Mr Ian Kent Director of Local Services West London Mental Health - - PowerPoint PPT Presentation

Mr Ian Kent Director of Local Services West London Mental Health Trust

About the Trust

• Whole spectrum of mental health services
• One of only three including a high secure

hospital

• Around 30 sites spread across 45 miles
• Plan to spend around £238m this year
• Around 4000 staff

About the Trust

• Up to 20,000 patient contacts every year at

home, in clinics and in hospital

• Who buys our services?

– Three primary care trusts (PCTs) – Commissioners for specialist mental health in NW London sector – High secure commissioning

About the Trust

Forensic Services

• Based on two sites
• Redevelopment of Broadmoor Hospital
• Service developments

Local Services

• Comprehensive range of mental health

services to three boroughs and two national services

• Partnership / inter-agency working
• Service developments

Prevalence and severity

London spends 21% more than England average PCTs spend approximately 12% of budget on mental health – c. £1.7 billion across London Very high levels of mental health needs associated with: poverty and unemployment social isolation, crime, drug misuse

Prevalence Across a typical population of 100,000 Londoners

Psychotic illness 257 (0.25%) Depression and anxiety disorders 10,725 (11.1%) All phobias 2,440 (2.5%) Drug dependence 2,697 (2.7%) Alcohol dependence 5,202 (5.3%) TOTAL 21,322 (22%)

Inequalities and diversity

• Life expectancy 10 years less for those with long-term,

serious mental illness

• High rate of diabetes, obesity and substance misuse
• Only 26% of referrals from GPs are from BME groups
• BME groups more likely to be referred by the police: 62%
• All BME groups have higher rates of detention than white

British but black groups have the highest rates

• All black groups more likely to experience restraint and

seclusion

Proposals: clear pathways

Integrated care and partnerships

• Public health needs assessment for mental health
• Commissioning (joint) development
• Shared care protocols
• Physical healthcare – diabetes, obesity,

substance misuse

• Network of care from multi-disciplinary team (MDT)
• Access in a crisis

Proposals: promoting recovery and social inclusion

Individual needs and choices

• Individual care plans – risks and needs assessment:
• Understanding/ownership by patient
• Choice
• Home, community, inpatient
• Medication/therapy
• Provider – primary care, specialist services, voluntary

sector

• Promote mental well-being

Proposals: early intervention

• Prevention is better than cure
• Work with young people aged 16-25
• Improved outcomes
• Stay in education, training, home
• CAMHS co-location family health and social care
• Prompt access to psychological therapies

Proposals: local treatment within the community

• Local where possible, central where necessary
• Fewer beds (down 15.4% from 1998/9 to 2004/5)

and continuing (slower rate)

• Significant expansion of capacity and range of

community provision

• Vision for inpatient services:
• Manage crisis, identify and initiate new treatment
• Quality of environment and therapeutic milieu
• Vision for community services:
• Assessment, rehabilitation, recovery, therapy
• Co-location with key partners - polyclinic

Next Steps

• Established Clinical Care Pathway Group-

Chair Professor Thorncroft

• Key Recommendations:

– Investment in a full and sustainable information campaign using modern communication methods to raise public awareness of mental health needs, and to reduce stigma and discrimination – Give far greater emphasis to the views of service users and carers in identifying needs with advance personal care agreements implemented for all

• Ensure assessment procedures are substantially

redesigned to produce consistency and reduce variation.

• Develop a system of care where assessments include an

evaluation of physical as well as mental health needs

• Where the evidence supports more than one type of

intervention at any clinical care pathway stage then these should be offered as choices to services users

• The interventions delivered to people needing the

treatment and care contained within a particular clinical care pathway should be available regardless of where the person lives.

• Models of care co-ordination that use regular reviews
• f needs should be assessed using minimum

standards, continually checking the appropriateness of the choice of care pathway.

• There is a clear need to make exit and re-entry

arrangements clearer and easier from the perspective of service users and family members. This approach is sometimes called “Easy in – easy out”.

• NHS London may benefit from working across the capital

with a range of pilot sites on the introduction of a small number of clinical care pathways in the first case with a focus on identifying good practice that enhances engagement and implementation

• Implementing Healthcare for London Workstream for

mental health established