Better Mental Health for Birmingham:

An overarching strategic direction for Mental Health Services for adults

2011 -2016


Contents

Contents / Page
Introduction / 3
Summary of the strategy / 4
Context and policy framework / 6
What do we know about needs? / 10
Feedback from consultation / 12
Meeting The Equalities Agenda / 14
Maximising return on investment / 15
Current and future investment / 17
Strategic objectives
  1. more people will have good mental health
  2. more people with mental health problems will recover
  3. more people with mental health problems will have better physical health
  4. more people will have a positive experience of care and support
  5. fewer people will suffer avoidable harm
  6. fewer people will experience stigma and discrimination
/ 19
21
25
26
28
29
Moving forward / 31
Appendix one: Strategic delivery plan / 32

Introduction

Mental health is important to everybody. Unfortunately, in some cases there will be times when our mental health suffers. At least one in four of us will experience a mental health problem at some point in our life[1]. Some people will live the majority of their life with a mental health issue.

The human and economic costs of mental ill health have been well documented[2][3][4][5]. Poor mental health has an impact on peoples’ quality of life and is can often be linked to suicide. When people have poor mental health they are more likely to be unemployed, become victims of crime, live in poorer housing, have worse physical health and die younger than the general population. The social isolation that mental ill health conditions can encourage is often exacerbated further by the stigma attached to seeking treatment or being labelled as ‘mentally ill’.

Social inequality also has an impact on mental health. People from black and minority ethnic communities, from deprived communities, older people, deaf people and people from other vulnerable groups have often found services more difficult to access and have not enjoyed the same outcomes as their peers. This view was underpinned by the Count Me In Census (2010)[6]which indicated that admission, detention and seclusion rates remain proportionally higher amongst some minority ethnic groups. People who are caring for an individual with mental health needs are also likely to experience poorer health, financial hardship and social isolation.

Better Mental Health for Birmingham sets out the intentions for the development of Mental Health services across the City.The strategy also focuses upon the way in which the NHS and local authority funding for mental health services for adults is committed. No Health Without Mental Health; A cross-government mental health outcomes strategy for people of all ages[7]is clear that improving the mental health of the population is not solely the responsibility of health services as the areas ofpromotion, prevention and recovery can only be achieved through collaboration with other sectors and the public themselves. This strategy makes links with other work being undertaken across Birmingham andas such, it is important that this strategy is seen as a part, rather than the totality of efforts to improve mental health and wellbeing in the City and should be read in conjunction with local strategies and guiding documents from across the health and social care landscape (E.g. the forthcoming Birmingham Public Health Strategy and Birmingham Child and Adolescent Mental Health (CAMHS) Strategy).

The annual budget for Adult (18+) Mental Health services is circa £170m. The NHS has been challenged to deliver £20billion in efficiency savings by 2015 through a focus upon Quality, Innovation, Productivity and Prevention (QIPP). Local Authorities have also been asked to make significant budget savings and achieve greater efficiencies. As such it is important that the money we spend on these services is used effectively to achieve the best possible outcomes. This means increasingly working in new and different ways so to best support people and communities to stay well and help themselves; making sure people get the right support as early as possible; reducing the length of time that people spend in hospital when this could be avoided and enabling people to live independently in their local community. These principles underpin theBetter Mental Health for Birmingham strategy.

In September 2010 we asked people to comment on a draft version of this strategy. The Strategy was well received with 75% of respondents either agreeing (49%) or strongly agreeing (26%) with the proposals. The feedback provided by respondents has been used to help shape this document, and in addition to this, the launch of the new government strategy for mental health outcomes has also further informed our work. The national strategy reinforces the general direction of travel already taken in Birmingham and this revised version of our strategy shows how the two documents are aligned.

This strategy therefore, outlines our 5 year vision for mental health services provided on behalf ofBirmingham City Council, the Birmingham and Solihull Cluster and the newly formed and developing Clinical Commissioning Groups. These changes however, will not happen overnight, that’s why we have set out a 5 year strategy which will guide the changes that we need to make.

Summary of the strategy

Birmingham has a proud history of being at the cutting edge of developing innovative mental health services particularly in secondary care. Services such as Assertive Outreach, Home Treatment and Early Intervention in Psychosis were tested, developed and implemented in Birmingham in the 1990s. These innovations informed much of the Department of Health’s’National Service Framework (NSF) for Mental Health(1999)[8]which were then adopted nationally. The City also has a dynamic 3rd sector that has in many areas grown in response to the needs of specific communities.

This strategy will build on the groundwork already in place but will also challenge current service provision to change where necessary to best ensure that it is represents value for money and meets the expectations of the public, the people who use services and their carers.

This strategy sets out:

  • The current policy context;
  • the mental health needs of people in Birmingham based upon the Joint Strategic Needs Assessment for Mental Health conducted by Birmingham Health and Wellbeing Partnership
  • a summary of feedback from the consultation process and the way in which the strategy will respond to this
  • the strategic aims and the changes we need to make, to improve the mental health of people in Birmingham.
  • The measures of success that will show us whether our aims are being achieved

The framework below shows in brief the alignment of the Six National Shared Objectives with Birmingham’s Strategic Aims.

National Shared Objective / Birmingham Strategic aims
1) More people will have good mental health / a) Promote good mental health and reduce the likelihood of people requiring mental health services.
b) Integrate programmes across NHS, local authority and public health
2) More people with mental health problems will recover / a) Provide quicker access to interventions when people become unwell
b) Help people with mental health needs to have a good quality of life
c) Improve outcomes of treatment for service users
d) Personalise rehabilitation
e) Support people to maintain and move towards employment
f) Improve access and outcomes for older people
g) Improve access and outcomes for people from BME communities and other vulnerable groups
3) More people with mental health problems will have good physical health / a) Improve physical health of people with mental health needs
b) Ensure a robust and safe medicine management in line with NICE guidance and formulary
4) More people will have a positive experience of care and support / a) Provide alternatives to hospital and institutional-based care
b) Offer independence and support for people to live at home
c) Put the needs of patients, service users and the citizens first
d) Give patients and service users more choice about who provides their care
e) Help people to have more control of the money that pays for their care
f) Improve recognition and support mechanisms for carers
5) Fewer people will suffer avoidable harm / a) Improve prevention of self-harm and suicide
b) Respond more effectively to self-harm and suicidal thoughts
6) Fewer people will experience stigma and discrimination / a) Promote social inclusion
b) Improve access to appropriate accommodation
c) Support people to maintain and move towards employment
d) Change attitudes towards mental health

Context and policy framework

TheNSFpublished in 1999 signalled the start of a decade of great change in mental health services for adults of working age. Nationwide we have seen the implementation of a range of new specialist and integrated services (across health and social care teams)and alongside this, unprecedented levels of new investment.

Some of these services such as Home Treatment, and Early Intervention were pioneered in Birmingham and have led the way for the policy implementation guidelines which accompanied the NSF. Whilst these services are, in essence, good services, the system of care has suffered from them being ‘bolted on’ to an existing, largely secondary care based system and has lacked the required integration with primary care, the third sector and universal services to produce a ‘Whole System approach.’

A Whole System Approach better incorporates all services and supports a system across health, social care, housing and employment and ensures meaningful activity to meet the needs of individuals and their personalised care needs. Services to date have utilised a ‘downstream’ approach as they have dealt with problems after they arose rather than having an ‘upstream’ focus on prevention.

Now that the implementation period for the National Service Framework has come to an end, there is a shift in national policy moving away from the ‘building blocks’ of services to a greater emphasis on

▪how services work with individuals and families;

▪how the system of care can be redesigned to work harmoniously to improve the service user experience

▪how services maximise the outcomes achieved both in mental health and mental well being; and

▪how this approach impacts on the wider determinants of health and well being.

Equity and Excellence: Liberating the NHS

In July 2010, the government set out its plans for the future of the NHS, in the white paper Equity and Excellence: Liberating the NHS[9]The white paper sets out a vision for the NHS in which decision making is devolved to the most local level possible with the principle of ‘no decision about me without me’ at its heart. The vision will be delivered by giving responsibility for commissioning services to Clinical Commissioning Groups; by reducing the number of centrally determined targets; by working collaboratively and through using a competitive process where that process best benefits the patient.

No Health without Mental Health

In February 2011 the Coalition Government launched its strategy for mental health outcomes No Health without Mental Health[10]. Significantly, the strategy is cross-governmental, age-inclusive and outcome focused. The Strategy identifies six shared national objectives (outlined on Page 5) spanning prevention, recovery, physical health, experience, morbidity and stigma. In line with the Coalition Government’s ‘Big Society’ agenda the strategy emphasises the role that families and communities have to play in improving quality of life and delivering public services. We know that carers already commit huge amounts of time, energy and resources to supporting people with mental health problems, this strategy reinforces the need to ensure that carers are properly supported to maintain their own health and wellbeing if they are to continue in their caring role.

A Vision for Adult Social Care[11]

The Government has published its strategic document for the future of adult social care services. It identifies the key values of Freedom, with a shift of power from the state to individuals and communities; Fairness, with a review of how social care services are funded, including contributions from those who use the service; and Responsibility, acknowledging the role of reciprocal giving between individuals and communities. It envisages better joint working between health, local authorities, private and voluntary bodies, communities and individuals.

Payment by Results in Mental Health

Following the implementation of a tariff based payment system known asPayment by Results (PbR) for general and acute hospital care; Mental Health Services nationally are working towardsa similar tariff based system. Work is ongoing to develop tariffs for 21 mental health care clusters which are based upon the Health of the Nation Outcome scale. At present PbR is being developed for Working-aged Adults and Older people with mental health needs. Development work is underway which considers the PbR approach to other areas of mental health e.g. secure services.

The timeline for implementing PbR has been nationally set as follows:

-in 2011-12 activity allocated to a cluster

-locally negotiated tariff for use in 2012-13

-2012-13 clusters (with local prices)become mandatory for contracting and payment purposes

-2013-14 earliest possible date for national tariff for mental health

Mental Health PbR will bring significant benefits especially helping to tackle the QIPP challenge, service reconfiguration and improvement to services for people with mental health care requirements.

Commissioners will work with the Strategic Health Authority and providers towards the implementation of PbR as per the timeframe outlined above.

Personalisation

Local Authorities are moving towards more personalised services as set out in Putting People First[12]. This means giving people more choice and control over the services which they use, helping people towards greater independence and self-sufficiency, and, for those who need it, offering personal budgets which people can use to purchase services. The emphasis will be on prevention, early intervention and enablement and supporting people to remain in their own homes for as long as possible.

Offender Mental Health

The Bradley Report[13], and Improving Health, Supporting Justice: the national delivery plan of the Health and Criminal Justice Programme Board[14], have both set out guidance and supported initiatives that address the fact that a significant proportion of people in prisons, and others who have offended have poor mentalhealth. The reports emphasise the need for early intervention and support. It is recognised that resources should be shifted upstream to prevent people becoming embroiled in the criminal justice system because of their mental health problems and where prevention has not been possible, that interventions are swiftly put in place to ensure that mental health problems are addressed.

Talking Therapies

Talking Therapies: A four year plan of action[15]highlights the need to improve identification and access to psychological therapies for depression and anxiety for people aged 65 years and above who are traditionally under represented in such services. The plan also seeks to deliver improved access for people with long term health conditions and for children and young people.

Older adults and Dementia

Services for Older Adults with mental ill health are covered by the National Service Framework for Older People[16] which had little cross-reference to the National Service Framework for Mental Health and very few specific targets. This was rectified through the publicationof Everybody’s Business: Integrated mental health services for older people a service development guide[17]which set out the key components of a modern mental health service for older people.

National Dementia Strategy[18]

In 2009 the National Dementia Strategy published guidance on the approaches and services required for people suffering from Dementia. Whilst there are some younger adults who develop Dementia this is largely a disease of older age. Dementia commissioning will therefore be undertaken by a joint programme board across health and social care and will develop a separate strategy for Dementia Commissioning and services for all ages which will be linked to this and other relevant strategies. This strategy will focus on the needs of those with functional mental health problems and illness and will be age neutral as indicated in the White Paper.

Local Context