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Hertfordshire Mental Health Needs Assessment Follow up Workshop

13th April 2016

Piers Simey, Consultant in Public Health

www.hertsdirect.org

Aims of the session

• To build on the needs assessment launch on 10/09/2015

– To consider how we can take forward a systems based approach in Herts

– To focus on three core identified local areas (with the potential for others to be reviewed in the future)

– To start setting out what can happen and how it can happen for these three areas

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Running order• 15 mins:

– Jim’s systems wide thinking• 50 mins each:

– Suicide prevention – Accommodation & Crisis – Workplace

• Standard format:– 15 mins – key issues & promising

ways to tackle them– 30 mins panel & floor discussion– 5 mins summary

• Wrap up: Maneka, Piers, Jim; (+write up)

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What does whole system look like? An architecture…

• Promoting wellbeing – a good & positive state

• Promoting psychosocial resilience – skills to cope with stressors & life

• Preventing ill-health – spotting signs, intervening early (basic interventions)

• Addressing & recovering from mental ill-health – best possible coping, functioning & recovery

https://jimmcmanus.wordpress.com/2016/01/08/a-whole-system-approach-for-mental-health/

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What does whole system look like? Critical Success Factors1. A clear shared view of the system2. Ability to focus up and down from system to particular issues3. Leadership across the system4. Understand need using data and peoples knowledge5. Agreed and set outcomes6. Identified and prioritised interventions across the four domains7. A balanced scorecard approach to this8. Multiple actors, multiple partnerships, shared vision – a

programme approach9. Evaluate and iterate

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HWBB Report• HWB - a whole systems report out of this

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What does whole system look like ? Interventions1. Invest in good parenting – reducing the cost of conduct disorder

and other problems in later life2. Maternal Mental Health during and after pregnancy, including

quick access to cognitive behavioural therapy as a priority3. Ensuring the key role of schools in mental health is delivered4. Primary School is key, and the first major external influence on

childrens’ resilience5. The whole school approach is the most effective thing you can do6. Ensure good adult resilience and early intervention7. Workplace interventions pay off – the positive and supportive

psychosocial working environment is a key part of this8. Early identification9. Reducing loneliness – a big task for resilience as well as recovery

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What does whole system look like ? Interventions1. Address alcohol issues especially where it’s used for self-

medication. You could do the same on drugs and tobacco2. Zero suicide – we have to be ambitious3. Relapse Prevention especially for psychosis4. Support Recovery , always and in every service5. Ensure you address physical and mental health Identify and

address unmet need, especially in people with long term conditions

6. Liaison Psychiatry in every Hospital7. Smoking – get people off tobacco,8. Make it happen using a system public health approach9. Reduce stigma and increase awareness

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Key areas Specific objectives Intervention Outcome indicators Target

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Promote good parental mental and physical health to improve early child development and wellbeing

Universal routine enquiry and targeted treatment for women at risk of depression

Home visiting programme and health visitor training for post-natal depression, as part of a package of measures to improve perinatal mental health.

Screening of all pregnant women in peri- and post-natal stage for low mood and depression

Promote maternal wellbeing to reduce adverse outcomes of pregnancy and infancy

Robust referral and treatment services set up to provide care to those screened positive

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Promote good parenting skills – universal and targeted early intervention programmes for common parenting problems

Universal access to training programmes: a) community based group programmes; home based individual programmes, b) pre-school/ early child education programmes, supporting development of home learning environment. c) prioritizing support for parents from higher risk groups and with children with emotional and behavioural problems.

Monitoring uptake and quality of service provision for commissioned and developed services.

More intensive interventions for high risk families to prevent conduct disorders.

Evidence of Service User and Carer consultation and involvement. PH Outcomes Framework - Numbers of children admitted with deliberate injuries

PH Outcomes Framework - Emotional well-being of looked after children -

Build social and emotional resilience of children and young people through whole-school approaches including prevention of violence and bullying.

School based Social and Emotional Learning (SEL) programmes achieving pupils’ core competencies.

Self-management& social skills training and mentoring programmes School based violence prevention programmes incl sexual abuse and bullying.

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Improving working lives: a) support for unemployed b) create healthy working environments c) early recognition and intervention for those with mental health problems d) supported work for those recovering from mental illness.

Workplace screening for depression followed by CBT where indicated. Early intervention to reduce risks of unemployment through primary care and Job

Centres and early intervention to promote engagement and participation of those who become unemployed.

Stress management: tailor interventions to the needs of the particular worksite, types of stressors etc.

Supported work for those recovering from mental illness.

Uptake and evaluation of information campaign resources PH Outcomes Framework - Self-reported well-being, Suicide Rate,

Employment Number of people attending annual GP health-check

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Improving quality of life through increasing opportunities for participation, personal development and problem-solving that enhance control and prevent isolation.

Access to social interventions in primary and community care pathways: through social prescribing – specifically volunteering, including timebanks, exercise, arts and creativity, learning and educational opportunities, green activity.

Signposting to welfare advice, particularly employment, benefit uptake, debt management, financial literacy and information and self-help.

Debt counselling and advice.

PH Outcomes Framework - Suicide rate PH Outcomes Framework - Under 75 mortality rate for people with severe

mental illness

Implementation of initiatives to prevent, identify and respond to emotional, physical and/or sexual abuse.

Multi-agency information sharing on alcohol-related assaults School based violence prevention programmes including sexual abuse and bullying

prevention.

Integrating physical and mental wellbeing through universal lifestyle programmes to reduce smoking and obesity, and to encourage exercise.

Universal access to lifestyle programmes. Target people with long term conditions who are known to be at risk of depression. Encourage good nutrition and diet.

Number of smoking cessation quit attempts.

Tackling alcohol and substance abuse, including direct measures with those abusing alcohol

Target problem drinking and alcohol abuse through multi-sectoral action (health, local authority, police, education etc.

Screening and brief intervention in primary care.

Reduce the prevalence of obesity in Hertfordshire

Community empowerment, improvements in physical and social environments, and strengthen social networks.

Include encouraging active travel, reducing effects of traffic, functionality of neighbourhood, safe green environments, community arts and culture, volunteering.

Measurement of population well-being through census

Agein

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Improve the quality of older people’s lives through psychosocial interventions and enhanced physical activity

Physical exercise (dance, gym, walking) on prescription. Falls prevention through social support and education Opportunity for volunteering activities Opportunities for life long learning.

Number of services becoming Dementia Friendly with a particular focus on pharmacies, libraries, fire service and CSW Sport.

PH Outcomes Framework – Dementia Diagnosis rate

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Key organisation that influence and shape the mental health well being