generalised anxiety disorder (53.3%), panic disorder or phobia (52.7%), Post Traumatic Stress Disorder (47.8%), and obsessive and compulsive disorder (34.6%). Only the ‘highly comorbid’ cluster had a higher proportion of cluster members reporting attempted suicide in the last year (17.6% of comorbid internalising, 28.6% of highly comorbid). Most of the respondents in the sample with psychosis and Borderline Personality Disorder (BPD) were in this cluster. While there was a moderate level of externalising conditions such as alcohol dependency (24.2%) and drug dependency (15.9%), these rates were lower than for the other three comorbid clusters. The mean number of conditions per cluster member was 3.5. Cluster 5: Externalising (National prevalence, all adults, 0.5%) Less than 1% of the sample was included in this cluster. They tended to meet the criteria or screen positive for fewer conditions than members of the comorbid internalizing group. Three-quarters (76.9%) of members of the externalising cluster


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met criteria for two conditions: these were almost invariably drug (94.9%) and alcohol (79.5%) dependency. Other conditions for which cluster members met the criteria were problem gambling (12.8%) and depressive episode (also 12.8%). This was the only cluster other than the highly comorbid group in which antisocial personality disorder (7.7%) occurred (other than cothymia, where it was present in 0.6% of members). The mean number of conditions per cluster member was 2.3. Cluster 6: Highly comorbid (National prevalence, all adults, 0.1%) This was an extremely small but highly comorbid cluster, accounting for just 0.1% of the sample. All cluster members met the criteria or screened positive for three or more conditions: in fact the mean number of conditions was extremely high at 8.0. All respondents had depressive disorder and panic disorder or phobia; six had drug dependency; five had borderline personality disorder, alcohol dependency, or generalised anxiety disorder. Four of the seven respondents in the cluster had psychosis and four had antisocial personality disorder. The table below maps the cluster estimates for Newcastle to the three broad target areas for mental health services:

1. Broader well being agenda. 2. Mental health issues that may be dealt with in primary care and /or through

psychological therapies. 3. Severe mental illness dealt with in secondary mental health services.

It shows that:

• There are approximately 7,500 people (Clusters 4 and 6) in Newcastle who are likely to be affected by severe mental disorders, requiring high levels of support from secondary mental health services.

• A further 1,500 (Cluster 5) are affected predominantly by substance abuse and may require high levels of support from substance abuse services and in some cases, mental health services.

• Approximately 20,600 people (Clusters 2 and 3) may benefit from primary care and/or psychological therapies for mental health problems.

• There are approximately 20,600 people (Cluster 1a) who may benefit from lower level preventive initiatives.

Co-morbidity cluster estimates

against target areas for mental health services, age 18-64

Cluster % of Newcastle population estimated to be in each group

Newcastle estimate of numbers

Target group Expected level of service use

Cluster 1 Unaffected

84.2% (of which 13.1% have one

157,050 (of which 20,570

Broader well being/ prevention

Low


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MH condition) have one MH condition)

Cluster 2 moderate internalising

7.6% 14,240 Mental health issues that may be dealt with in primary care and/ or through psychological therapies

Medium

Cluster 3 Cothymia

3.4% 6,390 Mental health issues that may be dealt with in primary care and/or through psychological therapies

Medium

Cluster 4 Comorbid internalising

3.9% 7,330 Severe mental illness dealt with in secondary mental health services

High

Cluster 5 Externalising

0.8% 1,510 Predominantly substance misuse

High

Cluster 6 Highly comorbid

0.1% 190 Severe mental illness dealt with in secondary mental health services

Assumed to be very high

Source Planning4care: Mental Health strategic needs assessment for Newcastle upon Tyne

Estimated proportion and increase in those with combined psychiatric disorders in Newcastle and England (private households)

Clusters 2-6 2009 (% 0f 16-64) % change 2009 -2029 Newcastle 15.9% -0.3% North East 14.7% -2.9% England 14.3% 6.7% Source Planning4care: Mental Health strategic needs assessment for Newcastle upon Tyne

The table above shows that the overall prevalence of comorbidity clusters in Newcastle upon Tyne is above that of England. However, the proportion of people in comorbidity clusters 2-6 is projected to decrease by 0.3% in Newcastle upon Tyne between 2009 and 2029, compared with a 6.7% increase across England as a whole. Indicators and Targets


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As part of the compliance framework via the Care Quality Commission, the PCT works collaboratively with NTW to manage a range of quality indicators. In addition to this, there is a performance dashboard which collects data on a variety of indicators, which includes EIP new patients, crisis resolution home treatment episodes, emergency re-admissions and CPA follow up 7 day discharge. The Public Service Agreement for Socially Excluded Adults (PSA 16), aims to ensure that the most socially excluded adults are offered the chance to achieve a more successful life, by increasing the proportion of at-risk individuals in settled accommodation and in employment. There are additional barriers to social inclusion for adults with severe and enduring mental health problems. In terms of delivering high quality personalised and value for money services we need to consider local performance in the context of key national indicators including: NI 130 Social care clients receiving Self Directed Support. NI 131 Delayed transfers of care. NI 132 Timeliness of social care assessment. NI 133 Timeliness of social care packages following assessment. NI 135 Carers receiving needs assessment or review and a specific carers service or advice and information. NI 136 People supported to live independently through social services. NI 142 Reduce the average length of stay in rehabilitation services and increase the number of people supported to maintain housing. NI 149 Adults receiving secondary mental health services in settled accommodation. NI 150 Adults receiving secondary mental health services in employment.

Quality and Outcomes Framework – QMAS indicators:

• MH 8 The practice can produce a register of people with schizophrenia, bipolar disorder and other psychoses.

• MH 9 The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses with a review recorded in the preceding 15 months. In the review there should be evidence that the patient has been offered routine health promotion and prevention advice appropriate to their age, gender and health status.

More broadly, the national Public Service Agreement (PSA) sets targets for improving outcomes for people with long-term conditions by providing personalised care for those most at risk, and focusing on health and well-being. This includes people with long term mental health needs.

Suicide reduction

The national target is to reduce the death rate from a baseline of 9.2 deaths per 100,000 population in 1995/6/7 to 7.3 deaths per 100,000 population in 2009/10/11. The latest available data (for the 3 years 2006/7/8) show a rate of 7.8 deaths per 100,000 population - a reduction of 15.2 per cent from the baseline.


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In Newcastle the local target is to achieve a rate of 9.9 per 100,000 in 2010 and 9.8 in 2011. The most recent data for 2008 show a rate of 6.9.

Performance

National performance crisis assessment and home treatment and EIP targets no longer exist, however there is ongoing monitoring of these services through performance review meetings between NHS North of Tyne commissioners and NTW Trust.

Quality and Outcomes Framework data for QMAS indicators are monitored through the NHS North of Tyne QOF Strategy Group. Practice visits inform Mental Health Improvement processes, which are overseen by this group. PSA 16 is monitored via the Care Programme Approach which is reported by NTW to Local Authorities. The Local Authority has a Strategic PSA 16 Group, which has mental health representation. Performance is reported to the Mental Health Partnership. The suicide target is monitored by the Mental Health Strategic Partnership which reports to the Health and Wellbeing Executive. WHAT IS THE STORY BEHIND THE DATA?

Stakeholder views

Local views are gathered by Launchpad, a user-run and user-led organisation, which acts as a standing forum and platform for involvement and issue-raising.

Launchpad has 1.5 staff (both users) and a cohort of user volunteers who support the following:

• outreach work • running internal groups to gather opinions, e.g. Lesbian Gay Bisexual

Transgender Group; Pride in Mind; Silver Lining depression group; Blissful women’s group

• run and facilitate groups for services, e.g. Primary Carer user panel; Personality Disorder group; asylum-seekers/refugee panel

• acting as a conduit for all other user groupings in the city, e.g. Manic Depression Fellowship Newcastle, social anxiety group, Obsessive Compulsive Disorder group, Tyneside Women’s Health.

• innovative events and initiatives which are also used to gather service user inputs and views.

Launchpad’s team leader sits on the Mental Health Strategic Partnership Board and its delivery groups, while Launchpad also has two members who are governors for the Northumberland Tyne and Wear Trust, and a board member on Newcastle Local Involvement Network.

Comment [51]: Alisdair, does launchpad have any input into the NTW SU Network?


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The organisation provides many strategic and policy inputs, including joint commissioning, the personalisation agenda and those regional decisions that affect Newcastle.

Service users are concerned about how personalised services will be developed and its potential impacts upon valued existing services particularly those that keep them ‘ticking-over” and prevent deterioration.

Communal, rather than individual, activities and services during evenings at weekends are also sought.

Crisis services still attract criticism for turning users away without adequate signposting elsewhere. Access to talking therapies other than Cognitive Behavioural Therapy is a recurrent issue, as is a need for appropriate services for Black and Minority Ethnic communities and Mental Health services for asylum-seekers. There are reported difficulties with benefits being denied due to erroneous Work Capability Assessments which are later overturned after a stressful appeals procedure) which are further causes of great concern to service users.

Support of, and growing need for, preventative and maintenance services is expressed. Services at a level above Primary Care are requested as primary care is seen as centering on mild-to-moderate diagnoses.

Many service users criticise welfare-to-work agencies for inflexibility and a lack of training or expertise in mental health.

Groups at Risk

Based on the PMS2007 comorbidity data, at national level 23% of all adults living in private households are estimated to have a mental health condition (16% have one, 4% two, and 3% three or more conditions). This is significantly higher than the 16.6 % of those aged 16-74 with any common mental disorder or psychotic disorder. The higher national prevalence rates for psychiatric comorbidity is in part due to the comorbidity cluster categories including a wider group of disorders, for example alcohol and drug dependency. In addition, the different methodologies used for the comorbidity estimates (based on Odds Ratios from the PMS 2007) and common mental disorders (Glover, 2008) will produce variation at local level, which in some cases may reduce the difference resulting from the wider scope of the cluster estimates. The table below shows groups at risk across clusters 2 to 5.

Category Groups at (significant) increased risk

Groups at (significant) decreased risk

2. Moderate internalising

• women

• people from black ethnic groups

• those widowed or divorced

• those in lowest 20% of equivalised household income

• none

3. Cothymia • those divorced • Those aged over 55


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• People from South Asian ethnic groups

4. Comorbid internalising

• All those not married

• Those in the lowest 40% of equivalised household income

• Those aged over 65

5. Externalising • Those single, widowed or divorced

• Women

• Those aged over 45 Source Planning4care: Mental Health strategic needs assessment for Newcastle upon Tyne

Current Activity and Services

Newcastle City Council

The City Council commissions services for people with severe mental illness through its Adult and Culture Services Directorate via Adult Social Care, Supporting People and housing commissioning arrangements.

The actual Adult and Culture Services Directorate spend for 2009/10 for Adult Mental Health was £7,562,430 This figure includes S256 (formerly S28a) transfers from the NHS of £995,990 to enable the purchase of social care services which contribute to meeting health care needs (including £534,970 originally founded on the resettlement of long stay patients from hospital to fund community services for subsequent generations) Culture and Adult Services Expenditure is split between a number of different areas. Budgets for 2009/10 are as follows:

Internally commissioned services:

• Assessment and care coordination services operated through multi disciplinary teams at a cost of £. Levels of staffing and activity are in line with regional norms

• Community Mental Health Resource Centres- £

• Home care adding a further £. Externally commissioned services fall into 4 main areas of provision:

• Prevention £327K for adult mental health related initiatives (2009/10)

• Residential and Nursing Care £.The Newcastle population of adults with SMI in residential and nursing care tends to be ‘older’ and ‘male.’ Care First shows a steady upward trend in residential and nursing care in recent years - probably related to lower rates of hospital admission

• Care at home services £. ‘Care at home’ contracts with independent providers fall into 3 categories –domestic support, personal care and enabling people develop skills.

• Day Services - £to fund 40 individuals who currently benefit from independent sector day services in March 2011 plus the Day Service Contracts in the table below:

Supporting People

Comment [52]: Awaiting confirmation of 2010/11 actual spend from finance.

Comment [53]: Do we need to consider the chronicity of the person’s condition?


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In addition to the above, the Council, via use of the Supporting People Grant, also spent a total of £1,737,771 in 2009/10, on designated housing related support for people with mental health issues against a total grant of £17.2m

A further £ 622,170 Supporting People Grant supplies 121 accommodation based support packages and 172 ‘floating support’ packages (including 39 delivered by CMHRs) to people with mental health problems – with the trend showing a gradual switch from accommodation to floating support. These are commissioned both internally and externally.

Newcastle City Council Grants and Contracts Day services 2009/10 (Shows s256 and Newcastle City Council funding)

Organisation Purpose Grant /contract value 2009/10 (‘000’s).

Tom Carpenter (MHC)

Drop in centre £134.6 (50% PCT S256 funded)

Clubhouse (MHC) Drop in /work structured centre £52 (NHS also fund to £111K-not S256)

STEP (MHM) Day services /employment £144.2 (Fully S256 funded)

Key Enterprises Day Services /employment £60.7 (£72.4 S256 funded)

Oasis Café (MHM) Day Services /employment £40 (S256 £15) Thursday club (MHC)

Evening drop in £5.2

Most third sector Day Services are coordinated through the Day Activities Consortium (DAC) which acts as an independent broker and seeks to manage the day services market to ensure a spread of provision. As such, the DAC is now part of the Social Inclusion and Recovery Delivery Group.There are considerable opportunities for people with mental health problems to engage in activities, and work is in place to forge links with, and to support people with mental health problems to access ‘mainstream services’. Modernised day opportunities can play a significant role in this area, through promoting quality of life and independence through flexible and individualised services, linked to person -centred planning, care and support packages designed to meet individual need, and the development of means to access ‘mainstream ‘ facilities .

Primary Care Trust

Current commissioning information and spend needed Northumberland Tyne and Wear (NTW) NHS Trust

Comment [54]: As above. Does the DAC spend need to be included? £120k to ADD IN EXCEPT EMPLOYMENT WORKER


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NTW NHS Trust manages Mental Health services from the Scottish border to Wearside. Data from the NTW website indicates that its annual income for 2007/8 was £292 m against expenditure of £280.5 m . The Trust has developed a 5 yr financial strategy in support of its application for Foundation Trust status which was awarded in December 2009. This plan seeks to deliver a cumulative surplus of £35m by 2013 to ensure financial stability, as well as delivering a recurring financial recovery programme of £9.3 m. per annum, and considerable investment in buildings over the next 5 years so its stock is’ fit for purpose.’ The NTW budget for services commissioned by Newcastle PCT for 2009/10is £51.4m spread across a number of different service areas

NTW NHS Trust budget 2009/10 : Newcastle PCT funding

Health Resource Group Units of Activity

Annual Budget

Children & Young People Services 4614 £4.88m

Corporate Trust Services Efficiency savings -£1.40m

Forensic Services 6,285 £1.97m

Learning Disabilities 18,368 £6.33m

Older Persons services 35,265 £11.33m

Specialised Services 10,993 £5.32m

Working Age Adult Services 73,266 £22.98m

TOTAL 148,792

£51.4m

Services for people with severe mental health problems are predominantly found amongst Working Age Adult services Following the NSF Mental Illness there has been a requirement for local areas to implement specific forms of service provision , which are designed to effect early intervention and treatment and effective ongoing support where needed in key areas- and three new teams :a Crisis Assessment and Home Treatment Team (CAHT); an Early Intervention in Psychosis Team , and an Assertive Outreach team have been developed as a result - whilst Community Mental Health Teams remain the preferred vehicle for ongoing community treatment and support . Newcastle has successfully implemented the required NSF related reforms but full and effective multidisciplinary working remains an aspiration. NTW also provides a range of inpatient services including, a Psychiatric Intensive Care Unit (Greentrees) as well as day, rehabilitation and recovery and substance abuse related services, services for older people, people with learning disabilities and children. As a regional centre Newcastle also has some specialisims including forensic services and neuropsychiatry which draw people with very specific needs into the city Locally, some adults with serious mental health problems are known to have chaotic lives with multiple and complex needs. These individuals are frequently referred to as ‘revolving door’ individuals and often have lengthy admissions and dependency


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on hospital admissions. Current performance information shows that length of stay on inpatient wards within Northumberland, Tyne & Wear NHS Foundation Trust (NTW) is 114 days, whilst the national guidance is for a maximum of 90 days.

WHAT DO WE KNOW ABOUT THIS GROUPS WELLBEING? Providers who receive Supporting people funding are required to return outcome information on a quarterly basis. The five outcomes are Achieve Economic Wellbeing; Enjoy and Achieve; Be Healthy; Stay Safe and make a Positive Contribution. During 2009/10 the following outcomes for people who identify mental health as their primary need were reported on:

Detail of each outcome

Mental health - required

need

Mental health -

achieved need

Mental health % of achieved

1. Achieve Economic Well Being 1a. Support to maximise income 68 64 94% 1b. Support to reduce overall debt 37 34 92% 1c. Support to obtain paid work 6 0 0% 2. Enjoy and Achieve 2a. Support to participate in training and /or education

28 20 71%

2b. Support to participate in leisure/cultural/faith/informal learning activities

58 4 7%

2c. Support to participate in any work-like activities

26 53 204%

2d. Support to establish contact with external services/groups/friends/family

74 21 28%

3. Be Healthy 3a. Support to better manage physical health

52 47 90%

3b. Support to better manage mental health

107 84 79%

3c. Support to better manage substance misuse issues

36 18 50%

3d. Assistive technology/aids and adaptations helping client to maintain independence

2 2 100%

4. Stay Safe 4a. Support to maintain their accommodation and avoid eviction

65 50 77%

4b. Support to comply with statutory orders and related processes in relation to offending behaviour

18 11 61%

4c. Support to better manage self harm 20 0 0% 4c(ii). Support to avoid causing harm to 24 16 67%

Comment [55]: Statistical evidence needed from Board Members


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others 4c(iii). Support to minimise harm/risk of harm from others

24 17 71%

5. Make a Positive Contribution 5. Support in developing confidence and ability to have greater choice/control/involvement

86 71 83%

These can be broadly mapped against the 7 Our Health, Our care, Our Say outcomes as:

Our Health, Our care, Our Say Outcome

Related SP outcome

No. entering service with

need

No. achieved

need

% of people with MH

achieving need

Are they healthy?

Outcome 3 - Be Healthy

Outcome 4 – Stay Safe (4c)

197

68

151

33

77

48 Do they have a good quality of life?

Outcome 2 - Enjoy and Achieve 186 98 53

Are they able to make a positive contribution? Are they able to exercise choice and control?

Outcome 5 - Make a Positive

Contribution

Outcome 4 – Stay Safe (4a and b)

86

65

71

50

83

77

Are they free from discrimination and harassment?

Do they have economic wellbeing?

Outcome 1 - Achieve Economic

Wellbeing 111 98 88 Can they maintain personal dignity? WHAT ARE THE GAPS IN DATA

For the future, outcomes based planning, commissioning, and service delivery requirements will require effective collection of data across agencies and over time, in relation to individual service users; either through ‘joined up’ or common information systems. Currently information on service users is split between Care First (NCC) and RIO, (NTW). It is not currently possible to follow a person’s journey through services, nor to identify outcomes of multi disciplinary intervention, as RIO and Care First have no seamless interface.


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Outcomes will increasingly need to be defined in terms of quality of life factors and from the perspective of the service user. Joined up person focused services will therefore require a facility for regular standardized but informative means of service user feedback in a fashion which can be readily collated. While we have a range of designated supported accommodation for people who have mental health needs, we need to improve access to it by utilising the Housing Gateway process. This will support an understanding of the outcomes people achieve. We have a range of short term supported accommodation which meets some needs, however, work needs to be undertaken to review these services in order understand whether the balance between short and long term supported accommodation meets people’s needs. This includes the requirement to develop our response to people who are in crisis. Around 75 per cent of the 4,000 people who take their own life each year in England are not in contact with mental health services.

Suicide tends to rise at times of

unemployment and economic problems, and the current recession will require interventions which support people who are facing debt, employment worries or who are in emotional crisis. Numbers of people with mental illness on incapacity benefit are currently above the national rate as can be seen from the data below. Incapacity Benefits for Mental Illness: rate per 1,000 working age population: Newcastle rate = 44.5 (number is 7870) England Rate is 27.5 Source: (CHP - DOH / Association of Public Health Observatories 2009)

Given the higher level of Incapacity Benefit Claimants for those with mental illness there is an identified need to work closely with Job Centre Plus to target those in deprived areas. Service users report gaps in their knowledge and a need for higher support to use direct payments. Previous research suggests that the reasons for health inequalities among people with long term mental health needs are complex and likely to include poverty, lifestyle, access to health assessments and treatments and side effects of anti-psychotic and mood stabiliser medication. The inequalities cannot be explained by the mental health problem alone and some work around gathering together data on these issues needs to be undertaken in order to understand all contributory factors. WHAT ARE THE NATIONAL AND LOCAL DRIVERS?

National Suicide Prevention Strategy for England, Department of Health, 2002. The Mental Health and Social Exclusion report, Social Inclusion Unit, 2004


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This identified the need to tackle social exclusion and promote equality and re-integration into mainstream community settings. Choosing Health Supporting the Physical health Needs of People with Severe Mental Illness. Commissioning Framework, Department of Health 2006. Our Health Our Care Our Say, Department of Health 2006. Advocated a move to delivery of more outcome focused community-based services that promote independence and are responsive to individual needs. The Commissioning Framework for Health and Well-being, Department of Health, 2007. Which built on ‘Our Health, Our Care, Our Say’ highlighting the need to engage the local community in how services are best delivered to support health and wellbeing. Putting People First: a shared vision and commitment to the transformation of adult social care, Department of Health, 2007. The concordat established the collaboration between central and local government, the sector’s professional leadership, providers and regulators. It set out the shared aims and values which guide the transformation of adult social care, and recognised that the sector will work across agendas with users and carers to transform people’s experience of local support and services. New Horizons, Department of Health 2009. A cross-government mental health strategy that addresses the impacts of wider social and environmental issues such as, stigma, employment, housing, income and social inequalities. Currencies for mental health payment by results (PbR) Work is going on to develop a Payment by Results (PbR) approach for Mental Health. This is a priority for the Department of Health, who are committed to making a currency available for use nationally in 2010-11. By currency we mean a common set of units for contracting for mental health services. The ultimate goal is the creation of a national tariff for these currencies. The PbR currencies will be based on the Care Pathways and Packages methodology that has been developed by six mental health trusts in the Yorkshire and Humber and North East Strategic Health Authorities. This approach groups service users into 21 different clusters based on their needs or characteristics. The groups are defined on the basis that they require similar amounts of clinical input. The currencies and tariffs being developed for PbR will be the basis for costing mental health clinical input at an individual level in the future. Ideally they should also be able to link in to prevalence data so that need for mental health services could also be costed at population level. This will require mapping the clusters used in the Care Pathways and Packages methodology, which have been developed from a detailed clinical perspective, to the analytic categories used for providing prevalence statistics in the Psychiatric Morbidity Study. Resource allocation systems for personal budgets

Comment [56]: Need to add in MHNE and NMHDU work


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The Council, in line with other Local Authorities and the requirements of the Putting People First agenda, is developing a system for allocating typical budgets for different levels and types of need. As with PbR, these may have potential for modelling population costs for social care for people with mental health conditions in the future. WHAT WORKS?

There have been significant developments to support physical health checks in primary care for those on SMI registers, and ongoing performance management of primary care practice will be needed. Data to May 2009 show that 1869 out of 2047 people on SMI GP registers, have received a health check within the last 15 months. This is 91.3% of those on the SMI registers.

Partnership working across the City has delivered positive outcomes as identified above. This approach however needs to be further enhanced in order to support the move towards personalised services which are effective and efficient.

Examples of good practice/ evaluation/ outcomes needed from the Board WHAT SHOULD WE BE DOING NEXT?

• Work with service users, partners and providers to develop and outcomes based approach to the commissioning and delivery of services

• Develop data and monitoring systems which reflect the complexity of need surrounding the inequalities people experience

• Review the balance between short and long term supported accommodation in order to ensure it meets future needs

• Develop the utilisation of the Housing gateway in order to ensure the supported accommodation offer meets people’s needs

• Investigate the need to develop or enhance specialist supported employment services

Comment [57]: Could we get the most up to date stat?

Consultation Draft – Dec 2010

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Emotional Wellbeing and Mental Health Joint Strategic Needs Assessment

Newcastle - a Healthy City

Newcastle is a Designated City within Phase V (five) of the World Health Organisation’s (WHO) European Healthy Cities Network. The UK has only 13 designated healthy cities so it is a great honour that we are part of the European network and the wider world movement around urban health.

Phase V of the European Healthy Cities Network lasts from 2009 to 2013. To become a designated city, Newcastle has demonstrated that it has the highest level political and strategic commitment to making sure that Newcastle is a setting where all people can live long, healthy and happy lives.

As a Designated Healthy City, we have adopted the WHO's 1946 definition of “health”:

“Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”.

To support this, we also have a vision for wellbeing which we see as:

“A positive physical, social and mental state; it is not just the absence of pain, discomfort and incapacity. It requires that basic needs are met, that individuals have a sense of purpose, that they feel able to achieve important personal goals

and participate in society. It is enhanced by conditions that include supportive personal relationships, strong and inclusive communities, good health, financial

and personal security, rewarding employment, and a healthy and attractive environment.”

This is echoed in the definition of wellbeing found in the New Horizons document which is:

“A positive state of mind and body, feeling safe and able to cope, with a sense of

connection with people, communities and the wider environment.”

Emotional Wellbeing and Mental Health Mental health problems are extremely common: one in six adults will have a mental health problem at any one time, and for half of these people the problem will last longer than a year. Over half of all adults with mental health problems will have begun to develop them by the time they were 14. For some people, mental health problems can last for many years, particularly if inadequately treated.


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The social and financial costs of mental health problems are immense. The burden on individuals, families, communities and society as a whole includes the psychological distress, the impact on physical health, the social consequences of mental health problems, and the financial and economic costs. Recent estimates put the full cost at around £77 billion, mostly due to lost productivity. Emotional wellbeing is about our ability to cope with life’s problems and maximise life opportunities. Mental ill-health generally leads to difficulties in coping in our everyday lives and thus has an adverse impact on our emotional wellbeing. Building resilience within individuals and communities has been shown to be a strong preventative factor. Initiatives which build social cohesion, and self help can mitigate against the development of mental health problems. Social prescribing of activity and participation can be a way to do this. There are clear links between poverty, social deprivation and mental health problems. There is also a strong association between relative poverty and poor mental well-being and health. People with mental health problems tend to have fewer qualifications, find it harder to get work, have lower incomes, are much more likely to be homeless and are more likely to live in areas of high socio-economic deprivation.

What is the data?

Prevalence of Common Mental Health Problems Common Mental Health Disorders (CMDs) include generalised anxiety disorder, mixed anxiety and depressive disorder, depressive episode, phobias, obsessive-compulsive disorder and panic disorder. They cause substantial emotional distress and interfere with daily function, but do not usually affect insight or cognition. People with common mental health disorders presenting to health services are most likely to be seen in primary care and, or, offered psychological therapies. Where symptoms are complex they may be referred to secondary mental health service. As shown in the tables below, an estimated 40,720 adults aged16-64 living in private households in Newcastle have a common mental disorder. This represents 21.8% of adults in this age group, compared to 18.6% in the North East region and 17.4% nationally. Incidence of need:

• Up to 80% of patients with a principal diagnosis of anxiety will have at least one other anxiety disorder or depression.

• An estimated 1 in 6 people suffer from mental health problems at any one time

• People with CMDs account for 1 in 4 primary care consultations.


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• Depression has been identified as the third most common reason for GP consultation

• Mental illness and stress related conditions are now the most common causes of sickness absence in the UK.

Table 1 Estimated numbers of adults in Newcastle aged 16-64 with a Common Mental

Disorder (private households), by age

Age band Any common Mental Disorder

Any Common Mental Disorder % of all with CMD

16 –-34 18 540 46 35 - 44 7 880 19 45 – 54 8 800 22 55 – 64 5 500 14 All with Common Mental Disorder 40 720 100 Source Planning4care: Mental Health strategic needs assessment for Newcastle upon Tyne

Table 2 Estimated numbers of adults in Newcastle aged 16-64 with a Common Mental

Disorder (private households), by category

2009 2019 2029 2009-2029 % Change Newcastle North

East England

Generalised anxiety disorder

10 920 10 910 10 830 -0.8% -3.0% 7.5%

Mixed anxiety/ depression

20 920 20 690 20 830 -0.4% -3.1% 6.6%

Depressive episode 7 640 7 560 7 590 -0.7% -2.8% 7.7% Phobias 5 000 4 970 5 010 0.1% -2.9% 6.9% Obsessive Compulsive disorders

2 590 2 550 2 580 -0.3% -2.9% 6.9%

Panic Disorders 2 200 2 210 2 110 -3.9% -5.5% 7.8% Any CMD 40 720 40 370 40 420 -0.7% -3.3% 6.9% Source Planning4care: Mental Health strategic needs assessment for Newcastle upon Tyne

The proportion of people with common mental disorders is projected to decrease by 0.7% in Newcastle between 2009 and 2029, compared with a greater decrease of 3.3% across the region, and 6.9% increase across England. Locally, the greatest increases are expected in the numbers of those with phobias (0.1% increase over the period 2009-2029).


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Social care spend on Mental Health services The tables below show the mental health social care budget and average spend per capita, and per client, in Newcastle compared to the region and England1. The tables show a similar annual spend per capita (working-age population), but significant variation in average spend per client receiving services. Newcastle has fewer clients per working-age population suggesting that expenditure differences may reflect differences in caseload severity. Further work is required to build up a larger and more generally representative portfolio of costs against severity in order to establish ‘typical’ values against level of need on which to base future cost and service projections and whole population estimates.

Table 3 MH social care budget and average spend per capita

Total

working age population 2009 (000)

Total adult MH budget2 2008-09 (£’000)

Assessment & care management (£ 000)

MH budget excluding care management (£ 000)

Annual spend per 1,000 working age population3 (£)

Newcastle 180 5,597 1,499 4,098 23 North East 1,598 52,374 16,461 35,913 22 England 31,938 1,070,059 358,829 711,230 22 Sources: NASCIS, 2008-09, (SSMSS) and Planning4Care: Mental Health strategic needs assessment for Newcastle upon

Tyne

Table 4

MH social care budget and average spend per client MH budget

excluding care management4 (£’000)

Number of clients aged 18-64 receiving services 2008-09

Average number of clients per 100,000 working age population

Average Annual spend per client (£)

Average weekly spend per client (£)

Newcastle 4,098 730 436 5,614 108 North East 35,913 8,365 484 4,293 83 England 711,230 197,235 401 3,606 69 Sources: NASCIS 2008-09 (SMSS, RAP P1) and Planning4Care: Mental Health strategic needs assessment for Newcastle upon Tyne

1 NASCIS 2008/9.

2 Gross current expenditure (excluding SP).

3 Excluding care management

4 Based on gross current expenditure (excluding SP).


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Indicators and Targets There is considerable evidence base for the efficacy of psychological therapies. Our Health, Our Care, Our Say (2006), Darzi Review (2007) and the NHS Plan (2000) all stress the need to improve access to mental health services. The Improving Access to Psychological Therapies initiative is geared toward developing psychological treatments in particular. This service will be developed within Newcastle in 2011. Improving Access to Psychological Therapies (IAPT) A key characteristic of an IAPT service is the effort individual therapists put into demonstrating the outcomes that are delivered. Routine outcomes measurement is central to improving service quality - and accountability. It ensures that the person having therapy, and the clinician offering it, have up-to-date information about individual progress, which is of therapeutic value in itself. At an overview level, service providers and commissioners can see a performance pattern for the service, which can be publicly reported. Performance of the integrated psychological therapy service is monitored through the community contract forum, which takes place on a quarterly basis, with representatives from Community Services and the Primary Care Commissioning Team. NICE guidelines exist for Anxiety, Depression, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Eating Disorders, Psychosis, and Self Harm. Integral to these guidelines is the delivery of treatments and interventions in a ‘Stepped Care’ framework. Typically, this would mean that brief interventions, and supported self help would be available for people whose difficulties are at the mild end of the continuum of mental distress. Alternatively, more complex interventions requiring more resources, over a longer period should be available for people whose difficulties are more complex. The large majority of people could be served by primary care mental health services. Key Performance Indicators Vital Signs Indicators

• The number of people who have depression and/or anxiety disorders (local estimate based on Psychiatric Morbidity Survey) = 42,241

• The number of people who have been diagnosed with depression and/or anxiety disorders (diagnoses during the reporting quarter)

• The number of people who have been referred for psychological therapies (during the reporting quarter) =

• The number of active referrals (people who have been referred for psychological therapies and are awaiting initial assessment) (at the start of the reporting quarter) =

• The number of people who have entered psychological therapies (during the reporting quarter) =

Comment [51]: We need info in here about the new IAPT service and what it means for Newcastle including performance targets

Comment [52]: Numbers needed


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Extending Access to NICE compliant Services

• The number of people who have completed treatment (for any reason including completed, dropped out, signposted on) (during the reporting quarter) =

• The number of people who are “moving to recovery” (of those who have completed treatment, those who at initial assessment achieved "caseness", i.e. were allocated and at final session did not ) (during the reporting quarter) =

• The number of people who have completed treatment not at clinical caseness at commencement of treatment =

Helping People Back to Work

• The number of people moving off sick pay and benefits (during the reporting quarter) =

Building a Skilled Workforce

• The number of high intensity trainees (At the end of the reporting quarter ) =

• The number of low intensity trainees (At the end of the reporting quarter) =

• The number of high intensity trained staff (At the end of the reporting quarter) =

• The number of low intensity trained staff (At the end of the reporting quarter) =

• The number of supervisors ( At the end of the reporting quarter) = The Mental Health Strategic Board brings together a network of statutory and voluntary service partners, and it oversees delivery of the work of the Social Inclusion and Recovery Delivery Group and the Prevention and Mental Health Promotion Delivery Group, across the City. Mental Health Promotion is an inherent part of the work of all services, and partnership working, with the support of the Mental Health Strategic Board, ensures added value to service planning for mental health through this network. The Strategic Board reports to the Newcastle Health and Wellbeing Partnership.

What is the Story Behind the Data? Groups Most at Risk

Group Risk

Age and Gender Prevalence rates were significantly higher among women than men across all categories of CMD, with the exception of panic disorder and obsessive compulsive disorder, where the excess prevalence in women was not significant. Those aged 75 and over were the least likely to have a CMD (6% of men, 12% of women). The rate among women peaked





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in the 45-54 age group, with a quarter (25%) meeting the criteria for at least one CMD. Among men, the rate was highest in 25-54 year olds (15% of 25-34 year olds, 15% of 35-44 year olds, and 14% of 45-54 year olds). Rates for having at least one CMD were higher for white, black and South Asian women than for white, black and South Asian men respectively. Women across all marital status categories were more likely than their male counterparts to have CMD, except for divorced people, in whom the prevalence for men and women was very similar. The greatest difference was among South Asian adults where the age standardised rate among women (34 % of South Asian women) was three times that of men (10% of South Asian men). Among men, those currently divorced had the greatest likelihood of having CMD. People in the lowest quintile for household income, were more likely to have CMDs than those in the highest quintile, with a linear trend through the income quintiles. The pattern was more marked in men than women by a factor of three.

Ethnicity Rates for having at least one CMD were higher for white, black and South Asian women than for white, black and South Asian men respectively

The greatest difference was among South Asian adults where the age standardized rate among women (34 % of South Asian women) was three times that of men (10% of South Asian men)

Marital Status

Women across all marital status categories were more likely than their male counterparts to have CMD, except for divorced people, in whom the prevalence for men and women was very similar Among men, those currently divorced had the greatest likelihood of having CMD

Equivalised household income

People in the lowest quintile of equivalised household income were more likely to have CMDs than those in the highest quintile, with a linear trend through the income quintiles. The pattern was more marked in men than women by a factor of three.

Source: National Psychiatric Morbidity Survey 2007 (PMS 2007)

Key Inequalities


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There is a clear association between good mental health and better outcomes across a number of domains: years of life, physical health, educational achievement, criminality and employment status. Those most likely to be economically inactive include people with mental illnesses and people with depression. Our vision is for all citizens to benefit from opportunities for positive mental well being, which include involvement with community, friends and family; meaningful activities and occupation; active learning and leisure and having the basics in place, such as good health care, housing and financial security. People with significant mental health problems should have access to the same opportunities that promote the mental well-being of all citizens, but they should also be able to access specialist services which provide for their individual needs and preferences, promoting their recovery from the effects of mental health problems. Linked to the fact that people from Black and Minority Ethnic (BME) backgrounds are disproportionately located in Newcastle’s deprived areas, they are also most likely to live in areas which are deprived based on health and disability. Mosaic Origins data shows that those areas which are in the 20% most deprived in terms of health outcomes, and where poor mental health is most likely to occur, have a BME population of 2.1%; more than double that of areas which have the 20% best health outcomes. Poor mental health is an issue for the City, therefore provision to support those suffering from mental health problems should continue be a priority. However, it is a complex issue, and different groups may need different kinds of provision, for example, some BME communities place a real stigma upon mental health problems and may be reluctant to engage with services unless they are presented in a way which reduces this stigma. Targeted communication and provision may encourage take up of services and could improve health outcomes, particularly where preventative measures can be taken. Mental health issues are high amongst lesbian, gay, bisexual and transgender (LGBT) people, particularly amongst those who are least comfortable with or most likely to conceal their sexual orientation. LGBT groups all demonstrate significantly higher levels of mental distress, which can often show through in the form of self harm and suicide. Young LGBT people are also up to 3-6 times more likely to self-harm, and attempt or commit suicide than heterosexual young people. Statistics from the Lesbian and Gay Forum highlight that approximately 40% of all young LGBT people self-harm and/or attempt suicide at least once.

Stakeholder views

Local views are gathered by Launchpad, a user-run and user-led organisation, which acts as a service user network and a standing forum and platform for involvement and issue-raising.

Comment [56]: Alisdair, does launchpad have any input into the NTW SU Network?


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Launchpad has 1.5 staff (both users) and a cohort of user volunteers who support the following:

• outreach work

• running internal groups to gather opinions, e.g. Lesbian Gay Bisexual Transgender Group; Pride in Mind; Silver Lining depression group; Blissful women’s group

• run and facilitate groups for services, e.g. Primary Carer user panel; Personality Disorder group; asylum-seekers/refugee panel

• acting as a conduit for all other user groupings in the city, e.g. Manic Depression Fellowship Newcastle, social anxiety group, Obsessive Compulsive Disorder group, Tyneside Women’s Health.

• innovative events and initiatives which are also used to gather service user inputs and views.

Launchpad’s team leader sits on the Mental Health Strategic Partnership Board and its delivery groups, while Launchpad also has two members who are governors for the Northumberland Tyne and Wear Trust, and a board member on Newcastle Local Involvement Network.

The organisation provides many strategic and policy inputs, including joint commissioning, the personalisation agenda and those regional decisions that affect Newcastle.

Service users are concerned about how personalised services will be developed and its potential impacts upon valued existing services particularly those that keep them ‘ticking-over” and prevent deterioration.

Communal, rather than individual, activities and services during evenings at weekends are also sought.

Crisis services still attract criticism for turning users away without adequate signposting elsewhere. Access to talking therapies other than Cognitive Behavioural Therapy is a recurrent issue, as is a need for appropriate services for Black and Minority Ethnic communities and Mental Health services for asylum-seekers. There are reported difficulties with benefits being denied due to erroneous Work Capability Assessments which are later overturned after a stressful appeals procedure) which are further causes of great concern to service users.

Support of, and growing need for, preventative and maintenance services is expressed. Services at a level above Primary Care are requested as primary care is seen as centering on mild-to-moderate diagnoses.

Many service users criticise welfare-to-work agencies for inflexibility and a lack of training or expertise in mental health.

WHAT ARE THE GAPS IN DATA


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Data for all primary care mental health services has been recorded through System One. This has been inadequate in capturing data for the Stepped Care Model, as different steps are addressed by different services. Data is currently reported as aggregated for all Primary Mental Health services, as systems haven’t been able to capture service specific data. The data reported in the ‘performance section’ is therefore for all IAPT, Primary Care Mental health and Psychological Therapy services. There is a lack of clarity in NICE guidance regarding the most appropriate input for people at step 4, with regard to IAPT input or moving into psychological therapies. As a future development this lack of clarity will be addressed as part of the pathway criteria for referral. There is little data available on levels of informal care for people with mental health needs, yet evidence would suggest that people who live alone or receive little informal support proportionally more likely to be affected by common mental disorders. WHAT ARE THE NATIONAL AND LOCAL DRIVERS? There are a range of national and local drivers which underpin our work in this area. The main ones are: The Mental Health and Social Exclusion report, Social Inclusion Unit, 2004 This identified the need to tackle social exclusion and promote equality and re-integration into mainstream community settings. Our Health Our Care Our Say, Department of Health 2006. Advocated a move to delivery of more outcome focused community-based services that promote independence and are responsive to individual needs. The Commissioning Framework for Health and Well-being, Department of Health, 2007. Which built on ‘Our Health, Our Care, Our Say’ highlighting the need to engage the local community in how services are best delivered to support health and wellbeing. Putting People First: a shared vision and commitment to the transformation of adult social care, Department of Health, 2007. The concordat established the collaboration between central and local government, the sector's professional leadership, providers and regulators. It set out the shared aims and values which guide the transformation of adult social care, and recognised that the sector will work across agendas with users and carers to transform people’s experience of local support and services. New Horizons, Department of Health 2009. A cross-government mental health strategy that addresses the impacts of wider social and environmental issues such as, stigma, employment, housing, income and social inequalities.

Comment [57]: Is this actually the case?


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Currencies for mental health payment by results (PbR) Work is going on to develop a Payment by Results (PbR) approach for Mental Health. This is a priority for the Department of Health, who are committed to making a currency available for use nationally in 2010-11. By currency we mean a common set of units for contracting for mental health services. The ultimate goal is the creation of a national tariff for these currencies. The PbR currencies will be based on the Care Pathways and Packages methodology that has been developed by six mental health trusts in the Yorkshire and Humber and North East Strategic Health Authorities. This approach groups service users into 21 different clusters based on their needs or characteristics. The groups are defined on the basis that they require similar amounts of clinical input. The currencies and tariffs being developed for PbR will be the basis for costing mental health clinical input at an individual level in the future. Ideally they should also be able to link in to prevalence data so that need for mental health services could also be costed at population level. This will require mapping the clusters used in the Care Pathways and Packages methodology, which have been developed from a detailed clinical perspective, to the analytic categories used for providing prevalence statistics in the Psychiatric Morbidity Study. Resource allocation systems for personal budgets The Council, in line with other Local Authorities and the requirements of the Putting People First agenda, is developing a system for allocating typical budgets for different levels and types of need. As with PbR, these may have potential for modelling population costs for social care for people with mental health conditions in the future. WHAT WORKS? The service delivers care to a population of 273,600 people across the City. Within these localities there are varying levels of need including some of the most deprived communities in the City. The integrated primary care psychological therapy service consists of:

• Primary Care Psychology

• Primary Care Mental Health Practitioners

• Peri-natal psychology; and will also incorporate High Intensity therapists; Low Intensity therapists; and Employment advice workers.

Primary care psychologists provide psychological assessment and treatment to adults who live in Newcastle, and who are suffering from common mental health problems. The services are attached to local GP practices and health centres in the local area. Primary care psychologists can help people with a wide range of difficulties.


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Some of the common reasons for adults to be referred to the service are:

• Depression (including post-natal depression)

• Anxiety and excessive worry

• Phobias

• Panic disorder.

Interventions can include:

• Brief Therapy

• Brief Intervention and guided self help including CCBT

• Problem focused work on anxiety and depression

• Formulation led CBT for anxiety and depression disorders.

HealthWORKS5

Newcastle, through the Health Improvement Board and Newcastle New Deal for Communities chose to use Communities for Health (C4H) funding to support a single project delivered by HealthWORKS Newcastle. Based in the west of the City the project aimed to develop, and if successful, scale-up a sustainable approach to providing a personalised and locally accessible response through a choice of activities delivered by voluntary sector providers. Apart from providing a more personalised, and accessible service, it was believed that this approach would be less expensive and more effective in preventing and reducing demand for expensive medical services than current approaches. In addition, this approach has the added value of being consistent with national policy such as ‘Putting People First’ and with DH commissioning guidance for long term conditions. The outputs, outcomes and costs from an early independent evaluation and from monitoring data demonstrate that the project is on track.

• Since 2008 over 4261 older people have been referred by their GP and have participated in the project. All have suffered from low mood, and social isolation

• All have at least one long term medical conditions, the majority have multiple conditions

• Costs range from £244 per person per year for high level of support and £70 per person per year for low level/ preventative work.

• Savings to the NHS are at least comparable to those demonstrated in the Partnerships for Older People Projects evaluation which stated that ‘community-facing' projects such as this showed increasing returns against economies of scale, such that the larger the project, the greater the saving.

• Over 180 previously sedentary individuals now taking part in regular physical activity.

• Over 1, 500 visits to Advice sessions (benefits, welfare, health)

5 Adapted from Communities for Health Executive Summary (2010), Prof. C Drinkwater


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• Over 1,700 people have benefited from the community investment

• 4 community organisations, promoting healthy lifestyles and tackling health inequalities in deprived areas, have been supported

• The project has benefited from the involvement of over 30 volunteers

• Employment opportunities have been provided for 2 people and increased working hours for 3 more people

• Good links have been established with GPs, Intermediate care, and many third sector organisations

• The project has been proven to have a positive impact on mental health for the participants and GPs have reported some evidence of participants visiting them less and requiring less medication

Further examples of good practice/ evaluation/ outcomes needed from the Board WHAT SHOULD WE BE DOING NEXT? In order to develop services which are personalised, outcomes based, deliver quality and reflect the needs of the population we need to:

• Work with partners to develop our community based support services in response to the personalisation agenda outlined in ‘Putting People First’. These services need to focus on outcomes, offer an effective preventative response, support people on the pathway to recovery, develop social inclusion options and offer value for money.

• Develop vocational and employment opportunities to deliver a greater range of choice and support.

• Work to re-model crisis services to ensure that people receive adequate advice, information and signposting. This priority also crosses over into the JSNA for People who have Long Term Mental Health Needs.

• Better meet the needs of specific members of our community, e.g. BME and LGBT groups, by offering targeted communication and support where appropriate.

• Work to align the Care Pathways and Packages approach to the personalisation agenda.

• Undertake some further work to develop a more representative portfolio of costs to support future commissioning decisions.

Communities For Health 2010

Executive Summary

By

Professor Chris Drinkwater

Executive Summary Unlike many local authorities that used Communities for Health (C4H) funding to support a number of short term initiativesi, Newcastle, through the Health Improvement Board and Newcastle New Deal for Communities choose to use the funding to support a single project delivered by HealthWORKS Newcastle in order to develop, and if successful, scale-up a sustainable approach to an area of unmet need. The approach was two-pronged: firstly to develop a model in which local people have a voice in designing and commissioning services, and secondly in response to locally identified needs and priorities to provide a range of accessible social activities in order to build supportive networks for vulnerable older people and people with long-term conditions. Initially the project focused on older people with anxiety and depression in inner west Newcastle and people with long-term conditions in outer west Newcastle, but it subsequently became clear that there was considerable overlap between these groups and the criteria where changed to people over 50 suffering from low mood and/or social isolation with any long term condition. What were initially two projects with separate target groups, therefore became a single project with the key principle of providing a personalised and locally accessible response through a choice of activities delivered by voluntary sector providers. Apart from providing a more personalised, and accessible service, the underlying hypothesis was that it would be less expensive and more effective in preventing and reducing demand for expensive medical services than current approaches. This approach had the added value of being consistent with national policy such as ‘Putting People First’ and with DH commissioning guidance for long term conditions and has clearly become increasingly important at a time of impending public sector cuts. The outputs, outcomes and costs from an early independent evaluationii and from monitoring data demonstrate that the project is on track.

• Since 2008 over 4261 older people have been referred by their GP and have participated in the project. All have suffered from low mood, and social isolation

• All have at least one long term medical conditions, the majority have multiple conditions

• Costs range from £244 per person per year for high level of support and £70 per person per year for low level/ preventative work.

• Savings to the NHS are at least comparable to those demonstrated in the Partnerships for Older People Projects evaluationiii which stated that ‘community-facing' projects such as this showed increasing returns

1 This figure has been updated in October 2010 for the release of this summary

against economies of scale, such that the larger the project, the greater the saving.

• Over 180 previously sedentary individuals now taking part in regular physical activity.

• Over 1, 500 visits to Advice sessions (benefits, welfare, health)

• Over 1,700 people have benefited from the community investment

• 4 community organisations, promoting healthy lifestyles and tackling health inequalities in deprived areas, have been supported

• The project has benefited from the involvement of over 30 volunteers

• Employment opportunities have been provided for 2 people and increased working hours for 3 more people

• Good links have been established with GPs, Intermediate care, and many third sector organisations

• Proven to have a positive impact on mental health for the participants and GPs have reported some evidence of participants visiting them less and requiring less medication

The challenge now is to sustain and to scale-up the approach. In order to do this the project has combined with the Quality of Life Partnership as the ‘Joining the Dots’ Project. This has received joint funding from NHS and Adult Social Care Commissioners for a project development team which is a key element of transforming adult care in Newcastle. This is very welcome but the danger remains that unless funding can be found to support the activities once Communities for Health funding is exhausted in March 2011, then the project team will have nothing to develop.

‘I can’t tell you how much different I feel even after such a short time! I was feeling so stuck I didn’t know what to do’iv

The main report can be viewed at

www.hwn.org.uk i Department of Health. Communities for Health: Unlocking the energy within communities to improve health. October 2009 ii Iain Kitt. Communities for Health Project: evaluation report. May 2009 iii Personal Social Services Research Unit. The National Evaluation of the Partnerships for Older People Pilots. 2009. (www.pssru. ac.uk ) iv Female with cognitive damage due to repeated cardiac events, very low mood

http://www.hwn.org.uk/

1

FOR DEBATE – THE LOCAL MENTAL HEALTH SYSTEM

Background

A meeting between the Chair of the Social Inclusion and Recovery Delivery Group (SW) and the Prevention and Mental Health Promotion

Delivery Group (CD) identified the need to clarify the priorities, responsibilities and accountabilities of each group. Part of this discussion was

also about building on and re-assigning the actions identified in the Action Plan for Promoting Mental Health and Emotional Wellbeing in

Newcastle. This led to a discussion about the need to see mental health as a non-linear system in which people have different needs at one

and the same time in different parts of the system and consequently there is a an over-riding need to have a joined up and integrated

approach across the whole system.

The diagram on page 2 is an attempt to illustrate the various bits of the whole system. Some of these bits are better developed than others –

NTW Trust for instance when compared with the availability of social prescribing – and this can produce inefficiencies, unnecessary costs and

lack of a personalised approach. Agreeing who is responsible and accountable for which bits of the system and perhaps more problematically

agreeing how and what we prioritise will be critical to the success of Mental Health Strategic Board. There are also some major issues about

perceived lack of integration across the whole system, this is perhaps most obvious around the interfaces between GPs, Primary Care Mental

Health Services, the NTW Trust and social inclusion and recovery services.

Prevention and Mental Health Promotion

It is suggested that this group should have lead responsibility in community and workplace settings for promoting self-esteem and positive

mental health and for preventing the development of mental health problems. It should also have lead responsibility for addressing stigma

and diversity issues in communities and the workplace.

Social Inclusion and Recovery

It is suggested that this group should have lead responsibility for early intervention with brief support, together with continuing support and

that the focus of all of this work should be on recovery and social inclusion. The social inclusion element would address issues of stigma and

diversity in generalist and specialist service provision.

2

Interfaces and Gaps

Social prescribing is the interface between the two delivery groups and arguably the biggest gap in the system at present. This is also part of

the interface between adult social care and the NHS and it relates to a number of important policy agendas including personalisation, adult

services transformation and generic approaches to long term conditions. The Communities for Health Project has been working with GPs in

West Newcastle to develop a generic model of working with long term conditions – see diagram on page 4. The key approach is about

delivering a range and choice of activities that improve health and build local social networks. This is more likely to be successful if the groups

are inclusive and normalising, rather than condition specific. A summary of the Communities for Health evaluation is attached.

In addition to developing a range of social prescribing activities the Mental Health Strategic Partnership needs to ensure integrated approaches

to employment and housing needs for people with mental health problems.

Recommendation

It is suggested that this paper should be debated at the next meetings of the Prevention and Mental Health Promotion Delivery Group, the

Social Inclusion Delivery Group and the Mental Health Strategic Board. The overall aim should be to agree responsibility for the Actions within

the existing Mental Health and Emotional Wellbeing Action Plan and to agree an overall priorities framework.

Chris Drinkwater, Sheila Winter

3

THE LOCAL MENTAL HEALTH SYSTEM

COMMUNITY WORKPLACE

SOCIAL PRESCRIBING – ACTIVITIES, EMPLOYMENT, HOUSING

SOCIAL INCLUSION

RECOVERY GP & PCMH

NTW TRUST

PROMOTE SELF-ESTEEM

POSITIVE MENTAL HEALTH

PREVENT DEVELOPMENT OF

MENTAL HEALTH PROBLEMS

EARLY INTERVENTION AND

BRIEF SUPPORT

CONTINUING SUPPORT

HEALTH

CHAMPIONS (HTs)

V&CS WITH

OTHERS

OTHERS

GENERALIST, GP,

HEALTH

PSYCHOLOGY(IAPT

)

SPECIALIST

SERVICES ADDRESSING STIGMA AND

DIVERSITY

4

Social Enterprise

Condition specific care pathways

COPD, Diabetes, Obesity, Mental Illness, Learning disability

Initial assessment/stabilisation

Annual care planning

Social

Medical

Menu of activities related to needs/dependency

Self care Minimal support Moderate support High support

Own

programme

Direct access to services

with initial induction and

regular review

Health trainer

personalised

programme and

intensive review

5

Newcastle Wellbeing and Health Partnership: [Mental health social inclusion delivery group] – Terms of reference

Page 1 of 3

Name of group

Mental Health Social Inclusion & Recovery Delivery Group

Overall rolea

To plan and deliver a range of individual and community interventions with the overall aim of ensuring that adults with mental health needs contribute to and are included in their communities; are engaged in employment,volunteering, education, or training; and, can find and stay in a suitable home. To ensure the promotion of equality and diversity is intrinsic in the social inclusion and recovery agenda.

Key tasksb

• Work with and on behalf of Wellbeing and Health Partnership Mental Health Strategic Board to identify priorities for intervention

• Map and develop shared understanding of existing activity and resources (single partner or multi-agency) that contributes to the aim of the group

• Plan and deliver joint interventions maximising use of resources of all partner organisations

• Create opportunities for providers and practitioners to meet, share ideas and plan innovations.

Parent groupc

In Wellbeing and Health Partnership: Mental Health Strategic Board

Type of groupd

Delivery Group

Other key links – internal to Newcastle Wellbeing and Health Partnershipe

Other strategic boards

Other key links – external to Newcastle Wellbeing and Health Partnershipf

Supporting People Economy Partnership Environment, Housing and Transport Partnership Newcastle Partnership ICEE group

Membershipg

• Adult and Culture Services, Newcastle City Council (Adult Services and Commissioning Divisions)

• Newcastle Futures • Job Centre Plus • Northumberland, Tyne and Wear NHS Foundation

Trust • Representatives from the Social Inclusion &

Recovery Consortium & MH & Housing groups.


Page 2 of 3

• Launchpad • Carers representative.

Meeting detailsh

Initially monthly. To be reviewed

Chairi

S. Winter,Adult & Culture Services Directorate

Vice Chair

Lead officerj

Admin supportk

Adult & Culture Services Directorate

Date agreed by/last reviewed by Group

Date agreed by/last reviewed by Parent Group

Notes and guidance for writing Terms of Reference for a Wellbeing and Health Partnership group The following notes are intended to support you in completing the Terms of Reference and ensure standardisation in their presentation across the partnership. For support please contact Wellbeing and Health Partnership Coordinator

a Overall Role: This should be a short paragraph or a few short bullet points which encapsulate what the Group is

trying to achieve on behalf of Wellbeing and Health Partnership (the aim of the Group’s work).

• It should be jargon-free and easy to read for those less familiar with the work as it will be quoted in other documents.

• It may be useful to start with “To work on behalf of Wellbeing and Health Partnership to…..” b Key Tasks: These are the actual tasks or work areas the Group will do in order to achieve the overall aim.

• The section should help members of the Group to understand what is expected of them both in and out of the meetings.

• The tasks need to clearly link to the role of the group.

• In addition, it may be useful to think of the key tasks that the Group will undertake through consideration of an appropriate conceptual models of a relevant business process– e.g.

o a project group will carry out tasks that flow from consideration of different stages in a project management framework and/or content of project documentation;

o a (strategic) Board will carry out tasks that flow from consideration of a model of strategy c Parent Group: This is the part of Wellbeing and Health Partnership that established the Group and delegated

responsibilities to it.

• This section should also specify if the Group has been established as a joint Group with another partnership (e.g. Children and Young People Partnership, Safe Newcastle). Your own Parent Group must be briefed if you are making an arrangement to establish a Group in conjunction with another partnership. In these cases, changes may have to be made to the structure of the Terms of Reference to accommodate additional requirements of the other partnership.

d Type of Group: Groups may be:

[to come from other paper] Care must be taken not to duplicate the work of an existing group when establishing new Groups.


Page 3 of 3

e Other key links – internal to Wellbeing and Health Partnership

• All groups will be expected to liaise and work in conjunction with their own Parent Group and through them the Wellbeing and Health Executive so these needn’t be mentioned here.

• However, you do need to include other Wellbeing and Health Partnership groups that a group will need to influence or liaise with in order to carry out the responsibilities it has.

• It is important that you make sure the named groups know of this group’s existence! f Other key links – external to Wellbeing and Health Partnership

• Include here committees/steering groups external to Wellbeing and Health Partnership that a group will need to influence or liaise with in order to carry out the responsibilities it has.

• It is important that you make sure the named groups know of this group’s existence! g Membership:

• List here the Member Organisations and appropriate sections/departments that representatives need to come from to carry out the work of the group. You should not list the names or job titles of the representatives.

• Active consideration should be given to the appropriate involvement of voluntary organisations, community groups, and businesses either through sectoral representation or through inviting organisations with remits that fit with the role of the group.

• Co-optees should be identified separately if appropriate

• Any Officers/Advisers attending the subcommittee regularly should be listed by job title at the end of the section.

• If appropriate include a clause that invites others to join e.g. “Membership is open to any member organisation who is interested in taking part in the work of the group”

h Meeting details: include

• The frequency of the meetings

• The ‘rule’ for setting meeting dates e.g. third Wednesday of the month

• Usual time of meetings

• Venue of meetings, if the same venue is used each time. i Chair and Vice Chair: Include the name and organisation of the Chair and Vice Chair of the Group. In line with the constitution:

• The Chair and the Vice Chair must be (s)elected and agreed by the membership of the group

• The Chair and Vice Chair will have a two year term of office

• The Chair and Vice Chair will be able to re-stand for re(s)election

• There can be variations on this which should be outlined in the Terms of Reference and agreed by the Group and its Parent Group e.g. “The group will always be chaired by [job title]”

j Lead Officer: The Lead Officer is the person who will work with the Chair to make sure appropriate Agenda and Papers are prepared for the meetings. List the job title, not the person’s name. k Admin support: List the unit/department/organisation that will make arrangements for the group to have admin

support e.g. minute taking, distribution of info

Page 1 of 4

Wellbeing and Health Partnership

Mental Health Strategic Board

Meeting held on Monday 15 November 2010, 2pm – 4pm Bewick Room

Minutes

Item No Item Action

1. Present:

• Cathy Bull, Director of Adult Social Care NCC

• Alisdair Cameron, Launchpad

• Chris Drinkwater, Delivery Lead Prevention & Mental Health Promotion

• Brendan Hill, Chief Executive Mental Health Concern

• Denise Pickersgill, NHS North of Tyne

• Jan Thompson, Public Health Specialist NHS North of Tyne

• Caroline Wild, Head of Partnerships Northumberland Tyne and Wear NHS Foundation

• Roger Mould, Partnership, Policy and Projects Officer NCVS

• Graham Ricketts, Launchpad

• Angela Jamson, Commissioning Manager NCC

• Sheila Winter, Delivery Lead Social Inclusion & recovery

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In attendance:

• Helen Wilding, Wellbeing and Health Partnership Coordinator NCC

• Emma Burton, Administrator (Minute Taker)

Apologies:

• Clare Bethell, Community Health

• Rebecca Eadie, NHS North of Tyne

• Gary O’Hare, Northumberland, Tyne and Wear Mental Health Trust

1.1 The Chair opened the meeting with formal introductions and apologies for absence

2. Context: Wellbeing and Health Partnership

2.1 Helen referred to The Wellbeing and Health Partnership diagram and gave an overview of the Partnership explaining that it consists in tiers The Executive, The Strategic Board’s and Delivery Groups. The Mental Health Board is a Strategic Board and members need to consider how the delivery group arrangements need to work.

3. Draft Terms of Reference :

• Role of Group

• Membership of group

3.1 Helen gave an overview of the draft TOR and explained to the members that this was given to them to own and to take on board

Wide discussions took place and the following points were made:

• It was felt that we have a link to pull partners together and agree priorities, as a group we need to come together and look at strategies and strategic planning. We need to make sure that we make connections with other Partnerships and work together to make things happen.

• As we have JSNA responsibilities it was recognised that it may need to change in the future as the JSNA develops

• We need to allow for GP Commissioning Consortia to join the group as and when they are ready

• We need to think about how we manage Carers issues with the Carers Strategic boards it was decided the most effective way to deliver information was via the Carers Strategic Delivery Board we

Page 3 of 4

can revisit in the future if we need to

3.2 Conversations are ongoing who will take on the Lead Officer role, in the mean time we need to use the resources available but acknowledge the need it was agreed to await Helens advice.

It was agreed that the meeting should be chaired by someone with a Strategic Senior Management position Action: Cathy Bull to discuss with Meng Khaw and bring back to the next board meeting for further discussions

CB/MK

3.3 TOR were agreed subject to the following minor amendments:

Action: HW to make amendments

• Removal of North East Commissioning Consortia

• GP Consortia input to be confirmed

• Follow up response from Newcastle Hospitals NHS Foundation Trust

• Remove Carer representation (as we will develop relationship with Carers Strategic Board who lead on this issue)

HW

4. Delivery Groups

• Prevention and mental health promotion

• Social inclusion and recovery group

4.1 Mental Health Promotion are happy with the TOR and existing action plan Action: Circulate action plan to Board

CD

4.2 Sheila gave an overview of the progress of the newly formed Social Inclusion Recovery Group it was proposed that this group should have frequent communication with the board discussions took place and the following was agreed:

• Minutes from the board to be circulated to the recovery group

• Social Inclusion Recovery Group to forward on monthly progress report to board

Action: Sheila and Chris to meet to discuss Social Inclusion Group and Prevention & Mental Health Prevention Group

SW/CD

5. Joint Strategic Needs Assessment – work to date

5.1 Angela summarised the progress of the JSNA work which is currently being populated, as topic author it was proposed to bring the JSNA and Commissioning strategy to the board in draft form in order to

Page 4 of 4

develop further.

6. Forward Planning

6.1 The chair summarised the forward plans for the future and the following actions were agreed:

• Develop JSNA

• Emerging Commissioning Strategy

• Getting to know Delivery Board work

• Set up monthly board meeting

All

AJ

All

EB

7. AOB

7.1 Communications re: Mental Health Foundation ways to look after your Mental Health

Action: Helen to draw people together for further conversations

HW

8. Date and time of next meeting:

TBC

Documents

Agenda - Wellbeing for Life