Improving Access to Mental Health Services by 2020 31st March 2015 @Time4Recovery #EI2020

House Keeping Fire Exits Bathrooms Pictures & Video Twitter & Social Media @Time4Recovery #EI2020

Welcome & Opening Remarks Gary Ford CBE Chief Executive, Oxford AHSN 31st March 2015

AHSN core purpose – health and wealth • Licensed by NHS England for 5 years to deliver four objectives:

• Focus on the needs of patients and local populations: support and work in partnership

with commissioners and public health bodies to identify and address unmet health and social

care needs, whilst promoting health equality and best practice.

• Speed up adoption of innovation into practice to improve clinical outcomes and patient

experience - support the identification and more rapid uptake and spread of research

evidence and innovation at pace and scale to improve patient care and local population

health.

• Build a culture of partnership and collaboration: promote inclusivity, partnership and

collaboration to consider and address local, regional and national priorities.

• Create wealth through co-development, testing, evaluation and early adoption and spread of

new products and services.

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What and where are we?

Oxford AHSN – 1 of 15 in England

3.3M population

Annual NHS spend circa £5bn

NHS employees 65,000

12 Clinical Commissioning Groups

4 Local Enterprise Partnerships

12 Councils

Major international companies

300 Life Sciences businesses

Complex landscape with many providers and agencies

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Our healthcare, academic and LEP partners 11. South Central Ambulance Service FT 11

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Early Intervention in Mental Health Network – a year in Belinda Lennox

PSYCHOSIS:

Costs £11.8 billion

per year

(Schizophrenia Commission ‘The

Abandoned Illness’ 2012)

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the most positive development in mental health

services since the beginning of community care.

...no where else have we seen the constant high

standards, recovery ethos, co-production and

multi-disciplinary team working.

“

“

”

”

Schizophrenia Commission, 2012

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Source: A Lost Generation, Rethink 2014 #ei2020

Source: A Lost Generation, Rethink 2014 #ei2020

Oxford AHSN Early Intervention in mental health theme will:

• 1. Reduce variation in care in early psychosis

across the AHSN and improve outcomes

• 2. Increase research activity in early psychosis

– in causes, treatments and service delivery

• 3. Extend early intervention across other

conditions

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• What proportion of young people with a first episode of psychosis in the Thames Valley currently have access to an Early Intervention in Psychosis service?

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Proportion of young people with psychosis in Thames Valley under EIP

service = 20%

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Given that 6% of all young people are not in

employment education or training, to the nearest 10%,

what % of young people with psychosis do you think are

NEET in Thames Valley?

Not in Education, Employment Training with psychosis: 70%

19%24%

12%

26%22%

15% 18%27%

18%14%

23%27% 28%

9%6%

7%

9%10%

8%7%

7%

9%10%

14%15%

9%

72% 70%

81%

64%68%

77% 76%

66%72%

76%

63%58%

64%

100%

NHS Wokingham

CCG

138

NHS Windsor, Ascot and

Maidenhead CCG

148

NHS South Reading

CCG

194

NHS Slough CCG

272

NHS Oxfordshire

CCG

747

NHS North & West Reading

CCG

150

NHS Newbury

and District CCG

123

NHS Milton Keynes CCG

357

NHS Chiltern

CCG

387

NHS Bracknell and Ascot

CCG

213

NHS Bedfordshire

CCG

448

NHS Aylesbury Vale CCG

210

Oxford AHSN

3,532

Employed

Students in full-/part-time education

NEET (Not in Education, Employment or Training)

Source: Oxford AHSN user data contained in HES and MHMDS datasets licensed from HSCIC, 2014 #ei2020

Early Intervention achieves better outcomes for those with psychosis across Thames Valley

23% 18%11%

37%

41% 48%

33%

36%

15% 7%

10%

15%18%

19%

7%

100%

Other mental health, 16-35

5,722

10%

Psychosis, Other Age

Groups

7,068

4%

34%

Psychosis, Other teams, 16-35

2,747

8%

Psychosis, Early

Intervention, 16-35

785 7%

Employed Unemployed and seeking work Students in full-/part-time education Long-term sick/disabled, on benefits Unknown/Retired

Source: Oxford AHSN user data contained in HES and MHMDS datasets licensed from HSCIC, 2014 #ei2020

#ei2020

What is the average length of stay in hospital for a young person with

psychosis?

Average length stay = 8 weeks.

40

-31%

Average inpatient stay /person/year (days), 16-

35yrs

57

947

38% +24%

Proportion of users that get

admitted, 2 years, 16-35yrs

31%

Seen only by other teams Seen by Early Intervention teams in 2010-13

1.5 -10%

Average admissions

per person per year, 16-35yrs

1.6

Savings per 16-35 year old person per year @£300/bed day is £5,100

Source: Oxford AHSN user data contained

in HES and MHMDS datasets licensed from

HSCIC, 2014

16-35 yrs only

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How are we making a difference?

#ei2020

Lets hear it from our quality champions..

Make your pledge today

Early Intervention in Mental Health:

Extending Early Intervention

Mark Allsopp

Joint Network Lead

Early Intervention in Psychosis intervention n. Interference so as to modify a process or situation. • early identification - teenage and early adult • facilitating access and engagement with services • reducing stigma • promptly starting effective treatment • improving compliance by education and minimising side -effects • providing intensive psychological and social supports to promote recovery

and prevent relapse

Prevention Primary prevention Methods to avoid occurrence of disease either through eliminating disease agents or increasing resistance to disease. Examples include immunization against disease, maintaining a healthy diet and exercise regimen, and avoiding smoking.

Secondary prevention Methods to detect and address an existing disease prior to the appearance of symptoms.[1] Examples include treatment of hypertension (cardiovascular disease), cancer screenings, identification of prodromal or at risk mental states in Psychosis

Tertiary prevention Methods to reduce negative impact of symptomatic disease, such as disability or death, through rehabilitation and treatment. Examples include surgical procedures that halt the spread or progression of disease, medication compliance and relapse prevention in EIP

Early adjective, earlier, earliest.

1. occurring in the first part of a period of time, a course of action, a series of events, etc.: assertive intervention early in the course of a first episode psychosis 2. occurring before the usual or appointed time: early identification and engagement in EIP service 3. appearing or maturing before most others of its type: the early presentation of psychosis in a 14 year old.

Our Network Priorities

Our focus is : • on young people in adolescence and early adult life.

• on identifying Mental Health conditions arising in that period of the lifespan early

• on facilitating access to and engagement with services in innovative ways

We will prioritise: • those conditions with with high continuity and with significant risk of becoming severe and enduring if not addressed early.

• those conditions where there is evidence of, or potential for, effective early interventions

• those conditions where there is evidence of low uptake of interventions.

• and/or evidence of impact of symptoms on social and occupational functioning in adult life and /or cost of health care

Find innovative ways to help young people with mental health conditions improve access and engagement with services, obtain the right intervention at the right time,

and continuity of care

When relevant transfer elements of the early intervention in psychosis model to other mental health conditions

Explore ways in which existing early intervention in psychosis services might be extended in scope and time

Through Our Extending Early Intervention Steering Group we want to:

Collate the evidence and experiences available nationally and internationally for services which provide services for 16-25 year olds, and services which provide

alternatives to inpatient admission for young people

Scope the mental health conditions which arise in adolescence and young adulthood to explore research evidence for the effectiveness of early

intervention strategies

Explore evidence and experience of best practice in transition and joint working between CAMHs and AMHs to see what can be applied in EIP services locally

Through Our Extending Early Intervention Steering Group we have started to:

Alternatives to inpatient mental health care for children and

young people Sasha Shepperd1, Helen Doll1, Simon Gowers2, Anthony James3, Mina Fazel3, Ray

Fitzpatrick1, and Jon Pollock4

Authors’ conclusions— The quality of the evidence base currently provides very little guidance for the development of services. If randomised controlled trials are not feasible then consideration should be given to alternative study designs, such as prospective systems of audit conducted across several centres, as this has the potential to improve the current level of evidence. These studies should include baseline measurement at admission along with demographic data,and outcomes measured using a few standardised robust instruments.

Network of Networks 1

Strategic Clinical Network for Adult Mental Health : Crisis Care Concordat

Physical Health Monitoring

Strategic Clinical Network for Children and Maternity: Improved access in community CAMHS Transition between CAMHS and AMH

Early identification of puerperal psychosis

Network of Networks 2 Oxford Academic Health Science Best Practice Networks

Anxiety and Depression ( IAPT):

Social Anxiety

Severe Mood Disorders IAPT for Teenagers

Dementia:

Identification early in presentation Services for Younger Adults

An Example : Obsessive Compulsive Disorder

Recent Public Health Data of community based samples has improved but confirmed results of clinical samples from 1980 onwards Obsessive-Compulsive Disorder: Prevalence, Comorbidity, Impact, and Help-Seeking in the British National Psychiatric Morbidity Survey of 2000. Torres et al Am. J. Psychiatry 2006 “Our data suggest that obsessive-compulsive disorder does not fit conveniently into the fashionable relabelling of neurosis as “common mental disorder” and psychosis as “severe mental illness.” Obsessive-compulsive disorder is a neurosis that is both rare and severe and should be prioritised accordingly.” The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication ( US 2001 -2003) Ruscio et al Molecular Psychiatry 2010

An Example : Obsessive Compulsive Disorder

Onset in Young People: Peak incidence between 16 and 19 years with > 90% before 30 12 month prevalence 1.2% , lifetime prevalence 2.3% Females 1.4%, Males 0.9% . Those with very early onset mainly males High Continuity Most run a relapsing and remitting course Those who develop OCD spend a mean of 8.9 years with the disorder Prevalence reduces in later adult life

An Example : Obsessive Compulsive Disorder

Evidence of Effective Interventions Trials of SSRI anti-depressants effective in adolescent and adult populations CBT trials demonstrated effective in adolescent and adult populations NICE guidance 2005 Each PCT, mental healthcare trust and children's trust that provides mental health services should have access to a specialist obsessive-compulsive disorder (OCD)/body dysmorphic disorder (BDD) multidisciplinary team offering age-appropriate care. This team would perform the following functions: increase the skills of mental health professionals in the assessment and evidence-based treatment of people with OCD or BDD, provide high-quality advice, understand family and developmental needs, and, when appropriate, conduct expert assessment and specialist cognitive-behavioural and pharmacological treatment.

An Example : Obsessive Compulsive Disorder

Low uptake of interventions Significant delay in seeking help : embarrassment , stigma. 57% British sample not in contact with services US sample higher, but only if co-morbidity. If no Co-morbidity only 14% receiving help

Evidence of impact on social function Severe or moderate impairment a) Home management 71%, b) work 51% c) relationships 57% d) social life 53% e) any domain 79% OR for work or social impairment vs Neuroses 2.8 . 50% living alone. 50% unemployed. 86% earning under £300 per week 25% reported life-time suicidal acts OR vs Neuroses 2.0

An Example : Obsessive Compulsive Disorder

So OCD meets our Priorities and much evidence already exists. But is not the only example - where do we put our energies? Take for example eating disorders ………

The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors

Janet Treasure and Gerald Russell

Summary: Here we revisit and reinterpret the original study in which the so-called ‘Maudsley (London) model’ of family therapy was compared with individual therapy for anorexia nervosa. Family therapy was more effective in adolescents with a short duration of illness. However, this is only part of the story. A later study describing the 5-year outcome contains important information. Those adolescents randomised to family therapy achieved a better outcome 5 years later. Moreover, the group with an onset in adolescence but who had been ill for over 3 years had a poor response to both family and individual therapy, suggesting that unless effective treatment is given within the first 3 years of illness onset, the outcome is poor. We examine other evidence supporting this conclusion and consider the developmental and neurobiological factors that can account for this.

The British Journal of Psychiatry (2011) 199, 5–7. doi: 10.1192/bjp.bp.110.087585

Guidance to support the introduction of access and waiting time

standards for mental health services in 2015/16 :

Eating disorders

The Autumn Statement 2014 outlined the provision of additional funding of £30million recurrently for 5 years to be invested in

a central NHS England programme to improve access for children and young people to specialist evidence-based community

CAMHS eating disorder services.

Part of this programme funding will be used to develop an access and waiting time standard.

The aims of the programme are to:

Deliver swift access to evidence based community treatment for children and young people with eating disorders;

Reduce demand for specialist inpatient beds;

Reduce relapse;

Reduce transfers to adult services and mitigate the problems of transition for young people with eating disorders when they

turn 18 through the development of care pathways for children and young people up to the age of 25;

Ensure a consistent evidence-based outcomes- focussed model of care;

Through ring-fenced investment in specialist eating disorder services, build capacity within general CAMHS so that a greater

number of children and young people with other mental health problems, such as self harm, can access

More than 1.6 million people in the UK are estimated to be directly affected by eating disorders (ED). Anorexia nervosa has the highest mortality amongst psychiatric disorders. The CAMHS Tier 4 review (May 2014) noted that ED was the largest category of sub-specialist beds. NICE (2004) recommends: That most people with anorexia nervosa should be managed on an outpatient basis with psychological treatment provided by a service that is competent in giving that treatment and assessing the physical risk of people with eating disorders. Family interventions that directly address the eating disorder should be offered to children and adolescents with anorexia nervosa. Research shows that areas with specialist community CAMHS Eating Disorder services: Better identify ED in primary care; Have lower rates of admissions with non-specialist CAMHS admitting more than 2.5 times as many people; Demonstrate significantly lower relapse rates (5-10%) for children and young people who have responded well to outpatient family therapy than those following inpatient care and there is some evidence that long-term admissions may have a negative impact on outcomes. Are more Cost-effective over 2year follow up

Eating Disorders

NHS England has commissioned the National Collaborating Centre for Mental Health to set up an Eating Disorders Expert Reference Group (ERG), which will meet in early 2015. This is separate from the review NICE is undertaking to the ED guidelines published in 2004, although information and learning will be shared. The ERG will develop: A service model for providers and commissioners; The access and waiting time standard that will be put in place from 2016; and A specification for any necessary amendments to the CAMHS Minimum Dataset. There will be support to train existing and new staff in the appropriate model of care and to assure progress, including supporting clinical network development.

Help clinicians and managers in the Thames Valley area map existing services, improve early identification and access, and plan for the integration of the new

service model in their locality

Use and share research evidence , local experience and innovation to help evolve high quality cost effective eating disorders services for young people up

to the age of 25 years

Develop means to benchmark provision and reduce unwarranted variation in outcome in the Thames Valley area

Through an Early Intervention in Eating Disorders Best Practice Group we could

begin to:

Use technology, innovation and young people’ s involvement to improve access and engagement with services. Explore whether 16-25 services, or alternatives to

admission services are beneficial.

Use existing evidence to transfer when applicable elements of the early intervention model to other conditions such as OCD, Eating Disorders, Severe

mood disorders and emerging Personality Disorder

Explore ways in which CAMHs and existing early intervention services can work together to ensure all young people obtain the right intervention at the right

time, are not excluded from evidence based interventions where they exist and have good continuity of care

In Summary : Through Our Extending Early Intervention Steering Group we want to:

Change from within Zoe Emms Kathleen Millar Lyndsay Gittins Tsitsi Milo

• Reduce variation in care for young people with psychosis across the

AHSN

• Improve outcomes for young people with psychosis

Objective 1: Reduce Variation in Care

#ei2020

23% 18% 11%

37%

41% 48%

33%

36%

15% 7%

10%

15% 18%

19%

7%

100%

Other mental health, 16-35

5,722

10%

Psychosis, Other Age

Groups

7,068

4%

34%

Psychosis, Other teams, 16-35

2,747

8%

Psychosis, Early

Intervention, 16-35

785 7%

Latest across 2 years 2011-12 and 2012-13; Not all service users have Employment status recorded; 16-35 cohort identified by age in 2010-11

Employed Unemployed and seeking work Students in full-/part-time education Long-term sick/disabled, on benefits Unknown/Retired

Source: Oxford AHSN user data contained in HES and MHMDS datasets

licensed from HSCIC, 2014

Comparison of Education, Employment Status

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• Reduce variation in care for young people with psychosis across the

AHSN

• Improve outcomes for young people with psychosis

Objective 2: Common Assessment

#ei2020

• Increase research activity and recruitment to research amongst young

people experiencing a first episode of psychosis

Objective 3: Increase Research Participants

Measure Target Timing

Research champions identified in EIP teams 4 QC & 2 RAs recruited

August 2014

Number of research studies and current activity identified Number of participants per study

October 2014

Database of research ready participants in EIP Develop secure database

July 2015

Accruals to Portfolio research studies

50% increase ref: 2013

April 2016

Number of research studies active in EIP Increase ref: 2013

April 2015 #ei2020

#ei2020

Addictions Anxiety

BiPolar

Depression Developmental

disorders

Eating disorders Learning

Disabilities Personality disorders

Physical Psychosis

Self harm

Service evaluations

Social Other

Mental Health Studies by Disorder Nationally

#ei2020

• Improved transition between child and adult mental health teams

• Extend early intervention for young people with other conditions

Objective 4: Extend EI Model to Other Conditions

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Mind the Gap

AMHS 18-65 years

Primary Care and General Practitioners

EIP* 14-35 years

*For psychosis only

CAMHS 0-18 years

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Resilience Development in Schools Whole school approach to mental health and wellbeing – ethos, curriculum, positive behaviour, anti-bullying, pastoral care…

Resilience Development in Communities Strong network of youth services, voluntary and community organisations, confident and skilled to support and intervene early

Responding to Distress Frontline staff in many agencies should be helped to develop confidence and supported to intervene and help children and young people in situations of distress, including self harm and risk of suicide

Guiding Through the Service Maze Children, families & young people have range of support options for early intervention and need to be helped to find their way to appropriate help quickly

Peer help & Social Media Those who share their problems enjoy better mental health - build opportunities for young people to provide peer support, and to use social media for wellbeing

One Good Adult Importance of dependable adult to support and protect mental health of child and young person – e.g. strengthen parenting, mentoring, guidance, befriending initiatives

Systematic Review: Improving Continuity of Care

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Thank you

Any Questions?

School-based mental health services

Looking to the future

Mina Fazel NIHR Post-Doctoral Research Fellow,

Department of Psychiatry, University of Oxford Consultant in Child and Adolescent Psychiatry

Children’s Psychological Medicine, Oxford University Hospitals

• Mental health of school-aged children • School-based mental health

– What is it? – TaMHS project

• Oxfordshire PCAMHS InReach service – What has happened so far – Advantages and challenges of working in school – Future

Overview

Chief Medical Officer

“There is a great need for earlier treatment for children and young people with mental health problems. Half of adult mental illness starts before the age of 15 and 75% by the age of 18. Unless young people get help, they risk a life of problems including unemployment, substance misuse, crime and antisocial behaviour. Under-investment in mental health services, particularly for young people, simply does not make sense economically” CMO Annual Report, 9th September 2014

Children‘s mental health needs in the UK

40%

Currently treated within NHS context

Effective psychological interventions exist

Children with significant clinical needs not effectively reached by mental health providers

High persistence of disturbance into adult life

School front-line workers (TAs, SENCOs) already spending considerable time supporting these children

Vulnerable populations overrepresented in this group

20%

4%

10%

60%

90%

Anxiety or

Depression

Conduct

Disorder

ADHD Other (1%)

Children

untreated

*

Children with

psychiatric disorders

*

In a given classroom of

25 students….

1 in 5 will

experience

a mental

health

problem of

mild

impairment

1 in 10 will

experience

a mental

health

problem of

severe

impairment

Less than half of those who need it will get services

IS IT IMPORTANT TO IMPROVE EARLY DETECTION OF MENTAL HEALTH PROBLEMS IN YOUNG PEOPLE WITHOUT PARALLEL INCREASES IN SERVICE PROVISION? Question 1

WHAT IS A MAIN REASON WHY YOUNG PEOPLE WHO MIGHT NEED SERVICES DO NOT ACCESS THEM? Question 2

UK School-based mental health • Targeted Mental Health in Schools (TaMHS)

(2008-2011) – £60 million programme – innovative, locally determined models – early intervention for 5-13 year olds at risk – Included 3000 schools in 151 Local education

authorities (LAs) who determined budget allocations

• Longitudinal study and RCT – 137 primary and 37 secondary schools

TaMHS evaluation • Findings:

– More positive links with mental health services associated with greater reductions in behavioural problems in secondary school

– Parents reported schools as key point of first contact for mental health advice for child

• Implications: – Prioritise improved relationships and referral routes between

secondary schools and mental health services – Ensure schools retain a role in referral

• Future policy implementation: – Balance: prescriptiveness and flexibility – Emphasis on integration of services in schools

American experience • Established school mental health for >30 years • Over 2000 school-based mental health services • Growing evidence-base • Visits for mental health needs second highest after

accidental injury • 75% of children receiving mental health care receive it in

the school system • Fewer DNA and drop-outs • 12% American child psychiatrists spending time in schools

What are school-based mental health interventions? Who gives the treatment?

To whom?

Whole school

Classroom

Pupils at risk

Diagnosed pupils

What treat-ment?

Cognitive behavioural

therapy

Behavioural intervention

Art therapy

Counselling

Medication

Family therapy

Important prevailing issues

Internal External

Consent? Confidentiality Evidence based

1

2 3

4

Peers Pastoral support

staff

Teachers School counsellors

School nurse

School psychologist

Charities Mental health service

Whose responsibility?

£

Types of School Interventions Treatment/Indicated:

Cognitive Behavioral Intervention for Trauma in Schools, Coping Cat, Trauma Focused CBT, Interpersonal Therapy for Adolescents (IPT-A)

Prevention/Selected:

Coping Power, FRIENDS for Youth/Teens, The Incredible Years, Second Step, SEFEL and DECA Strategies and Tools, Strengthening Families Coping Resources Workshops

Promotion/Universal: Good Behavior Game, PATHS to PAX, Positive Behavior Interventions and Support, Social and Emotional Foundations of Early Learning (SEFEL), Olweus Bullying Prevention, Toward No Tobacco Use

Oxford Opportunity

Oxfordshire Services Mental health services • Discontent about availability and access of mental health services • Overwhelmed services

– 30% increase in referrals

Education – 34 state funded secondary schools

• 7,000 children per school year

– Over 20 independent schools – Mental health provision in schools

• School-dependent – School counsellors – Pastoral care system – No strong links with local mental health services

School: Location quotations

I don’t know maybe it would be more complicated or

something …. Maybe just to find it and maybe she doesn’t

know who you are, where you come from, … I don’t know

it’s just different. I think in the school is better

Good to have it in school, if come to hospital it is scary, I

don’t know if I would go if it was in a hospital …no one likes

hospital

Oxfordshire Opportunity • Oxford Health NHS Foundation Trust

– Uniquely placed to develop school-based mental health services • Newly commissioned school health nurse service for secondary

schools • Mental health: PCAMHS and CAMHS

• Oxford University • To develop and evaluate a new school-based mental health

service in Oxfordshire secondary schools by placing existing Primary Child and Adolescent Mental Health Service (PCAMHS) workers into each school for a fixed weekly session

The Oxford PCAMHS InReach Service

Consult with teachers

and other key school

professionals

Specific school

Group

interventions

Give assemblies, talk

to parents

1:1

treatment

PCAMHS worker

Half a day each week

What might be the effect of this for Oxford services?

• See young people earlier in services • See more young people as many have difficulty accessing

services • Engagement might improve with fewer non-attendances • Help schools manage difficult and concerning problems on

– Individual cases – Classroom problems – Whole school difficulties

• Provide additional support to school staff

Roll-out plan

• Roll out slowly (ish) – 3 schools May 2014 – 10 more January 2015 – more with each subsequent term

• Monitor PCAMHS worker activities • So far:

– New service welcomed by school staff – Schools holding considerable risk within their systems of care – Learning how best to integrate

• Which students • What happens to the students • Parental involvement

DO YOU THINK CHILDREN BETWEEN THE AGES OF 12 & 15 SHOULD HAVE PARENTAL CONSENT TO ACCESS MENTAL HEALTH SERVICES?

PCAMHS worker utilisation in schools – Training

• Whole school assembly • Teachers and pastoral care system

– Individual cases • Can see for brief interventions • Convenient • Follow-up easier

– Interface with pastoral care system • Offer supervision • Non-threatening involvement

Challenges 1

• Ethical – Consent – Notes & confidentiality

• Screening – Should we do this – When and how – Teacher nomination system?

• Pastoral care systems within schools – How best to work in collaboration – Threatened

• Space • Private schools

Challenges 2- Future • NHS service

– Subject to pressures of service delivery context

• Other models of care in the region – Swindon – Milton Keynes – Local care options

• PCAMHS worker 1 session • PCAMHS 2 sessions • PCAMHS + training school nurse • PCAMHS + training school staff • PCAMHS + CAMHS/Child psychiatrist

IS IT ETHICAL TO DELIVER AND CHANGE SERVICES WITHOUT PROPERLY EVALUATING THEM? Question 4

WHO HAS PRIMARY RESPONSIBILITY TO FUND SERVICE EVALUATION? Question 5

WHO IS BEST PLACED TO CONDUCT SERVICE EVALUATION? Question 6

How to move forward

• Education and Health Integration challenges

• Services in schools democratises access to services – Opportunity for early intervention

– Access the most vulnerable

• Evaluation challenges for health services – Electronic patient records

Personality Disorder: Evidence and Innovation Dr Rex Haigh https://prezi.com/kmh3m1fb6_bg/personality-disorder-evidence-and-innovation/?utm_campaign=share&utm_medium=copy

Physical Health & Wellbeing Clinic Early Intervention in Psychosis Service

Elwira Lubos

Nurse Researcher

Outline

1. Why? Ten minute pitch on why this is important

2. How? What works well within and beyond the clinic

3. So What? Actions for the future

#ei2020

‘From how I am to how I act’

FUNCTIONING HEALTHY WEIGHT

ACTIVE & FIT LIFESTYLE ENERGY

MENTAL & EMOTIONAL BALANCED & NUTRITIOUS DIET ABILITY TO EXERCISE Q7. How would you define being healthy? Please complete the following statement in the box below: To me, being healthy means . . . . [OPEN-ENDEDQUESTION] (Global) * Codes 3% or below do not appear in image

Why is this important?

1. Life expectancy gap of 15-20 years.

2. Only 35% of this population had adequate physical health monitoring in the past 12 months (NAS, 2014)

3. Higher mortality related to cardio vascular events (Crump et al, 2013; Laursen et al, 2012; Wysokinski et al, 2014).

4. Change in NICE guidelines for Schizophrenia (2014)

#ei2020

Health promotion

activity, physical health

assessments and

interventions need to

be integrated at every

level if the 15-20 year

mortality gap is to be

closed.

#ei2020

So What? • Drop-in service for EI clients within Oxfordshire.

• Physical health checks, include weight, BMI, blood pressure, waist circumference, comprehensive bloods, life style screening, health advice and signposting.

• Full cardiometabolic monitoring check.

• Side effect monitoring.

• Physical health history and family history of cardiovascular risks/ diseases and diabetes.

• From July till October 2014 - 20 service users attended the drop in.

#ei2020

Cardiometabolic Monitoring Results:

0 2 4 6 8 10 12 14

Life style risk factors

Current smoker

Blood pressure over 140/90

BMI over 25 kg/ m2

Cholesterol/ HDL ratio

Blood Glucose over 5 mmol/L

#ei2020

top motivators for sustaining behaviour change

Information

HEALTH BEHAVIOUR CHANGE MOTIVATORS

Aspiration Social Influence Incentives

.

. .

.

Source: Health Barometer, 2014

&

Positive ways forward • Self monitoring, e.g. weight and blood pressure. • At the point of access provide condition and medication

specific information. Development of apps may be a way forward.

• Incorporate physical health checks as part of routine outcome measures.

• More designated staff time to facilitate staff training to develop roles within the team (champions), and to offer outreach service.

• Investment in portable ECG machine to assist people unable to leave home.

#ei2020

Thank You ANY QUESTIONS?

#ei2020

Raising Awareness of Early Signs of Mental Health problems in

young people and supporting rapid

access and signposting to services Gwen Bonner, Head of Adult Mental Health Services, Reading

Berkshire Healthcare NHS Foundation Trust

• Similar to other services nationally Early Intervention Services in

BHFT have been eroded to accommodate changes to care

pathways models of working

• Reduction in referrals into services

• Difficulties in the transition from young people to adult services

• Young people coming into services much later than they should be

• Current pathway excludes a number of young people that could

benefit from treatment interventions

Background .

• Five month time limited project

• Four nursing staff covering six geographical localities

across Berkshire

• Based within Adult Community Mental Health teams but

linking with CAMHS services

EIP project Berkshire .

• To increase awareness and understanding of early signs

of mental health problems in young people in the

communities where they are engaged

• To facilitate early signposting to appropriate services for

young people experiencing MH problems

• To facilitate early assessment and treatment for young

people who have early signs of psychosis

Aims .

• Improved understanding by other agencies – schools,

universities and colleges, GP’s, our own internal services

• Early referral into services for appropriate assessment

and treatment

• Increase in referrals into CAMHS for young people

presenting in a prodromal stage of psychosis

• Reduction in unscheduled hospital admissions in acute

and mental health sectors

Desired outcomes .

• Four project workers working across six localities

• Map out stakeholders to focus the education intervention

• Develop a training package to take out to a variety of stakeholders

• Review and increase use of technology

• Highlight early warning signs and where to access help and support

• Support early referral into services

• Evaluate impact of training on these stakeholders

• Work with existing teams to support timely access and treatment

The project .

• Baseline number of people receiving training package –

broken down by agency / organisation

• Evaluation of training impact – post session survey

• Increase in referrals in for young people for assessment

Key performance indicators .

• Evaluate project impact

• Awaiting outcome of substantial funding bid

• Integrate this approach into above

• Work with AHSN around informatics for future –

establish comprehensive national picture

Next steps .

Any questions?

Contact details:

gwen.bonner@berkshire.nhs.uk

Thanks for listening .

Daniel Maughan

Royal College of Psychiatrists Sustainability Fellow

Sustainable Psychiatry

Sustainable health care

system

Over-burdened health care system

Healthy community

Chronically unwell

patients

CENTRE for

SUSTAINABLE

HEALTHCARE

Social Sustainability

Recovery:

Hope

Agency

Opportunity

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✔

BIOPSYCHOSOCIAL

£ P

R

I

N

C

I

P

L

E

S

MODELS

OF CARE

Prevention Patient empowerment Lean service design (reduce waste) Preferential use of low carbon interventions

CENTRE for

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Thank you