Manchester CCGs Mental Health & Wellbeing Grant Improving - - PowerPoint PPT Presentation

Manchester CCGs Mental Health & Wellbeing Grant

Improving Access to IAPT Enhancing Social Inclusion for People with Serious Mental Illness 25th May 2016

Jane Thorpe - Head of Mental Health Improvement Programme and Mental Health Commissioning, Manchester CCGs Michael Salmon – Commissioning Manager Mental Health, MCC Sandra Castle - Clinical Lead Primary Care Mental Health Team (MMHSCT) Melissa Briscoe-Head of Psychological Therapies | Self Help Services Dr Ruth Thompson, GP and Mental Health CCG Clinical Lead

Overview

• Context - Mental health needs in Manchester
• Landscape of mental health and social care provision in

Manchester

• Strategic aims of commissioners regarding mental health in

Manchester

• Intended outcomes and objectives of the Grant Programme
• Case Studies

Background to Wellbeing Grant…

The Five Year Forward View for Mental Health (DoH, February 2016) reported that:

It is estimated that people with a diagnosis of schizophrenia will have up to 20 years less life expectancy At least one in four people will experience a mental health problem at some point in their life and one in six adults has a mental health problem at any one time Almost half of all adults will experience at least one episode of depression during their lifetime One in five mothers suffers from depression, anxiety or in some cases psychosis during pregnancy or in the first year after childbirth. Suicide is the second leading cause of maternal death, after cardiovascular disease. Sickness absence due to mental health problems costs the UK economy £8.4 billion a year More women than men are diagnosed with common mental health problems (women 21.5%, men 13.5%)

Background to Wellbeing Grant…

Manchester’s Joint Strategic Needs Assessment outlines:

It is estimated that between one in eight and one in ten Manchester adults are prescribed antidepressant medication 6.9% of North Manchester patients over 18 have ‘unresolved depression’ compared to 5.8% for England In Manchester, 3,981 people are in contact with mental health services for every 100,000 of the population (1 in 25), compared to 2,176 nationally (1 in 46) The Care Programme Approach (CPA) is a planning system for people with more severe mental illness and complex needs. In Manchester 685 people are registered with CPA for every 100,000 of the population, compared to 531 nationally. Manchester has a significantly higher rate of suicide (14.5 people per 100,000

• f the over 15 population) than averages for England (8.5 per 100,000).

For those using secondary care mental health services in Manchester, 78% are not in paid employment and 18% are not in settled accommodation

Mental Health Funding

• The three Manchester CCGs collaboratively commission Mental

Health Services, 2015/16 recurrent funding of c104m

• Manchester Mental Health & Social Care Trust (MMHSCT),Psychological

Therapies, Acute hospital and community services, Community mental health teams, Rehabilitation services, Independent Hospitals,

• Central Manchester Foundation Trust (CMFT) deliver Child and

Adolescent mental health services (CAMHS) and Learning Disability

• services. Third Sector organisations – Self Help Services, Survivors,

Gaddam, LGBT, ACHMS, Age Concern, 42nd st

• First episode in psychoses service, and other mental health trusts in GM
• Manchester City Council Investment into Mental Health Services

2015/16 recurrent funding of c£16m

• MMHSCT (Social Care), Social Care Packages (Residential &

Nursing, Home Care, Individual Budgets), Housing Related Support, VCS – Community based provision

Manchester’s Health & Social Care Locality Plan

• Mental health is a significant issue for Manchester- Mental health of

citizens is integral to its success

• Preventative
• Accessible at the times needed to prevent worsening of symptoms and

especially to intervene early in crises.

• Integrated into the needs arising from and affecting physical health
• Responsive to need and ‘recovery’ focussed ensuring people are

supported and encouraged to return to active working lives, where relevant

• Clear in its pathways of care for all users of services
• The ‘system’ then, needs to ensure that it is effective, efficient, based on

‘best practice and outcome focussed so that services are sustainable and provided as close to the users community as possible.

Manchester’s Health & Social Care Locality Plan – The 3 pillars

• A single commissioning system (‘One Commissioning Voice’) ensuring the

efficient commissioning of health and social care services on a city wide basis with a single line of accountability for the delivery of services;

• ‘One Team’ delivering integrated and accessible out of hospital

community based health, primary and social care services; and

• A ‘Single Manchester Hospital Service’ delivering consistent and

complementary arrangements for the delivery of acute services achieving a fully aligned hospital model for the city. The plan represents Manchester’s health and care partners’ agreed approach to managing a predicted ‘do nothing’ deficit of £284m by 2020/21.

Commissioners Position statement

• Transaction: services currently provided by MMHSC to transfer to a

sustainable provider who can provide clinical and financial

• sustainability. Preferred provider to be known in August 2016
• NHS Planning Guidance ‘must do’s – parity of esteem (PoE): CCGs

are required to demonstrate in financial plans that they deliver PoE, by investing in mental health services in line with the allocation growth received in 2016-17

• CCGs supported and approved increased investment into First

Episode in Psychosis, IAPT, IAPT waiting list clearance and Mental Health Liaison amounting to a total of £3,555k

Persistent challenges

• A system for managing acute and urgent mental health needs
• Delayed access to talking therapies
• Fragmented delivery of services across poorly-integrated providers

(mental and general/physical healthcare)

• The stigma of mental health
• Hard for people to leave mental health services
• Routes back into employment, education and independent

accommodation are not easy and can hinder a persons sense of well being

What is IAPT?

• From Talking Therapies: A Four Year Plan of Action (DoH, 2011):
• National programme to Improve Access to Psychological Therapies
• Targeted at adults suffering from anxiety and depression
• Developed so the first treatment option is not just medication
• IAPT services have developed links with employment support services
• Interventions offered based on NICE guidance- evidence base, more interventions now included
• Manchester is assessed as having 88,398 adults who maybe depressed or anxious and the national target

is for 15% access

• Target that 50% of those who access the service will recover
• Step 2
• Computerised CBT (CCBT), Guided Self –

Help, Behavioural Activation and Graded Physical Exercise

• CCBT, Guided Self Help and Pure Self

Help

• Mindfulness CBT
• Step 3
• CBT
• Couples Therapy
• Counselling for Depression
• Brief Dynamic Therapy
• Interpersonal Psychotherapy
• EMDR (eye movement desensitisation

and reprocessing

• Mindfulness CBT

Current IAPT information tells us…

• Access should be 15%, for Manchester we anticipate an end
• f year around 9%
• Recovery averages at 37.5% (N 32%; Central 35%; South 44%)
• 6 week wait- 29% N, 33% C, 38% S
• 18 week wait – 78% N, 73% C, 80% S

Why the grant?

• More investment, service expansion
• Need to increase access and improve recovery
• How you deliver ‘IAPT’ is evolving, we need to make it work

for Manchester and for the One Team

• Deliver the interventions and support in a way which is

meaningful for the people who need it

• Communities and organisations are and can help mental

health services deliver differently or in collaboration

Community Mental Health Teams

• Community Mental Health Teams (CMHTs) are multi-

disciplinary teams that provide health and social care assessment, care, support, treatment, intervention, advice, guidance and liaison for individuals with severe and enduring mental health problems with a high complexity of need

• Friendships, socialising, occupation, being in control of

personal finances, good housing and good physical health are crucial for mental wellbeing

Stepping down into the local community: Case Study 1

• Fred has been involved with a Community Mental Health Team (CMHT) for 8 years following

a psychotic episode

• Long-term homelessness prior to contact with Mental Health services.
• Has experienced 2 mental health admissions to acute hospital. Alongside his mental health

needs, Fred has a number of physical health concerns, including diabetes which requires that he regularly attends the Manchester Diabetes Centre.

• During his most recent admission to Hospital Fred’s after-care needs were considered and it

was agreed with him that he would benefit from a placement in supported accommodation which was funded via a Personal Budget allocated to him by the Local Authority Funding Panel.

• Fred has made significant progress within supported accommodation over a two year period,

to the point where all involved in his care are of the view that he would benefit from stepping-down to an independent tenancy.

• Fred is in agreement with the proposal but is highly anxious about the prospect of managing

his own tenancy never having done so previously.

• Fred’s anxieties are centred around issues relating to household budgeting, fear of isolation,

and opportunities for social inclusion, including his aim to undertake voluntary work perhaps leading to paid employment. He is anxious about how any work undertaken may affect his current benefit awards.

Grant could provide: Support to attend ATOS Medical reviews with a view to maintaining DLA/PIP Awards Identify volunteering options for him, and pre-employment support. Identify public transport options for him in new community Support to maintain a healthy lifestyle and diet. Support to attend GP for annual physical health check, and specialist appointments at he Manchester Diabetes Centre with the aim of reducing related complications. Provide opportunities for ‘Befriending ‘ from the local community, or neighbourhoods, to combat social isolation and loneliness. Identify range of interests and community groups that are accessible in local community and support people to feel accepted.

Stepping down into the local community: Case Study 1

A story

• http://www.patientvoices.org.uk/flv/0806pv3

84.htm

Case Study 2: Female, aged 21

• CZ presented to the service stating she was feeling overwhelmed after the birth of

her then 3 month old daughter. She reported feeling isolated and hopeless and as though she was a bad parent. She stated she often felt panicky and overwhelmed by concerns that she wasn’t a good mother. She stated she had no family supported and had spent several years in care.

• When discussing the therapy options with CZ she found the idea of entering therapy
• r counselling overwhelming. She stated she felt lonely and scared and didn’t think a

few weeks of weekly appointments would be enough to help her low mood.

• CZ would have benefited from a support for new mothers struggling with their

mental health. She did not feel ready for a structured group environment or structured therapy but was isolated and needed peer support and reassurance around her ability to parent her daughter. If CZ could discuss those issues in a facilitated peer environment this may have helped her become ready and able to engage in more structured therapy.

Case Study 3: Male, aged 45

• NW presented to the service with a long history of low mood. He had been under

the care of the same GP for over ten years and tried several anti-depressants that had had little effect. He had been referred by the GP for face to face cbt to try and build some strategies to address the issues of low mood.

• NW spoke Farsi and required an interpreter to enable him to engage in therapy.

This led to a longer wait than usual for NW to engage in therapy. It also meant the sessions were longer. NW fed back that it was difficult for him to concentrate on the session for that length of time and found the pause in conversation as all information went through the interpreter unsettling and made him feel anxious. NW failed to recover in the therapeutic interaction.

• NW was then referred to a depression group delivered by a community
• rganisation using solely Farsi speaking practitioners. NW found the interactions in

this setting much easier to follow and also gained support from the other members of the group, some of whom he saw outside of the group setting and after the group had ended. His low mood improved greatly in comparison to the

• ne to one interpreter interactions he had previously had also he was also much

less socially isolated.

Opportunities

• Creates exciting opportunities for mental health providers to work collaboratively with third

sector providers/community groups – share expertise, knowledge and resources.

• Make it easier for ‘ALL’ parts of the community to access support for their mental health –

target under represented groups (BME, Language, Gender, Age, LGBT, disabilities) – attempt to remove barriers – raise profile of the support that is available. Embed the message in local communities that mental health is EVERYONE’S business

• Test out new methods of delivery - targeted / evaluated / best practice / shared outcomes –

inform future commissioning decisions

• Give voice to service users – service development in response to community feedback –

Improve the connection between mental health services and the communities they serve

• Create new pathways – multiple doors for support (one size does not fit all) – accessible

(service delivery in new locations)

• Integrated support – co-locating – sharing of clinical info – collaborative care planning.

Joining up clinical interventions with practical support (housing advice, Debt management). Evaluate whether this leads to better client outcomes/engagement. ‘Fill in the gaps’ and prevent clients being passed around

• Parity with physical health care – placing mental health and wellbeing on the agenda.

Influence the development of the ‘One Team’ - and how mental health support and interventions will be delivered in local communities in the future.

Grant Aims

• To increase the social inclusion within their neighbourhoods of

people with serious and enduring mental health problems.

• To increase the take-up of Improving Access to Psychological

Therapies (IAPT) programme services among communities that finds them difficult to access.

• To increase the level of support offered to people with mental

health problems who find it difficult to access existing services in their neighbourhoods.

• To create a sustainable improvement in the levels of productive

working relationships between voluntary and community sector

• rganisations and teams/staff that are part of, or potentially part of,

the One Team approach.

Objectives of the Grant Programme

• Equality: strengthen knowledge, understanding and evidence base about communities so that the CCGs

can design services that meet everyone’s needs and increase community cohesion

• Partnership: increased collaboration between public sector health and social care services and voluntary

and community activities

• Social value: show how they will contribute to the social, economic and environmental welfare of

Manchester

• Sustainability: how they will be sustainable beyond the lifetime of the funding other than through

sourcing additional funding. The assessment of sustainability of projects relates to the legacy of continuing impact rather than ongoing funding

• Safeguarding : All bids must be clear about how they will adopt best practice in safeguarding vulnerable

adults

• Value for money: The value for money that a project delivers will be assessed against its total contribution

to both the aims and objectives

• User involvement and empowerment : Activities are designed to enhance the capacity and capability of

people with mental health problems to participate within the community and local social networks, to take charge of their own care and to increase their social capital.

Neighbourhoods

Neighbourhoods are defined as the 12 areas covered by One Team

Challenges

• IAPT:

How to ensure people get the help they need as soon as possible and increase numbers Need to improve uptake of services for older people and men Who accesses IAPT needs to reflect the community profile Access to people whose first language is not English Working with people who have long term health conditions People have many social needs High drop out rate, impacts on recovery Long waiting times for step 3 Improved recovery

• Serious mental illness:

Helping people access services and activities important to them, whether that's education, training and employment opportunities, appointments or community groups Ensuring people become active participants in the development of their future care Helping people secure a better quality of life by being socially included

The Mental Health & Wellbeing Grant Programme is an exciting opportunity to test out some ideas and develop a number of projects that will support how we work together to help improve the mental health system in Manchester and most importantly improve the mental health and wellbeing of those accessing our services. We look forward to reading your applications! Thank you

Commissioners Summary