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Introduction

The West Midlands' Strategic Health Authority, working with all Mental Health Provider Trusts and Primary Care Trust Mental Health Commissioners in the Region, is developing a model of suggested care pathways for mental health derived from the care clusters model developed in Yorkshire. PLEASE NOTE THESE ARE DRAFT PATHWAYS AT PRESENT (AND WE ARE KEEN TO HEAR FEEDBACK ON THEM - SEE THE BOTTOM OF THIS PAGE).

The draft pathways model presented here and on the pages linked from the above diagram draw together into a systematic structure many resources, including those from the Department of Health, the Yorkshire Care Clusters and Pathways Consortium, research evidence, key national guidance, and expert opinion.

The draft model has a number of potential benefits to assist in commissioning mental health services, planning services and negotiating the care for individuals and their families and carers.

The model is:

• developmental - it is evolving all the time based on new evidence and advice from experts.  We are keen to hear feedback to inform this development such as on how suited the model and the content for each pathway are, and where we can further define elements of the pathways.  We are developing a better interface for the pathways, but the prototype interface in the pathways is suitable for now;
• suggested - the model is not prescriptive in expecting all care pathways to be exactly as the model, but the suggested pathways are a starting point for considering the efficacy of local and individual care pathways.
  

Prototype pathways for each cluster are linked from the diagram above (in the diagram click on the appropriate cluster number you are interested in to go to the prototype pathway).  They are prototype in terms of their  interactive presentation, the structure of the model and the content of each pathway.  We welcome your comments on each of these aspects of the prototype pathways (see details below).

Overview of the structure of the draft pathway model

The structure of the model begins from 20 clusters of needs, grouped in terms of non-psychotic conditions, psychotic conditions and organic conditions.  This is being developed in line with the Department of Health's approach to Payment by Results for Mental Health.  The clusters are:

1. Common Mental Health Problems (Low Severity)
2. Common Mental Health problems (Low Severity with
   Greater Need)
3. Non-Psychotic (Moderate Severity) 
4. Non-Psychotic (Severe)
5. Non-Psychotic (Very severe)
6. Non-Psychotic Disorders of Overvalued Ideas
7. Enduring Non-Psychotic Disorders (High Disability)
8. Non-Psychotic Chaotic and Challenging Disorders
9. (Formerly Substance abuse, but currently a blank cluster).
10. First Episode in Psychosis
11. Recurrent Psychosis (Low Symptoms)
12. Ongoing or Recurrent Psychosis (High Disability)
13. Ongoing or Recurrent Psychosis (High Symptom and Disability) 
14. Psychotic Crisis
15. Severe Psychotic Depression
16. Dual Diagnosis
17. Psychosis and Affective Disorder Difficult to Engage
18. -21. Organic illness, but awaiting further definitions and development

Each draft pathway in the model has:

• a statement about the underpinning values - these are the ways in which the pathway should be delivered;
• Explicit therapeutic aims;
• Suggested minimum quality and outcome indicators;
• Core content that we would ideally expect all people in that pathway to be offered;
• Auxiliary content that would be most relevant to only some people in that pathway based on specific needs and ought to be offered to them if relevant;
• Flexible content that would not always be offered to individuals, but may be on the basis of individual circumstances and/or local services.
• These levels of content are then each described in terms of 8 headings of activity: assessment, monitoring, enabling, therapeutic interventions, role support, carer/family interventions, accommodation and care coordination.  Descriptions of these headings are given in the pathway diagrams on the following pages.

In the pathway diagrams, where you see a dot, point to it with the cursor and further detail will come up.

Allocation to a cluster and associated pathway is on the basis of an assessment using the Mental Health Allocation Tool, based on the Health of the National Outcome Scale (HoNOS).

Quality and outcome indicators

To assit with developing the pathways and building a better understanding of their benefits we have a developing framework of quality and outcome indicators for the pathways.  This was developed by a group from across the West Midlands Region and is intended to build on existing work mental health providers are doing to collect better data, and on the systems and ethos for the pathways model on these pages.

For the latest update report on the quality and outcomes indicator framework click here.  The structure was developed with consideration of what a mental health system overall is aiming to achieve for the people it serves.  This has been informed by outcomes ideas in other government documents, including the NHS Constitution, Every Child Matters, Putting People First, and  Our Health, Our Care, Our Say.   Our developmental set of overarching principles/goals/outcomes for the system is:

• Help people to enjoy the best possible health and wellbeing;
• People will be supported to develop their resilience and be actively able to identify and build on their strengths;
• To work to address stigma and discrimination and help ensure that people with mental health problems feel safe and free from harrassment and discrimination;
• Assist people to enjoy the best possible quality of life;
• Support people to aim for their recovery and optimise their choice and control;
• Support people to positively participate as active citizens, economically and socially.
  

Library of resources

There is a library of resources for the pathway model, including key guidance for pathway content.  Links from the actual pathways take you to specific sections of the library relevant to each pathwath.  There is also a section of links generically helpful across the pathways, and one of links for the underpinning values for the model.

Contact

For more information about the development of these pathways or to send in feedback and suggestions please contact Michael.Clark@wmrdc.org.uk.  A feedback template is available here.

As the work develops we would be interested to hear people's ideas about improvements and innovations to pathways, especially in line with delivering the QIPP agenda.