International School for Communities, Rights and Inclusion Commissioning Guidance for Public Mental...

International School forCommunities, Rights and Inclusion

Commissioning Guidance for

Public Mental Health and Well-being

Karen Newbigging

22nd October 2009


Overview

Why is this important?Making the case for mental well-beingOverview of the guidance: content and processNext steps

The mental wealth of nationsNature 23 October 2008

Mental capital + Mental well-being

Policy focus across government on quality of life and wellbeing: population health, prevention and early intervention alongside emphasis on decentralisation, community responsibility and social justice

Policy focus across government on quality of life and wellbeing: population health, prevention and early intervention alongside emphasis on decentralisation, community responsibility and social justice


The case for mental wellbeing Increased quality of life and overall wellbeing Improved educational attainment and outcomes Safer communities with less crime Reduced health inequalities – both physical and mental health

related and lower health care utilisation Improved productivity and employment retention Reduced sickness absence from work Reduced levels of poor mental health and mental illness

1. Economic case2. Moral or

communitarian case


Economic Case Early intervention with Conduct and Emotional Disorders. Total value of

benefits of prevention from treating a one year cohort of children with conduct disorder is estimated at £5.2 billion.

Promote good mental health as well as social & emotional skills in childhood (especially those with conduct disorders). Estimated lifetime benefit of £115,000 per case of child with conduct disorder. Cost savings for mental health promotion are £75,000 per case. Total value of benefits of prevention of promoting positive mental health in a one year cohort of UK children is £23.25 billion.

Early Intervention is cost effective in reducing the risk of re-offending: Every £1 spent on a prevention programme for those at risk of offending saves £5.

Later targeted parenting programmes with children with emotional and conduct disorders. Programmes cost £600-4000 but a total cost of a child with conduct disorder is £70,000 by 28 years of age.

Family Intervention Programme: Cost of programme £8-20,000 compared to costs, if no intervention, of £250-350,000.

Refer and treat alcohol misuse problems in perpetrators of violence across health and CJS systems. Alcohol is a key risk factor for carry out and being a victim of violence and abuse. For every £1 spent on treatment, the public sector saves £6.

Purpose of the guidance

The guidance is designed:to enable local health and local authority commissioners, and their partners, to make decisions about mental health improvement strategies to suit local circumstances

commissioned by the National Mental Health Development Unit


New Horizons: Twin aims

Improving the mental health and wellbeing of the population

Improving the quality and accessibility of services for people with poor mental health (mental illness)

Paradigm Shift! Towards a whole system approach to well-being

Mental health is an essential component of general health Mental well-being is more than absence of mental illness. Mental well-being is a key social asset of economic significance as a

resource for long-term social and economic prosperity. Wellbeing is the other side of the coin of personalisation – an

opportunity for greater personal responsibility in health and social care. Mental wellbeing and physical illness are connected with long-term

health conditions, particularly CHD, CVD, hypertension, diabetes, obesity Addressing mental wellbeing is key to local action to tackle health

inequalities Responsibility for promoting mental well-being extends across all

disciplines and government departments

Improving public mental health and well-being

General publicPeople vulnerable to poor mental health

Intervention processesPractitioners

What?

Improving public mental health and well-being

General publicPeople vulnerable to poor mental health

Intervention processesPractitioners

What?

Implementation processes

Adapted from: Blase & Fixsen (2005): Measuring the Fidelity of Implementation. National Implementation Research Network

How?

Local Strategic Partnerships, Local Authorities and Primary Care Trusts

The key challenge is commissioning for sustainable long-term development to build individual and community resilience


Two levels of guidance prepared to date

1. Strategic Guidance for Boards and senior staff of PCTs and Local Authorities

Making the case and starters for ten

2. Technical (detailed) Guidance for commissioning managers in health and local authorities (social care, education, regeneration, community development etc.)Detailed and practical to include tools, resources and

positive practice examples

Overview of guidance

Meaning of mental well-being Values and principles underpinning the approach Business case for public mental health and well-being Key messages from the relevant policy documents Opportunities to link public mental health agenda with others ‘Basic buys’ for commissioning mental health improvement Practical tools: decision tool, monitoring and evaluation


Key documents that underpin the guidance Every Child Matters The NHS Next Stage Review Working for a Healthier Tomorrow Putting People First Commissioning Framework for Health and Well-Being World Class Commissioning competencies etc Flourishing People, Connected Communities. New Horizons: towards a shared vision for mental

health

Whole system approach

Develop a whole system approach with interventions in all domains according to

Robust evidence for interventionsLocal priorities and values (established through the JSNA and LSP processes)Continued development and learning from promising practice and actionGood practice in commissioning A practical

decision tool to enable commissioners to prioritise investment

Identifying local priorities

JSNATurning inputs into outcomes using Joint

Strategic Needs assessment (JSNA)Using:

Analytical data on demography, social context and epidemiology

Local views and community engagement

Reflecting and contributing to commissioning plans and LSP/LAA targets

Draft Guidance:Domains for outcomes and evidenced based interventions

Life course domains in the draft guidance Develop safe sustainable connected communities; Child and adolescent years (incorporates ‘Build resilience

and safe and secure base’ and ‘Ensure a positive start in life’)

Adults (incorporates ‘Integrate physical and mental health and wellbeing’)

Older People (incorporates ‘Promote meaning and purpose’)

Vulnerable groups (includes mental illness prevention and wellbeing for people living with the effects of disability)


Criteria for the ‘Basic Buys’

• Maximise cost effective health gain– Effect size– Burden of disease– Population benefit

• Wider social gains• Education, employment, community safety,• Feasibility and achievability• Not the last word on evidence!

Examples of the ‘Basic Buys’

• Universal screening for perinatal mental health problems and targeted interventions for women at risk of postnatal depression including home visiting and support

• Targeted early interventions for common parenting problems

• Healthy Schools approaches including social and emotional learning programmes to strengthen self esteem

• Social prescribing to increase opportunities for social contact and participation

• Improving wellbeing for people living with the consequences of mental health problems


TimeframePhase 1: Draft guidance was prepared during

the spring and early summer 2009Phase 2:

Review of the evidence base continues Further work on the New Horizons vision and

programme of action (to be published early December)

Rigorous field testing of the guidance during the autumn with key stakeholders and a leadership group

Possible development of a web based tool

Publication in March 2010

In conclusion..

Addressing mental health and well-being will

achieve two different objectives simultaneously: Improve health, reduce health and social services

interventions, and assist in wider social gains Assist those who have mental health problems

and prevent such problems occurring

Interested in field testing and

developing the guidance?


[email protected] [email protected];

International School for Communities Rights and Inclusion, University of Central Lancashire

Tel: 01772 892780

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