Commissioning Crisis Care for mental health · Commissioning Crisis Care for mental health Dr Liz England GP Laurie Pike Health Centre, RCGP Mental Health Commissioning Lead and Co-Chair

Commissioning Crisis Care for mental health

Dr Liz England

GP Laurie Pike Health Centre,

RCGP Mental Health Commissioning Lead and Co-Chair

JCPMH

NIHR Clinical Lecturer, University of Birmingham

Why do we need a mental health

crisis care concordat?

• Parity of Esteem

• Quality of care

• Timely

• Recovery and prevention

Defining ‘crisis’

The experience of service users and their carers is that each person’s perception of crisis is individual.

People themselves, family carers or friends, often recognise patterns of behaviour or external events that may indicate or trigger a crisis.

What for one person or carer may feel manageable may for another feel overwhelming.

From JCPMH

Defining crisis involves different perspectives

•Self-definition

•Negotiated or flexible definition

•Pragmatic, service orientated definition

•Risk-focused definitions

•Theoretical definitions

Emergency mental health care- NHS Choices

If a person's mental or emotional state gets worse quickly, this can be called a mental health emergency or mental health crisis. In this situation, it's important to get help quickly to stop the person harming themselves or others.

Mental health emergencies can include:

•threats of suicide or self-harm

•self-neglect, such as stopping eating or drinking

•aggressive behaviour

•being extremely distressed

•going missing

Closing the Gap: Priorities for essential

change in mental health

15.No-one experiencing a mental health crisis should

ever be turned away from services

As set out in our Mandate, NHS England is expected to

make rapid progress, working with CCGs and other

commissioners, to help deliver our shared goal to have

crisis services that, for an individual, are at all times as

accessible, responsive and high quality as other health

emergency services. This includes ensuring there are

adequate liaison psychiatry services

Commissioning principles

• What sort of service would I want to receive? What sort

of service would I want my mother, father, brother,

sister to receive?

• Service users and their carers involved

• Pathway

• Needs analysis/ asset based approach

Challenges

Commissioning challenge

Hearts and minds challenge

Process versus outcomes challenge

Addressing the challenges

VALUES BASED

COMMISSIONING

Principles underpinning VbC An agenda of broader social change and a holistic approach to service development

Investment in building relationships between communities, professionals and service users; developing people’s potential, turning the focus away from their mental health status and staff training to support communication and co-production of organisational change

Openness and transparency about the level of involvement and influence service users will have

Provision of accessible information which focuses on the context of the commissioning project, government policy guidance and other relevant material meaningful to service user and carer collaboration in the commissioning process ( “co-commissioners”) an approach and style that enables a context conducive to user, patient and carer leadership

Values based Commissioning for Mental Health

Evidence base

Commissioners and

Clinicians skills and

experience

Thoughts, feelings,

opinions and values

of service users and

carers

Commissioning

decisions

The wobbly stool

Assessing needs or asset based approach?

The term ‘commissioning’ has been defined by the No Health Without Mental Health strategy as “the process of assessing the needs of a local population and putting in place services to meet those needs”.

Meaning of needs:

“Where activities are co-produced in this way [commissioning]…Taking this approach emphasises that the people who use services have assets, which can help to improve those services, rather than simply needs which must be met.”

“…informed service development – including the development of more effective services, which better reflect the needs, values and experiences of patients and carers”.

Deciding priorities and service improvement

• Service users and carers are made full members of any groups responsible for assessing health care needs such as the Joint Strategic Needs Assessment. By using the principles of the VbC approach, commissioning organisations will enable inclusion of a wider range of individuals and hard to reach groups.

• VbC promotes a shared decision-making approach, involving service users to better understand individual and population groups’ mental health needs and desired outcomes, and work co-productively to develop locally appropriate integrated pathways with service user relevant outcomes.

• VbC gives equal status to service user and carer input, clinical expertise and formal evidence and should lead to services that better reflect people’s needs and therefore are more likely to help them recover.

Pathway and partnerships VbC…work co-productively to develop locally appropriate integrated

pathways with service user relevant outcomes.

Need mature multi-agency approach

•Police

•Courts

•Rail network

•Education

•Social services

•Primary care

•Ambulance services

•DATs

•Public health

•And so on…

National level support and local implementation

National:

•Inform, equip, guide

•Mental health intelligence network

•MH Clinical Leadership programme

•Integrated pilot learning

•Implementation steering group

•NICE guidance, JCPMH Guidance

Locally:

•Local protocols

•Monitoring standards e.g. use of police cells as place of safety

•Clarity around individual and organisational roles and responsibilities

•Local declarations

•Local mental health partnership boards

•H&WB

Examples of what we should be commissioning

• Early intervention (respite, crisis plans, peer support liaison

and diversion, mental health first aid training)

• Aligned services- coterminosity

• Simplify access – SPA

• Safety and support of person

• Equitable- ageless, nationality, languages spoken

• Liaison psychiatry

• Patient Relevant Outcomes : CQC Mental Health Crisis

Care Putting people first

Liaison psychiatry B10 People in crisis who present in Emergency

Departments should expect a safe place for their immediate care and effective liaison with mental health services to ensure they get the right ongoing support

Clinical commissioning groups should therefore ensure that there are effective liaison psychiatry services in place, to make the links between Emergency Departments and mental health. services.

Taken from the Mental Health Crisis Care Concordat, Feb 2014

NICE NICE guidance

NICE quality standards

e.g. National Institute for Health and Care Excellence. Quality

Standard for self harm. QS 34. June 2013.

http://publications.nice.org.uk/quality-standard-for- selfharm-

qs34

National Institute for Health and Care Excellence. Quality

Standard on crisis planning.

http://www.nice.org.uk/guidance/qualitystandards/ service-user-

experience-in-adult-mental-health/ CrisisPlanning.jsp

JCPMH

Ten key messages 1 Commission services that they would recommend to family and friends.

2. There should be evidence of service user, patient and carer involvement

3. Commission a range of services in the acute pathway

4. Should ensure that sufficient resources are available

5. An acute care service should be available 24 hours a day, 7 days a week.

6. Should expect clear criteria for entry and discharge from acute care.

7. Ensure service provider collects, analyses and acts upon a range of outcome data.

8. The full range of NICE approved interventions should be available

9. Clear standards for communication with primary care should be set and audited.

10. Must ensure that acute care pathway providers meet their statutory duties under the

Mental Health Act and Mental Capacity Act: Humanity, dignity and respect

Mental Health Crisis Care Concordat: the joint statement

“We commit to work together to improve the system of care and support so people in crisis because of a mental health condition are kept safe and helped to find the support they need – whatever the circumstances in which they first need help – and from whichever service they turn to first.

We will work together, and with local organisations, to prevent crises happening whenever possible through prevention and early intervention. We will make sure we meet the needs of vulnerable people in urgent situations. We will strive to make sure that all relevant public services support someone who appears to have a mental health problem to move towards Recovery.

Jointly, we hold ourselves accountable for enabling this commitment to be delivered across England.”