Commissioning Crisis Care for mental health · Commissioning Crisis Care for mental health Dr Liz...
Transcript of Commissioning Crisis Care for mental health · Commissioning Crisis Care for mental health Dr Liz...
Commissioning Crisis Care for mental health
Dr Liz England
GP Laurie Pike Health Centre,
RCGP Mental Health Commissioning Lead and Co-Chair
JCPMH
NIHR Clinical Lecturer, University of Birmingham
Why do we need a mental health
crisis care concordat?
• Parity of Esteem
• Quality of care
• Timely
• Recovery and prevention
Defining ‘crisis’
The experience of service users and their carers is that each person’s perception of crisis is individual.
People themselves, family carers or friends, often recognise patterns of behaviour or external events that may indicate or trigger a crisis.
What for one person or carer may feel manageable may for another feel overwhelming.
From JCPMH
Defining crisis involves different perspectives
•Self-definition
•Negotiated or flexible definition
•Pragmatic, service orientated definition
•Risk-focused definitions
•Theoretical definitions
Emergency mental health care- NHS Choices
If a person's mental or emotional state gets worse quickly, this can be called a mental health emergency or mental health crisis. In this situation, it's important to get help quickly to stop the person harming themselves or others.
Mental health emergencies can include:
•threats of suicide or self-harm
•self-neglect, such as stopping eating or drinking
•aggressive behaviour
•being extremely distressed
•going missing
Closing the Gap: Priorities for essential
change in mental health
15.No-one experiencing a mental health crisis should
ever be turned away from services
As set out in our Mandate, NHS England is expected to
make rapid progress, working with CCGs and other
commissioners, to help deliver our shared goal to have
crisis services that, for an individual, are at all times as
accessible, responsive and high quality as other health
emergency services. This includes ensuring there are
adequate liaison psychiatry services
Commissioning principles
• What sort of service would I want to receive? What sort
of service would I want my mother, father, brother,
sister to receive?
• Service users and their carers involved
• Pathway
• Needs analysis/ asset based approach
Principles underpinning VbC An agenda of broader social change and a holistic approach to service development
Investment in building relationships between communities, professionals and service users; developing people’s potential, turning the focus away from their mental health status and staff training to support communication and co-production of organisational change
Openness and transparency about the level of involvement and influence service users will have
Provision of accessible information which focuses on the context of the commissioning project, government policy guidance and other relevant material meaningful to service user and carer collaboration in the commissioning process ( “co-commissioners”) an approach and style that enables a context conducive to user, patient and carer leadership
Values based Commissioning for Mental Health
Evidence base
Commissioners and
Clinicians skills and
experience
Thoughts, feelings,
opinions and values
of service users and
carers
Commissioning
decisions
Assessing needs or asset based approach?
The term ‘commissioning’ has been defined by the No Health Without Mental Health strategy as “the process of assessing the needs of a local population and putting in place services to meet those needs”.
Meaning of needs:
“Where activities are co-produced in this way [commissioning]…Taking this approach emphasises that the people who use services have assets, which can help to improve those services, rather than simply needs which must be met.”
“…informed service development – including the development of more effective services, which better reflect the needs, values and experiences of patients and carers”.
Deciding priorities and service improvement
• Service users and carers are made full members of any groups responsible for assessing health care needs such as the Joint Strategic Needs Assessment. By using the principles of the VbC approach, commissioning organisations will enable inclusion of a wider range of individuals and hard to reach groups.
• VbC promotes a shared decision-making approach, involving service users to better understand individual and population groups’ mental health needs and desired outcomes, and work co-productively to develop locally appropriate integrated pathways with service user relevant outcomes.
• VbC gives equal status to service user and carer input, clinical expertise and formal evidence and should lead to services that better reflect people’s needs and therefore are more likely to help them recover.
Pathway and partnerships VbC…work co-productively to develop locally appropriate integrated
pathways with service user relevant outcomes.
Need mature multi-agency approach
•Police
•Courts
•Rail network
•Education
•Social services
•Primary care
•Ambulance services
•DATs
•Public health
•And so on…
National level support and local implementation
National:
•Inform, equip, guide
•Mental health intelligence network
•MH Clinical Leadership programme
•Integrated pilot learning
•Implementation steering group
•NICE guidance, JCPMH Guidance
Locally:
•Local protocols
•Monitoring standards e.g. use of police cells as place of safety
•Clarity around individual and organisational roles and responsibilities
•Local declarations
•Local mental health partnership boards
•H&WB
Examples of what we should be commissioning
• Early intervention (respite, crisis plans, peer support liaison
and diversion, mental health first aid training)
• Aligned services- coterminosity
• Simplify access – SPA
• Safety and support of person
• Equitable- ageless, nationality, languages spoken
• Liaison psychiatry
• Patient Relevant Outcomes : CQC Mental Health Crisis
Care Putting people first
Liaison psychiatry B10 People in crisis who present in Emergency
Departments should expect a safe place for their immediate care and effective liaison with mental health services to ensure they get the right ongoing support
Clinical commissioning groups should therefore ensure that there are effective liaison psychiatry services in place, to make the links between Emergency Departments and mental health. services.
Taken from the Mental Health Crisis Care Concordat, Feb 2014
NICE NICE guidance
NICE quality standards
e.g. National Institute for Health and Care Excellence. Quality
Standard for self harm. QS 34. June 2013.
http://publications.nice.org.uk/quality-standard-for- selfharm-
qs34
National Institute for Health and Care Excellence. Quality
Standard on crisis planning.
http://www.nice.org.uk/guidance/qualitystandards/ service-user-
experience-in-adult-mental-health/ CrisisPlanning.jsp
Ten key messages 1 Commission services that they would recommend to family and friends.
2. There should be evidence of service user, patient and carer involvement
3. Commission a range of services in the acute pathway
4. Should ensure that sufficient resources are available
5. An acute care service should be available 24 hours a day, 7 days a week.
6. Should expect clear criteria for entry and discharge from acute care.
7. Ensure service provider collects, analyses and acts upon a range of outcome data.
8. The full range of NICE approved interventions should be available
9. Clear standards for communication with primary care should be set and audited.
10. Must ensure that acute care pathway providers meet their statutory duties under the
Mental Health Act and Mental Capacity Act: Humanity, dignity and respect
Mental Health Crisis Care Concordat: the joint statement
“We commit to work together to improve the system of care and support so people in crisis because of a mental health condition are kept safe and helped to find the support they need – whatever the circumstances in which they first need help – and from whichever service they turn to first.
We will work together, and with local organisations, to prevent crises happening whenever possible through prevention and early intervention. We will make sure we meet the needs of vulnerable people in urgent situations. We will strive to make sure that all relevant public services support someone who appears to have a mental health problem to move towards Recovery.
Jointly, we hold ourselves accountable for enabling this commitment to be delivered across England.”