Contribution to closing the financial gap: North West London (NWL): Mental Health Crisis Care Contact: Susan Whiting (susan.whiting@nhs.net) and Jane Wheeler (jane.wheeler2@nhs.net) 1. Our Population1 15% of people who experience an episode of psychosis will experience repeated relapses and will be substantially impacted by their condition, and 10% will commit suicide. Those who experience episodes of psychosis have intense needs and account for the vast majority of mental health expenditure - nearly 90% of inpatient bed days, and 80% of spend in mental health trusts. 4. STP Mental Health Aims Implementing a new model of care for adults which includes investing in a more proactive, recovery-based model to prevent care needs from escalating and reducing the number of people who need inpatient acute care. Addressing the very specific needs that relate to some of our populations – such as for people with learning disabilities (through the Transforming Care Partnership) and for new mothers. Improving services for people in crisis and providing a single point of access to services, 24/7, so that people can access the professional support they need – building on current early intervention in psychosis and liaison psychiatry services and optimal usage of refurbished Health Based Places of Safety (HBPoS), as well as successful assessment lounge models. More crisis management and recovery at home and in the community, including a crisis house pilot in Ealing. Implementing ‘Future in Mind’ transforming the care pathway for children and adolescents with mental health needs, introducing a ‘tier free’ model and ensuring that when children do need to be admitted to specialist tier 4 services they are able to do so within London, close to home. Mental Health Crisis Care Children and young people’s mental Health - crisis care pathway pilot now live. Adults, community, acute and crisis care - detailed plans co-produced in most areas. Progress in liaison psychiatry services towards Core 24. Health and justice - liaison and diversion a priority for crisis care group in 2017/18. Co-commissioning mental health care for the armed forces community to be developed. Development of an enhanced HBPoS at St Charles Hospital that will support all ages. On going work to identify appropriate early intervention and diversion support and services. Around 23,000 people in NWL have been diagnosed with schizophrenia, bipolar and/or psychosis, which is double the national average. The population with mental illness have 3.2 times more A&E attendances and 4.9 times more emergency admissions. Target Population: 262,000 2. Background Mental Health has been in a silo for too long and historically struggled to achieve parity of esteem. The NWL Sustainability and Transformation Plan (STP) has mental health threaded throughout the delivery areas – within prevention and within work on long term conditions. But we know that focus is also required as poor mental health has catastrophic impacts for individuals – and also a wider social impact. Contribution to closing the financial gap: £11.8m 3. Current Picture In NWL we have had a shared whole systems mental health programme (across health and social care) since 2012 reflecting a commitment to improving mental health and wellbeing for the 2 million residents of NWL. The like minded strategy is a ‘whole systems’, all ages strategy. Throughout the programme we recognise the critical role that services and initiatives across the system have in supporting mental health and wellbeing. Our combined work across NWL naturally builds on the local transformation and co-production work within each borough, and on work led by local mental health providers – Central North and West London (CNWL) and West London Mental Health Trust (WLMHT). 5. Single Point of Access (SPA) In collaboration with CNWL and WLMHT, NWL has introduced a 24/7 single point of access, 7 days a week central advice telephone line, with access to rapid response and home treatment. The service accepts referrals from individuals, GPs, the ambulance service, housing associations, the police, and anybody else with access to a phone. The service covers the entire NWL population of 2.2 million people who may need support in a mental health crisis. On average, WLMHT received 3,439 calls per month between April and June 2016. The SPA is described as the best anti-anxiety drug for GPs. Our 24/7 urgent care pathway has been the critical development over the last year and unlocks the gateway to wider services for adults with serious and long term needs. We have also developed primary care mental health services, specialist pathways for children and perinatal services as examples of work to date. However, everyone working together on mental health transformation would recognise there is still much more we can do to improve the experience of our population – and the national focus, strategy and leadership provides additional focus and clarity on our priorities. Progress to date would not have been possible without significant workforce development including: integrated training, GP mental health leadership training and interoperability planning. References 1 NW London Sustainability and Transformation Plan: Appendices, October, 2016, (https://www.healthiernorthwestlondon.nhs.uk/sites/nhsnwlondon/files/documents/nwl_stp_october_submission_appendices_v01pub.pdf )