Published on March 11, 2014
Bringing about change: Improving the nation’s mental health and wellbeing Sean Duggan
The Government’s aspirations ‘Parity of esteem’ features in: ‘No Health Without Mental Health’ (2011) Health and Social Care Act (2012) Implementation framework (2012) The NHS Mandate (2013) Closing the Gap: action plan (2014)
No Health Without Mental Health objectives (i) More people will have good mental health (ii) More people with mental health problems will recover (iii) More people with mental health problems will have good physical health (iv) More people will have a positive experience of care and support (v) Fewer people will suffer avoidable harm (vi) Fewer people will experience stigma and discrimination
Implementation framework Published July 2012 Actions for local organisations, eg: NHS commissioners and providers Local authorities Employment services Schools and colleges Housing providers Police, probation and prisons Voluntary and community organisations
National support for the strategy But also key roles for national bodies: NHS England Public Health England Care Quality Commission NICE Monitor Health Education England NHS IQ DfE, DWP, MoJ, etc
The NHS Mandate Sets priorities for the NHS Requirements include: “Delivering a service that values mental and physical health equally” “…extending and ensuring more open access to the Improving Access to Psychological Therapies programme” “…improve access and waiting times for all mental health services”
Parity of esteem: the starting point Disparity: Mental ill health accounts for 28% of morbidity and 13% of NHS spending Three quarters of people never treated No national measures for access and waiting Different payment systems 15-20 year mortality gap
What would a level playing field look like? Improved access to psychological therapies, with agreed waiting time standards Better crisis care – local declarations baesd on principles in Concordat Better physical health care for people with severe mental illness, eg smoking cessation, weight management More research investment: just 5.5% of research spending is on mental health
Prevention and promotion Half of people with a mental health problem first become unwell by age 14 Children with early starting behavioural problems especially vulnerable, eg: To all adult mental health problems To poorer physical health To school exclusion and unemployment To crime, gang involvement and antisocial behaviour
Parenting programmes Cost of severe behavioural problems is £260,000 per person over a lifetime Cost of parenting programme is £1,300 per child Programmes most effective if delivered as intended; promoted by teachers and GPs; targeted to families who need them
Other effective early interventions Early intervention in psychosis (EIP) saves £18 per £1 invested Anti-bullying initiatives in schools Workplace mental health promotion Alcohol brief advice in primary care
Addressing inequalities within mental health Race equality CAMHS Transitions at 18 and 65 Later life Personality disorder Learning difficulties
Opportunities for parity Health and Wellbeing Boards Public health in local government Strategic clinical networks NICE Guidelines National Mental Health Intelligence Network Financial pressures?
Barriers to parity Financial pressures? Inertia Competing payment systems Lack of outcome measures NHS Constitution
What needs to happen now nationally? Improve access and waiting times Develop better outcome measures for mental health Ensure NICE guidance is followed Encourage joint commissioning and pooled budgets Sustain cross-government approach
And locally? Local Authority Mental Health Challenge: the ‘member champion’ Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies CCG mental health leads at Board level Local HealthWatch and health scrutiny committees
For more information visit: www.centreformentalhealth.org.uk
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