'New Horizons' Listening Event 17th June 2009

Birmingham, Botanical Gardens, 17th June 2009

The West Midlands Strategic Health Authority and the Department of Health (in conjunction with Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) and the NHS West Midlands Regional Development Centre (WMRDC)) organised a Listening Event to ensure stakeholder input into government mental health policy for the next decade. The day was held at the Botanical Gardens in Edgbaston, Birmingham on 17th June 2009.

Introductions

Professor Swaran Singh, Clinical Engagement (Darzi) lead for Mental Health, West Midlands SHA, welcomed participants and explained that Professor Louis Appleby, National Director for Mental Health at the Department for Health, had come to West Midlands to gather views on the forthcoming policy document on national Mental Health service Delivery, 'New Horizons in Mental Health'.

Lawrence Moulin, Mental Health Lead for NHS West Midlands welcomed Professor Louis Appleby and all attendees on behalf of Ian Cumming, the new Chief Executive of NHS West Midlands, who was unable to attend. Mr Moulin said that Prof Appleby has been the driving force in Mental Health over the last ten years, and that New Horizons will play a key part in keeping up momentum & energy in improving Mental Health services into the future.

Presentations

To view the presentations, please link to: http://www.wmrdc.org.uk/newhorizonswmpresentations

1. Prof. Swaran Singh: ‘Sustaining the Gain’

Summary Comments -

The last 10 years have seen unprecedented investment Mental Health, this is coming to an end - we need to find a way to sustain the gains made so far & keep moving forward with restricted resources

The Clinical Pathways Report for Mental Health had identified 4 key objectives for the region:

1. Getting Core Services Right 2. Stopping premature deaths & focusing on prevention (e.g. Improve physical health of people with mental health problems) 3. Improving the mental health of people with physical health problems 4. Getting the foundations right for delivery
Getting this right required intelligent monitoring (counting what really counts rather than what can simply be counted) and ensuring that changes made led to whole system transformation

2. Max Birchwood: Youthspace

Professor Max Birchwood described the development of a Youth Mental Health Service within Birmingham & Solihull Mental Health Foundation Trust which aimed to extend the early intervention paradigm to a other clinical areas such as eating disorders, personality disorders, youth offending etc. Professor Birchwood described the clinical need and evidence base for such an approach.

3. Felix Davies: Delivering IAPT Services: Benefits and Challenges

Dr Davies outlined:-

Main aims:- Better Health & Well-being; help people stay employed; more choice & better accessibility; high levels of satisfaction with the service
Key characteristics & main challenges in the main areas: Shropshire, Telford & Wrekin, North Staffs
Benefits to Service Users, the local Health economy, and to Society in general
The ‘IAPT Institute’:- Centre of Excellence, Share best practice’ Develop expertise, Training, R&D hub, Economies of Scale

4. Emma Brown: ‘Changes’

Changes is a User-led, 3rd sector organisation, 20 years old, delivering wellness & recovery-focused services, all in response to members (Users) - whole person, physical emotional, social, spiritual
Well-being workshops – emphasise that everybody has Mental Health, element of choice in own mental Well-being, which is more than just absence of distress; we each need a healthy store of thoughts feelings & behaviours, a ‘toolbox’ to improve (top up) our mental fitness
‘Wellness Wheel’ - Personal & Social determinants of Well-being; examines how thinking affects how you feel & what you do, encourages you to address your environment, take responsibility & action where you can
Changes very good at monitoring outcomes; referred back to ‘let’s count what really matters...’ (Prof Singh). How do you measure Well-being - people can see progression; 88% of people who accessed these services in any capacity reported improvement
8 weeks Well-being Workshops with up to 20 people in each one - a lot of people! Low drop-out rate. High demand & reluctance to access traditional services, including because of stigma.
General willingness to work together throughout Stoke; warm people! Work hand in hand with partners.
Start with Young People to give them tools to look after their own Mental Health

5. Gwyn Higginson and Lisa Sharrock from North Staffordshire Combined Healthcare Trust: Early Interventions in Pre-Clinical Dementia

Patients with silent, ischemic vascular changes .... Not memory problems, Thinking difficulties.
Dementia set to rise - call to Louis Appleby: please make the Government recognise the importance of those services.
Bridge the gap between IAPT & National Dementia Strategy Primary Care ideal setting in which to detect these conditions.
People need a clear pathway in Mental Health – as with treatment of other significant medical conditions: this service (including CBT) able to identify some of the ‘treatment resistant’ patients. Target those at risk (‘alerter’ checklist).
CBT assessment but with added specific aspects (see presentation slides)
Repeat: Not memory problems ...
Why important? From reaction to prediction…
‘Reduce our Risk’ & ‘Take Heart’ booklets - taking own responsibility for making changes: impact physical on mental health.
‘Look After your brain & your brain will look after your mood!’

Key Speaker

Louis Appleby ‘Doing Better by People with Mental Health Problems’

Link between what Government documents say & real experience

Case study 1: When a Consult psychiatrist, Dr Appleby had a client - young African Caribbean man - come into Mental Health through the Crimnal Justice system (turbulent relationship with services) - every 3 months attended Louis Appleby’s clinic, who saw his work as a ‘heroic battle’ to erase every last symptom

Q - are you getting out of this clinic what you want?
A - actually what I really want is a new fridge!

He wanted a normal life: so was the focus of therapy right?
Can we do better by people?
Can we organise services to deal with the real purpose of improving the Quality of Life of people with Mental Health problems?

Case study 2: A survivor of mental illness. A friend gave him job - cold calling sales, very demanding, very stressful - he relapsed, came onto a ward, Louis Appleby had a phone call from the patient’s bank asking to cut up his credit card.

Would we do better by someone like that now, be more tolerant, more accepting, find the right place for him or her?

There is Unfinished Business in the National Service Framework for Mental Health (NSF) - e.g. Carers
NHS is in different place now than when the NSF came out - emphasis now on local leadership.
Empowering patients, Quality, Innovation (Darzi)
New Horizons needs to be a document that translates Darzi into practical help for people.
Dementia Strategy is mentioned in the NSF but not very prominent, likewise links between physical & mental health.
We need now to take these various strands & take forward a whole set of initiatives & guidance, support & sit along existing plans.

Two Main Themes for New Horizons:-

Public Mental Health: improve Mental Health of society as a whole - prevention, broad multi-agency working (including 3rd Sector).
Mental Health Care: Early Intervention - EI has moved from ‘a team’ to a Philosophy of Care - Dementia, Offenders.

New Horizons must also include IAPT, Dual Diagnosis, Improving inpatient wards, anti- stigma: Mental Health for adults of all ages
What about Children?: can’t do prevention without intervening in earlier life (but not about CAMHS)
Next-stage work must be Recession-proof. Provision for Mental Health services suffers in hard times, unemployment, debt etc. People generally need practical advice as well as, sometimes, needing therapy.
Future developments must emphasise Value For Money – Early Intervention is a good example
Today’s is one of several events that are providing a genuine opportunity to influence what goes into the New Horizons document.
A consultation document is coming out in July
Link >> Publication of New Horizons Public Consultation Document >>
Our ultimate aim from all of this is high quality clinical care & social justice for all.

Attendees' Participation

In the active afternoon session, the groups were asked to discuss their priorities for the future of Mental Health care, and submit 3 key priorities from each group as what they’d like to be carried forward into shaping the New Horizons Policy Document

Prof Swaran Singh Summarised outcomes of group discussions as follows

(There will be a formal submission from the event to the Department of Health, but) there follows a brief flavour of the feedback:-

Resource allocation must be decided by quality of care, not just numbers of Service Users
Policies developed in consultation with Service Users, Carers & Clinicians
Ongoing & holistic Care, supports people through care journey
A couple of carers commented on immense improvement (30 years) given to Service Users, but not to Carers - and remember young carers - relieving the State of great costs
Services must be needs-based, not simply age-based
Mental well-being is a BIG issue – we should have population-wide strategy for improving Mental Well-being & this should be reflected in commissioning strategies, which should look at all areas including schools workplaces where Mental Well-being is key – actually, that means everywhere!
Services should be personalised to individuals; move away from categorising patients by their illness.
Turn around media portrayal of Mental Health - use media to promote positive images
Focus on Particular issues for BME within Criminal Justice & Mental Health
Single point of entry into The System & ‘joint needs assessment’ (cross agencies)
New Horizons should be given a New Workforce. Suggest - NHS Direct for Mental Health (including a website) giving access to accurate information. For New Horizons to work, it must cut across all Government Departments; workplaces, schools – New Horizons needs to be OWNED by various Government Agencies

Louis Appleby rounding up

A very lively & informative day - fantastic to be able to come here & hear so many points of view & so many experiences
Can’t guarantee all of the points made will go into New Horizons
Can guarantee that some of them will
Can guarantee that all of it will be considered
Very interesting & gratifying - always something new; a different slant even on some things that we’ve heard before.
We do need to say more about assessment, and more about Carers… Unsure if this is something new, or a matter of really doing now what we’ve been talking about doing for a long time –

“If you tell me what’s the next step for Carers, I’ll get it into New Horizons”.

Commissioning for Well-being must be another priority
In the end, this will be a cross-government strategy, because Mental Health is more than just an NHS issue - this will definitely be included.
Personalisation - we’ll do our best to get it right. It’s odd for Government to be telling people what to do on Personalisation; it needs to be personal! But it will feature very prominently: referring to one of his earlier anecdotes, he said ‘remember my man with the fridge’.

Prof Singh thanked everyone again for attending, and expressed his hope that we’d all had the chance to say all that we wanted to say. Finally, he gave his thanks again to Louis & Sue from the Department of Health for coming up to Birmingham for the day.

(These notes by Martin Fisher, NHS West Midlands Regional Development Centre and
Professor Swaran Singh, Clinical Engagement (Darzi) lead for Mental Health, West Midlands SHA)

Tags for this page
What are tags? Tag cloud