Initiative 8: Mental health (adults) by bvXADQR3


									Initiative 8: Mental health (adults)

Lead Director: Donna Kinnair
Project lead: Gwen Kennedy

To improve the mental health and wellbeing of people in Southwark through prevention,
and high quality and accessible support, care and treatment services

PCT strategic Goals: 1, 2 and 5

Links to other strategic plans: HfL, LAA, local Vital Signs, IAPT, and PSA.

Mental health care is based on the premise that care for serious mental illness is best
delivered to people in their own homes, with medical and other care staff working in
multidisciplinary teams in community settings. Admission to hospital is a part of the
system, rather than its core.

Intervene as early as possible in the course of illness to improve long term prognosis, to
maximise independence and life choices for service users. These services aim also to
improve cost effectiveness.

London’s mental health services have achieved major advances in the last twenty years.
Bed numbers have reduced substantially, cost effectiveness has improved, more people
are receiving care and support in community settings.

The Framework for action in mental health sets out six key objectives:

        Early intervention; to promote mental health and provide effective preventative
         strategies to help those at risk of developing mental health problems, especially
         severe mental illness
        A clear pathway of care; to provide timely access to appropriate services and
         more consistent pathways through care
        Promoting recovery and social inclusion; to improve outcomes and to improve
         access to evidence-based interventions
        Local treatment within the community; to refocus the work of community teams
         and to reduce dependency on treatment away from home
        A new strategy for inpatient care; to rethink the purpose and improve the
         quality of inpatient care
        Working with those at most risk; to develop effective service models for
         offenders, to reduce stigma and to improve access in primary care.

Local context

Mental health is a key national and local priority. The personal, social and economic
benefits of good mental health are significant both for people who use mental health
services and for the rest of the community.

Traditionally mental health has been defined in deficit terms – the absence of
diagnosable disease. It is increasingly seen as a holistic, all embracing concept – “a
state of well-being in which the individual realises his or her own abilities, can cope with
the normal stresses of life, can work productively and fruitfully and is able to make a
contribution to his or her community”. It is this understanding that underlies current
Government policy and is used as a basis for developing services in Southwark.

We have been modernising mental health services in Southwark as part of the
implementation of the National Service Framework for Mental Health. Over the past few
years NHS Southwark and the local authority have sought to build a firm platform upon
which integrated services are developed. The way forward emphasises the development
of support for people with mental ill health outside of health and care settings. For
example, in education and employment, schools will include emotional literacy in
curriculum and will support students experiencing problems. Southwark is aiming to
become a ‘Wellbeing Workplace’ which demonstrate good practice in supporting staff
who experience problems and in positively recruiting those who have had mental health

The population characteristics of Southwark result in higher than national average rates
of both common mental illness and serious mental illness. In Southwark a quarter of all
GP consultations are mental health related, 47% of people on incapacity benefit are
related to mental health problems, 20-30% of people seen in primary care have
unexplained medical symptoms (52% in secondary care). The Mental Illness Needs
Index for Southwark is 118 compared to 100 nationally, which means that needs are
18% higher in Southwark than average.

Some of the reasons behind this include having a younger population, higher levels of
single households and homelessness which are common across London. However,
Southwark is also facing greater challenges with regard to substance misuse and dual
diagnosis. Southwark also has a large refugee population where forced migration often
as a result of torture, imprisonment and war, compounds the already difficult issues of
adjustment and settlement.

People with serious mental illness (SMI) are more likely to have poor physical health,
have a 20% shorter life expectancy than the general population, double the incidence of
cardio vascular disease, five times high rates of diabetes and higher rates of stroke,
coronary heart disease, obesity and respiratory disease. People suffering with common
mental illness, including depression also have a higher risk of physical illness. This is a
consequence of a combination of disease and treatment related causes, risky health
behaviours and fragmented and poor access to care across the system.

People with mental health problems experience a greater degree of social exclusion
than the general population. For example, only 24% of adults with long-term mental
health problems are in work. However, a larger proportion (35%) of people with mental

health problems who are economically inactive would like to work, compared with 28%
of people with other health conditions.

For people with more severe and enduring mental health problems, the experience of
social isolation is greater. It is clear that there are differences and inequalities in service
experience and outcome for some minority ethnic groups.

Data collection and analysis of secondary mental health services in Southwark has
allowed demand forecasting to begin. For example Peckham, Nunhead, the Lane and
East Dulwich have been identified as having the highest incidences of Schizophrenia. In
relation to secondary mental health services, usage by acute admissions, referrals and
use of home treatment, the areas of Peckham and Camberwell have the highest levels
of need.

Demographic projections indicate that Peckham and Camberwell will have the largest
growth in children (0-14) by 2016. Incidences of first onset psychosis are also greater in
these localities than elsewhere in Southwark. Therefore demand for services will grow
here – the links already highlighted between mental and physical health mean that
community primary and acute services will need to be engaged.

NHS Southwark main provider of mental health services is the South London and
Maudsley NHS Foundation Trust (SLAM). SLAM provide an extensive portfolio of mental
health services to both our local population and nationally. They provide integrated
services that aim to address both mental health and social care needs and are
supported by internationally recognised training and research. Over the next five years
Southwark NHS will be working with the NHS London, the South East Sector,
particularly Lambeth, and SLAM to re-focus SLAM services towards a recovery model,
shifting care from in-patient activity to more community based care. This will ensure that
we gain maximum benefit from our contractual arrangements and ensure that we utilise
the learning from the Academic Health Sciences Centre - a partnership between King’s
College London, Guy’s and St Thomas’ NHS Foundation Trust, and King’s College NHS
Foundation Trust. Our plans also include increasing increase the numbers of mental
health providers to gain maximum benefit from the voluntary sector.

Commissioning intentions for 2010/11 and onwards
Commissioning intention
       Planning the redesign of mental health services focusing on recovery and mental
        health and well being, establishing clear pathways of care
       Review of cost, duration and capacity of placements, including forensic and
        complex care to assess utilisation of capacity, setting a clear context for the
        commissioning of these services within Southwark.
       Promoting access to psychological therapies, improving the interface with
        Medically Unexplained Symptoms (MUS) in primary and acute settings
       Work towards implementing a unified care pathway for dementia in line with
        government policy

Investments and disinvestments

Impact on outcomes
      Services provided closer to home, reducing dependency on in-patient and long
       term care - more people are well and able to stay in their own homes and feel
       they contribute to and are part of their local community
      Community mental health services provided as part of polysystem provision
      Improved access to psychological therapies in the community, thereby reducing
       the need for mainstream psychiatric services and medication
      Users are supported in maintaining and improving their own overall physical
       health and wellbeing
      Strong partnership working in Southwark involving all stakeholders interested in
       promoting the mental wellbeing of citizens of Southwark. This includes statutory
       agencies, service users, carers, providers of services and voluntary and
       independent organisations
      People with mental health problems prevented from being placed outside of
       Southwark for specialist treatment
      Individual care plans will better reflect the outcomes, goals and choices people
       have made about their own personal recovery
      Emphasis on prevention and early intervention, through mental health promotion
      Support from the Community Mental Health Teams adapted to meet people’s
      More information available on how to access services and what support is
      Closer work with the Local Authority to provide effective mental health support
      Service users involved in developing and monitoring services
      Employment opportunities for people with mental health needs will be
       incorporated into mainstream employment services such as Job Centre Plus.
       Access to training, leisure and other community facilities will have been improved
      Carers are supported in their caring role and are involved in the development and
       delivery of services in Southwark

Stakeholder engagement

Extensive service user involvement in the planning and commissioning of mental health
services through the Mental Health partnership board, the MIND user council and Mental
Health stakeholder events.

Timetable for Delivery

Outcomes and Quality Markers


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