Value based system of care in England:

• What are the common needs people tell us they haveNeeds

• What outcomes do people tell us they want• What outcomes are now being routinely measuredOutcomes

• How do we coproduce better assessments and agree formulation and diagnos(es) with the person Assessment, formulation, diagnoses

• What effective care interventions can guide our practice to address those needs & deliver outcomesEffective care: NICE/SCIE

• What Best outcomes, Best Value care do commissioners want Commissioning

• What care pathways and service delivery models enable evidence based care to be delivered with Value added Home based careCare pathways

• What information do we have on current baseline• What information do we critically need for ValueInformation

• Current leaders and the new CCGs, Area team, SCNs, AHSNs, CLARHs, health economists Leaders

Working together, mental health can deliver social and wealth

capital for England

From the patient’s

perspective

Safety “Will I be ok?”

Effectiveness “Will it do me any

good?”

Experience“Access, information & treatment experience”Efficiency

Was it fast, safe , near home , back to work

asap

What Outcomes do our service users ask us to achieve in partnership with them

Professor Bruce Keogh, Medical Director of the NHS

Parity and equalities: Benchmark October 2013There is a disparity in the number of people with mental illness in contact with services, compared to physical health, yet it is a major cause of premature death & lives lived in distress and misery

26% of adults with mental illness receive care92% of people with diabetes receive care

By condition…. % in treatment

Anxiety and depression 24PTSD 28Psychosis 80ADHD 34Eating disorders 25Alcohol dependence 23Drug dependence 14

Mental health problems are estimated to be the commonest cause of premature death

Largest proportion of the disease burden in the UK (22.8%), larger than cardiovascular disease (16.2%) or cancer (15.9%)

People with schizophrenia die 15-25 years earlier

Depression associated with 50% increased mortality from all disease

Value based system of care in England

• What effective care interventions can guide our practice to address those needs & deliver outcomesEffective care:

NICE/SCIE

• What Best outcomes, Best Value care do commissioners want

Commissioners

• What care pathways and service delivery models enable evidence based care to be delivered with Value added

• And to increase access and self management Care pathways

• What information do we have on current baseline• What information do we critically need for Value• Economic remodelling

Information

• Current leaders and the new CCGs, Area team, SCNs, s

Leaders

NICE Guidelines 2013

Alcohol dependence & harmful use & clinical managementAntenatal and postnatal mental healthAntisocial personality disorderAnxiety disorders Attention deficit hyperactivity disorder (ADHD) Bipolar disorder Borderline personality disorder (BPD) DementiaDepression in adults Depression in children and young peopleDepression with a chronic

physical health problemDrug misuse: opioid detoxificationDrug misuse: psychosocial interventions Eating disordersMedicines adherenceObsessive compulsive disorder (OCD) and body dismorphic disorder (BDD)Post-traumatic stress disorder (PTSD)Schizophrenia (update)Self-harmViolenceWhen to suspect child maltreatment

 Completed public health guidance

Brief interventions and referral for smoking cessationInterventions to reduce substance misuse among vulnerable young people

Mental wellbeing and older peopleNeedle and syringe programmes

Preventing the uptake of smoking by children and young peopleSchool-based interventions on alcoholSmoking cessation servicesSocial and emotional wellbeing in primary educationSocial and emotional wellbeing in secondary educationWorkplace interventions to promote smoking cessation

Autism spectrum disorders in children and young peopleDeliriumIdentification and care pathways for common mental health disordersPsychosis with substance misuseSelf-harm (longer term management)

Public health guidance in developmentAlcohol-use disorders (prevention)Home-based approaches to promoting children's wellbeingLooked after childrenPersonal, social and health education focusing on sex and relationships and alcohol educationPre-school approaches to promoting children's wellbeingPreventing domestic violenceQuitting smoking in pregnancy and following childbirthSchool-based interventions to prevent smoking

Value in mental health NICE/SCIE 1. Right information 2. Right physical health care3. Right medication4. Right psychological therapies5. Right rehabilitation, training for employment6. Right care plan addressing housing, work, healthcare, self management

7. Right crisis care

8

Mental health : Is the problem that we have no evidence or value based guidance?

Mental health has over 100 NICE Health Technology appraisals, NICE guidelines, Public health related guidelines and Quality standards…..

The problem is not lack of guidance The problem is that we have not focused on how we learn and disseminate from

those that can and have implementedCan the FT network lead a new NHS Change model?

9

“Crossing the Quality Chasm”

Ohio State Psychiatry Grand Rounds 12.05.2012

National Audit of Sschizophrenia Physical Health• Significant premature mortality among those with a diagnosis of schizophrenia

(M=20yrs; F=15yrs).

• Only 29% had all 5 risk factors monitored only 25% had treatment for elevated BP

Medicines • 10 fold variation among trusts in relation to adherence to safe, effective medicines

practice

Psychological Therapies• The range of those offered psychological therapies varied from 0% to 94%.

What are the reasons for increased Length of stay

Comorbidities: physical ill health, substance misuse, PD Detentions under the mental health act Implementations of NICE/SCIE evidence based care Workforce capacity and competence

• People with SMI die 15-25 years younger due to 5-12 times increased levels of un assessed and untreated COPD, Diabetes, High BP, Cancer

• Substance misuse is 6+ times more common in people with SMI• Workforce strategies and training programmes need to be provide training

in evidence based treatments

Co-morbidity is the norm

Lancet, Barnett, Mercer et al 2012

5. Integrated physical and mental health care Long term conditions Mental health raises costs in all sectors

Chris Naylor, Kings fund

• Overall, international research finds that co-morbid MH problems are associated with a 45-75% increase in service costs per patient(after controlling for severity of physical illness)

• Between 12% and 18% of all expenditure on long-term conditions is linked to poor mental health and wellbeing – at least £1 in every £8 spent on long-term conditions. Hea

rt Fa

ilure

Stroke

Heart

disease

Diabete

s

Hypert

ensio

n

Arthriti

sCOPD

Cancer

Asthma

0%

20%

40%

60%

80%

100%

120%

140%

160%

180%

DepressionAnxiety

% in

crea

se in

ann

ual p

er p

atien

t co

sts

(exc

ludi

ng c

osts

of M

H c

are)

Mental health has the capacity to improve England's social and wealth capital

Economic remodelling programmes • Unplanned care pathways • Psychosis pathways• Children and Young people pathways• Integrated physical and mental health care pathways

Prevention and Early intervention (Knapp et al, 2011)highly effective treatments: major economic benefit

For every one pound spent the savings are:

Parenting interventions for families with conduct disorder : £8

Early diagnosis and treatment of depression at work: £5 in year 1

Early intervention of psychosis £18 in year 1

Screening & brief interventions in primary care for alcohol misuse £12 Yr 1

Employment support for those recovering from mental illness: Individual Placement Support for people with severe mental illness results in annual savings of £6,000 per client (Burns et al, 2009)

Housing support services for men with enduring mental illness: annual savings: £11,000–£20,000 per client (CSED, 2010).

Outcomes in Mental health