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Sectorised mental health services in England. Alan Yates – Director, Unique health solutions. Introduction. Previously Chief Executive of three Trusts in England with mental health services Latterly, the Chief Executive of Mersey Care NHS Trust for 13 years: Treatment to 34,000 patient pa - PowerPoint PPT Presentation
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Secto
rised
men
tal h
ealth
serv
ices i
n Engla
nd
Alan Yates – Director, Unique health solutions
IntroductionPreviously Chief Executive of three Trusts in England with
mental health services
Latterly, the Chief Executive of Mersey Care NHS Trust for 13 years:
Treatment to 34,000 patient pa
672 In-Patient beds
520,000 out patient contacts per year
33 buildings
€250m pa
4,600 staff
Retired in September 2012 and with four colleagues established UHS – a healthcare management consultancy
Advise clients about integration, finance, quality and service redesign
History and Reasons
Long tradition of the asylum – hospitals which withdrew people from society if they showed mental health or social “maladjustment”
In England In-Patient beds peaked in 1954 at 148,000
These beds have reduced to 19,000 in 2011/12 as a result of psychotropic drugs, the development of community services and scandals of abuse and neglect in large out of town hospitals.
Before 1980 about less than 20% of English mental health services were sectorised and community based
After 1990 80% of English mental health services were sectorised and community based
In 1999 the UK Government produced the National Service Framework for Mental Health describing a good service and over 6 years it was implemented
National Service Framework for MH (1999)
A strategy based on evidence rather than political preference for the first time,
Prof Francis Creed (1997) and others demonstrated that IP care was mostly no better than day care and more expensive,
Assertive outreach was effective in keeping people out of hospital at no increased risk
Early intervention in Psychosis significantly increases the number of patients who have only one episode of psychotic illness.
NSF supported Community Mental Health Teams (CMHTs) as the basis of diagnosis, treatment and care
NSF created Crisis and intensive home care teams, Early intervention teams, Assertive outreach teams and Criminal Justice Liaison teams as well as CMHTs
Model
General context in england - 2012
Adult acute beds
Median beds per 100,000 popl. 22
Median bed occupancy 90%
Median admissions per 100,000 popl. 240
Median length of stay 29 days
Community
Referrals to CMHTs per 100,000 4000
CMHTs caseload per 100,000 1700
CMHT contacts per 100,000 33,000
Crisis caseload per 100,000 25
Crisis contacts per 100,000 4000
The range is great For Beds
And for community services
A sectorised service In englandTypical organisation in England and Wales which I have supported has:
Population of 500,000 with
8 sectors
Each sector will typically have:
Average population per sector of 75,000-100,000
Multi-disciplinary team with Psychiatrists, Nurses, Psychologists, Occupational Therapists, Social workers, Care assistants and Administration – a team of perhaps 30
In-patient beds of 20 – 25 per sector
3000-4000 referrals per year
A caseload of 1500 patients
28,000 appointments per year
The future
Two problems:
Difficulty of managing the community and the in-patient service
Challenge of integrating the work of the generalist mental health teams (CMHT) and the specialist teams (assertive outreach, early intervention, crisis, criminal justice liaison etc)
Solutions
“Acute care model” which provide separate In-patient teams
Merge specialist teams and CMHTs
Conclusion
The French had “La politique du secteur” before the English in the 1960s
However UK Government policy in the 1980s and 1990s enabled the establishment of well resourced community based services
UK spend as a % of total health spend is 14% - in France it is 8%
Sectorisation is very dependent on the use of other community resources such as housing, employment, social care and these have been reduced by 25% in England in the last 3 years – very difficult circumstances
The English mental health services are moving into increased social and educational approaches to recovery. This is a challenge for Community Mental Health Teams.
Sectorisation has worked well in England but is now coming under strain.