Transcript Progress on Delivering for Mental Health

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Mental Health
Implementation Board
15 August 2007
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Mental Health Implementation
Board
15 August 2007
Alex McMahon and Denise Coia
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Background
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Delivering for Mental Health – 5/12/2006
LDP/trajectories for targets in place – April
First implementation visits – April/May
Report back to CEs – July
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Overview
 Good energy, with Boards using DfMH to drive
service improvement
 Top teams at review meetings (though some
interesting gaps)
 Need to improve evidence gathering to better
assess and benchmark progress
 Generally good progress, but CAMHS challenging
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Commitments with Boards
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3 – Depression
4 – Psychological Therapies
5 – Physical Health
8 – Crisis Standards
9 – Acute Inpatient Forums
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Depression
 Most areas seem to know what they know
 Standardised tools generally being used (but we don’t
know much about coverage across GP practices)
 Some therapies in place in some places (more to come as
part of ICP implementation)
 Some areas using stepped care approach
 Action on CHD/diabetes co-morbidity less evident
 Most areas have plans, but many unresolved issues and
question over pace of change
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Psychological Therapies
 Generally good information about staff trained to deliver
therapies, but poor information about therapies being
delivered
 Local planning arrangements mostly in place
 NHS NES developing plans to significantly increase
number of trained staff (with appropriate supervision)
 Improvement Collaborative will focus on redesign to
ensure skills are used
 Action point for HD – set baseline for commitment
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Physical Health
 Evidence of good progress, But some Boards flagging
need for support and guidance (consultant adviser in place)
 Very different approaches being taken (GP; day hospital;
secondary services; etc.)
 Some Boards moving beyond the commitment to match
interventions to assessed needs
 Some Boards taking approach into inpatient settings
 Consultations September to November 2007
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Crisis Standards
 Lots of activity – crisis response; OOH
provision, IHTT; etc.
 Coverage – geography and time – issues,
particularly in rural areas
 But delivery not being benchmarked against
standards – need for guidance from HD?
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Acute Inpatient Forums
 No forums in place yet, but discussions underway and
local models being developed
 No significant problems identified with regard to 2009
timescale
 Issues with respect to Orkney and Shetland and their use of
mainland facilities
 Main challenge will be in demonstrating added value
 Similar issues – staff engagement, environment, activity,
privacy – raised for continuing care wards by MWC report
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Commitments with HD
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1 – Cultures and Behaviours
2 – Peer Support Workers
6 – ICPs for 5 Diagnoses (NHS QIS)
7 – Suicide Training for Frontline Staff
12 – CPA for Restricted Patients
13 – MH/Substance abuse co-morbidity
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Support Programme
 Leadership Programme – 24 April
 Benchmarking Project – August
 Collaborative – launch September (has
slipped)
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CAMHS
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Leadership and accountability not clear
Significant gaps in intensive community responses
Risks in respect of funding sources
Ongoing discussion about service model for
specialist services
 ? Need for clearer statement of necessary service
elements
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New Challenges
 Possible revised commitment to 10%
reduction by [2009] in anti-depressant
prescribing
 Dementia now a higher priority
 Focus on health improvement and public
health approaches
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Next Steps
 Board specific letter to each NHS CE
 Further work on how we gather and present
evidence
 Focus on HEAT targets for Annual Reviews
 Next visits in October/November
 Guidance on Substance Misuse and on Physical
health- December / January
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Mental Health
Implementation Board
15 August 2007
MENTAL HEALTH and SUBSTANCE MISUSE
Peter Rice,
Consultant Psychiatrist, NHS Tayside and
Chair, Mental Health and Substance Misuse Group
THE MENTAL HEALTH and SUBSTANCE MISUSE GROUP
- To improve the awareness of co-occurring mental health
and substance misuse problems and
- To improve support and service provision for people who
have both mental health and substance misuse problems.
- Our goal is to enable individuals to improve their life
chances and live to their potential.
MENTAL HEALTH AND SUBSTANCE MISUSE GROUP
Dr Peter Rice (Chair): Consultant Psychiatrist, Tayside Alcohol Problems Service, NHS Tayside
Dr Alex Baldacchino: Director, Centre for Addiction Research and Education Scotland, University of Dundee
Dr Seonaid Anderson, Specialist Registrar, NHS Grampian (from December 2006)
Dr Stephen Bell: Consultant Clinical Psychologist and Neuropsychologist, NHS Grampian
Dr David Blaney: Director of Postgraduate GP Education, NHS Education Scotland
Jim Carroll: Clydebank Addiction Team
Dr Fiona Clunie, Consultant Psychiatrist (Rehabilitation), NHS Lothian and Chair of Rehabilitation Sub Group,
Dr Denise Coia: Psychiatric Adviser, Scottish Executive Health Department
Frank Fallan: Voices of Experience (VoX) (from January 2007)
Dr Andrew Fraser: Director of Health Care, Scottish Prison Service
Ellen Hair: Planning and Commissioning Officer, Mental Health Services, Edinburgh an (ADSW)
Dr Audrey Hillman: Consultant Psychiatrist (Mental Health and Substance Misuse), Inverclyde Community
Health Partnership, NHS Greater Glasgow and Clyde
Dr Charles Lind: Consultant Psychiatrist (Substance Misuse), NHS Ayrshire & Arran
Chris Lock: Voices of Experience mental health service user representation (to November 2006)
Dr Tom MacEwan: Consultant Psychiatrist (Old Age Psychiatry), NHS Grampian
Mike McCarron: Association of Alcohol and Drug Action Teams, National Substance Use Liaison Officer
Lorraine McGrath: Scottish Association for Mental Health
Dr Debbie Mountain: Consultant Psychiatrist (Rehabilitation), NHS Lothian and Chair of Rehabilitation Sub Group
Dr Donald Mowat: Consultant and Clinical Director in Old Age Psychiatry, NHS Grampian
Karen Norrie: Addictions Adviser, Scottish Prison Service
Barbara O’Donnell: National Alcohol Liaison Officer, Alcohol Focus Scotland
Chris Park: Acting Service Manager – Alcohol and ARBD, Inverclyde Council
Dougie Paterson: National Operations Manager, Choose Life (from October 2006)
Jacqui Pollock: Carers Scotland and also representing Princess Royal Trust of Carers and Coalition of Carers in Scotland
Eunice Reed: Consultant Clinical Psychologist (Substance Misuse), NHS Lothian
Gail Reid: Secondary Services Manager, Glasgow Addiction Services, NHS Greater Glasgow and Clyde
Linda Reid: Senior Mental Health Liaison Officer, Scottish Executive Health Department
Marion Shawcross: Mental Welfare Commission for Scotland
Addie Stevenson: Director of Children and Family Services, Aberlour Child Care Trust
Clive Travers: Head of Mental Health, North Community Health Care Partnership, NHS Greater Glasgow and Clyde
Alan Wilson: Al-Anon (from November 2006)
THE NATURE OF THE GAP
- “Individuals with substance misuse-related issues often
did not have sufficiently severe mental health problems to
be eligible for attention from community mental health
teams which prioritised severe and enduring mental illness.”
(CARES report) and
- “Despite high prevalence rates of drug misuse, only a
small number (less than 5%) of mental health patients
exhibited patterns of drug use that would have been likely
to satisfy eligibility criteria for statutory drug treatment
programmes in their areas mainly because they were not
opiate users.” (Department of Health 2004)
PROMOTION, PREVENTION &
COMMUNICATIONS
- Promotion and prevention policy, strategy and delivery
for addressing substance misuse and mental health
problems and illness should be part of and integral to
broader promotion and prevention action.
- These promotion/prevention strategies and actions
should also highlight and target those populations most at
risk and the interventions that are most effective in
minimising risk and promoting protective factors.
SUICIDE PREVENTION
of UK suicides in contact with services:
- 27% have “dual diagnosis”
- 50% have a history of alcohol problems
- 37% have a history of drug problems
- 13% of Scottish drug overdose deaths “intentional”
SUICIDE PREVENTION
- Substance misuse services should be involved in and
provide training in suicide risk assessment and
prevention in line with commitment 7 in Delivering for
Mental Health.
- Drug Related Death Monitoring Groups and Choose
Life and Suicide Prevention Groups should work
together.
- NHS boards should establish a mechanism to monitor
alcohol related suicide trends.
STIGMA
- Identified as a major issue in user consultation
- Scottish research work with staff indicates problems
- Training and supervision programmes improve staff
expectations and attitudes
RESEARCH and MONITORING
- To continuously monitor the epidemiology of co-morbid
mental health and substance misuse issues in Scotland
- To evaluate of current practice to ascertain efficiency
and effectiveness
- To study the impact of parental co-morbidity on children
- To understand the prevalence, type and impact of
co-morbidity present in the prison, psychiatric and general
practice populations
IDENTIFICATION
- All substance misuse and mental health agencies
should have assessment processes which identify
co-morbidity systematically to match care appropriate
to level of need
- We have suggested
co-morbidity
validated
tools
to
identify
- Recognise the training needs for services to use these
SERVICE PLANNING AND DELIVERY
- Improve public awareness of the relationship between
substance use, misuse and mental health as part of
stepped care approach.
- Substance misuse services should develop knowledge,
skills and capacity in psychological treatments for
substance misuse and to meet the mental health needs
of their client group.
- NHS mental health services should have the lead
coordinating responsibility for care for those whose
mental health needs are severe and enduring and whose
needs are best met within specialist care, for instance, by
integrated care pathways.
TRAINING
- A training strategy should be developed by NHS boards
and partner agencies, including NHS Education Scotland
- The Alcohol and Drugs Workforce Development Strategy
Group should include mental health competencies within
their remit
- Other accreditation bodies should consider the needs for
skills development in co-morbidity in their criteria
ALCOHOL RELATED BRAIN DAMAGE (ARBD)
- Limited data, but major concern by housing agencies
- Improve identification and stepped approach to
assessment
- Improve prevention by population and high risk
approaches
- Development of cognitive impairment complex and
multi-factorial
- Care needs best met alongside other forms of cognitive
impairment and brain injury
- Need for strategic review of services for younger people
with cognitive impairment and brain injury
SPECIAL CONSIDERATIONS
Older People
- Demographic trends
- Lack of research on effectiveness
Children and Young People
- Impact of parental problems
- Services for younger people
Learning Disability
- Distinct needs for health promotion and services
Trauma and Abuse Survivors
- Staff competencies
- Stepped care approach
PROCESS AND PROGRESS
4 August 2006
First Meeting of Group.
May/June 2007
Late Draft Discussions with:
- NHS Health Scotland
- Health Improvement
- Mental Health Division
- Public Health and Substance Misuse Division
Involvement of Scottish government Ministers
21 June
Consultation draft circulated at Event
George Hotel, 200 attendees
Presentations, facilitated groups, conference report
21 June
Formal Consultation launched
13 September
Consultation ends
10 December
Report Launch
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Mental Health
Implementation Board
15 August 2007