Transforming Mental Health Care through Innovation

Transforming Mental Health Care through Innovation

Ruth Wilson

Provide you with an understanding of how we are introducing and embedding innovation in Mental Health across Yorkshire and Humber

YHAHSN Mental Health team

• Vicky Vanes – Programme Manager

• Khalida Wilson – Programme Manager

• Ruth Wilson – Programme Lead

Our aim today

• Please spend 10 minutes discussing on your table and write your ideas on the post it notes provided

• What are the common themes?

What are the barriers to implementing innovations in mental health?

Our work includes:

• Encourage and support; innovators, use of quality improvement

• Signpost – sources of funding, possible collaborators

• Link health care providers, academia, commissioners and industry

• Work in partnership with local ICS and STPs

• Project management

• Provide evaluation

• Source expertise

Innovation to transform lives for people experiencing mental health challenges

CONNECT

We connect innovations to mental health needs enabling the NHS to use resources effectively and improve peoples lives

DELIVER

We provide solutions to improve the diagnosis, treatment and recovery of patients. These can be national, local or health system based

IDENTIFY

We align our priorities with the mental health needs of our population and national requirements

IDENTIFY – local priorities

National

• NHS England • NICE • Other AHSNs• NIA, ITP

Regional

• ICS/STP Mental Health Programme Boards and

Directors• Mental Health

Commissioners • Urgent and Emergency

Mental Health Network • Y&H Suicide Prevention

Collaborative • Local Universities

Third sector/patient view via YHAHSN

patient involvement

Analysis of population data eg

CYP, University Population, ASD

Local priorities

Use our networks and contacts we connect people with relevantinnovations. To help achieve this for digital innovations we willhold a series of events

CONNECT- people and ideas

24th June 2019 Y&H Mental Health Digital – Introduce a range of innovations that can be used to support mental health service delivery and personalise care

Local priorities will determine what events are next, for example

Subject based innovations – eg

Long Term Conditions

Age based innovations – eg

Children and Young People

Local system required innovations – e.g use of staff

resources

A new model of care using specialist police officers within community

mental health services to help support high intensity users struggling

with complex, behavioural disorders. This improves quality of life for

people and reduces costs to the local health and police systems.

In Yorkshire and Humber:

• The SIM Yorkshire team established in Doncaster is working with 5 high

intensity users.

• We have run workshops in North Yorkshire, Humberside and West

Yorkshire and are supporting local systems to identify the potential for

including the SIM approach in their care pathways for high intensity

users.

National Programme – Serenity Integrated Mentoring(SIM)

Chris Guest- Mental Health Practitioner/ SIMGulshan Akram- SY Police officer/ SIM

• HIU Have Clear Boundaries set.

• HIU appreciate the extra support from Police.

• Consistent Multi-Agency Approach ie A&E, Ambulance, MH and Police.

• HIU is no longer going into crisis before receiving help –Monitored continuously.

• MH and Police based in the same office.

Benefits

• NO 136 admissions

• Reduced GP and A&E admissions.

• Better relationship between Police and the Users

• All agencies are consistent in their approach, have not previously worked in this way.

In the first quarter of SIM Yorkshire:

Source: SIM Yorkshire team

• 24 year old gentleman

• Experience of childhood trauma

• Frequent attendance of NHS service -171 A/E attendance since March 2018- O/D, chest pain

• Various possible mental health diagnosis Emotional unstable personality disorder, PTSD, Anxiety

• Pre-occupied by health anxieties

• Police involvement – charged with assault/ drunk and disorderly

Client A, Case study

Consistent Approach

SIM Plan &

Mentoring

Mental Health Crisis Team

South Yorkshire

Police

Yorkshire Ambulance

Service

A&E

• Promote the spread and adoption of a physical health check template and Elearning module to help primary care deliver physical health checks and therefore improve health for people with a serious mental illness (SMI)

• Funding targeted support to train primary staff in using the template for local ICS/STPs

• Supporting NHS E in further development of the template for primary care

• Evaluating impact of template use, on health checks and interventions for people with SMI

Local Programme – Mental Health Physical Health

You & Your Carewww.bdct.nhs.uk

Improving the Quality of Physical Health Checks for people with SMI

Ruth WilsonProgramme Manager

Yorkshire & Humber, Academic Health Science Network

Kate DaleMental/Physical Health Project Lead (Y&H AHSN)

Bradford District Care NHS Foundation Trust (Honorary)


Addressing health inequalities for SMI population initially Bradford & Airedale

• A more specific standardised data entry template based on existing mental health QOF indicator

• Specific to areas of physical health risks prevalent to those with SMI

• More specific tests e.g. blood tests for diabetes, cholesterol, ECG and other appropriate tests

• Auditable across the whole city using the SystmOne primary care information system


Health Need FYFVMH• Shorter lifespan, reduced by around 20 years compared to the

general population - one of the greatest health inequalities in England

• Two thirds of these deaths are from avoidable physical illnesses, including heart disease and cancer, many caused by smoking

• Lack of access to physical healthcare for people with mental health problems – less than a third of people with schizophrenia in hospital received the recommended assessment of cardiovascular risk in the previous 12 months


Health Need: MH / PH, Audit Findings

• No patients had been given a cardiovascular risk calculation

• This would be a good way to identify high risk people for prevention

• No patients had a blood test for prolactin levels

• Elevated prolactin is a significant and common adverse effect of antipsychotic treatment


The SystmOne Physical Health Check Template


IMPACT: Bradford

• Rolled out to all GP practices in Bradford & Airedale

• Replicated on different IT systems

• Replicated in secondary care using RIO

• Rolled out in all in patient areas

• SHARED CARE: Communicated to GP electronically for inpatient discharges


Regional & National spread – enabled by Y&H AHSN

“By 2020/21, at least 280,000 people living with severe mental health problems

should have their physical health needs met”

FYFV MH

Priority action for the NHS by

2020 /21

FYFV MH

Project sponsored

and championed

by MH CEOs

across Y&H


YEAR 1 PILOT: SWYPFT

https://www.youtube.com/watch?v=2KNaZzEqgnM

https://www.youtube.com/watch?v=2KNaZzEqgnM


Real impact for patients

“One of the things that

really impressed us… was

how well integrated it was

into people’s everyday

practice and the way in

which it integrated with

Primary Care”

Adrian Berry, Medical Director at

SWYPFT, August 2016

One pilot site saw a

372%

increase in physical

health checks

targeting

preventable

deaths

reducing

health

inequalities


Real impact for patients: YEAR 1 PILOT, SWYPFT

• Adopted RIO Version of Template

• Robust polices and procedures to support PH assessments

• PH clinics operationalised

• Developed training regime

• Improvements can now be monitored

• Strategic intention - roll out to a further 8/10 SWYPFT sites

Within six-weeks

130 patients received a

comprehensive physical health check


National Transformation: Health Economics Evaluation


National Transformation: Health Economics Evaluation

VALUE

across the

system

with

47,713

health

checks (YHEC, September 2016)

Potential cost saving for

Y&H

£11.3m


National Transformation: Template published for use

SystmOne:Template published at the end of December 2015

Over 2,700 GP practices using SystmOne

EMIS Web:Template published May 2016

Over 3,000 GP practices use EMIS Web

Real impact for patients, across the country.


National Transformation: Elearning Module

ELearning module to support implementation of robust MH / PH programmes using the Bradford Physical Health Assessment Tool


Toolkit for spread

• Incentive schemes for GPs to encourage monitoring of physical health

• Continue efforts to reduce smoking - one of the most significant causes of poorer physical health for this group

• Identify National Champions for MH / PH

Former National Clinical Director for Mental Health Dr Geraldine Strathdee is a major advocate for this

programme


Thank you very much for listening

Contact details:

[email protected]

Ruth [email protected]

• Telemedicines and quality improvement project focused on the use of telemedicine in addictions clinics in Humber

• Working across three mental health trusts in South Yorkshire and Bassetlaw to facilitate the implementation of workforce transformation in the ADHD and Autism pathway.

• Scoping work to identify key concerns in patient safety from people with lived experience of mental health and learning disability and their carers across West Yorkshire

Local System Transformation

Dr Soraya MayetConsultant Psychiatrist Humber Teaching NHS FT

Honorary Senior Clinical Lecturer Hull and York Medical School

Opioid Dependence Heroin dependence is a chronic relapsing condition

High risk of death through accidental overdose

Opioid substitution treatment (OST)

Prevents deaths

Reduces and stopping heroin use

Reduces and stops injecting & spread of Hep C and HIV

Reduces criminal offences

Improved effectiveness with psychosocial interventions

Addiction Prescriber Reviews Patients prescribed OST should have an addictions prescriber review

three monthly (DH 2017)

Holistic assessment and medication safety

Non-attendance high in addictions services nationally

Local audit found 53% of patients attended

Quality improvement work increased this to 72%

Improving attendance 100 prescriber appointments missed per month

So fewer appointments available for other patients

Extra costs associated with non attendance

We wanted to look at ways of improving attendance

Could telemedicine help? Use of telecommunications technology to provide clinical health care from

a distance

‘Overcome geographical barriers, and increase access to health care services’

Address challenges in providing accessible, cost effective, high-quality health care (WHO)

Evidence for telemedicine Cost effective

Reduce travel time and costs

Improve access to healthcare

Improve patient satisfaction

But limited research with addictions and none in UK

Why Telemedicine in Addictions?

East Riding of Yorkshire >900 square miles

Hub and Spoke (outreach) Addictions service

Three Hubs in Hull, Bridlington and Goole

Patients seen in spoke sites near home

But few addictions prescribers

Patients mainly travel to Hubs to see prescribers

Some outreach prescriber clinics

Aims

To assess whether telemedicine in addictions:

Increases attendance rates

Improves patient and staff satisfaction

Involves less travel

Reduces costs due to less travel

Randomised Controlled TrialPatient with opioid dependence

Prescribed opioid substitution treatment

Requiring an addictions prescriber review (n=60)

Telemedicine

Face to face

Work so far Meetings with collaborators (University of Hull, HYMS)

Patient and Staff Involvement co-produce research design

University of Hull Research Design Service and stats advice

Academic Health Science Network support

Humber Teaching FT Trust governance approvals

IT support for internet at sites, technology and software

Permission for software and software testing completed

Protocol development

Ethical approval application almost complete

To co-produce the research design

Patient Involvement Why do you think patients miss appointments?

They feel unwell

Costs a £9.40 return

Money could be used to “score”

Don’t feel they need appointment

Forget

Patient Involvement What do you think would help patients attend

appointments?

Appointments coincide with payment of benefits

More text alerts

Closer to their home

Afternoon appointment

Patient Involvement What are your thoughts on telemedicine project?

It would cut down travel and less travel time

But might still want a face to face review

Good if you want to reduce dose

Patient Involvement What do you think of the project design?

Overall positive reaction.

Could save NHS money and time

Could help people attend training

Quicker and easier treatment

Funding Yorkshire and the Humber Academic Health Science Network

East Riding of Yorkshire CCG Small Grants

Project not possible without this funding

[email protected]

We work with innovations in Mental Health to accelerate the spread and adoption of those that meet the needs of our local population and their health challenges

Examples can be found here https://www.yhahsn.org.uk/hie/

Working with innovations

https://www.yhahsn.org.uk/hie/

MESSAGING SERVICE

CLINICIAN’S THOUGHTS ON RISK IN MESSAGING …

• Imminent high risk

• 24/7

• Shared responsibility

• Availability changes

• Missed messages

• Excessive record keeping

• Identity verification


Young people 16-24 yrs MOST likely to report suicidal thoughts. Cases of depression and self harm

have doubled. Number of anti depressants prescribed in the UK is at its highest.

• Imminent high risk

• 24/7

• Shared responsibility

• Availability changes

• Missed messages

• Excessive record keeping

• Identity verification

• Vacancies - 11% and rising

Clinicians thoughts on

risk in messaging

FOLLOW US

PATIENTRECORD

In 2018/2019:

63

UK spread

Julie Jones

07775720192

[email protected]

@juliejones45 @ChatHealthNHS

mailto:[email protected]

Have we broken down any barriers?

• What can you do?

• What can your organisation do?

• Follow our progress - https://www.yhahsn.org.uk/

What can you do?

https://www.yhahsn.org.uk/

Thankyou

Transforming Mental Health Care through Innovation

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Transcript of Transforming Mental Health Care through Innovation