North East London (NEL): Mental Health Crisis Care Programme Sponsor: John Brouder, Chief Executive, North East London NHS Foundation Trust Background Across North East London (NEL) there is a high prevalence of mental heath illness, particularly within inner East London CCGs who have reported the highest levels of new psychosis cases in England. Progress has been made to improve the quality of care and treatment across primary and secondary care. The Sustainability and Transformation Plans (STP) represent an opportunity for health and care services across NEL to work together with the voluntary sector and local communities to improve health outcomes and manage the projected increase in demand over the next five years. The STP vision is to have sustainable and person-centred mental health services as part of a whole health and social care system, placing mental health at the heart of new models of care. 4. Progress to date Significant progress has been made in quality and performance against national indicators, Child and Adolescent Mental Health Service (CAMHS) transformation and dementia. However, variation in performance (e.g. bed usage and placements) still exists across NEL. Whole system transformation will be required to sustainably meet the FYFV. Priorities Improve the population’s mental health and wellbeing by increasing self care and prevention, particularly focussing on the use of digital support. Improve access and quality of services to meet national requirements: including perinatal psychological therapies, early intervention of psychosis (EIP), crisis care, and dementia. Ensure sufficient capacity for predicted additional demand for mental health services. Place mental health at the heart of NEL integrated care models across primary, secondary and community care. Improve psychological support for those with long term conditions (LTCs) and the physical health of those with a serious mental illness. Ensure the efficient and sustainable use of resources. Initiatives Improve prevention interventions and strengthen community resilience. Early years mental health initiatives, including children and young people, and perinatal. Improve access to psychological treatment for those with anxiety and depression. Improve psychosis support covering productive pathways, crisis & accommodation. Support system effectiveness through physical and mental health integration. Develop new models of commissioning, supporting recovery-focussed services. Enhance capacity, step-up/step-down services and demand management in specialist mental health. 2. Awards and Recognition In September 2016, East London NHS Foundation Trust was rated as ‘outstanding’ by the Care Quality Commission (CQC), awarded provider trust of the year at the Health Service Journal (HSJ) Awards, commended for providing excellent, patient-centric care built on strong engagement, and acknowledged for embedding culture of continuous improvement in partnership staff, service users and carers. The dementia crisis support team in North East London NHS Foundation Trust was awarded the 2016 HSJ Award for Specialist Services Redesign. 3. NEL Challenges Health inequalities are high, with poor physical and mental health driven by factors such as smoking and childhood obesity. People frequently move around the geography and are highly dependent on secondary care placing significant pressure on local services. With a rising older population, and two CCGs currently not meeting the dementia diagnosis target, continuing work towards early diagnosis of dementia and social management is a priority. A majority of NEL CCGs, but not all, are meeting Improving Access to Psychological Therapies (IAPT) access targets. Parity of esteem has not yet been achieved across NEL. Acute mental health indicators from the mental health task force report, identify good performance, however concerns have been identified of the level of new psychosis presentation. Further work is required to quantify and respond to challenges such as high first episode psychosis rates. There is a low employment rate for those with mental illness. NEL‘s population is approximately two million and has significant health and wellbeing challenges. Around 297,000 (15.3%) of NEL population have a common mental health disorder. The population is set to grow by 18% within the next 15 years, and five of the eight boroughs are in the lowest quintile for deprivation in the UK. 5. Mental Health Crisis Care Commitments Provide access to Integrated Urgent Care (IUC), with mental health crisis response in hospital and part of the ambulance response programme. Improve access to mental health services for those in crisis e.g. rapid response access Prevent crisis by taking a proactive approach on prevention, including: Ensuring community-based 24/7 mental health crisis assessment is available close to home by 2016/17. The integration of services, working together with the voluntary sector and local communities to further improve health outcomes and manage the projected increase in demand over the next five years. Work is also underway to initiate a cross-system approach to prepare for the forthcoming urgent care waiting time standard for those in a mental health crisis.