Integration of public mental health intelligence into JSNAs to inform - - PowerPoint PPT Presentation

1

Jim McManus (Director of Public Health, Hertfordshire) Dr Jonathan Campion (Director of Population Mental Health, UCLPartners)

Integration of public mental health intelligence into JSNAs to inform priorities, strategic development and commissioning

1st April 2014

2

Authors

Jonathan Campion is a Psychiatrist and Director of Population Mental Health for UCL Partners. Dr Campion undertook the Hertfordshire Jim McManus is Director of Public Health for Hertfordshire

j.campion@ucl.ac.uk jim.mcmanus@hertfordshire.gov.uk

3

JSNA

The Hertfordshire JSNA for Mental Health is in process of being updates since Prof Campion undertook it https://www.hertfordshire.gov.uk/microsites/jsna/jsna- documents.aspx?searchInput=&page=3&resultsPerPage=10&view=card#res ultsContainer You can find Prof Campion’s UCL JSNA for Hertfordshire in full here https://www.hertfordshire.gov.uk/microsites/jsna/jsna- documents.aspx?searchInput=UCL&page=1&resultsPerPage=10&view=card

4

Joint Strategic Needs Assessments

• Provide information about the local levels of health and social care

needs as well as information about broader determinants (DH, 2012)

• Informs actions which local authorities, local NHS and other partners

need to take to improve the health and wellbeing of their population.

• Mental disorder accounts for at least 23% of the burden of disease in UK

compared to 16% for cancer or cardiovascular disease (WHO, 2008) – therefore particularly important area

• Only a minority of people with mental disorder receive treatment while

provision of interventions to prevent mental disorder/ promote mental wellbeing is extremely limited - this unmet need requires representation in the JSNA.

5

The Golden Thread

Marmot JSNA CCG Plans Priorities Strategy Commissioning Outcomes (New Outcomes Frameworks)

• Need, Outcomes
• Priorities, Interventions

6

Informing Informing

Joint Strategic Needs Assessment

Public Health Information National Dataset Local Commissioning Intelligence Health & Social Care Prevalence Information Research and Trends Information

Community Strategy

Priority Setting

Local Area Agreement Client Group / Issue Based Commissioning Plans eg Mental Health, Older People, Obesity, Long term Conditions PCT & PBC Business Plans Children & Young People’s Plan

Influencing

Housing / Supporting People Strategies

Local Peoples Views and Experiences

Locality Plans

7

Commissioning Roadmap

Identify Priorities What Works in delivery Commission Monitor and Evaluate Assess Need

JSNA Health & Wellbeing Strategy Commissioning Plans

8

9

10

11

What mental health intelligence is required in a JSNA? Groups of 4-5 people (5 minutes)

12

Mental health intelligence required in a needs assessment

• Level of risk and protective factors across the population
• Numbers from higher risk groups
• Local levels of well-being and mental disorder
• Proportion receiving intervention including from higher-risk groups
• Current levels of provision of effective public mental health

interventions

• Joint Strategic Asset Assessments augment JSNAs and identify local

assets to improve health and social outcomes

13

Good public mental health commissioning

• Prevents large proportion of mental disorder and promotes population

wellbeing/ resilience

• Enhances coverage of effective intervention to treat mental disorder,

prevent mental disorder and promote mental health

• Focuses on children and families
• Effectively targets higher risk groups to prevent widening of inequality
• Results in significant improvements in NHS, public health and social care
• utcomes
• Facilitates joined up and collaborative working between different service

providers

14

What is the current level of unmet need for integration

• f public mental health intelligence in JSNA’s?

15

Current level of integration of public mental health intelligence in JSNA’s

• Inadequately and inconsistently covered often only in passing (UCLP

audit of 23 JSNAs, initial findings)

• Public mental health information within JSNAs often inaccessible, being

both difficult and time consuming to locate

• Mental wellbeing mentioned in 44% JSNAs
• Child and adolescent conduct and emotional disorder mentioned in 50%

JSNAs although often only in passing

• Adult mental disorder: depression mentioned in 72% of JSNAs, SMI 67%,

personality disorder 28%, dementia 89%

16

Current level of integration of public mental health intelligence in JSNA’s

• Little information about impact of broader determinants on mental

health required by DH (2012) or how poor mental health impacts on

• ther areas e.g. tobacco
• Poor coverage of higher risk groups, costs of mental disorder, savings

from interventions

• Lack of information about size or impact of unmet need

17

Current level of integration of public mental health intelligence in JSNA’s

Review of child and adolescent mental health in JSNAs and JHWSs (Lavis & Olivia, 2013) assessed the content and quality of data intelligence of 145 JSNAs

• Two thirds of JSNAs had no section which specifically addressed child

and adolescent mental health needs

• One third of JSNAs did not include an estimated or actual level of need

for child and adolescent mental health services in their area

18

Possible reasons for PMH intelligence gap in JSNAs?

19

Possible reasons for PMH intelligence gap in JSNAs

• Lack of awareness about the importance and impact of mental health
• Lack of agreed set of PMH intelligence required for JSNAs - no standard

template, format or mandatory data requirements

• Lack of access to up to date public mental health intelligence
• Lack of support to provide local relevant PMH intelligence
• Lack of resources for a time consuming exercise (Burnham, 2012)

20

Steps to integrating public mental health intelligence into JSNAs Groups of 4-5 people (5 minutes)

21

1) Bringing together up to date local PMH intelligence

• Identification of relevant intelligence
• Nationally collected data
• Locally collected data
• Comparing against deprivation, national and other similar populations
• Facilitating understanding of data such as through graphical

representation

22

2) Agreeing most appropriate structure to integrate into JSNA

• Currently no standardised structure for JSNAs or what mental health

data is included (DH, 2012)

• Share existing PMH intelligence with commissioners, CCGs, local

government and public health

• After consideration of intelligence, agree best way to integrate PMH

intelligence into JSNA as

• Stand alone section
• Integrated into other sections

23

Communication of PMH intelligence to inform local strategic development, commissioning and Health & Wellbeing Board priorities Groups of 4-5 people (5 minutes)

24

Communicating PMH intelligence

• Set of up to date PMH intelligence
• Tables/ graphical representation which facilitate understanding of PMH

intelligence

• Current provision and impact of PMH interventions
• Level, impact and cost of unmet PMH need at primary, secondary and

tertiary levels

25

Communicating PMH intelligence with different organisations

• Improved population mental health requires coordination between

different organisations

• PMH intelligence needs to take account of the activities of these
• rganisations

26

Different organisations providing PMH interventions

Highlights importance of knowledge of activities of different

• rganisations to facilitate cross-sector coordination:
• Primary and secondary care
• Local government
• Public health
• Social care service providers
• Third sector social inclusion providers
• Education providers
• Employers
• Criminal justice services

27

Tailoring PMH intelligence for presentations and briefings for particular audiences

• Presentations and briefings highlight local impact and cost of different

types of unmet PMH need to different audiences

• PMH intelligence needs to be made understandable for the audience

and include local context

• Different organisations have responsibility for certain areas which is
• ften overlapping and requires coordination

28

Different sectors cover different PMH issues which often overlap

• Public health
• Bringing together PMH intelligence
• Addressing risk factors such as abuse/ violence
• Promoting protective factors
• Enhancing population recognition of mental disorder
• Primary care/ secondary care
• Detection/ treatment of mental disorder at earliest opportunity
• Addressing health risk behaviour/ physical health

29

Communication of PMH intelligence with range of stakeholders facilitates

• Greater cross sector coordination
• Greater transparency about decision making process
• A more local needs approach to prioritisation
• Closer link between needs assessments and commissioning

30

Example of conduct disorder and criminal justice sector

• In Northamptonshire, 5299 children aged 5-16 estimated to have

conduct disorder

• Lifetime costs of each one year cohort of the 5299 with conduct disorder

in Northamptonshire is £795 million with £564 million arising from associated crime

• Effective interventions exist to treat conduct disorder
• First line treatment for conduct disorder are parenting interventions

(NICE, 2013)

• However, only 154 parents were recorded as receiving parenting

interventions for managing child behaviour with no recording of whether these children had conduct disorder

31

Example of conduct disorder and criminal justice

• Parenting interventions result in net savings of £8 for each £ spent with

67.4% of savings occurring in criminal justice (Knapp et al, 2011)

• Provision of parenting interventions to every parent of the 5299 5-16

year olds with conduct disorder in Northamptonshire would result in net returns of £38,862,866 for group intervention and £33,118,750 for individual intervention

• Briefing and discussion with police commissioner who now wants to

spend some of the police budget on parenting interventions

32

5) Using local PMH intelligence to inform impact of for PMH interventions and next commissioning cycle

• Next presentation on outcomes and commissioning