Commissioning Guidance for Public Mental Health and Well-being

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Commissioning Guidance for Public Mental Health
and Well-being

• Karen Newbigging
• 22nd October 2009

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Overview

• Why is this important?
• Making the case for mental well-being
• Overview of the guidance content and process
• Next steps

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The mental wealth of nations Nature 23
October 2008
Mental capital Mental well-being

• Mental capital encompasses both
• cognitive and emotional resources.
• It includes peoples cognitive
• ability their flexibility and efficiency
• at learning and their emotional
• intelligence or social skills and
• resilience in the face of stress. It
• captures a key dimension of
• the elements that establish how
• well an individual is able to
• contribute to society and to
• experience a high quality of life.
• Mental well-being is a dynamic
• state that refers to an individuals
• ability to develop their potential,
• work productively and creatively,
• build strong and positive
• relationships with others and

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Policy focus across government on quality of life
and wellbeing population health, prevention and
early intervention alongside emphasis on
decentralisation, community responsibility and
social justice
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The case for mental wellbeing

• Increased quality of life and overall wellbeing
• Improved educational attainment and outcomes
• Safer communities with less crime
• Reduced health inequalities both physical and
  mental health related and lower health care
  utilisation
• Improved productivity and employment retention
• Reduced sickness absence from work
• Reduced levels of poor mental health and mental
  illness

• Economic case
• Moral or communitarian case

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Economic Case

• Early intervention with Conduct and Emotional
  Disorders. Total value of benefits of prevention
  from treating a one year cohort of children with
  conduct disorder is estimated at 5.2 billion.
• Promote good mental health as well as social
  emotional skills in childhood (especially those
  with conduct disorders). Estimated lifetime
  benefit of 115,000 per case of child with
  conduct disorder. Cost savings for mental health
  promotion are 75,000 per case. Total value of
  benefits of prevention of promoting positive
  mental health in a one year cohort of UK children
  is 23.25 billion.
• Early Intervention is cost effective in reducing
  the risk of re-offending Every 1 spent on a
  prevention programme for those at risk of
  offending saves 5.
• Later targeted parenting programmes with children
  with emotional and conduct disorders. Programmes
  cost 600-4000 but a total cost of a child with
  conduct disorder is 70,000 by 28 years of age.
• Family Intervention Programme Cost of programme
  8-20,000 compared to costs, if no intervention,
  of 250-350,000.
• Refer and treat alcohol misuse problems in
  perpetrators of violence across health and CJS
  systems. Alcohol is a key risk factor for carry
  out and being a victim of violence and abuse. For
  every 1 spent on treatment, the public sector
  saves 6.

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Purpose of the guidance

• The guidance is designed
• to enable local health and local authority
  commissioners, and their partners, to make
  decisions about mental health improvement
  strategies to suit local circumstances

commissioned by the National Mental Health
Development Unit
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New Horizons Twin aims
Improving the mental health and wellbeing of the
population Improving the quality and
accessibility of services for people with poor
mental health (mental illness)
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Paradigm Shift! Towards a whole system approach
to well-being

• Mental health is an essential component of
  general health
• Mental well-being is more than absence of mental
  illness.
• Mental well-being is a key social asset of
  economic significance as a resource for long-term
  social and economic prosperity.
• Wellbeing is the other side of the coin of
  personalisation an opportunity for greater
  personal responsibility in health and social
  care.
• Mental wellbeing and physical illness are
  connected with long-term health conditions,
  particularly CHD, CVD, hypertension, diabetes,
  obesity
• Addressing mental wellbeing is key to local
  action to tackle health inequalities
• Responsibility for promoting mental well-being
  extends across all disciplines and government
  departments

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Improving public mental health and well-being
General public People vulnerable to poor mental
health
What?
Intervention processes
Practitioners
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Improving public mental health and well-being
General public People vulnerable to poor mental
health
What?
How?
Intervention processes
Practitioners
The key challenge is commissioning for
sustainable long-term development to build
individual and community resilience
Local Strategic Partnerships, Local Authorities
and Primary Care Trusts
Implementation processes
Adapted from Blase Fixsen (2005) Measuring
the Fidelity of Implementation. National
Implementation Research Network
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Two levels of guidance prepared to date

• Strategic Guidance for Boards and senior staff of
  PCTs and Local Authorities
• Making the case and starters for ten
• 2. Technical (detailed) Guidance for
  commissioning managers in health and local
  authorities (social care, education,
  regeneration, community development etc.)
• Detailed and practical to include tools,
  resources and positive practice examples

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Overview of guidance

• Meaning of mental well-being
• Values and principles underpinning the approach
• Business case for public mental health and
  well-being
• Key messages from the relevant policy documents
• Opportunities to link public mental health agenda
  with others
• Basic buys for commissioning mental health
  improvement
• Practical tools decision tool, monitoring and
  evaluation

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Key documents that underpin the guidance

• Every Child Matters
• The NHS Next Stage Review
• Working for a Healthier Tomorrow
• Putting People First
• Commissioning Framework for Health and Well-Being
• World Class Commissioning competencies etc
• Flourishing People, Connected Communities.
• New Horizons towards a shared vision for mental
  health

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Whole system approach

• Develop a whole system approach with
  interventions in all domains according to
• Robust evidence for interventions
• Local priorities and values (established through
  the JSNA and LSP processes)
• Continued development and learning
• from promising practice and action
• Good practice in commissioning

A practical decision tool to enable commissioners
to prioritise investment
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Identifying local priorities

• JSNA
• Turning inputs into outcomes using Joint
  Strategic Needs assessment (JSNA)
• Using
• Analytical data on demography, social context and
  epidemiology
• Local views and community engagement
• Reflecting and contributing to commissioning
  plans and LSP/LAA targets

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Draft GuidanceDomains for outcomes and
evidenced based interventions
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Life course domains in the draft guidance

• Develop safe sustainable connected communities
• Child and adolescent years (incorporates Build
  resilience and safe and secure base and Ensure
  a positive start in life)
• Adults (incorporates Integrate physical and
  mental health and wellbeing)
• Older People (incorporates Promote meaning and
  purpose)
• Vulnerable groups (includes mental illness
  prevention and wellbeing for people living with
  the effects of disability)

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Criteria for the Basic Buys

• Maximise cost effective health gain
• Effect size
• Burden of disease
• Population benefit
• Wider social gains
• Education, employment, community safety,
• Feasibility and achievability
• Not the last word on evidence!

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Examples of the Basic Buys

• Universal screening for perinatal mental health
  problems and targeted interventions for women at
  risk of postnatal depression including home
  visiting and support
• Targeted early interventions for common parenting
  problems
• Healthy Schools approaches including social and
  emotional learning programmes to strengthen self
  esteem
• Social prescribing to increase opportunities for
  social contact and participation
• Improving wellbeing for people living with the
  consequences of mental health problems

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Timeframe

• Phase 1 Draft guidance was prepared during the
  spring and early summer 2009
• Phase 2
• Review of the evidence base continues
• Further work on the New Horizons vision and
  programme of action (to be published early
  December)
• Rigorous field testing of the guidance during the
  autumn with key stakeholders and a leadership
  group
• Possible development of a web based tool
• Publication in March 2010

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In conclusion..

• Addressing mental health and well-being will
• achieve two different objectives simultaneously
• Improve health, reduce health and social
  services interventions, and assist in wider
  social gains
• Assist those who have mental health problems
  and prevent such problems occurring

Interested in field testing and developing the
guidance?
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• KNewbigging_at_uclan.ac.uk CJHeginbotham_at_uclan.ac.uk
  
• International School for Communities Rights and
  Inclusion, University of Central Lancashire
• Tel [phone]