Every Colleague Matters Event Opening Seminar – Responding ... · health challenges they may...

Every Colleague Matters 2016

Every Colleague Matters Event

Opening Seminar – Responding to the Mental Health and Wellbeing of

the City

10th October 2016Albert Hall, Nottingham

A warm -up activity



Mental Health: Setting the Scene

Katy Ball: Director of Commissioning and Procurement, Nottingham City

Council


Taking a strategic approach to improving mental health and

wellbeing in Nottingham.

Dr Jane Bethea.Consultant in Public Health.

Nottingham City Council.


Key strategies for the city:

• Future in Mind• Health and Wellbeing strategy (Happier,

Healthier Lives)• Wellness in Mind. The Nottingham City Mental

Health and Wellbeing Strategy 2014-2017• Nottinghamshire Suicide Prevention Strategy

2015-2018• NHS Nottingham City CCG – Commissioning

Strategy 2016-2020

Future in Mind Overview: The Government’s aspiratio ns are that by 2020 we should see:


Local Activity on Future in Mind

• Academic resilience/emotional health in School

• Improving care for young people in mental health crisis

• Increasing access to a range of MH services for mums and mums to be

• Prioritising workforce development


The Behavioural, Emotional, and Mental Health Pathway in Nottingham for Children and Young People


Happier, healthier lives : Nottingham City Joint Health and Wellbeing Strategy 2016 – 2020

• Children and adults will adopt and maintain healthy lifestyles

• Children and adults in Nottingham will have positive mental wellbeing and those with long-term mental health problems will have good physical health

• There will be a healthy culture in Nottingham in which children and adults are supported and empowered to live healthy lives and manage ill health well

• Nottingham will have a sustainable environment, and citizens will be supported and enabled to have good health and wellbeing


A focus on:

• Those at risk being able to access an appropriate level of support when they need it

• Those with long term mental health problems having healthy lives

• Employment – access to employment and staying in employment

• Ensuring that people who are lonely or isolated or at risk of loneliness and isolation are identified and supported


Wellness in Mind. The Nottingham City Mental Health and Wellbeing Strategy 2014-2017 .

• Promoting mental resilience and preventing mental health problems

• Identifying problems early and supporting effective interventions

• Improving outcomes through effective treatment and relapse prevention

• Ensuring adequate support for those with mental health problems

• Improving the wellbeing and physical health of those with mental health problems


Parity of esteem

• Tackling discrimination and stigma

• Making sure that all strategies promote and consider mental health and wellbeing as well as the physical health of the population

• Ensuring that services that might have traditionally been associated with physical health all have mental health and wellbeing at their centre


Working together for a healthier Nottingham

Simon CastleAssistant Director of Commissioning –

Mental Health, Cancer, Acute Contracts


Core elements of the 5 year Strategy

• Developing multi-disciplinary community

based alternatives to hospital

• Achieve greater well-being, build resilience

and independence and optimise life chances

• Intervening earlier and integrating the care

of peoples mental and physical health

• NHS cannot deliver this alone. Delivered in

partnership with local organisations

including local government, housing,

education, employment and voluntary

sector.


Common Mental Health Problems

• Increased access to psychological therapies

• Expansion of existing services

• New services integrated with physical

healthcare for patients with co-morbid

physical and mental health conditions

• Particularly patients with LTC – diabetes, CVD,

COPD and also cancer, pain management

• 3000 new mental health therapists

• Address variation in outcomes and access

within different populations – BME, older

people, perinatal


STP

• Local vehicle to implement core elements within the Five Year

Forward View.

• Covers Nottingham and Nottinghamshire footprint

• Focus on Health and Wellbeing, Care & Quality, Finance and

Efficiency


STP - High Impact Areas

• Promote Wellbeing. Prevention, Independence and Self-Care

- support people to stay healthy and independent, and prevent

avoidable illness

• Strengthen primary, community, social care and carer services

- Help people with LTCs stay well and avoid acute care,

improve access to primary / community bases services


GP

or

self-

refe

rral

STEPS Provides mental health advice and support for Black, Asian, Minority Ethnic and Refugee communities - the STEPS

team are from a range of diverse communities, languages and cultures

Primary Care Psychological TherapiesDelivers a range of therapies for people experiencing common mental health difficulties such as feeling low, depressed,

anxious or stressedLet’s Talk Wellbeing, Insight Healthcare,

Trent PTS, Turning Point

Wellness in MindProvides individualised support to improve people’s mental wellbeing (or that of friends, families or carers) - advice and information is available to connect people with relevant services including health, advice on debt/housing/employment

or linking people to other groups to reduce loneliness/isolation

Primary Health, Wellbeing & Recovery CollegeOffers a range of educational courses aimed at equipping people with the skills they need to deal with emotional/mental

health challenges they may face.

Rape CrisisProvides specialist support to people who have experienced any form of sexual violence, whether recently or in the

past

KoothFace to face and online self-harm counselling services for children and young people in Nottingham City (11-24 years)

Eating Disorders in Students Service (EDISS) First StepsEarly identification and intervention for mild to moderate eating disorders for university students

Open Door ProjectOffer a range of recovery based and social activities including coping skills courses, discussion groups, cookery

groups, walking, art, reading, relaxation etc.

Nottingham Health & Employment Service One-to-one support with health issues (including mental health) which impact upon people’s ability to return to, or stay

in, work.


Challenges

• Navigation: Increasing number of providers, services and

pathways. Confusing for patients, carers and clinicians -

Wellness in Mind, Primary Care Mental Health Service, Care-

Coordinators within Integrated Care Teams

• Duplication: inefficient, layers of services overlapping – clear

specifications, continually reviewing service models, service

user / clinical teams evaluation.

Wellness in Mind is the central point of

advice and support for anyone in

Nottingham seeking better mental health, It;

1. Supports people in Nottingham seeking

help and advice around their mental

health.

About Us

2. Provides a telephone helpline, accessible drop in, and

signposting service for people seeking support with

their mental health.

3. Provides assessment, support and outreach to individuals and

groups who may need additional support.

Finding your bearings

Openness and curiosity

Helping people find and access the treatment and support they need , and to

navigate the system.

Developing persistence

Promoting recovery

Developing resilience

Lost without a map

Support

• One off support (i.e. drop-in face to face, phone call

or via email) for the provision of information

• A few weeks on service (e.g. initial meeting, followed

by info gathering/signposting, then support in

attending an activity for the first time)

• Longer term (e.g. referred to IAPT, then offered

emotional support and advice re self care whilst on

waiting list)

• Recognising problems early, and addressing them, can help prevent

things getting worse.

• Finding and engaging with support can be really helpful in making

progress.

Philosophy

of service

• Everyone experiences mental health,

which can be positive, but also cause

challenges in our lives.

• Making positive changes in your mental

health is possible for everyone.

• Knowledge, understanding and

awareness of issues, and services

available can help people make

positive changes.

• A holistic approach which considers all aspects of one’s life is

more likely to promote wellbeing and resilience.

• People may need help in overcoming stigma, which can

act as a barrier to people getting help.

• People may need support to help them navigate their

way through services and find what works for them.

Philosophy

of service

In pairs. Describe a time in your life when WiM. May have been useful to

you. 1 min, each

Connecting

to WiM.

Great ideas come easy, it’s the turning them into reality that’s the

difficult bit.

What are the biggest challenges in making this happen?

Making it a

reality

Steering Group

• The Primary Care Mental Health & Wellbeing Steering group will ensure that the

these services work effectively together.

• It will ensure that these services connect with other key services, in particular G.P.s

, I.A.P.T services, self-care services, and other community projects.

Any

Questions?

Overview of the Primary Health,

Wellbeing & Recovery College

with

Tracey TaylorOperational Manager

Community and In-Patient Rehabilitation

Services

On your tables you will find the

Spring Term 2017 courses.

Which would you choose and why?

[email protected]

@NottmRecCollege

Email Us

Follow Us

Visit Us www.nottinghamshirehealthcare.nhs.uk

/primary-recovery-college

Thank you!

40

Adult Mental Health Services

Tracey Taylor – Operational Manager

Nottingham City

Primary Care Mental Health Service

41

National Context � Five Year Forward View for Mental Health

○ Integrated care can substantially reduce poor outcomes for those with physical

and mental health problems.

○ Mental Health care should be delivered in Primary Care.

� Joint Commissioning Panel for Mental Health report on Primary CMH

○ 17.6% of adult population have a common mental health problem

○ 6% have a alcohol dependence,

○ 3% drug dependence,

○ 21% nicotine dependence (42% of tobacco consumed in England is by mental

health patients)

� DOH

○ 15 million people with long term conditions

○ Long term chronic conditions affect 30% of population and account for 50% of

GP consultations

42

Local Context �Nottingham City CCG Strategy ‘Working together for a healthier

Nottingham’

○ Nottingham City: registered population 360,832 (approx. 3390 SMI)

○ Improving mental health is one of 6 key priority areas for

transformational change.

○ Primary Care pathway that supports early intervention and prevention

○ PCMHS integral part of the whole Primary Care pathway

• Improving access for Mental Health patients

• Improving knowledge and skills

○ Supports parity of esteem (mental health and physical health)

43

Patient Group

� Registered with Nottingham City GP

� 18 years + (17 if transitioning from CAMHS to GP)

� Common Mental Health Problems

○ Non psychotic disorder: depressed mood, anxiety, OCD, stress reaction/adjustment disorder, phobic

anxiety disorders, risks to mental health due to self neglect and non compliance with prescribed

medication, self harm/OD not followed up by secondary care. Psychosis not needing secondary care

○ Misuse of Alcohol or drugs

○ Patients that present with a pseudo dementia which is related to depression

� Problems are short term

� Patients who don’t meet the severity threshold for a secondary mental health service

� Patients not suitable for IAPT

� Referrals from GP (and other primary care professionals)

� Future: The demand and capacity of the service will be reviewed from commencement

of the service.

44

Service Delivery

� Mental Health Assessment

� Provision of short term Care and Treatment Interventions

� Review/advise on treatment/medication prescribed by GP

� Prevention of crisis, assessment of risk and need for secondary referral

� Advise and Guidance to other professionals in the Primary care services

� Improving access to Primary care services for marginalised groups such as

Opportunity Nottingham service users and other third sector providers

� Signposting and Referral onto other services as appropriate

� Prevention of unnecessary referral onto secondary mental health services or

referral onto secondary mental health services if appropriate

� Discharge back to GP with advice for on-going management

45

Service Structures � Main Team Base: St Anns Valley Centre� Team of 10 nurses, 1 NMP, 2 Peer Support Workers, medical

sessions� Clinic base appointments in GP practices across 8 CDG� Some flexibility to see people at home � Clinicians working with designated cluster groups � Attending MDT meetings � 9.00-5.00 Monday to Friday with flexibility for early morning or

evening appointments� 9.00-12.00 Saturday � Using Primary care IT systems (system 1 and emisweb)

46

Primary Care Pathway: Partners � GP’s and Care Delivery Group professionals � Neighbourhood teams � Framework

○ Opportunity Nottingham � Wellness in Mind

○ Framework ○ Awaaz○ NCHA

� STEPS � Primary Health-Well being and Recovery College � IAPT services � Drug and Alcohol services � Secondary Care Crisis resolution and Home Treatment service

47

Thank-you

Improving Access To Psychological Therapies Services All IAPT providers Nottingham

Mental Health

What is IAPT?

What is IAPT? Created following a report by Lord Richard Layard regarding the economic cost of mental ill health on the country.

Before IAPT, the NHS spent just 3% of its mental health budget on talking therapy.

IAPT tripled that budget, and has trained 6,000 new therapists who have so far treated over one million people for depression and anxiety (as of 2012).

It’s the biggest expansion of mental health services anywhere in the world, ever.

What is IAPT?

• Primary care psychological therapies service delivering

treatments to adults over the age of 18 and registered

with a Nottingham GP

• Receive self referrals, conduct screening assessments

and offer a wide variety of treatment choice, using

evidence based therapies

• Use early interventions in a stepped care approach

Referrals

� Depression

� Stress

� Panic (with or without

Agoraphobia)

� Phobias

� Generalized Anxiety Disorder

� OCD

� Low Self Esteem

� Post Traumatic Stress Disorder

(PTSD) single incident

� Health anxiety

(hypochondriasis)

Referral criteria

� Depression or anxiety in adults

with chronic physical health

problems (LTC) and comorbid

Chronic Pain and/or Medically

Unexplained Symptoms

� Social anxiety

� Body Dysmorphic Disorder (BDD)

� Complex grief

Referrals:

Exclusion criteria

� Under 18

� Not registered with a GP

� Referrals for help with addictions (main problem/high

use)

� Referrals for help with bipolar, psychosis or personality

disorders (main problem)

� Already in therapy/counselling/secondary care services

� Events or needs that preclude stable engagement

(immediate housing, physical safety, etc.)

Treatment

Stepped Care (Nice 2010)

STEP 1. Recognition and diagnosis – GP, primary care practitioner

STEP 4.Secondary care

STEP 3. Primary Care - IAPT

STEP 2. Primary Care –IAPT

High intensity psychological interventions, ECT, multiprofessional and inpatient care

CBT, CBT Treatment Groups, IPT, EMDR, Counselling for Depression, DIT

Psychological wellbeing practiioners - Guided Self help, groups, seminars, bibliography

Assessment, support, psychoeducation, active monitoring and referral for further assessment and interventions, self help, normalising

Stepped Care IAPT (Nice 2014)

STEP 1. Recognition and diagnosis – GP, primary care practitioner

STEP 4. Secondary care Severe and complex presentations, risk /crisis

STEP 3.IAPT High Intensity Moderate -severe (and mild-mod if no improvement at step 2): 1.Depression 2.Panic disorder 3.Generalised anxiety disorder (GAD) 4.Social phobia (mild – severe) 5.Post traumatic stress disorder (PTSD) (mild –severe) 6.Obsessive compulsive disorder

STEP 2. IAPT Low Intensity Mild -Moderate: 1.Depression 2.Panic disorder 3.Generalised anxiety disorder (GAD) 4.Obsessive compulsive disorder (OCD)

Highly specialised psychological interventions, multi-disciplinary and multi agency

HI Interventions 1.Cognitive behavioural therapy (CBT), interpersonal therapy (IPT), behavioural activation (BA), dynamic interpersonal therapy (DIT), couples therapy and counselling for depression (CfD) 2.CBT 3.CBT 4.CBT 5.CBT, eye movement desensitisation and reprocessing (EMDR) 6.CBT CBT, CBT Treatment Groups, IPT, EMDR, Counselling for Depression, DIT

LI Interventions 1.cCBT, guided self-help, behavioural activation (BA) and exercise 2.cCBT, guided self-help, pure self-help 3.cCBT, guided self-help, psychoeducation groups, pure self-help 4. Guided self-help Psychological wellbeing practitioners -

Assessment, Assessment/watchful waiting, active monitoring and referral for further assessment and interventions, self help, normalising

Stepped care

The principles of stepped care include:

Ensuring the client is in the right step at the right time

It’s not necessarily the case that a client will start at the

bottom and move up

Clients can move up and down the model

Clients should be receiving the least intrusive intervention

possible for their problem

Decisions are made on the basis of need and

collaboratively with the patient.

� Step 2 – Psychological Wellbeing Practitioners

delivering Low Intensity Interventions

� Step 3 – Psychotherapists delivering:

– Cognitive Behavioural Therapy

– Interpersonal Therapy

– Eye Movement Desensitisation and Reprocessing

Therapy

– Counselling for Depression

– Dynamic Interpersonal Therapy

Treatments

Step 2

� Guided self help

� Telephone, cCBT, face to face at the office or group support

� Mild to moderate depression and anxiety (excluding PTSD and social anxiety): Managing panic, Sleep hygiene, problem solving, activity scheduling, exposure, thought evaluation skills, signposting, medication support.

� Present and future focussed

� Based on the Cognitive Behavioural model

� Aims to make changes in clients behaviour or thinking patterns to reduce distress

� Groups, seminars and workshops

Telephone

Drop in clinics

Post

Online

Email

How can clients self refer

� Uywruwer

� Iyteiruwytruiwyteriu

� Wuierowriert

� Let's Talk Wellbeing

� Nottinghamshire Healthcare NHS Foundation

� Trust, Duncan Macmillan House, Porchester Road, Nottingham, NG3 6AA

� Tel: 0115 956 0888

� Visit: www.letstalkwellbeing.co.uk

� Email: [email protected]

� online referral form https://www.iaptportal.co.uk/Home.aspx

Who provides the services?

Insight Healthcare,

Edgeley House, Tottle Road,

Nottingham, NG2 1RT

0300 555 5580www.insighthealthcare.org

0300 555 55800300 555 5581

Trent PTS

Psychological Therapies Service

19 The Ropewalk, Nottingham NG1 5DU

t: 0115 896 3160

Turning Point Talking Therapies

Second Floor, Nottingham Counselling Service, Unit 5,

Victoria Court, Kent Street, Nottingham, NG1 3LZ

T: 0300 555 0456

WEB: talking.turning-point.co.uk

EMAIL: [email protected]

Who provides the services?

Any questions?

Market Place


Every Colleague Matters Event Opening Seminar – Responding ... · health challenges they may...

Documents

Transcript of Every Colleague Matters Event Opening Seminar – Responding ... · health challenges they may...