This page contains a Flash digital edition of a book.
COMMUNITY CARE MENTAL HEALTH


The treatment of mental health problems is one of the tougher tasks in front of CCGs as they look to improve an area of care which has historically been problematic for the NHS. GEORGE CAREY asks how commissioners can improve this element of their population’s wellbeing


L


acking the immediate tangibility of physical health problems and still, unfortunately, carrying an element of stigma with it, mental health is a problem that looms large, and quality provision is a major challenge for CCGs. Indeed, when the Government delivered the NHS’s first


ever mandate in November last year, mental health was one of the areas highlighted as requiring improvement. It set the NHS Commissioning Board and CCGs the task of tackling the longstanding, and long outdated, disparity between mental and physical health support on the NHS. The mandate also calls on the board to make measurable progress to closing the health gap for people with severe mental illness, whose life expectancy now stands 15 to 20 years lower than the average, and sets the objective of improving the diagnosis of post-natal depression. Backing up the view that this area of treatment is crucial to the


success of the new-look health service, a report published only a week before the mandate by the Centre for Mental Health and the NHS Confederation, concluded that ensuring every hospital had an effective liaison psychiatry service could save the NHS £1.2bn a year. Unfortunately the CQC’s ‘Monitoring the Mental Health Act 2011-2012’ report still found very uneven delivery of mental health services: ‘It is with great regret that CQC notes that there are themes that recur year on year and paint a picture of practice in some areas of mental health provision that is a far cry from the policy vision. Yet, it is clear from the excellent practice that CQC observes in some providers, that the policy vision is not an unrealistic one.’ So what can CCGs do to improve the situation? Like every other area of life, technology increasingly has a part


i“Digital models shift the ndividual health journey from


one of being passive and alone to active and supported”


health act for the past nine years, put it: “I don’t know much about care plans. I don’t have much experience of them.” Something that commissioners can get behind to change this is providers of mental health services that are making health education resources available online, as well as setting up online portals where service users can keep track of their care plans. South London and Maudsley NHS Foundation Trust has set up a service called My Health Locker. Service users with an account can see their care plan online, keep track of how they are feeling, and access resources and tips on managing health and wellbeing. Co-author of ‘E Mental Health: What’s all the fuss about?’ and founder and chief executive of Big White Wall, Jen Hyatt says: “Transformative digital models open the door to future healthcare. They shift the individual health journey from one of being passive and alone to active and supported.” One initiative that CCGs should consider that is low cost and so far seems to be working well in primary care is a mathematical model used by physicians. Researchers announced at this start of this year that they have developed a score for GPs to identify patients who are most at risk of developing major depression. The study tested the predictD score in general practices across Europe, including the UK. Nearly 5,000 patients aged 18 to 74 years and with no diagnosis of depression were included. The score contains 10 factors, including age, sex, education level, family history, difficulties at work and discrimination. They assessed the model’s ability to predict the risk of depression over


two years using the c-index, equivalent to the area under a receiver operating characteristic curve, with a higher value indicating better discrimination at predicting depression.


to play, as people spend an increasing amount of time attached to their smartphones and tablet devices. A recent report, ‘E-mental health: what’s all the fuss about?’, discusses how innovative technology can support cultural transformation in the mental health sector. Produced jointly by the Mental Health Network, Big White Wall, and the Tavistock and Portman NHS Foundation Trust, the paper says there is massive potential for digital technology to enable service users to become service leaders in the design and delivery of mental healthcare. It calls for service users, providers and commissioners to engage in dialogue about how to optimise the potential of digital technology to transform mental healthcare, and share ideas about what works, what is needed, and how to overcome potential risks and challenges. One issue that the CQC’s report found was an ignorance from


people of their care plans, or the development of them, as one service user, repeatedly detained under section 3 of the mental


At two years, the overall c-index for predicting the risk of depression was 0.78. Of the four countries included, the UK had the highest c-index for the 12 to 24 month period, at 0.75 – meaning on 75% of occasions it is correctly identifying those UK-based people at risk of developing depression. The authors concluded that the predictD score can predict risk of depression onset over 24 months and it may be a useful strategy for identifying those at risk of developing the disease. At that stage, cost-effective interventions, such as minimal contact psychotherapy and bibliotherapy, can be implemented if somebody screens positive. Whatever CCGs decide to do with this contentious area of


healthcare, there is a fine balance to be achieved, attempting to commission services that guarantee a person’s dignity, recovery and participation. They must ensure that commissioned models of care are underpinned by an in-depth knowledge of their statutory duties under the Mental Health Act and by the experiences of service users.


WWW.COMMISSIONINGSUCCESS.COM | 37


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72