Appendix - Southend-on-Sea Borough Council

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South Essex Joint Mental Health Strategy

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DRAFT








South Essex Joint Mental Health Strategy



Essex County Council

South Essex

PCTs’

Cluster

Southend
-
on
-
Sea Borough Council

Thurrock Council




January

201
2



























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Contents


Chapter

Section


page

1


Executive Summary

3









2


The Case for Change

7









3


Local Health and Social Care Needs
Assessment

13









4


Current Investment, Activity and
Performance

20









5


The Way Forward

32

















Appendices



Appendix 1


Consultations about Mental Health Services
in South Essex

38

Appendix 2


Policy Context: National Drivers for Change

43

Appendix 3


Local Needs Assessment

47

Appendix 4


South Essex Mental Health Commissioning
Board Terms of Reference

53









Appendix 5


Glossary

57

Appendix 6


References

58













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Chapter 1: Executive Summary


This Strategy sets out the approach to the
commissioning of Mental H
ealth services
in South Essex for the five year period April 2012 to March 2017.


It has been produced by partners responsible for ensuring that adult mental health
services are commissioned appropriately and efficiently for the people of South
Essex. The key partners are Essex County Council, South Essex PCT’s Cluster

representing Cli
nical Commissioning Groups
, Southend
-
on
-
Sea Borough Council
and Thurrock Council.



CASE FOR CHANGE


Following extensive engagement with a wide variety of stakeholders there has been
a strong consensus around the need to significantly change services:




Feedback from service users shows they want recovery focused integrated
services which are easy to access. They want services which promote peer
support and self
-
management.
They want services which provide continuity.



Feedback from GP’s shows they have particular difficulty accessing crisis
and
early intervention
services.



Feedback from mental health professionals is that some of the mo
dels of care
are old fashioned

and do not fully utilise specialist skills.



Feedback
from PCT commissioners is

the need to
develop affordable
pathways which reduce demand for expensive, specialist care.



Feedback from social care commissioners is that the social work role is
changing with the impact of person
a
lised services and the growing
division
between assessment and service provisi
on.



OUTCOME
S

FRAMEWORK


To deliver improved mental health outcomes will require stronger commissioning.
The aim is for the three local authority commissioners and the NHS commissioners
to align health and
social care commissioning arrangements from the 1
st

April 2012.
This will include formalising the South Essex Mental Health Joint Commissioning
Board and its governance links with all three Health and Wellbeing Boards.


The outcomes framework ensures there

is a link between the overarching population
outcomes and the services being commissioned. We need to be able to demonstrate
that the services being commissioned are delivering effective services and that these
services are meeting the needs of the popula
tion. It is intended that t
hese actions
will form part of detailed operational action plans
and drive future commissioning.





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The
proposed
four population

outcomes

are:


1.

People have good mental health

2.

People with mental health problems recover

3.

People
with mental health problems have good physical health and people
with physical health problems have good mental health

4.

People with mental health problems achieve the best possible Quality of
Life



The
outcome framework
sets 4 population outcomes,
12 population
indicators and a
series of actions to deliver change.

We aim to be able to show how the services that
are commissioned are impacting on the population indicators. One of our outcome is
‘People have good mental health’ and we will measure this

through a number of
indicators. For example, improving psychiatric liaison services should reduce the
number of incidence of undetermined injury or self harm. We can analyse the impact
this will have on waiting times, whether the intervention helped and
whether it would
stop self
-
harm in the future.


MODELS OF CARE


The current model of service
is unlikely to deliver these outcomes in the future
because it
has a number of
limitations
:




Lack of primary care in reach to manage the onset of mental health problems
or mental health as a long term condition.



A narrow single point of access (CAS) into secondary care managed by
a
single dominant
provider.



Block contract arrangement with ill
-
def
ined secondary care pathways
.




Reliance on A&E as the pathway for crisis interventions from primary care
.



Social care services delivered by community mental health teams rather than
individually purchased services through a personal budget.



The strategy

therefore proposes that we need whole system redesign. The new
model of care will need to meet a number of success criteria. The strategy proposes
a number of key design principles:




Safety


rapid access for people in crisis and no gaps in clinical responsibility.



Integrated and efficient


meet health and social care needs whilst avoiding
multiple assessments or hand offs.



Affordability and sustainability


developing pathways which

intervene early
and manage demand for expensive specialist services without
destabilising

the provider base.



Personalised

and accountable
-

provide choice, develop markets and become
more accountable to commissioners.



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OPTIONS FOR DIFFERENT MODELS OF C
ARE


There is no
national consensus on the best model of care for mental health.
Therefore it is the responsibility of local clinical commissioners to develop local
pathways to meet local needs.


As a first step, it is important to consult on the model of care. The models of care are
the building blocks of system reform which will enable commissioners to develop a
coherent approach to commissioning outcomes.


The commissioners will continue a dial
ogue with a wide range of stakeholders to
refine and develop the model of care. The engagement to date has not provided a
consensus on the optimum model of care which would meet all of the required
design principles. Therefore to further aid discussions we

have set out 3 broad
options for consideration. This is intended to stimulate discussion rather than limit
innovation and other options are actively welcomed:


Option 1
: INDEPENDENT CLINICAL ASSESSMENT SERVICE (iCAS)


One option being considered is to
procure an iCAS
. Th
is model would mean that all
non
-
emergency patients would be r
e
ferred into the iCAS. The iCAS would be
responsible for assessing need, agreeing a care plan and commissioning a package
of care. This would help increase choice for patients
, diversify service provision and
make the system more accountable to commissioners. The removal of block funding
would encourage providers to enter the market and meet need in innovative and cost
effective ways.


Option 2


PRIMARY CARE MENTAL HEALTH MODEL


The second option being considered is to
organise

services around primary care.
This model would mean that all non
-
emergency patients would be referred into a
primary care mental health team. The configuration of the te
am would be developed
by the Clinical Commissioning Groups in order to meet local need. There are
different ways of organizing these services. For example, through early intervention
walk in centres or through primary care in reach services.


Option 3


DEVELOP BOTH PRIMARY CARE SERVICES AND AN INDEPENDENT
ASSESSMENT SERVICE.


The third option being considered combines elements of option 1 and 2. In effect,
services are organised around primary care for the early intervention phase but can
only be refe
rred into the specialist pathways once it has been agreed by
commissioners. The commissioners would recruit additional clinical support to
assess whether the referral into specialist services was justified and whether
alternative pathways had been explored
. This is best viewed as a strengthening of
the commissioning function rather than a significant change to the patient pathway.


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Option
4



CONTINUE WITH EXISTING SERVICE MODEL MAKING CHANGES TO
ACHIEVE THE OUTCOMES.



The fourth option being considered wo
uld be to continue with the existing service
model in South Essex and to make incremental changes to improve the services
whilst increasing efficiency and moving towards the four outcomes.




The South Essex Mental Health Strategy does not exist in isolati
on its underlying
premise is that of partnership working illustrated in the fact that it is jointly produced
by all Commissioning partners to best serve the population of South Essex.

The strategy is of course underpinned by the outcomes within
No Health
Without
Mental Health: Cross Government Mental Health Outcomes Strategy

(February
2011) which explains how care and support services, Public Health, Adult Social
Care, NHS Healthcare and Children’s Services, will all contribute to the ambition for
improved

mental health. The South Essex Mental Health Strategy is therefore also
fundamentally linked to the key work that has been undertaken across Essex,
Southend
-
on
-
Sea
and Thurrock to produce:



The Joint Health and Wellbeing Boards currently in shadow form set

up to
cover Southend
-
on
-
Sea, Essex and Thurrock



The Dementia Strategy



The Drug and Alcohol Strategies for all localities



The Children and Adolescent Mental Health Strategy



Southend
-
on
-
Sea, Essex Thurrock (SET) Safeguarding Procedures




Joint work that
is being undertaken on Autism, Sensory impairment, Learning
Disability and Public Health


To ensure that each Commissioning partner meets not only the cross cutting
commissioning needs of South Essex but also the unique needs of each locality and
service,
each partner will develop individual implementation plans, which will meet
local need and be shared and supported within the Joint Commissioning Team.

The Strategy
is set out

as follows
:


Chapter 2:
The Case for Change

outlines clearly the need to change how mental
health services are provided in South Essex. It summarises feedback from local
engagement with service users, carers, mental health professionals, the community
and voluntary sector and others. Consistent
themes emerge about access to
services, how crises are responded to and the strong desire for individuals to be
seen as a whole person rather than the focus being on the mental health condition.
These themes have underpinned the development of the Strateg
y. Reductions in
funding, rising demand for services and changes to how services are commissioned
mean that doing nothing is not an option


this is a great opportunity to review how
we can build on and improve the way things are currently done.

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Chapter
3: the
Local Health and Social Care Needs Assessment

summarises
what is known about mental health in South Essex from the Joint Strategic Needs
Assessment, in terms of the scale of need, local risk factors and local high risk
groups. It highlights the hig
h correlation between mental and physical ill health and
the importance of suitable housing. Many of the high risk factors are linked to
deprivation, which means that parts of Basildon, Southend
-
on
-
Sea and Thurrock are
likely to be most affected. More lo
cal evidence of need is required to help implement
the Strategy.

Chapter 4:

Current Inves
tment, Activity and Performance

illustrates the financial
challenge for mental health service provision in South Essex. Over £91million is
currently spent in South E
ssex, 86% of which by the health service, but all partners
are being called upon to reduce expenditure and make sure that the money that
is

invested has the most impact in terms of improving outcomes for those who use the
service. The Chapter outlines the

current investment in mental health, how this is
used and provides information on how South Essex is performing when compared
with others providing similar services.


Chapter 5:
The Way Forward

sets out a new framework for commissioning and
delivering
improved outcomes, including suggested measures of performance and
guidance on how commissioning will work in South Essex.



We Want to Know …


In this phase of consultation, the commissioners wish to know:



Q1. Do you support the case for change? Please explain your reasons.


Q2. Do you support the analysis of local need? Please explain your reasons.


Q3. Do you support the outcomes framework? Please explain your reasons.


Q4. Please describe any risks that

you see with the 4 service models.


Q
5
. Which of the models of care do you prefer? Please explain your reasons
and/or provide alternative models.



Q1.


Guidance on how to respond, who to, by when








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Chapter
2
: The Case for Change


Key Messages




One in six adults is likely to have some kind of mental health problem at some time
in their life



The social and economic costs of mental ill health are high, to those experiencing
problems, their families and to the wider economy, and a great deal of publ
ic
money is spent dealing with the consequences of mental ill health



Local people who experience mental ill health are clearly saying they want different
responses focusing on recovery, ease of access, consistency and a focus on their
individual needs



Ther
e are other key drivers for change
-

doing nothing is not an option



The case and opportunity for change is compelling, and service responses can be
redesigned to support people in a more constructive way with a wider
understanding of mental ill health and

more prevention with earlier treatment of the
causes



Implementation of this Strategy will bring a new approach



Mental Ill Health and its Impact


Mental health is defined as
‘an individual’s ability to manage and cope with the
stresses and challenges of

life’

(p132, Mental Health National Service Framework,
Department of Health 1999).


Mental health problems are more common in the general population than most
people would think:




One in six adults will have some kind of mental health problems such as
dep
ression, neurosis or psychosis at some time in their life
1
. For most of these
people, the problem lasts longer than a year.




The World Health Organisation (WHO) predicts that by 2020, depression will be the
second leading cause of disability world
-
wid
e




One quarter of routine GP consultations are for people with mental health problems
and around 90% of mental health care is provided solely by primary care
2



Mental health problems are also associated with social exclusion and disadvantage.
People are
more likely to be socially and financially disadvantaged, unemployed,
have poor quality housing and have poor physical health. Mental health problems
often adversely affect social and family relationships and are poorly understood by
the wider community.






1

Mental Health National Service Framework, Department of Health 1999

2

Mental Health National Service Framework, Department of Health 1999

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The economic and social costs of mental health problems are high, both to those
who experience mental health problems and their families, as well as to employers
and society as a whole. Mental ill health constitutes a heavy burden in terms of
suffer
ing, disability and mortality, and contributes substantially to both health and
social care costs.


Mental ill health can cause loss of economic productivity due to people being unable
to work, being ill at work and premature death from mental illness fo
r example from
suicides or physical illness, and can contribute significantly to poverty (Harris and
Barraclough, 1998). People with mental illness are more susceptible to physical
illness with related mortality and morbidity than the general population (
Lawrence
et
al.,

2009). Mental health problems are recorded as the main reason people claim
Incapacity Benefit (Department of Health, 2004). The Centre for Mental Health
estimate the annual costs have risen from just under £80 million to over £100million
during the peri
od between 2002/03 and 2009/10.


Figure 1: Economic and social costs of mental health problems in England




















Source: Centre for Mental Health (2010)


The Department of Health report ‘Mental health promotion and mental illness
prevention: the economic case’ (April 2011) set out the evidence base for a number
of cost effective interventions, including support to families in the early years
development of children and early identification of illness at work, that support the
preve
ntative agenda and can create long
-
term savings to the NHS and the wider
economy.





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Engagement events


A number of workshops and focus groups have been held across South Essex with
service users, carers, professionals and other stakeholders to understand how
current services are experienced, and how they can be improved. A summary of
the engagement activi
ty and the key feedback is provided at
Appendix 1.


The engagement events built on ‘The Big Conversation’ workshops held by MIME
(Making Involvement Matter in Essex), which demonstrated how much
people who
experience mental ill health want to be involved in shaping and influencing services.
Follow up workshops and surveys were done with Thurrock service users, who
shared their experiences of services and mental ill health (outlined in
Appendix 1)

-

around 22 users were involved with 44 questionnaires returned.


A workshop was held in Southend
-
on
-
Sea

for around 30 service users and
professionals, where the emphasis was on developing ideas from a deep dive
exercise around accommodation, community su
pport and service provision.


Clinical engagement workshops were then developed to take these outcomes
forward and prepare for further follow up ‘clinical’ workshops with GPs, third sector
providers and clinical staff to discuss new ways of delivering serv
ices. Details are
also provided
in Appendix 1.



Around 40 people, including service users, commissioners, providers, third sector
organisations and GPs, have also come together to develop an ‘outcome based
accountability’ model for delivering the Strate
gy, which is outlined in Chapter 5.


Summary feedback


The key messages emerging from the engagement are:




The desire for recovery focused services was common amongst service users and
carers and also professionals. People do not want to be managed by
professionals
for the rest of their life, they want to reach a point where they can take control to
manage their condition and become as socially included and independent as
possible.




Service
U
ser and Carer involvement, employment and support are all cruc
ial, as it
is families and carers who know their loved one best. Once informed and
prepared, they can help the service user remain in their environment. Having daily
activity and employment helps. These aspects combined ensure a growing sense
of self
-
wo
rth.




Integration and partnership between service providers is important as combined
knowledge and expertise is central to achieving an holistic view and approach to
helping people receive the service they deserve.


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Holistic assessment and service provision, single access, one
-
stop
-
shops, with as
few visits to
Centers

as possible
-

helping the individual feel listened to and seen
as whole person.




Ease of access to services, increased opening hours to make specialist
services
more available, not confined by walls and time, with choice and accessibility




Continuity of professional presence
-

seeing different people each visit has been a
real concern for service users, having to repeat one's story and to develop yet
anot
her trusting relationship only slows down improvement




Well trained, knowledgeable and informed staff who ensure effective responses,
assessment and care.




Multipoint access to information can aid the quick location of important advice and
assistance.




Le
ss use of hospitalisation, with community alternatives for pre
-

and post
-
hospital.
Many people commented that they did not like being in hospital. It is clear that for
some, being in hospital does not aid recovery but can cause serious deterioration.
Al
so it is clearly a very expensive option.


Other Drivers for Change


The current provision of services is impressive and beneficial to those who receive
them. However comments made by the service users, carers and others make it
necessary to refine what we do by realigning and remodeling our response to mental
ill health.



There are other key drivers for change:




The need to make savings in all public services, and limited future investment,
means that growth in real terms will be dependent on focusing on priorities and
doing thing better




We are also entering a new phas
e in how services are provided by passing the
responsibility for NHS commissioning to GP colleagues




Personalisation is the new method for helping people maintain their independence
in social care, ideally in their own home, and local authorities are movin
g away
from delivering services directly. The principles of choice and control, and keeping
people in their own homes where possible, are equally acceptable for health
service responses to mental ill health.




Variable service provision is no longer
acceptable in a society where information is
shared instantly electronically and where people are seen as equal citizens.


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Gaps can occur in services where people have multiple needs for example
between Mental Health and Drug and Alcohol, Physical and sens
ory or Learning
disabilities and in the transitions b
etween services that cater for
different age
groups: older people/ working age adults/ and children and adolescent services.
Boundaries preventing service users accessing services and falling between gap
s
need to be removed
-

services can no longer run in isolation




The stigma of mental illness is a major barrier that needs to be addressed
-

social
exclusion can be reversed by tackling aspects of poor social attitude and
discrimination toward race,
culture, gender, sexual orientation, age, intellectual
ability and condition


The national drivers for change are explained in more detail in
Appendix 2

which
helps support the case for change.


Evidence for Change


The evidence we have collected shows us
that there is a case for changing the way
in which mental health services are provided in South Essex.


Some of the issues that emerged from engagement activity were about access to
services in crisis, access to services when the person did not seem to qui
te fit with
any service, how service users can gain entry back into services once they have
been discharged, treating the person as a whole and not just an illness, and reducing
the need for people to go to hospital or receive treatment in a specialist men
tal
health service.


The GPs we spoke to want to build on the skills they have to support patients with
complex mental health needs as they do with any long term condition. They consider
they would benefit from additional support to manage the many differi
ng levels and
complexities of long term mental illness.


People want to know that they can move in and out of services without having to go
back on a waiting list so that they can be secure in the knowledge that should they
suffer an episode of particu
larly poor mental health that they will be able to access
help instantly to prevent deterioration and that those around them will recognise this
and be able to offer support. This will also help to break the culture of dependency
on services. There are als
o ethical issues to be considered in maintaining people in
services that are of a higher level than they need.


This would mean that for a number of people currently known to secondary mental
health services their needs could be met through their GP with
community support
but this has implications for the way services are currently constructed
.


The question of how support would be provided needs to be considered, examples
could be as to whether it is through a central point where people are able to see a
n
expert or from a location closer to home where people would get generalist support
but may need to be referred on again for more specialist care. Either way the main
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focus of the service would be the access provided to GPs and service users to
support t
he management of the condition through local Doctors surgeries and
through the community. We want to be able to provide services in the most person
centred and least restrictive way for individuals with easy access and clear ways of
exiting services to ens
ure that dependencies on services are not created.


People who use services do not necessary want professional input all the time and
valued the support they were able to share as peers. They find some of the
facilitated peer support as important in recov
ering from mental illness and found a
value in themselves helping others going through the same situation.


Working together we can challenge stigma and discrimination to ensure that people
who have suffered from mental ill health are not discriminated aga
inst in the
workplace or wider community


Our Vision


Is that People in South Essex achieve the best quality of life and maintain both
good physical and mental health and wellbeing



Implementation of this Strategy will bring a new approach to the joint
commissioning and provision of mental health services in South Essex
.


It will support our vision for improving mental health by:




focussing on recovery and what works for individuals



providing rapid access to services and advice


“anytime, anyplace,
anywhere”



ensuring that pathways are mapped to support the individual



challenging stigma, creating visibility and promoting inclusion



encouraging peer support and personalised responses



providing more support to GPs and the community



ensuring that physic
al and mental health are considered together


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Chapter 3: Local Health and Social Care Needs Assessment


Key Messages




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social, political and economic circumstances of people’s lives.


This Chapter brings together a range of data on factors wh
ich can give rise to poor
mental health, including estimates of mental illness drawn from national data and an
assessment of what this means for South Essex, and commentary on contributory
risk factors and high risk groups.


Indicators of Mental Health ‘
Need’


There have been several attempts to create a clear and objective measure of mental
health ‘need’ that can help decision makers to determine priorities and to plan,
commission and evaluate services. These measures often focus on rates of mental
illn
ess as this data is relatively accessible, despite problems with variable data
quality and completeness.

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Empirical evidence shows that variation in psychiatric admission is partially
explained by a wide range of socio
-
economic factors, including generic
deprivation
measures, poverty and unemployment.


Mental Health Demographics


The data shown in figures 2 and 3 give an outline of the mental health demographics
in South Essex including both health and social care information. This illustrates how
all the
key indicators that affect an individual’s mental health are present to a
significant degree across South Essex for example there are some of the most
deprived wards in the Country within South Essex which have a higher incidence of
mental health problems.

There is a need to support people in the Community but
also a proportion of people with higher needs who require support in residential and
nursing care.


Figure 2: Mental Health Profile of South Essex


NHS South West Essex PCT

NHS South East Essex PCT



South West Essex has a
population of 405,115 (2009)




The ethnic composition is 93%
white, 1% mixed race, 3% Asian,
2% black and 1% Chinese




The three most deprived wards
are Tilbury St Chads, Tilbury
Riverside and Thurrock Park, and
Vange




There were
4,560

claimants of
incapacity benefits due to
mental
health conditions in 2010




There were

319 inpatients formally
detained and 777 informally
detained in hospital in 2010/11




There were
1474 hospital
admissions for mental health
illness in 2010/11




There
were 1,707 on CPA in
2010/11




South West Essex PCT spent
£146 per head on mental health
care in 2006/07



South East Essex PCT has a
population of 336,551 (2009)




The ethnic composition is 95%
white, 1% mixed race, 2% Asian,
1% black and 1% Chinese




The
three most deprived wards
are Kursaal, Victoria and Milton






There were
4,220

claimants of
incapacity benefits due to
mental
health conditions in 2010




There were
336 inpatients formally
detained and 653 informally
detained in hospital 2010/11




There were
1207 hospital
admissions for mental health
illness in 2010/11




There
were

1,356 on CPA in
2010/11




South East Essex PCT spent £184
per head on mental health care in
2006/07

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Figure 3 Social Care Profile for South Essex



Essex CC

Southend
-
on
-
sea
BC

Thurrock BC

Community
Support

In 2010/11 1608
people were
supported to live in
the community

In 2010/11
796

people were
supported to live in
the community

by
the trust

In 2010/11

569

people were
supported to live in
the community

Residential Care

In 2010/11 Essex
supported 82
people to live in
residential care

In 2010/11
116
people supported

to live in residential
care

In 2010/11
Thurrock supported
26 people to live in
residential care

Nursing Care

In 2010/11 Essex
had 26 people i
n
nursing care


In 2010/11
Thurrock had 1
person in nursing
care

Employment

There were 139
people known to
the MH Trust in
employment as at
March 2011

There were
44

people known to
the MH Trust in
employment as at
March 2011

There were 85
people known to
the MH Trust in
employment as at
March 2011

Advocacy

72 people received
forensic advocacy
support in 2010/11



Day Services

In 2010/11 57
people were
supported with day
services

In 2010/11
98

people were
supported with day
services

In 2010/11 21
people w
ere
supported with
day services

Personal
Budgets/ Direct
Payments

In 2010/11 73
people were
supported by a
personal
budget/direct
payment which
enabled them to
choose their own
support

In 2010/11
38

people were
supported by a
personal
budget/direct
paymen
t which
enabled them to
choose their own
support

In 2010/11 15
people were
supported by a
personal
budget/direct
payment which
enabled them to
choose their own
support


Estimates of Common Mental Health Disorder (CMD) and Psychosis
Prevalence in South
Essex


The main source of data about mental illness in adults and older people is the Adult
Psychiatric Morbidity Survey (NHS IC, 2007), which provides information on both
treated and untreated psychiatric disorders in the population. The two main groups o
f
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psychiatric disorders are termed ‘Common Mental Disorders’ (CMD) and
‘psychoses’.

Common mental disorders (CMD) also known as neurotic conditions

(neuroses)
, do
not usually affect insight or cognition and are characterised by a variety of symptoms
such as fatigue and sleep problems, forgetfulness and concentration difficulties,
irritability, worry, panic, hopelessness, and obsessions and compulsions, which ar
e
present to such a degree that they cause problems with daily activities and distress.
This group of disorders includes depression, anxiety, phobias, panic disorder and
obsessive compulsive disorder.

Psychoses are disorders that produce disturbances in t
hinking and perceptions
severe enough to distort perception of reality. Symptoms include auditory
hallucinations, delusional believes and disorganised thinking, these may be
accompanied by unusual or bizarre behaviour, difficulties with social interaction
and
activities of daily living. The main types include schizophrenia and affective
psychosis such as bi
-
polar disease and manic depression.

The figures below show the projection prevalence to 2020 of mental health illness in
the adult population in south E
ssex, an increase of 2.7%

based on population
forecasts.

Figure 4

South Essex Common Mental Disorders (CMD)
Prevalence Projection to 2020
0
10000
20000
30000
40000
50000
LA
Adults 18 - 64yrs
2009
2015
2020
2009
40793
15623
15633
2015
40855
16140
15716
2020
41468
16693
15844
South Essex
Thurrock
Southend



Source: Adult Psychiatric Morbidity Survey (NHS IC, 2007)









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Figure 5


South Essex Psychoses and Personality
Disorders Prevalence Projection to 2020
0
500
1000
1500
2000
2500
3000
3500
LA
Adults 18 - 64yrs
2009
2015
2020
2009
3026
1160
1163
2015
3032
1197
1171
2020
3076
1239
1180
South Essex
Thurrock
Southend


Source: Adult Psychiatric Morbidity Survey (NHS IC, 2007
)



Deprivation


The table below shows us that Basildon, Southend and Thurrock are significantly
more deprived than other areas in Essex.
Many of the risk factors for mental illness
are linked to deprivation
.

Essex has some of the most affluent and some of the most
depriv
ed areas in the country. 6.8% of Essex residents live in seriously deprived
small areas, defined as those in the 20% most deprived nationally.



Figure 6
: Percentage of people living in the most deprived areas




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Employment and Support

Allowance (Incapacity Benefit)
can be claimed by working
age adults unable to work because of illness
.

It is a proxy measure of severe mental
illness in the community and is also a direct measure of socio
-
economic
disadvantage due to mental illness. Incap
acity Benefit claimants make up the largest
group of economically inactive people of working age in Britain and almost 40% are
on Incapacity Benefit because of mental illness.
“Mental illness is the most common
reason for claiming health related benefits
and costs the economy between £30
billion and £40 billion through lost production, sick pay, NHS treatment as well as the
personal and financial costs that result from being out of work. The human, social
and economic cost of mental illness is immense.”


Figure 7

below

shows the last 5 years of incapacity benefit claims due to mental
illness in South Essex; it illustartes that Southend
-
on
-
Sea, Thurrock and Basildon
have the highest rate of claiments which correlates with levels of deprivation in figure
6.

Figure
7

Working age adults Incapacity Benefits
Claimants South Essex 2007 - 2011
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
LA
Working age adults
2007
2008
2009
2010
2011
2007
2,540
680
840
670
3,210
2,000
2008
2,680
680
910
700
3,400
2,060
2009
2,450
640
870
610
3,130
1,900
2010
2,250
560
800
570
2,870
1,750
2011
2,090
510
730
510
2,700
1,620
Basildon
Brentwood
Castle
Point
Rochford
Southend-
on-Sea
Thurrock

A more complex measure the Mental Illness Needs Index (MINI) which is derived
from a number of social demographic measures that best explains the variation in
psychiatric admissions shows that the areas of Southend
-
on
-
Sea, Thurrock and
Basildon
have relatively higher needs compared to the rest of Essex

(see figure 22 in

Appendix 3
).



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Contributory Risk Factors Affecting Mental Health

Some of the primary indicators of mental ill health are as noted above lack of
employment and poor housing
together with social deprivation; these have a
significant impact on particular high risk groups including BME communities, traveller
communities, those within the criminal justice system, those with autism and the
Deaf community. Information regarding the

effects of mental ill health for these high
risk groups and the impact of unemployment and poor housing are explained more
fully in Appendix 3


Impact of Health Behaviours and physical health on mental health

There is a powerful relationship between physi
cal health and mental health (Royal
College of Psychiatrists, 2008).


Life expectancy of people with serious mental illnesses such as schizophrenia and
bipolar disorder is between 10 to 25 years less than the general population. This is
predominantly du
e to cardiovascular disease and many of the risk factors are
preventable. Overall mortality is increased by 50% in people with depression.
Increased mortality occurs for a wide range of conditions, including cardiovascular
disease, cancer, respiratory di
sease, metabolic disease, nervous system diseases
and accidental death. People with physical illness are more likely to be depressed,
but studies have shown that depression itself predicts the later development of
coronary heart disease, stroke, colorecta
l cancer and back pain (JSNA, 2010).


People with mental health problems have higher rates of health risk behaviour,
including smoking, alcohol and drug misuse, high risk sexual behaviour, lack of
exercise, unhealthy eating and obesity. Smoking rates
are much higher among
people with mental illness than among the general population. Over 70% of mental
health in
-
patients smoke. Around 44% of people with common mental disorders are
smokers and more than 70% of people with schizophrenia smok
e.


Alcohol
consumption can be a cause of mental illness, or a resulting factor.
Evidence suggests an association between increased alcohol consumption and
mental illness. Alcohol is responsible for much psychiatric co
-
morbidity, with chronic
heavy drinkers likely
to suffer from depression, anxiety, and/or more serious
cognitive impairment and psychosis. 65% of adult suicides are associated with
excessive drinking.


Further detail regarding the relation between mental well
-
being and physical health
can be found in
Appendix 3





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Chapter 4: Current Investment, Activity and Performance


Key Messages




Total investment into Mental Health in South Essex in 2011/12 was over £91m



Health invests 86%, with local authorities contributing the remaining 14%



The majority of
current investment is focussed on adults rather than older adults



Approximately 60% of health investment is spent on inpatient services, 30% is
spent on community services and assessment and 10% is spent on primary care
or the voluntary sector



Approximatel
y half of local authority investment is spent on residential care or
nursing care, a quarter is spent with SEPT on case management and a quarter
on voluntary sectors such as day services



There is wide variability in the split between inpatient and communi
ty services
across the region, with South Essex being in the middle



There is a significant productivity challenge over the next

3 to 5 years, which
means that services will have to be delivered differently



Current Levels of Investment


Figure 8

below shows expenditure on Functional Adult and Older People Mental
Health services from health and social care in South Essex during 2010/11. The
total health investment into older people’s mental health has been adjusted to reflect
the caseload mix of
organic/functional disorders. Organic disorders such as
dementia are outside the scope of this strategy.


The social care data does not include older people functional mental health, because
older people mental health teams are included within generic te
ams and the mental
health element is not easily identifiable. Future action plans will include the
investigation of the feasibility of all age condition specific mental health services.


Figure 8

Total Spend on Mental Health Services


Area of Spend

Heal
th

Social Care

Total


Total


£78.749m

£12.58m

£91.07m

Percentage split


86%

14%

100%


The 2009/10 National Survey of Investment in Adult Mental Health Services
suggests the national split in investment between health and local authorities is
80:20.





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Figure 9

L
ocal authority
Adult Mental Services
Expenditure 2010/11 (£000s)


Service
Category

Essex
County
Council

Southend
Borough
Council


Thurrock
Council

Total

Assessment
and Care
Management

1,889

852


876

3,617


Residential and
Nursing Care

2,742

2,658


1,376

6,776


Carer Services



40





40

Day Services


10



128

24

162

Home Support


820



192

608

1,620

Advocacy


170

141

311

Mind
(excluding
advocacy)



54

54

Total Direct
Costs

5,501

4,000


3,079

12,580


Note: The values indicated above
relate to expenditure that is directly attributable to adult mental
health services. Additional expenditure is also included within generic adult social care but the
mental health element is not easily identifiable.


Figure10

below shows where the three local authorities in Southend
-
on
-
Sea,
Thurrock and Essex County Council invest in South Essex in 2011/12 on adult
mental health services.


Figure 10

Local

Authority I
nvestment in South Essex, 2011/12


Type of Investment
Investment £,000
Residential and nursing care
6,776.00
£

Assessment and care management
3,617.00
£

Day services
1,620.00
£

Carer services
40.00
£

Advocacy
311.00
£

Home support
216.00
£

Total
12,580.00
£




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Figure 11 Local Aut
hority I
nvestment in South Essex 2011/12




Approximately half of the local authority investment is spent on residential/nursing
care, almost a quarter is spent with SEPT for assessment and case management
and around a quarter is spent with the voluntary
sector on day services, advocacy,
carers support and home support.


South Essex

PCT’s Cluster I
nvestment: adults

Figure 12

shows the breakdown of investment by the South Essex PCT’s Cluster in
2011/12 on adult mental health services.


Figure 12
South E
ssex PCT’s Cluster investment (adults) 2011/12


SEE
SW
Cost
Cost
Tertiary
9,065
£

9,043
£

18,108.00
£

Secondary inpatient
7,163
£

6,339
£

13,502.00
£

Rehab and Continuing Care
2,602
£

4,762
£

7,364.00
£

Secondary community services
8,461
£

7,329
£

15,790.00
£

Assessment and recovery
3,905
£

3,465
£

7,370.00
£

Primary care
1,637
£

2,171
£

3,808.00
£

Prevention
-
£

-
£

Voluntary (non housing)
869
£

1,540
£

2,409.00
£

TOTAL
68,351.00
£

£ '000
Adult
Area of investment







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Figure 1
3
South Essex PCT’s Cluster investment (adults) 2011/12




The vast majority of tertiary referrals are for secure inpatient serv
ices.
Tertiary
services, acute inpatient units and inpatient c
ontinuing care accounts for nearly 60%
of health investment.


A third of investment goes into community services such community mental health
services, including the crisis resolution home treatment team, early intervention in
psychosis team and assertiv
e outreach teams.


Just under 10% of investment is spent on psychological therapies and counselling
and the voluntary sector. The PCT does not commission any direct prevention
services, although many of the generic health promotion schemes have a positi
ve
impact on mental wellbeing, for example exercise.


South Essex PCT’s Cluster investment: older people



Figure 14

shows the breakdown of investment by the South Essex PCT’s Cluster in
2011/12 on older people mental health services. Organic disorders are not within
the remit of the strategy so this investment has been adjusted to reflect that the
majority of the case
load is for dementia.








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Figure 1
4
South Essex PCT’s Cluster investment (older people) 2011/12


Inpatient
19,429.00
£

Community
6,564.00
£

Total
25,993.00
£

Reduction 60% organic
10,397.20
£

£ '000
Older
people
Area of investment


The figure reflects that the current models of service are focussed on inpatient
services. Older people are not excluded from some of the community te
ams and
primary care psychological therapy services described under the adult mental health.
However, the uptake of these services by older people is traditionally poor.


Current Services, Activity and Performance


Local authority funded services


All
three Essex Councils commission SEPT to provide social care services. This
service provides for the statutory social care assessments and reviews, and the
management of individuals’ care packages.


The Councils individually purchase residential and nursin
g care from a variety of
care providers based on the individual’s assessed need. All Councils are in the
process of transition from purchasing directly provided care to giving individuals
choice and control with an individual budget following the national

personalisation
agenda.


All commissioning activity is subject to best value, quality monitoring and market
stimulation. Each Local Authority approaches this through either a central team or a
contracting team, which not only commissions mental health pr
ovision, but also older
people, learning disability and disability services.


NHS funded services Adults


Tertiary services


The PCT invests over £18.5million in tertiary services. The majority of investment
into tertiary services is for secure inpatient services. These are people who are
detained under the Mental Health Act but cannot be managed within mainstream
services bec
ause of their behaviour and risk to themselves or others.


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Secure services are provided by a number of NHS and private providers. The vast
majority of local provision is provided by SEPT at the newly built Brockfield House.

These services are low volu
me and high cost packages, and are commissioned by
the specialist commissioning group at a regional level. Referrals for this provision
are from consultant psychiatrists or the criminal justice services.


Secondary inpatient services


The PCT invests o
ver £13.5million in adult inpatient services. The PCT
commissions four acute wards (104 beds) and one Psychiatric Intensive Care Unit
(PICU) (10 beds):




Cedar Ward at Rochford Hospital



Willow Ward at Rochford Hospital



Grangewaters Ward, Basildon Hospital



Westley Ward, Basildon Hospital



Hadleigh Unit, Basildon Hospital


Referrals for acute inpatient services come from consultant psychiatrists,
assessment wards, crisis resolution home treatment, inter unit transfer (fr
om secure
services, courts or wards) and rehabilitation and continuing care.


The PCT currently invests £7.5m on mental health continuing care and rehabilitation
services. Nearly half of this investment lies within the SEPT contract. However
these servic
es are being reconfigured. The current bed based rehabilitation model is
being reconfigured to provide a better balance of inpatient and community services.
This will reduce the number of rehabilitation beds from 36 to 10.


Nearly £1m is invested in pu
rchasing individual packages of care from the private
sector. Approximately 40% of rehabilitation investment is within the voluntary sector
to provide for old long stay patients in the community.


Secondary community services


The PCT invests nearly £1
6million in secondary care community services. This
category covers several teams including:




Community mental health teams



Assertive outreach teams



Early intervention in psychosis services



Medical outpatients



Resource therapy



Psychological services



Community rehabilitation



Eating disorder services



Personality disorder services


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The PCT commissions 146,000 face to face community contacts per year or 2,807
contacts per week. Overall there are 8,000 people in contact with seco
ndary care
services each year, of which 4,875 people are on the new Care Programme
Approach (CPA).


Assessment and recovery


The PCT invests £7.3million in assessment and recovery services.


This covers three services:


Clinical Assessment Service

(CAS)
-

The CAS, which operates as the gateway to
secondary care services, received 4,200 referrals in 2010/11. This equates to an
average of 81 referrals a week. The majority of referrals come from primary care.
The diagram below shows the referral pr
ocess and expected waiting times.


Figure 15

Clinical Assessment Service referral process and waiting times



The Crisis Resolution Home Treatment

team (CRHT)


The CRHT will manage
approximately 2467 treatments in 2011/12 or 291 face to face contacts per week.
The team gate keep admissions as well as facilitate early discharge, often straight
from the assessment unit.


The assessment unit is a 2
0 bedded unit which manages the initial assessment
period. The maximum length of stay is 7 days. Referrals are mainly from GPs or
accident and emergency liaison services.





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Primary care


The PCT invests approximately £4million into primary care ps
ychological therapies
(IAPT). In 2010/11 the primary care psychological therapy service completed 7,015
treatments. The initial triage usually occurs in GP practices, but people can also
self
-
refer. The service offers a range of options including one to

one therapy,
computerised cognitive behavioural therapy, group therapy and psycho
-
educational
courses.


Prevention


The PCT invests in several generic health and wellbeing promotion schemes which
affect mental wellbeing. However, there are no direct m
ental health prevention
schemes currently commissioned.


Voluntary S
ector


The PCT invests £2.5million in a number of voluntary sector services including:




Day services


traditional drop in services, community bridge builder services and
befriending services



Domestic violence services



Other counselling such as bereavement



Service user involvement groups


NHS funded services O
lder
P
eople


Older people mental health services have not seen the investment that adult
services have received over the last 10 years. The service configuration is therefore
more straightforward.


The PCT invests around £26million in older people mental health serv
ices, but the
majority of this investment is targeted at organic disorders. Therefore the PCT has
estimated that 40% of this investment is focussed on functional older people mental
health services.


The older people’s mental health services are:




Older peoples continuing care



Older people’s assessment inpatient services



Older people’s community mental health teams



Older people’s day treatment services.





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Comparisons with others


The East of England Strategic Health Authority, with PCTs and

Trusts asked the
Audit Commission to work with both commissioners and providers to develop a
jointly agreed set of indicators for acute mental health services.


The indicators are:




Inpatient bed days per weighted population



Community contacts including day care per weighted population



Crisis Resolution Home Treatment (CRHT) team and Assertive Outreach Team
(AOT) contacts per weighted population



Average length of stay for all admissions



Caseload



Adult acute costs per weight
ed population



Split between inpatient and community spend


The figures
in Appendix 4 provide

some comparisons for each of the indicators with
other comparable PCT’s in the East of England
.



Finance Mapping 2010/11


The finance mapping for 2010/11for South Essex compares investment against the
SHA, the ONS clusters (Office of National Statistics) which are the closest
comparator area in terms of characteristics and against the England average.


South Essex invests £2
09.50 per head of adult weighted population compared to an
SHA average of £192.70, ONS average of £194.70 and an English average of
£195.90.


For older peoples services South Essex spends £376.60 per head of weighted
population compared to £342.20 per the

SHA area, £330 for the ONS and £344.70 in
England.


Mental Health Productivity Challenge


The comprehensive spending review removed the complicated system of Grants that
Local Authorities received and replaced it with a much simpler structure. This als
o
led to a reduction in the level of grants received as well as a freeze on council tax.

Southend
-
on
-
Sea

Borough Council faced cuts of 8.8% in 2011/2012, 6.1%
2012/2013 and a further 10
-
13% in 2013/2015. The combined effects led to a
budget gap of £15.5m
in 2011/2012 (with Adult and Community services facing a
£6.43m reduction). 2012/2013 will see a gap of £12m, 2013/2014 £7m and
2014/2015 £9m.

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Thurrock Council, in line with all other local authorities across England, is facing
considerable reductions in
its budget of around 15
-
20% over the life of the current
Comprehensive Spending Review cycle. At the same time Adult Social Care is
facing considerable demand pressures


growing numbers of older people,
increased expectations from service users and young
er people coming through
transition who have a longer life expectancy. These are positive factors but place
further pressures on over stretched budgets.

Members in Thurrock have prioritised front line services for vulnerable groups and
that, combined with

transferred funding from the PCT, has meant the level of budget
reductions has been lower. For 2012/13 we are forecasting a standstill budget which
will mean demand pressures (estimated to be around 5%
-

approx. £ 2m) plus any
inflationary pressures will
have to be found from efficiency savings within Adult
Social Care.

Figure 16

Essex County Council
Mental Health
-

South Area Draft Budgets




Financial Year

2012/13

2013/14

2014/15



Total



£'000

£'000

£'000



£'000













Opening Budget

6,546

6,574

6,212



19,333













Cost Pressures

425

265

265



956













Net Inflation uplift

34

37

40



111













Sub total

7,005

6,877

6,517



20,399













Net Efficiencies

-
431

-
665

-
317



-
1,413













Funding Envelope

6,574

6,212

6,200



18,986


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Demand

Income

Years

Efficiency

It should be noted that the
Essex County Council
Mental Health budgets are
estimates only at this stage.


The actual level of required budgets and efficiencies
will become clearer once the annual planning round commences.


However the likely
impact of the above scenario on the resources available in fut
ure years is shown in
the table.

O
n top of the inflationary efficiency programme it is also assumed that
providers will deliver a further, 1% efficiency in 12/13, 5% in 13/14
and 1% in 14/15.
All providers will be asked to deliver this saving in 12/13.

Each organisation undertakes an annual budget setting process. Therefore it is
difficult to precisely forecast the mental health budgets over the period of the
strategy.

The tab
les below show two scenarios. Both scenarios assume that no providers will
receive an inflationary uplift. The assumption is that each organization will have to
deliver efficiency savings to manage their inflationary pressures. This is a
considerable under
taking for both large and small providers.

Figure 17


QIPP is the local projects aimed at improving Quality, Innovation, Productivity and
Prevention. The plans contained within this is consultation strategy will be developed
into QIPP schemes to deliver the required savings.

It should be noted that this are
estimates only at this stage. The actual level of
required efficiencies will become clearer once the annual planning round
commences. However the likely impact of the above scenario on the resources
available in future years is shown below:

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In scenario o
ne, on top of the inflationary efficiency programme it is also assumed
that providers will deliver a further 1.5% efficiency. Nationally, all health providers will
be asked to deliver this saving in 12/13. The total productivity challenge will therefore
be

approximately £6m.

Figure18

Financial Year

2012/13

2013/14

2014/15



Total

Opening Budget

91,000

89,635

87,394



91,000

No Inflation uplift

0

0

0



0

Sub total

91,000

89,635

87,394



91,000

Efficiency @ 1.5%

-
1,365

-
2,241

-
2,185



-
5,791

Funding
Envelope

89,635

87,394

85,209



85,209


Scenario two

In scenario two, on top of the no uplift, the 1.5% national tariff reduction, the
providers will be asked to deliver a 2% saving. The total productivity challenge will be
therefore be around £10m.

Figure

19

Financial Year

2012/13

2013/14

2014/15



Total

Opening Budget

91,000

87,815

84,741



91,000

Inflation Uplift @ 0%

0

0

0



0

Sub total

91,000

87,815

84,741



91,000

Efficiency @ 1.5%

-
1,365

-
1,317

-
1,271



-
3,953

QIPP @ 2%

-
1,820

-
1,756

-
1,695



-
5,271

Funding Envelope

87,815

84,741

81,776



81,776




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Chapter 5: The Way Forward



Key Messages


The strategy is underpinned by:




A Mental Health Outcomes Framework



A joint commissioning approach through a Joint Board and aligned health and

social care commissioning teams



Options for redesigning Models of Care



Developing an Outcomes Framework


In line with the Government Strategy, No Health Without Mental Health, the South
Essex Mental Health Strategy will focus on an outcomes based
approach to
commissioning.


“Outcome strategies reject the top down approach of the past. Instead they focus on
how people can best be empowered to lead the lives they want to lead and keep
themselves and their families healthy, to learn and be able to wo
rk in safe and
resilient communities, and how practitioners on the front line can best be supported
to deliver what matters to service users within an ethos that maintains dignity and
respect.”
(Department of Health,
2011).



W
orkshop
s were

held with stak
eholders to train people to use the ‘Outcomes Based
Accountability’ approach
and develop an Outcomes Framework
for commissioning
mental health services.
Stakeholders will identify which of the indicators are already
collected and which ones we need to esta
blish baselines and set targets.




The proposed four

population

outcomes are:


1.

People have good mental health

2.

People with mental health problems recover

3.

People with mental health problems have good physical health and people
with physical health
problems have good mental health

4.

People with mental health problems achieve the best possible Quality of
Life









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What success looks like?


The following table shows for each of the high level outcome what we are aiming to
achieve, with suggested indicators and levels of performance.

Figure 2
0


Outcome 1


People have good mental health

Outcomes (state of wellbeing)
Indicators (population
measure)
Actions
Key performance measures
Number of people seen by
psychiatric liaison services
% people seen within 4
hours
% referred onto other
services
% being helped by onward
referral
Number of people seen in
early intervention service
Percentage seen within 4
hours
Percentage helped by the
intervention
Reduction in people
admitted on section
Increase in people
supported at home by
home treatment team
Reduction in time people
held in s136 suite
Increase number of police
who have attended mental
health awareness training
Improve case
management of
frequent flyers
Reduce number of FF in
A&E on SEPT caseload
Number of crisis episodes
Number of referrals direct
to assessment unit
Research link between
IAPT and prescribing
Reductions in inappropriate
prescribing
Nobody over 28 days IAPT
waiting times
60% Recovery rates
15% Service coverage
Increase capacity of
IAPT to meet need
Levels of prescribing of
mental health medications
in primary care
People have good mental health
Develop early
intervention services
Develop robust
psychiatric liason
pathways
Number of mental health
detentions
Number of mental health
assessments
Improve crisis
response
Incidence of
undetermined injury and
self harm
A&E mental health
frequent flyers
Develop alternative
pathways



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Outcome 2


People with mental health problems recover

Outcomes (state of wellbeing)
Indicators (population
measure)
Actions
Key performance measures
People have a positive
experience of care and
support
To establish a mental
health service user
reference group,
under health watch, to
oversee the
implementation of the
strategy.
Percentage of people who
report they have a positive
experieince of SEPT
services
Implementation of PbR
action plan
All pathways clearly
mapped, costed with clear
outcomes
Develop recovery
orientated services
Reduction in people on
caseload over 2 years
Improve quality of
reviews for people in
residential care
Reduced spend on
residential care
Number of people seen by
primary care in reach
Number of people helped
by in reach service
Number of people in
contact with specialist
mental health services
Develop primary care
in reach services
People with mental health problems
recover

Outcome 3


P
eople with mental health problems have good physical health and people
with physical health problems have good mental health

Outcomes (state of wellbeing)
Indicators (population
measure)
Actions
Key performance measures
Number of people on SMI
register who smoke
Number of people on SMI
register who are obese
% of people on CPA who
have completed physical
health checks
% people referred to health
intervention
% of carers receiving advice
and support
Public health to deliver
targeted lifestyle
support programme
for people with mental
health problems
% who made lifestyle
change as a result of
programme
To facilitate the use of
personal budgets to
encourage healthy
lifestyles
Percentage of personal
budgets used to support
imporvements in lifestyle
Increased mental
health training for
community services
Increase depression and
anxiety screening for
community services
Improve links between
community and mental
health services
increased number of pople
over 65 using IAPT
Increase the number
of physical health
checks as part of CPA
process that lead to
health intervention
Mental health of people
with long term conditions
Develop annual health
checks for people on
SMI registers
Mortality rates for people
with serious mental health
problems
People with mental health problems
have good physical health and
people with physical health
problems have good mental health

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Outcome 4


people with mental health problems achieve the best possible quality of
life

Outcomes (state of wellbeing)
Indicators (population
measure)
Actions
Key performance measures
Develop step down
pathways for secure
patients
Reduction of Specialist
Commissioning spend
Develop rehabilitation
pathways
Residential care budget
Work with housing
providers to ensure
there is a range of
accomodation and
related support to
meet identified need
increase in the number of
identified providers by ECC
specialist placment team
Return to work
pathways for primary
care clients
Increase number of people
supported into
employment by IAPT
Number of people receiving
SDS for employment
support
Employment specialist
outcomes
To facilitate use of
personal budgets to
encourage people to
develop frienships and
networks in their
communities
increase in the percentage
of personal budgets used
to support access to the
community
To review voluntary
day centre and bridge
builder services and
the potential to use
joint health and socila
care resources in more
personlaised way
% increase in the use of
personal budgets
implement the
recommednations of
the Esteem project to
promote peer support
% increase in the
availability of peer support
led services
People with mental health problems
achieve the best possible quality of
life
Percentage of people
playing an active role in
their community
Return to work
pathways for
secondary care clients
Number of people
receiving incapacity
benefit with mental health
problems
Number of people with
mental health problems in
settled acomodation









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A

joint commissioning approach


Vision


The vision is to imp
rove the mental health for citi
z
ens of Essex, Southend and
Thurrock,


It is proposed that the vision will be achieved through integrated commissioning in
2012/13 that will support Primary Care Trusts (PCTs), Clinical Commissioning
Groups (CCGs) and the three local authorities (Essex, Southend
-
on
-
Sea and
Thurrock) in using th
eir resources more effective by commissioning services through
jointly agreed strategies and an outcomes frameworks. Economies will also be
achieved through collaboration over commissioning support functions, for example
procurement.


Principles of operat
ion


Our approach to integrated working will be:
-




MH Commissioning for a whole system.



Strategic leadership and a jointly agreed outcomes framework.



Informed by service user needs at population and locality level.



Commissioning of service through best
value principles including integrating
commissioning support resources and shared information.



Drive up performance and deliver improved mental health outcomes



Commissioning which address the specific issues of age transition and
interface between related
areas of Mental Health
-
including
LD/CAMHS/substance Misuse



Commissioning which reduces fragmentation by age and allows for services
to be delivered effectively to people with complex needs.



Commissioning with workforce skills fit for the future
-
including
enhanced
business and market analysis skills, provider negotiating skills



Integrated commissioning for individuals through a jointly contracted
assessment service or strengthened management of commissioning for
individual care.


This will be underpinned b
y strong leadership through the South Essex Mental
Health Joint Commissioning Board (SEMHJCB)
(See appendix 5
-

Terms of
reference)
which will be accountable to the three Health and Well
-
Being Boards;
individual Health and Local Authority Executive Boards
and Clinical Commissioning
Groups.


Priorities


In developing an integrated approach to commissioning, one of the first tasks will be
to agree the terms of reference and to focus on the following key areas:



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1)

Transparency of Governance in decision making

2)

Clarity about where and how financial risk and benefit is shared

3)

Joint agreements on the scope of services to be jointly commissioned
so that we are working together on health and social care priorities and
avoiding fragmentation. This will include developing a single joint NHS
contract and local authorities’ Partnership Agreements and Joint
locality commissioning delivery plans to implement the south Essex
strategy.

4)

The use of data to assess need; monitor an
d evaluate performance
and drawing on the assets that public health can bring to the table.

5)

Evidencing benefit to individual citizens, populations and localities.