Strathdee MH Parity FT
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Transcript of Strathdee MH Parity FT
October 16th 2013
Valuing Mental Health Geraldine Strathdee, National Clinical Director of Mental Health, NHS England
Valuing mental health in the NHS
Why does the NHS need to value mental health The impact of mental health on outcomes & costs
Parity between mental health & physical health what would it mean in practice
Fast tracking Value in the NHS what role can the FT network have in delivering it?
Asking for your narrative, brains, expertise, insights & leadership for England
The clinical and economic impact: 2012
Why does the NHS need to value mental health because mental ill health it is very common & it impacts on all outcomes
How common is mental ill health
Common Conditions Outcome impact
Primary care :
30-50% of daily workload
Depression & anxietySubstance misuseChildren's conditionsPsychosis
Premature mortality : 15-25 yearsQuality of life in LTCsRecovery from illness Patient safety
Acute care
40% of A&E in London 40% acute beds in London 50% acute outpatient clinics
Alcohol & drugsDepression & self harmDementiaPsychosis relapse
Premature mortality Quality of life for LTCsRecovery from illnessPatient safety Patient experience
Prisons & offenders
70-80% especially young men
ADHD, ASDDepression Substance misuse PD
Premature mortality
Specialist mental heath services
Psychosis Neurodevelopmental Substance misuse Personality disordersComplex multi axial
Premature mortality : 15-25 yearsQuality of lifeRecovery from illness Patient safety
Mental health Value: depression and anxiety are the commonest healthcare comorbidities & have major impact on Costs Chris Naylor, Kings fund
• International research finds that co-morbid MH problems are associated with a 45-75% increase in service costs per patient (after
controlling for severity of physical illness)
• Between 12% and 18% of all expenditure on long-term conditions is linked to poor mental health and wellbeing – at least £1 in every £8 spent on long-term conditions. Hea
rt Fail
ure
Stroke
Heart
disea
se
Diabet
es
Hyper
tens
ion
Arthrit
is
COPD
Cance
r
Asthm
a0%
20%
40%
60%
80%
100%
120%
140%
160%
180%
Depression
Anxiety
% in
cre
as
e in
an
nu
al p
er
pa
tie
nt
co
sts
(
ex
clu
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f M
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)
http://www.kingsfund.org.uk/publications/long-term-conditions-and-mental-health
Commissioning for Value with partners Life span care pathways focusing on downstream
Prevention & health promotion
Early identification & early
intervention
Timely Access to services offering choice, quality outcome focus
Care at home or in the least restrictive settings,
Crisis response that is easy to
access & expert
Parity for people with physical & mental health
& in relationships with our service users
Integrated physical & mental health & social care
Where every contact is a kind enabling, coaching experience
Parity and equalities: There is a disparity in the number of people with mental illness in contact with services, compared to physical health, yet it is a major cause of premature death & lives lived in distress and misery
26% of adults with mental illness receive care
92% of people with diabetes receive care
By condition…. % in treatment
Anxiety and depression 24PTSD 28Psychosis 80ADHD 34Eating disorders 25Alcohol dependence 23Drug dependence 14
Mental health problems are estimated to be the commonest cause of premature death
Largest proportion of the disease burden in the UK (22.8%), larger than cardiovascular disease (16.2%) or cancer (15.9%)
People with schizophrenia die 15-25 years earlier
Depression associated with 50% increased mortality from all disease
Prevention & Early intervention (Knapp et al, 2011)highly effective treatments deliver value
For every one pound spent the savings are: Parenting interventions for families with conduct disorder : £8
Early diagnosis and treatment of depression at work: £5 in year 1
Early intervention of psychosis £18 in year 1
Screening & brief interventions in primary care for alcohol misuse £12 Yr 1
Employment support for those recovering from mental illness: Individual Placement Support for people with severe mental illness results in annual savings of £6,000 per client (Burns et al, 2009)
Housing support services for men with enduring mental illness: annual savings: £11,000–£20,000 per client (CSED, 2010).
Parity and premature mortality Annual primary care QOF assessments of people with mental illness and those with diabetes
Parity mapping between people with diabetes cf those with SMI
Diabetes%age assessed
Severe mental illness
No. patients 2,488,948 422,966
BMI ( Body Mass Index) 94.9% 79.4%
Cholesterol 96.1% 71.7%
HbAC1 97.5% 64.8%
BP 98.4% 84.1%
Total 97.3% 74.7
All with p<0.001
Commissioning for Parity : what it means in reality
NHS Mandate: what does it mean in practice in a GP’s surgery
GPs are trying to do everything for everyone, too much of 21st Century care is being provided through 19th century organisational models………Professor Michael Porter is a world authority on strategy in business, & has spent the past decade working in healthcare systems in dozens of countries.
• I was struck the other day when I saw a patient - who has been off work for 3 months waiting for CBT. He is depressed and was just told to go on sick leave- no medication, just a referral for CBT in the distant future.
• When I saw him , what upset me most was that if he had broken his leg, he would have been treated asap, given rehab, told to go to work on crutches and would not have just been abandoned.
• I want to make it impossible for mental health problems to be treated as second class illnesses - with patients with treatable conditions languishing on waiting lists or worst still with no treatment at all
Clare Gerrada, president of the Royal College of GPs
Value based Integrated care pathways design: commissioning for 60% volume, 60% spend; top 10%
Depression: is the most common MH condition in PC, acute, MHT, addictions, adolescents , veterans
• 30-50% of the daily work of GPs is MH related, especially depression• Post graduate training for GPs, PNs, HVs, PC has been less available and tailored to PC mental health• 78% of people who commit suicides have seen their GP in the month before the suicide• Long term conditions: 70-80% of all healthcare & depression is the common comorbidity in 25-40%• Untreated depression in COPD, CHD, cancer, stroke, diabetes, means patients die early & cost more• 60-90% of those who misuse alcohol and drugs have depression• Children and young people can be helped to develop resilience against depression• Transport hub suicides are high in London and can be prevented• RCGP & AHSCs are keen to develop new population & pathway based approaches to depression in all
sectors
The young people with psychosis & complex needs in high cost top 10% tier• 95% patients are treated in the community, but 60% spend is on beds • The Top 10% patients who account for 50-60% spend are not well recognized, helped by
caseload zoning and risk stratification• Our detention rates are rising year on year despite CTOs• 70-80% of those in MSUs and LSUs are young black men with long LOS• Substance misuse is a very common comorbidity which triggers 60% high risk events e.g.
suicide , homicide, partner impact, but the commissioning & provision are not understood
What is NHS England doing to support commissioners and providers move to an outcomes based value system
1. CCG: building capacity and capability in mental health leadership
2. Primary care mental health
3. Care of people with psychosis : ‘industrializing’ improvement
4. The acute care pathway and suicide prevention
5. Integrated physical & mental health care pathways
6. Mental health intelligence informatics network programme• new model of information led commissioning & integrated provision • Whole pathway commissioning of Tiers 1-4
Underpinning Value based commissioning and care• Outcome measurement• Service specifications aligned to PbR• Reducing burden to free up time to care
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“Crossing the Quality Chasm”
Ohio State Psychiatry Grand Rounds 12.05.2012
Value in mental health NICE/SCIE 1. Right information
2. Right physical health care
3. Right medication
4. Right psychological therapies
5. Right rehabilitation, training for employment
6. Right care plan addressing housing, work, healthcare, self management
7. Right crisis care
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Mental health : Is the problem that we have no evidence or value based guidance?
Mental health has over 100 NICE Health Technology appraisals, NICE guidelines, Public health related guidelines and Quality standards…..
The problem is not lack of guidance The problem is that we have not focused on how we learn and disseminate from
those that can and have implementedCan the FT network lead a new NHS Change model?
To FT leaders
• Can you help build a very different comms. platform
• Narrative stories of recovery and success
• Narrative stories of how mental health has led the health services in the world in our deinstitutionalisation & community care……..
• Can you put on all your websites service specifications of your services to prepare NOW for choice and PbR
Can you lead for transformation to make England's services the best in the world for our wonderful service users:
• Can you plan for one point of access for all crisis response streamlining from current 12 access points
• You have brilliant services, but we have wide variation : to upscale and industrialize improvement PLEASE can you share good practice & have fun
We have enough brains, energy & track record in collaboration….let’s use it
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