The parity dividend: Mental health and the Five Year Forward ViewAndy Bell30 June 2015

Why mental health matters

It accounts for 23% of ill health but 13% of NHS spendingMental ill health affects a quarter of people of all agesIt carries an economic and social cost of £105 billion a yearOnly a quarter of adults and children get any treatment

Mind the Gap

The NHS spends about £14 billion treating mental ill health, and…It spends another £14 billion not treating mental ill health

The costs of not treating mental ill health

4.6 million people have a long-term physical illness and a mental health conditionPhysical health outcomes are worse and costs are higher for this groupThis costs the NHS £10 billion a yearMedically unexplained symptoms cost a further £3bnMental ill health among NHS staff costs £1bn

Key themes from Five Year Forward View

Prevention EmpowermentEngagementNew models of careInnovationEfficiency

Integrated care and support (1)

King’s Fund and Centre for Mental Health report, 2012, recommended:

Targeted mental health promotion for people with LTCsActive detection of mental health needsImprove access to psychological therapiesIntegrate mental health support in chronic disease management programmes

Integrated care and support (2)

King’s Fund and Centre for Mental Health, 2012, also recommended:

Support self-management (eg peer support)Bring mental health specialists into primary careInvest in liaison psychiatry in hospitalsKey role for social support and voluntary sector (eg managing debt)

A local example of integrated care

Hillingdon Hospital included psychological support in a breathlessness clinic for COPDReduced A&E presentations and bed days in six months after interventionSavings estimated at £837 per person: four times cost of intervention

Hackney primary care service

Based in City and HackneyRun by Tavistock and Portman NHS FTBegan in October 2009Offers advice and support to GPs in managing patients (including joint consultations)Provides direct service to patients with a range of psychological therapies

Patient outcomes

75% show improvement in mental wellbeing55% ‘recovered’Higher recovery rate than IAPT services despite more complex needs

Costs and benefits

Service costs £578,000 a yearTypical course of treatment costs £1,348Reduces other health service use £463:

GP consultations (by 25%)Outpatient visitsHospital admissionsA&E attendances

Cost per QALY £10,926

GP survey

42 of 44 GPs surveyed used the service:95% referred someone for treatment62% got professional advice48% had joint consultation64% had case-based discussion

High levels of satisfaction (average 8-9/10)

Prevention and early intervention

Perinatal mental health problems cost £8.1bn a year in EnglandOne in ten women with perinatal depression get access to effective treatmentSome areas lack community teams and access to mother and baby unitsNational funding pledged to support new provision

Children’s mental health

Childhood mental health problems cast lifelong shadowWide range of effective treatments for depression, anxiety and behavioural problemsBut few get the help they needNew investment promised in 2015 Budget to support improvementsLocal Transformation Plans will be key to improving children’s experiences

Access and waiting

New standards now introduced, including:Adult psychological therapy for depression and anxietyEarly Intervention in PsychosisLiaison psychiatry in hospitals

Crisis Care Concordat:Declarations now in place across EnglandLocal implementation is key

Supporting recovery

Hope, control and opportunityKey roles of employment and housingFamily, friends and relationshipsPeer supportRecovery CollegesSafer inpatient wards

Promoting equality

Physical health: 20-year mortality gap for people with schizophreniaSome groups of people have poorer experiences of mental health supportContinued high levels of mental ill health in criminal justice system

What next?

Understand local needs: using JSNAs to find biggest gaps in supportBuild partnerships: CCG mental health leads, council member champions, Public Health, PCCs, etcInclude mental health in all local plans: emergency care, Vanguards, LTCs…Raise knowledge and awareness of all health workers

Finding local solutions

Reinvestment in and within mental health are vital for sustainability of the NHSLots of small-scale innovation happeningBut lots of salami slicing and cuts to effective interventionsBuilding on evidence and finding new ways to meet needs will be crucial

But whatever you do…

‘There is no health without mental health’

Thank you

For more information:Email andy.bell@centreformentalhealth.org.ukFollow @CentreforMH www.centreformentalhealth.org.uk