Modernising Mental Health in Bristol – a case study

Dr David Soodeen and Christina Gray

Intelligent Commissioning Approach

• What is the issue we want to address? • What is the different knowledge and experience of service users,

families and support networks, VCS, people who could not access services,  GP’s,  staff….

• What does the published evidence tell us about best practice, innovation and quality?

• What do we know about our population and levels of need?

Background

• Serious concerns had been expressed by service users and GPs about the existing mental health services over a number of years.

• Wide engagement and consultation undertaken from July – September

2011 to understand these concerns in detail

• Expert Clinical reference group, including experts by experience, was convened to look at the evidence both of best practice service design and population mental health need

• Clear message from consultation with stakeholders and the clinical reference group that we needed to change the way services are delivered

Creating reliable intelligence from the data

Four different lenses • Place: Whole population and Neighbourhoods • People: Patterns of risk factors within different groups • Diagnostic: Estimated prevalence of mental health disorders • Need and Demand: Estimated demand against estimated prevalence of

need looking at each activity / service line

Sources of data

Place: Population demographics Deprivation and other indices People: Information about risk factors Suicide Audit Diagnostic: Adult Psychiatric Morbidity Survey SMI register Demand and Need: MH Trust activity / OOH/ Ambulance / ED

Other data sources

GP prescribing MINI Community MH Profiles Local surveys

All sources of data have limitations and strengths

Valid Timely Complete Reliable Comparable

Data considerations - examples for discussion only

Valid • Census (not timely) • Suicide trend data (not timely) • Adult Psychiatric Morbidity Survey (a sample of the population) • SMI Register (people in contact with services only) • IAPT data

Timely • Annual Quality of Life Survey (a sample of the population only) • Activity data - GP/ MH Trusts/ ambulance (data may not be

‘clean’) • Suicide case audit (timely and complete – but not comparable) • SMI Register (people in contact with services only) • IAPT data

Complete • Census (not timely) • Suicide trend Data (? Dependent on coroners verdicts) • IAPT data

The result

• Work with patients to promote resilience and wellbeing within service design & delivery

• Inclusive • Locally accountable and Bristol focussed • Meet  the  diverse  needs  of  Bristol’s  population • Deliver high quality services regardless of age • Consider the wider context of the patient • Recognise and deal with safeguarding issues • Focus on patient outcomes rather than activity (i.e. results rather than

numbers) • Eliminate  ‘bounce’  – a  needs  led  and  ‘yes’  service

The shape of the new service

• Community Mental Health Service • Community Rehabilitation Service • Specialist Dementia Well Being Service • Employment Service • Community Access Support Service • Assertive Engagement Service • Role of GPs