Leeds Mental Health Framework 2014 -17   OUR VISION Leeds is a city that values people’s mental wellbeing equally with their physical health.  “Our Ambition is for people to be confident that others will respond to our mental health needs without prejudice or discrimination and with a positive and hopeful approach to our future recovery, wellbeing and ability”.  

Closing the Gap: Priorities for Essential Change in Mental Health Closing the Gap: Priorities for Essential Change in Mental Health. The “What” Aims to bridge the gap between our long-term ambition within No Health Without Mental Health and shorter-term action. It seeks to show how changes in local service planning and delivery will make a difference, in the next two or three years, to the lives of people with mental health problems. 25 areas where people can expect to see, and experience, the fastest changes. These are the priorities for action To reduce the damaging impact of mental illness and improve mental wellbeing.

25 Priorities for Action Increasing access to mental health services High-quality mental health services with an emphasis on recovery should be commissioned in all areas, reflecting local need We will lead an information revolution around mental health and wellbeing We will, for the first time, establish clear waiting time limits for mental health services We will tackle inequalities around access to mental health services Over 900,000 people will benefit from psychological therapies every year

There will be improved access to psychological therapies for children and young people across the whole of England 7. The most effective services will get the most funding 8. Adults will be given the right to make choices about the mental health care they receive 9. We will radically reduce the use of all restrictive practices and take action to end the use of high risk restraint, including face down restraint and holding people on the floor We will use the Friends and Family Test to allow all patients to comment on their experience of mental health services – including children’s mental health services 11. Poor quality services will be identified sooner and action taken to improve care and where necessary protect patients 12. Carers will be better supported and more closely involved in decisions about mental health service provision

Integrating physical and mental health care 13 Integrating physical and mental health care 13. Mental health care and physical health care will be better integrated at every level 14. We will change the way frontline health services respond to self-harm 15. No-one experiencing a mental health crisis should ever be turned away from services Starting early to promote mental wellbeing and prevent mental health problems 16. We will offer better support to new mothers to minimise the risks and impacts of postnatal depression 17. Schools will be supported to identify mental health problems sooner 18. We will end the cliff-edge of lost support as children and young people with mental health needs reach the age of 18

25. We will stamp out discrimination around mental health Improving the quality of life of people with mental health problems 19. People with mental health problems will live healthier lives and longer lives 20. More people with mental health problems will live in homes that support recovery 21. We will introduce a national liaison and diversion service so that the mental health needs of offenders will be identified sooner and appropriate support provided 22. Anyone with a mental health problem who is a victim of crime will be offered enhanced support 23. We will support employers to help more people with mental health problems to remain in or move into work 24. We will develop new approaches to help people with mental health problems who are unemployed to move into work and seek to support them during periods when they are unable to work 25. We will stamp out discrimination around mental health

Why do we need the Mental Health Framework now Why do we need the Mental Health Framework now? The NHS Mandate sets out five “domains” four of which have indicators related specifically to mental health Domain 1 Preventing people from dying prematurely Reducing premature death in people with serious mental illness Indicator: Excess under 75 mortality rates in adults with serious mental illness  (PFOF) Domain 2 Enhancing quality of life for people with long term  conditions Enhancing quality of life for people with mental illness Indicator: employment of people with mental illness (ASCOF, PHOF)   Adult Social Care Outcomes Framework: People are able to find employment when they want, maintain a family and social life and contribute to community, avoid loneliness and isolation Indicator – number of people in contact with secondary mental health service living independently, with or without support PHOF 1.6 Domain 3 Helping people to recovery from episodes of ill health and following injury Access to psychological therapies Indicator – number of people entering therapy, recovery rate, BME access and over 65 recovery rates CCG OF Domain 4 Ensuring people have a positive experience of care Improving experience of healthcare for people with mental illness Indicator – patient experience of community mental health services Friends & Family Test indicator in development  - to be introduced in mental health

Good things about Leeds Leeds has well established mental health services provided by primary care, adult social care, voluntary sector agencies and secondary mental health providers that are structured to meet the range of needs along the mental health continuum. These are currently commissioned by Leeds City Council, CCGs, and NHS England.  The level of investment is on a par with other areas. Partnership working is well established and the voluntary sector providers are very well integrated into mainstream services and are highly valued. Commissioners and providers work together to plan and provide high quality mental health service and these are closely monitored through contractual mechanisms. Leeds has well-established service users and carer involvement networks and processes for engagement with membership and representation at all levels.

More to do Feedback from consultation events in 2013 with service users, carers, clinicians and service providers identified that there is still work to do in ensuring effective joined up working arrangements between statutory and all voluntary sector providers to deliver continuity of care. The main issues with the current system are: It is not easy to understand to anyone outside of it There is no central point of information that describes it well Specialist advice is not easy to access if you are outside the service There is inconsistency of care management The wait for talking therapies is too long It is not consistently “outcome” focussed We also want to engage the general public, economic, social and commercial communities in Leeds, and secure their support in promoting well-being and resilience ................“Mind Out for Leeds”

Local Challenges Leeds has good range of services but they have become complex and at times fragmented  - we need to have a clearer and more integrated mental health service for Leeds, that everyone can understand  Mental health as an issue is still not well integrated into wider services and still being seen as separate and specialist ·     Unemployment and the economic downturn, including welfare reform are having an impact on people’s mental health across the city and not just in ‘deprived Leeds’  Demand for services is unlikely to decrease and we need to accommodate the needs of increasingly diverse communities in the city ·     Information about mental health and mental health services is not centralised in the city – making it difficult for public and professionals to navigate their way to what will help. We need to focus more on early intervention to prevent crises ·     Leeds is an unequal city – with widely different life expectancy depending on the area you live in – those inequalities also impact on mental health ·     Expenditure on mental health needs to be re-defined as an investment in communities, their resilience and cohesion

“No health without mental health” Mental Health Framework More people will have good mental health More people with mental health problems will have good physical health More people with mental health problems will recover More people will have a positive experience of care and support Fewer people will suffer avoidable harm Fewer people will experience stigma and discrimination

Public Mental Health - a conceptual model derived from the WHO framework . Annual Report of the CMO 2013. Mental illness prevention Treatment, recovery and rehabilitation Mental health promotion

We will deliver the mental health framework by focussing on five Outcomes Focus on keeping people well – to build resilience and self-management Mental health and physical health services will be better integrated Mental health services will be transformed to be recovery and outcome focussed We will ensure access to high quality services informed by need We will challenge Stigma and Discrimination

Process for developing the Framework Engagement Listening More engagement Policy drivers Local health and well-being strategy Listening to comments on Draft versions Version 1 agreed Oct 14

If you don’t know where you are going any road will do; If you don’t know where you are no map will help

Agreeing the priorities for action Support from NHS Improving Quality team

Partnership Provider Event 06.11.14 Priorities Crisis Social capital Recovery Risk Information Service user involvement Choice Information The best start in life Informed by need Recovery Cultural change Stigma and discrimination esp. in Physical health services

Priority Aims in whole system change 1. INFORMATION All members of the public, service users and professionals can easily obtain relevant accurate information about prevention, mental health services and how to access them. 2. DATA All commissioners, clinicians and managers have access to timely relevant clinical and operational data sources that are known and shared by all to inform their decisions. 3. CHILDREN AND FAMILIES Children and families obtain appropriate professional support early in their lives. 4. CRISIS Mental health crises are prevented where possible but where they do occur service users receive timely comprehensive professional support. 5. MENTAL HEALTH IN THE COMMUNITY Community services are recovery focussed and configured to deliver sustainable recovery taking account of wider determinants.

Other pathway developments since the last workshop Mental Health Crisis & Urgent care meeting Mapping workshop January 15 Common Mental Health pathway meeting Mapping workshop January 15 Information hub Workshop 3rd December 14 Children and Young people JM JW meeting Partnership Provider event Service Providers Nov 14 Dual Diagnosis Network event Nov 14 Data – audit of our process of developing the Mental Health Framework Nov 14