Post on 30-May-2020
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
Every Colleague Matters 2016
Every Colleague Matters 2016
Mental Health: Setting the Scene
Katy Ball: Director of Commissioning and Procurement, Nottingham City
Council
Every Colleague Matters 2016
Every Colleague Matters 2016
Taking a strategic approach to improving mental health and
wellbeing in Nottingham.
Dr Jane Bethea.Consultant in Public Health.
Nottingham City Council.
Every Colleague Matters 2016
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:
Every Colleague Matters 2015
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
Every Colleague Matters 2016
The Behavioural, Emotional, and Mental Health Pathway in Nottingham for Children and Young People
Every Colleague Matters 2015
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
Every Colleague Matters 2016
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
Every Colleague Matters 2016
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
Every Colleague Matters 2016
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
Every Colleague Matters 2016
Working together for a healthier Nottingham
Simon CastleAssistant Director of Commissioning –
Mental Health, Cancer, Acute Contracts
Working together for a healthier Nottingham
Working together for a healthier Nottingham
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.
Working together for a healthier Nottingham
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
Working together for a healthier Nottingham
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
Working together for a healthier Nottingham
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
Working together for a healthier Nottingham
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.
Working together for a healthier Nottingham
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?
Primary.health.college@nottshc.nhs.uk
@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
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: letstalknottingham@nottshc.nhs.uk
� 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: nottingham.talking@turning-point.co.uk
Who provides the services?
Any questions?
Market Place
Every Colleague Matters 2016