Strategy for
Mental Health and Wellbeing
A Two Year On Update from
A Mental Health Strategy for Lanarkshire 2006-2011
Prepared by: / Mental Health Strategy Editorial GroupReviewed by:
Endorsed by:
Responsible Person: / Alison McMullan, Clinical Lead
Previous Version/ Date: / March 2007
Version Number/ Date: / September 2008 (DRAFT 3)
Review Date:
Contents
Lanarkshire’s Vision / 4
1 / Introduction / 5
2 / The Strategic Aim / 5
3 / The Case for Change / 5
3.1 Demography / 5
3.2 National and Local Evidence / 6
4 / The Mental Health and Social Care Model / 8
4.1 A model for delivering care / 8
4.2 Tier 0: Community Health and Wellbeing / 10
4.3 Tier 1: Primary Care and Mental Health Services / 12
4.4 Tier 2: Specialist Mental Health Services (Inpatient and Community) / 14
4.5 Tier 3: Tertiary Care / 20
5 / Interface with other mental health care groups / 22
6 / Supporting Service Delivery / 23
6.1 The patient journey / 23
6.2 How we will do this / 24
7 / Supporting Infrastructure / 25
7.1 Partnership working / 25
7.2 Service User and Carer Involvement / 26
7.3 Clinical Governance/Staff Governance / 27
7.4 Workforce Plan / 27
7.5 Estates strategy / 27
7.6 IT Systems within Mental Health / 27
8 / Conclusion / 29
9 / Appendices / 31
1. Financial Framework
2. Estates Strategy
3. Implementation Plan
4. Key Policy Drivers
5. Glossary
6. Editorial Group
Foreword by Colin Sloey
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Lanarkshire’s Vision
“We wish to see a Lanarkshire where we all understand that there is no health
without mental health, where we know how to support and improve our own
and other’s mental health and wellbeing and act on that knowledge, and
where our flourishing mental health and mental wellbeing contributes to a
healthier, wealthier and fairer, smarter and safer Lanarkshire……... people
have a capacity for change and are able to achieve productive change both
in how they feel and how they live their lives. Key to this belief is that
national and local government and other agencies are able to help set the
context, conditions and opportunities for change”.
Translated into a Lanarkshire context from Towards a Mentally Flourishing Scotland (2007) document
1. Introduction
The principle aim in producing this two year updated mental health strategy is to revisit areas within the strategy which require updated and in doing so, ensure that NHS Lanarkshire and its partners align our service models closely to national policy. The fundamental principles have not been changed from the original strategy, only updated and the document restructured.
2. The Strategic Aim
The strategy is to move towards care models based in the community and away from institutional inpatient care settings. To achieve this, existing resources will be moved to provide the necessary community infrastructure to ensure the provision of safe, effective and efficient modernised mental health services[1].
Mental health and wellbeing has been a national clinical priority for NHS Scotland since 1999. NHS Lanarkshire (NHSL), in partnership with North and South Lanarkshire Councils, voluntary sector and service users and carers, developed a mental health strategy in 1999 and significant work has been undertaken to implement many aspects of this.
3. The Case for Change
3.1 Demography
· It is estimated that 1 in 4 (110,000) adults will have mental health care needs at some point in their life.
· Some people are more likely than others to experience a mental health issue. In the last week 70,500 adults (16%)[2], 6,700 children aged between 5-15 years (10%) [3] will have experienced mental health care needs.
· An estimated 5,000 adults (1%) are living with severe and/or enduring mental health care needs.
· An average of 83 Lanarkshire residents per year completed suicide between 1997 and 2006, with suicide being the greatest cause of death in young adult males.
· Approximately 75% of the Lanarkshire population will know someone personally who has had mental health care needs.
· Mental ill-health (including suicide) accounts for 20% of the total burden of disease in the UK[4]. This is as a result of the high prevalence of mental ill-health, earlier onset and long duration in many cases, and the impact on many areas of people’s lives including physical health, education, employment, income, personal relationships and social participation.
· Associated costs for Scotland have been estimated at £3.8 billion.
· In Scotland in 2006, only 14% of the population were classified as having good mental wellbeing, 73% average mental wellbeing and 14% poor mental wellbeing[5].
· However, mental health is not just about mental illness, it is about wellbeing; levels of confidence, life satisfaction, happiness and contentment and ability to cope with life’s difficulties and being able to contribute.
The findings from nine large scale population-based studies demonstrate a significant association between mental health problems and material deprivation, education status, employment status, the environment and adverse life events[6]. Greater local focus is required to address the underlying community and structural factors that clearly impact on wellbeing.
The number of people aged 65 and over is rising in Lanarkshire. While the numbers of older people reporting functional mental health problems is lower than the adult population (10% v 16%) the absolute numbers are likely to increase reflecting population trend. The increase in functional mental health problems will also be matched with an increase in organic mental health problems. So while living longer is to be celebrated, there is a significant increased risk of poor physical health and social isolation. Services must continue to plan for the future in terms of preventing mental ill-health, promoting wellbeing and providing care and treatment for the older population.
Within NHSL there are two Community Health Partnerships (CHP) (North and South Lanarkshire) whose aim is to improve the long-term health and wellbeing of communities and enhance the quality of health and social services.
3.2 National and Local Evidence
There are a number of national and local strategy documents which influence and direct the way in which care is planned and delivered:
· SEHD Mental Health (Care and Treatment) (Scotland) Act (2003) [7]
The implementation of this Act places a duty on Health Boards and Local Authorities to deliver quality services in hospital and community to all those with mental disorder, not only those where the compulsory powers of the Act have been applied. There is also a new duty on Local Authorities and their partners to develop services for people with mental health care needs that promote wellbeing, social development and recovery.
· NHS Lanarkshire A Picture of Health (2006)
This document deals with a rationalisation of hospital services in order to further develop community services across all healthcare groups in Lanarkshire.
· SEHD Delivering for Mental Health (2006)[8]
This mental health delivery plan for Scotland sets out targets and commitments for the development of mental health services. Meeting these commitments will deliver improved outcomes for people requiring care and treatment under pinned by the values of recovery.
· NHS QIS Integrated Care Pathways (2007)[9]
NHS Quality Improvement Scotland has produced a strategy for improving quality in mental health services based on producing standards for integrated care pathways for different problems and conditions.
· DoH New Ways of Working for Psychiatrists (2005) [10]
This document provides a framework to assist in modernising the ways multidisciplinary mental health teams function in the future.
· SEHD Local Improvement Targets for the Joint Future Agenda (2004) [11]
Community services will also be shaped by the increasing emphasis on joint working with local authority colleagues through Joint Futures and through locality community planning structures.
· SEHD Quality Outcomes Framework Primary Medical Services 2005/06 [12]
This contract provides incentives for primary care to improve primary care services for people experiencing depression and dementia as well as severe and/or enduring mental health problems.
· SEHD National Review of Mental Health Nursing in Scotland - ‘Rights, Relationships & Recovery’ (2006)[13]
This review and action plan sets out new ways of working and service developments for mental health nursing.
· Concordat between the Scottish Government and COSLA (2008) [14]
The concordat between the Scottish Government and Coalition of Scottish Local Authorities (COSLA) which has been issued provides new opportunities for mental health improvement.
· The Scottish Executive’s National Programme for Improving Mental Health and Wellbeing Action Plan (2007)[15]
This programme aims to: improve the mental health and wellbeing of everyone living in Scotland and improve the quality of life and social inclusion of people experiencing mental health problems.
· Scottish Government, Better Health, Better Care Action Plan (2007)[16]
This action plan re-emphasises mental health and wellbeing as a national priority highlighting the need to take a whole systems approach to promote wellbeing, prevent mental ill-health and promote recovery through effective care and treatment.
· Scottish Government Discussion Paper Towards A Mentally Flourishing Scotland: the Future of Mental Health Improvement in Scotland (2008-2011) (2007) [17]
This paper outlines the proposed direction for mental health improvement for individuals and populations for 2008-2011.
4. The Mental Health and Social Care Model
4.1 A model for delivering care
The intention is to create a multi-agency mental health model that is embedded in each natural community in Lanarkshire. This approach will influence the promotion of positive mental health and wellbeing and will deliver a range of services including treatment, care and support to those who encounter mental health problems. Services will be locality based. Specialist interventions and hospital treatment will be available but used only where necessary. Services will be accessible to local communities and access to services will be based on the needs and preferences of those receiving the service. Services will promote recovery using a model of social inclusion.
Communities will be involved in organising services, helping to achieve a balance between the rights of individuals to their preferred care with the responsibility of providing care to all with needs in their community.
A range of services are offered through the Tiered Approach Model (see Figure 1 and Table 1) which matches the person against the appropriate service in response to their level of need. Service users may access services in more than one tier at one time and may pass through several tiers during one episode of care. Further up the tiers the threshold of access tends to increase. More assessment is needed to be able to access the higher tiers.
The Tiered Approach Model (Figure1)
Description / By who
Tier 0 / Generic services providing education, health improvement and preventative approaches / Voluntary services, education, public health
Tier 1 / Entry level for care whereby professionals in this tier will seek to address issues before they may require referring on to more specialised and focussed services at the next level of care. / General Practitioner, Public Health Nurse, District Nurse, Practice Counsellor, Dietician, Primary Care Psychologist
Tier 2 / Specialist community and inpatient based structured treatment services. . Access by referral from tier 1. / Out/Inpatient services, Community Mental Health Team, Focused Intervention Team, Outreach Team, Psychiatric Assessment Team, Dietician, Occupational Therapist, Clinical and Counselling Psychology
Tier 3 / Specialist and high intensity treatment services. Access by referral from tier 2. / Forensic service, Eating Disorder service, Psychotherapy service, Antenatal & Postnatal Mental Health & Wellbeing service
Table 1 Description of tiers
Throughout the tiers, a range of psychological therapies play an important role in the treatment of a wide range of mental health problems and clinical disorders. The evidence base for their effectiveness has grown significantly over the past 10 years and are more sought after by service users.
NHSL is committed to providing a range of appropriate treatment options, using a stepped / matched care approach. In addition to commonly presenting mental health problems, psychological therapies are a necessary component of a comprehensive treatment package for people with more severe and enduring conditions such as psychosis. Psychological therapies are no longer considered optional; they are fundamental to basic mental health care and can make a highly significant contribution to outcome and user satisfaction.
NHSL, through the review of Psychological Therapies is committed to providing a range of evidence based psychological therapies:
· For all conditions
· Across the age range
· Across the range of presentations from mild, to severe and enduring
· In a range of settings from primary care to tertiary services and where possible in the local area
· In physical and mental health
· Provided by a range of providers that are appropriately trained and supported in the delivery of psychological therapies.
The Mental Health and Wellbeing Needs Led Model (Figure 2)
(Adapted from Towards a Mentally Flourishing Scotland, SEHD 2007. The Dual Continua Model
4.2 Tier 0: Community Health and Wellbeing
Mental health is a term used to describe emotional and psychological wellbeing. For individuals, mental health is how a person thinks, feels, and acts when faced with different situations. It is affected by factors that promote or demote people’s sense of wellbeing either individually or at population level.
Mental health improvement is an inclusive term that may include action to promote mental health and wellbeing, to prevent mental health problems and to improve quality of life for people with a diagnosed mental health problem. Mental health improvement works at three levels and at each level is relevant to the whole population, individuals at risk, vulnerable groups and people with mental health problems:
· Strengthening individuals - by increasing emotional resilience through interventions designed to promote self-esteem, life and coping skills, e.g. communicating, negotiating, relationship and parenting skills.
· Strengthening communities - by increasing social support, social inclusion and participation, improving community safety, neighbourhood environments, promoting childcare and self-help networks, developing health and social services which support mental health, improving mental health within schools and workplaces e.g. through anti-bullying strategies and mental health strategies.