Parity of Esteem & Mental Health Services

Pat Drohan Patient Engagement, Experience & Equality Lead

Amanda Derbyshire Support, Time and Recovery Worker and Trainee Assistant Practitioner

Parity of Esteem

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

Royal College of Psychiatrists

Amanda Derbyshire

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

Introduction

• Background Rationale – Research evidencing the importance of the physical health

care needs of individuals with a severe mental health illness

• Pilot Study

• My role in implementing change to improve:– Service users’ physical health, wellbeing and self care – Team unity by using a multi-disciplinary team approach– Links with primary and secondary care services

• Future Developments

Background Rationale• The Mental Health Strategy (2011) states that having a

mental health problem increases the risk of physical ill health.

• Individuals suffering with mental illness like Schizophrenia, die on average 20 years earlier than the general population (Rethink, Lethal discrimination, 2013) and experience up to three times more physical health problems.

• Less than 30% of individuals with Schizophrenia receive annual comprehensive physical health screenings.

• The mortality gap is widening and will continue to do so if this population do not receive the same benefits of care, as the general population (Brown et al, 2010).

Pilot Study

• Pilot Study – AQuA Project – (2013) – Don’t Just Screen Intervene, – Lester cardio-metabolic tool (RSPHYSC, 2014)

– Adhering to NICE Guidelines Schizophrenia (2013)– Lethal Discrimination (Rethink 2013)

• Base Line Audit (finding the starting point)– Liaised with GP surgeries and worked with care co-

ordinators to compile service users physical health records.– Input data into a Survey Monkey – Only 6% of service users had received a baseline

comprehensive screening– Falling to 3% at the two-year stage of treatment

Lester Cardiometabolic Tool (RSPHYSC, 2014)

Implementing Change• Physical Health Lead Role established

– Dedicated time

• Establishing Steering Group– Primary and Secondary Care links– Public Health– Service users representatives

• Enhanced Clinical Skills through training

• Developed Health and Well-being Clinics– Clinical setting– Home visits - incorporating local Wellbeing nurses– Liaison and communication links with team, GPs and

Wellbeing nurses

Implementing Change• Database Development

– No I.T. infrastructure available– Created own using evidence based, best practice guidelines. – Became a live document (April 2013)– Outlook appointment reminder

• Produced Educational DVD and GP Leaflet

• Re-Audit (six months after implementation) – Comprehensive physical health screenings improved to 95%– Unmet and underlying physical health problems have been

identified and interventions have been put into place

• British Journal of Medical Practitioners article

…cont.

Audit Results

Baseline Audit Re-Audit

Baseline 6% 66%

3 months 5% 72%

12 months 6% 77%

24 months 3% 95%

Case StudiesPre Audit

– Ad-hoc screenings– Results missing and not recorded– No interventions in place– Referrals not followed up– GP liaison inconsistent

Post Audit– Full comprehensive baseline screening– Follow up screenings completed – All results recorded comprehensively– Co-ordination with GPs/wellbeing nurses– Intervention plans initiated immediately– Weekly follow up appointments and screenings

What are people saying….

“The service Amanda offers has opened my eyes and

really helped me to understand the importance of

my physical health and the need to stop smoking”

Service User

“Partnership working helps us to achieve our targets and ensures that service users needs are met

and data is shared without duplication”

Wellbeing Nurse in Primary Care

Future• Developing an Early Intervention Outcomes Dashboard

• Academic Research–Links with Liverpool John Moores University

•Access to services standard for Early Intervention– NICE approved care package

• Early Intervention Service

- New Role Development

- Physical Health Clinic in partnership

with primary and secondary care

• Developing a service user-led Health andWellbeing Group

Conclusion• All service users now receive baseline comprehensive

physical health screenings and are monitored regularly throughout their care.

• A multi-disciplinary team approach used to work together and promote physical health– Working proactively to ensure physical and mental health run

concurrently, addressing inequalities and examining the wider determinants of health to embed the importance of protecting and improving the nation’s health.

• Data is stored electronically and is shared between primary and secondary care services to enable integration of services

GP Leaflet

University Project

Draft Dashboard

Video Link

https://www.youtube.com/watch?feature=player_embedded&v=x3zgM46Ne6w#t=

62

Later Life and Memory Service (LLAMS)

Who are LLAMS?LLAMS help and support older people who are experiencing mental health difficulties like anxiety or depression.

We also help with memory problems and Dementia.

Later Life and Memory Service (LLAMS)

Borough 2012 2014 2016 2018 2020% Increase from 2012

Halton 1,229 1,256 1,314 1,421 1,518 23.5%

St Helens 2,081 2,134 2,224 2,366 2,506 20.4%

Warrington 2,155 2,321 2,450 2,641 2,837 31.6%

Knowsley 1,594 1,699 1,805 1,917 1,96623.3%

 

Wigan 3,259 3,443 3,637 3,918 4,123 26.5%

Total 10,318 10,853 11,430 12,263 12,950  

Projected Prevalence of Dementia

LLAMS Care Philosophy

• Rapid and Early Assessment and Diagnosis

• Holistic (all round) Patient and Carer support to live well close to home

• High Quality Specialist and Intensive In-Patient support

Locally Based Borough Community Teams

CMHTCMHT

AssessmentAssessment

Memory

Team

Memory

Team

In-Patient CareIn-Patient Care

Post Diagnostic Support

Post Diagnostic Support

Local Authority

Local Authority

Acute CareAcute Care3rd

Sector3rd

Sector

Primary Care

Primary Care

LLAMS community redesignReferral Received

Triage into Urgent and Routine

Provide an appointment to undertake core

assessment within 10 working days

Undertake assessment within 1

working day

Senior Practitioner feeds the findings

into a MDT

Need identified – Memory Service

function

Need identified – CMHT function

Allocation & treatment begins within 10 working

days

Pre-diagnostic assessment /

treatment begins within 28 days

Provide Service User & Carer with

diagnosis

Deliver therapeutic post diagnosis

support/intervention

Review treatment plan within 6

months

Manage as appropriate under

shared care arrangements

EndCo

ntinu

e

Routine

Urgent

Shared Care

Referral

Assessment

Intervention

Review

Discharge from service

Discharge

• A single community service

• 4 key service functions

• Improved throughput, capacity and speed of response

• Began May 2013

1 Years’ Experience in Wigan

• Waiting Time reduction > 9 Months to 3 Months referral to Diagnosis

• Increased Diagnosis Rates by 15%• Full year effect on in-patient unit

– 23% reduction in occupancy: 84% to 65%– 10 day reduction in average occupancy 53

to 43 days

Building on Strengths

Oct/Nov 2011

Model of Care Presented to PCT’s,

OSC’s

March to September 2012

Community Pathway Piloted in

Wigan Borough

September 2012 to March 2013

Pilot results and change plans

presented to CCG’s and OSC’s

Redesign Steering groups established

May 2013

’Go Live’ of Community Pathway in remaining Boroughs

Before Changes After Changes

• Waiting Time up to 1 year• Assessment to Diagnosis - up to 9

months• Multiple teams• In Patient Occupancy (Wigan) 84%• LOS 53 days

• Waiting Time 24 hrs (Urgent) and 10 days (Routine)

• Assessment to Diagnosis at 3 Months• Integrated Teams• Carers Assessments• In Patient Occupancy (Wigan) 65%• LOS 43 Days

Any Questions?