Mental Health in London

David Jobbins

Associate Director of Mental HealthLondon Health Programmes

No Health without Mental Health – 2011

• At least one in four people will experience a mental health problem at some point in their life and one in six adults has a mental health problem at any one (1)

• Almost half of all adults will experience at least one episode of depression during their lifetime (1)

• The cost of mental health problems to the economy in England have recently been estimated at £105 billion, and treatment costs are expected to double in the next 20 years. (1)

(1) Department for Health (2011) No Health without Mental Health: A Cross Government Mental Health Strategy for People of All Ages

Mental Health in London (1)• The expenditure in London by the NHS and local authorities on

mental health conditions exceeds £1.4bn per year (1)• London has a higher proportion of mental health admissions of

people detained under the Mental Health Act 1983, compared to the rest of the country. In 2008/9 – 37% of the inpatient population in London compared with 31.8% nationally. (2)

• About one in every 40 people in London is a carer for someone with a mental illness which can harm their own mental health and wellbeing. (3)

(1) Mental Health Strategies (2010) 2009/10 National Survey of Investment in Adult Mental Health Services(2) Mental Health Minimum Data Set 2008/9(3) The Princess Royal Trust for Carers, Mental Health Carers – Key Asks for Government and Local Commissioners.

March 2011

Mental Health in London (2)• 46% of those claiming incapacity benefit in London (122,000 people) do so for a

mental illness, largely anxiety disorders and depression. (1)• African Caribbean people are twice as likely to be diagnosed with mental illness

as white people, but they are less likely to access services. (2)• Black Caribbean, Black African and White/Black Caribbean Mixed groups were

40-60% more likely than average to access services via the criminal justice agencies.(3)

• The mental health strategy highlights particular issues for asylum seekers and refugees who may need mental health support following their experiences in their home countries. (4)

• Migrants may also experience obstacles in accessing mental health support including language, stigma, confusion and cultural differences. (5)

(1) Office for National Statistics (2010) Latest data retrieved March 2011

(2) Greene, R., Pugh, R., & Roberts, D. (2008) SCIE Research briefing 29: Black and minority ethnic parents with mental health problems and their children. London: Social Care Institute for Excellence

(3) Care Quality Commission (2010) Count Me In 2009: Results Of The 2009 National Census of Inpatients In Mental Health And Learning Disability Services In England And Wales. London: CQC

(4)DH (2011) No Health without Mental Health: A Cross Governmental Mental Health Strategy for People of all Ages

(5) Mind (2011) Migrant mental health

Mental Health in London (3)

• LGBT (over 10% of the population of Greater London)people suffer from more mental health problems including suicidal thoughts, substance misuse and deliberate self- harm (1)

• Evidence suggests in London more than 3,400 people slept rough between March 2008 and April 2009. Research into mental health and homelessness suggests that 30-50% of homeless people have mental health problem.(2)

(1) National Institute for Mental Health in England (2007) Mental disorders, suicide, and deliberate self-harming lesbian, gay and bisexual people: a systematic review. London: NIMHE

(2) Homeless Link. Retrieved March 2011

Mental Health Problems and Health Related Behaviours

• The physical health of people with long term mental health conditions is a key element of the National Mental Health Strategy published in February 2011. People with severe mental illnesses die on average 20 years earlier than the general population (1)

• People with mental health problems experience increased risks of a range of physical illnesses including coronary heart disease, respiratory disorders, diabetes and obesity - 20-25% of people with schizophrenia over the age of 60 have diabetes. (2)

(1) Department of Health (2011) No Health Without Mental Health

(2) Academy of Medical Royal Colleges (2009) No Health without Mental Health: the supporting evidence

Mental Health service activity in London (1)

• In London the expenditure by local authorities. Funding largely targeted at accommodation, carer and home support services was estimated to be £ 270m in 2009/10 which represents 18% of the total expenditure. These figures include the cost of out of area placements. (1)

• For those interventions classified as psychiatric (mental health), it is estimated that the LAS costs for these classifications would exceed £7m per year.(2)

• The development of crisis services has varied across London, whilst all London boroughs have CRHT teams, their staffing, eligibility criteria and interventions may vary. (2)

• The A&E costs for patients admitted as an inpatient and identified as ‘mental health’ on the admissions system exceeds £13m per year across London. (2)

(1) 2009/10 National Survey of Investment in Adult Mental Health Services

(2) London Health Programmes (2011) Mental Health Services Case for Change

Mental Health service activity in London (2)

• London – total spend on medication prescribed for mental health conditions in primary care is £81,000,000. (1)

• It is estimated that 30% of GP consultations have a mental health component (2)

• GPs are unlikely to start treatment before referring to a specialist. In a recent study, 51% of GPs stated that they started treatment in less than 10% of individuals with first-episode psychosis. (3)

(1) NHS Information Centre. Retrieved September 2010

(2) Sainsbury centre for mental health (2002) Briefing 19: Primary care mental health services. London: SCMH

(3) El Adl, M., Burke, J., & Little, K (2009) First-episode psychosis: primary care experience and implications for service development. Psychiatric Bulletin. 33: 165-168

Health & Social Care Act 2012

• The Health and Social Care Act 2012 has now gained Royal Assent.• The NHS Commissioning Board will have a focus on ‘Improvement

and Transformation’. National and sector structures being developed.

• Clinical Commissioning Groups – delegation of budgets well advanced and management structures being designed.

• Commissioning Support Services submitting business plans.• In 2012/13, borough public health teams will be working in shadow

form with local authorities and Public Health England being set up. • HealthWatch, Health & Wellbeing Boards, Local Education &

Training Boards, Clinical Senates and Strategic Clinical Networks being developed.

Impact of the Changes in the System (1)

• CCGs, senates and networks…..• Opportunity for much wider clinical engagement and

involvement• Opportunity for more collaboration and integration across

primary and secondary care• Changing commissioners and decision making

processes – but not necessarily different contract managers

• Evolution of collaborative commissioning

Impact of the Changes in the System (2)

• Renewed focus on integration from Future Forum• Outcomes Framework• Impact of Health & Wellbeing Boards• Increased focus on IAPT• Mental Health PbR introductory year• Meeting the QIPP challenge

Opportunities from Mental Health Payment by Results

• Focus on data and information systems• A uniform currency• Creates a direct relationship between activity and cost• Greater transparency on content, type and volume of

provision• Requires a dialogue and joint approach to implement

across commissioners and providers• Opportunity to link to outcomes• Of course there are still challenges……

Conclusions

• Many of the issues are the same• The QIPP challenge - £20billion• Opportunities for different approaches and solutions• The system is still developing –opportunities to influence