Joint Mental Health Commissioning Strategy

1

• Joint Mental Health Commissioning Strategy
• Mainstreaming Mental Health

2
Mental Health Partnership BoardVision Values

• Vision
• The vision for Kirklees is designed to enable our
  local population, to maintain and improve their
  mental health and wellbeing.
• For those who experience mental health distress,
  our aspiration is for them to obtain the highest
  level of self sufficiency within their
  communities, through the use of valued, quality
  support, networks and services

Values In working towards our vision we
will Act with integrity in the spirit of
openness and true partnership Encourage and
empower individuals to exercise their rights to
choice , respect, dignity and independence
through equality, opportunity, and
inclusion Embrace the diversity of our local
population to facilitate their mental
wellbeing Involve and inform local people in
planning and reviewing services to meet their
needs Implement rapidly and systematically
improvements in service delivery, based
on evidenced practice through effective and
accountable leadership and management Ensure
appropriate and timely access to services Value
and accept feedback from Individuals and
providers across Kirklees Do what we say we will
3
What Works and Ways Forward
Target High Risk Groups People with MH
problems People with disabilities Vulnerable
Young people Offenders Homeless
people Disadvantaged families Isolated older
people Travellers asylum seekers BME Groups
Promote Well being
Address underlying Risk Factors
Promote Protective Factors
Reduce Risk Factors
Resilience Life Skills to deal with
Everyday traumas Violence Abuse

• Promote
• Protective Factors
• Access to Creativity
• Emotional Literacy
• Relationship Skills
• Talking Therapies

Mental Well Being
Individual Physical Risk Factors

• Reduce Risk Factors
• Smoking
• Drugs
• Alcohol

• Promote Protective Factors
• Healthy Eating
• Physical Activity

Physical Well Being
Social Determinants
Social Well Being

• Reduce Risk Factors
• Unemployment
• Poverty Homelessness
• Discrimination
• Family Breakdown

• Promote Protective Factors
• Housing,Benefits Advice Advocacy
• Community Activity Social Networks
• Health settings-work, Hospitals, Prisons

Access and Discrimination
Engagement with Third
Sector and Citizens
4

Psychological Services
Biological Services
Environmental Experience

Social Services
Economic Trends
Social Integration
Recovery
5
Stepped/Tiered Approach - Prevalence
Incidence
Between 1000 1200 people
Acute Illness Significant Risk
Tier 1
Treatment resistant - Severe enduring illness
Between 1,200 3,000 people
Tier 2
Tier 3
This is the neglected majority. Between 5,000
7,000 people
Common Enduring Illness
Tier 4
Milder Disorder
In Primary care 40,000
Tier 5
Some concern watchful regard
In Primary care 10,000
The whole working age population some 237,250
people.
It has been acknowledged that the science behind
the numbers is not as precise as everyone would
want. This is particularly significant at Tiers
3, 4 and 5. In Kirklees the overall adult
population is predicted to rise by 3. It has to
be the case that numbers alone will not best
inform what needs are.
6

• Community resilience is problematic together with
  some key areas of provision. In using a
• range of approaches to assess need, we can
  capture themes expressed by people who
• experience services. In the national MIND survey
  of 2004 the issues below were seen as a
• major or contributory cause of isolation and
  mental distress.
• Issue
  Mentioned by
• Discrimination
  58 of people
• Isolation
  79
• Lack of confidence
  78
• A lack of close relationships
  74
• A lack of work
  54
• Lack of money
  59
• Lack of transport
  42
• Lack of supportive housing
  42
• Lack of information
  43
• Lack of support
  57
• Not feeling safe
  60

7

• There is little education and training for work
• Literacy and innumeracy are issues.
• Learning for itself is not available
• Creative arts and cultural activity is important
• They want physical activity alongside
  recreational and sporting activity
• Volunteering needs to be an option.
• They want more coping resources including self
  help.
• Can I connect with faith-based groups?
• Is there money, debt, and legal advice?
• Are there opportunities for social participation?
• They want an increased sense of responsibility.
• Friendships and social support outside of
  professional networks.
• Access to the telephone or the internet.
• Mentoring and buddying around skill development.
• Access to ways to campaign.
• Affordable, accessible social activity

8
(No Transcript)
9
Target Service What does this mean for Mental
Health

• Now
• Focus on secondary care services
• Small numbers
• High cost/High risk
• Single local provider
• Discharge difficulties
• Limited partnership working
• Patchy investment in community based services
• Blocked care pathways
• Serious gaps in prevention
• Lack of capacity in primary care
• Too little emphasis on public service roles in
  health promotion, diagnosis and assessment, and
  well-being
• Major unmet need
• e.g. Employment

• Future
• Focus on integrated partnership working
• Across NHS services
• With social care and local government
• With the third sector
• With people who experience services
• and their carers.
• Emphasis on health promotion and well-being,
  community capacity and diversity. Responding to
  the key themes of need.
• Greater investment in improved practice-based
  primary care services for diagnosis, assessment,
  more treatment and care options
• Investment in more community-based care
• management
• Changing focus on investment from
• services to neighbourhoods.
• Investment in employment opportunity

10

• Desired Service Model 2010
• The focus of public services will be on
  well-being, rather than on mental ill-health.
• Citizens-commissioners will be accessing
  personalised services via individualised budgets.
• More choices the third sector will be
  available and include access to learning,
  leisure, creativity, volunteering and employment.
• There will be increased investment in community
  based solutions at the expense of more
  traditional provision.
• M.H. services need to be integrated into
  ordinary services such as libraries, G.P.
  surgeries, places of work and community groups.
• Care management will be based on the principles
  of hope and recovery and will have a brokerage
  function.
• Supported living will have been enhanced.
• The anti-stigma movement will be stronger

• Current Service Model 2007
• Recovery model established to support people
  leaving hospital.
• Integrated assessment and care management
  service across health and social care.
• Service users and carers involved in service
  planning and monitoring.
• Single point of entry via CMHTs.
• Supporting People schemes supporting people to
  live independently.
• A limited range of living options available
• Too much reliance on out of area placements.
• PICU managed by SWYMHT 5 additional local
  acute beds.
• Assertive Outreach Service in place
• Range of specialist mental health Carers
  Support Services available.
• Independent Mental Capacity Advocacy Service in
  place.
• Partial early Intervention in Psychosis (EIP)
  Service in place.

• Planning for Services for Adults with Mental
  Health Needs

Planning for Services for Adults with Mental
Health Needs
Commissioning / Service Activity
Workforce planning will focus on well-being and
recovery
Specialist employment support provision will be
enhanced by social Enterprise
The breadth of supported accommodation will
increase
Carer assessments will feature as core services
Break provision will be supported
S117 situations will be reviewed annually
The number of Approved Social Workers will
increase to 1 per 10,000 of the population
Capacity in primary care around ccbt, cbt and
talking therapies will be enhanced
Day activity will have more of a focus on
community linkages
April 2009
April 2011
April 2010

• 200 people using Direct Payments.
• Out of area places down to 5.
• 3 Social Enterprises established.
• 60 people in paid work or work preparation
• Day Care reframed as community link
• Some open access provision
• 100 of workforce equipped with skills to deliver
  well-being and recovery

• 100 people using Direct Payments.
• 30 people in paid work or work preparation.
• 730 bed nights of break provision available a
  year.
• CCBT network established in primary care.
• Creative options in place

• 250 people using Direct Payments.
• Citizen Commissioning network established
• Supported accommodation increased by 100 units
  of floating support.
• Dual diagnosis service in place
• Brief intervention team in Primary care
  established.

11
(No Transcript)