Mental Health Services

2015 & Beyond

Dr Nick Broughton

Broadmoor Hospital

Points to cover

• Case for change – humanitarian & economic• Situation now• The way forward

“Apart perhaps from global warming, there is no other major problem which is so neglected worldwide”

“Thrive – the power of evidence-based psychological therapies”

Richard Layard & David Clark

Mental health: the basis of a humane and wealthy society

By condition…. % in treatment

Anxiety and depression 24

PTSD 28

Psychosis 80

ADHD 34

Eating disorders 25

Alcohol dependence 23

Drug dependence 14

Largest proportion of the disease burden in the UK (22.8%), larger than cardiovascular disease (16.2%) or cancer (15.9%)

People with psychosis die 14-20 years earlier than the general population

Depression associated with 50% increased mortality from all disease

59% triple amputees can be treated to get back into employment7% SMI in paid work

The Statistics

• 1 in 6 suffer from depression or anxiety• 1/3 of families include someone who is mentally ill• Mental illness accounts for 40% of all illness• 75% never get treatment• As many people kill themselves as die from war &

homicide• 7% of British teenagers have tried to kill or harm

themselves• 10% 5-16 year olds suffer from a serious mental health

problem• 50% of serious mental illnesses begin in childhood• 4.6 million living with long term physical & mental health

problems

Economic cost to Britain of Mental Illness

Cost to economy Cost to taxpayers

Unemployment, absenteeism & presenteeism

4 2

Crime 2 1

Physical healthcare

1 1

Total 7 4

(% of national income)

Integrated physical & mental health care for

long term conditions

Integrated physical & mental health care for

long term conditions

• Co-morbid MH problems are associated with a 45-75% increase in service costs per patient

• Between 12% and 18% of all expenditure on long-term conditions is linked to poor mental health and wellbeing

• If a person with a LTC has an untreated MH condition they cannot recover as well and they die earlier

NHS Landscape post 2012

24/7 Assertive outreach/ community forensic team

24/7 Assertive outreach /rehabilitation & recovery team

24/7 Assertive outreach /rehabilitation & recovery team

Rehabilitation / recovery team

Rehabilitation / recovery team

CMHT/ Enhanced primary care SMI with 3rd sector outreach

CMHT/ Enhanced primary care SMI with 3rd sector outreach

NHSE direct commissioned services

CCG commissioned services

Local authority commissioned

Commissioning the beds Commissioning the beds Commissioning the teams Commissioning the teams

The Mental Health System

No Health Without Mental Health - 2011

• Government strategy set out six key 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 good 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

Increasing political support

• “This government has made improving mental health services a bigger priority than ever before, and we’re determined that mental health is treated with as much importance as physical health in the NHS”

Rt Hon Norman Lamb MP, 16 September 2014

London Health Board: MH priorities

• Mental Health & Employment The development of more effective support to ensure that

talent is not lost from the London workforce because of mental illness

• Adolescent Resilience Working with schools & across all agencies to support

adolescents to improve their resilience, so improving education outcomes & mental wellbeing

• Digital Mental Wellbeing Supporting the joint commissioning of a digital wellbeing

service to all 6 million adults in London to enable them to develop & maintain emotional resilience

Call for commitment to parity of esteem

• Ensure fair funding for mental health services• Give children a good start in life• Improve physical health care for people with mental health problems• Improve the lives for people with mental health problems• Enable better access to mental health services

The way forward

• Promote good mental health: Neighbourhoods, communities, schools (the 4 Rs), building resilience, addressing dyslexia, training school nurses & form tutors, engaging school governors

• Prevention and early intervention:– Parenting programmes– Early intervention in psychosis– Students against depression

Effective treatment

• Timely access to help when it’s needed:– Perinatal mental health support– Psychological therapy– Crisis care– Liaison psychiatry– Diversion

Support recovery

• ‘Job, home, family and friends’• Employment and education• Action to tackle stigma & discrimination• Support with housing, benefits, debt, etc• Peer support• Support for carers

The Role of the Third Sector

• Addressing stigma• Identifying need & gaps in service provision• Research – MH research underfunded• Innovation – developing new service

models• Collaboration with public sector• Co-production & co-design