2016/17 JSNA People with Mental Health Needs
Who is at risk and why?
We are all at risk of poor mental health and 1 in 4 of us will experience a mental health problem in the course of a year.
Good mental health is more than the absence of a mental disorder it is a ‘state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, work productively and fruitfully and is able to make a contribution to community’ (WHO 2008).
The importance of good mental health and wellbeing shouldn’t be underestimated. Positive mental health protects the body from the impact of life’s stresses and traumatic events, enabling the adoption of healthy lifestyles including the management of long term illness. Mentally healthier individuals have better physical health, positive interpersonal relationships and lead to socially healthier societies, supporting people to achieve their potential, realise ambitions, cope with adversity, and work productively.
Promoting mental wellbeing and supporting mental ill health is essential not only for individuals and their families, but also to society as a whole.
- Happier people, those with a positive subjective sense of wellbeing can add at least 7.5 years to their life (Veenhoven 2008)
- 1 in 4 adults in the UK will experience a mental health problem over the course of a year.
- 1 in 10 new mothers experiences postnatal depression.
- Mental ill health represents almost a quarter of all ill health in the UK and is the largest single cause of disability.
- People with mental health problems die on average 12-13 years younger than the general population (OPSN 2015)
- Around half of people with long term mental health problems experience their first symptoms by the age of 14
Level of need in the population
Mental illness in adults can take the form of ‘common mental disorders’ (including anxiety, depression and obsessive compulsive disorder), personality disorders, including psychoses and eating disorders or disorders related to substance misuse (alcohol and drugs).
Using prevalence estimates from the most recent Psychiatric Morbidity Survey we know that more than 26,000 adult residents of Milton Keynes (aged 18-65) are estimated to have a common mental health disorder at 2017 (10,250 men and 16,390 women).
The number of people anticipated to have different mental health disorders (based on predicted population increase) in Milton Keynes is expected to increase.
Common mental health disorder will increase by more than 2500 individuals by 2030.
Most recent figures from the Public Health England Mental Health Dementia and Neurology Fingertips Tools, show the prevalence of recorded depression on GP registers amongst people aged 18+ in Milton Keynes for the year 15/16 ranges from 5% to 10.5% but averages 8.1% similar to the England average (8.3%). This amounts to 17,475 individuals. The current NHS Milton Keynes prevalence for serious mental illness including schizophrenia and bipolar disorder is 0.68% which is lower than the national recorded prevalence of 0.90%.
There appears to be a correlation between recorded mental health prevalence and deprivation across Milton Keynes.
Although suicide is not always related to an existing mental health condition, nationally around 28% of people who take their life by suicide have been in contact with mental health services in the 12 months prior to their death (Appleby 2016). The most recent suicide audit for Milton Keynes found 42% were known to psychiatric services.
The most recent suicide figures for Milton Keynes are 8.6 per 100,000 (for the 3-year aggregated period of 2013-15). This is statistically similar to the rate for England of 10.1/100,000.
Each completed suicide is known to directly adversely affect at least 10 other individuals from family members, work colleagues, witnesses and health care staff and the majority of people who take their live by suicide will have had previous attempts also impacting on the wider community. Prevention is complex and cannot be delivered by one organisation. A multi-agency suicide prevention plan has been produced for Milton Keynes.
Current services in relation to need
Milton Keynes Clinical Commissioning Group and Milton Keynes Council jointly commission services for people with mental health problems.
The Mental Health Service in Milton Keynes comprises multi-disciplinary teams providing social care, rehabilitation, therapy and nursing interventions to users. The services are provided by Central and North West London Foundation NHS Trust (CNWL MK) and Milton Keynes Council working in partnership.
In addition to secondary mental health services CNWL MK is commissioned to deliver an Improving Access to Psychological Therapies (IAPT) service. This provides evidence-based psychological therapy services for people experiencing depression and anxiety disorders and currently treats more than 4000 people a year.
Voluntary sector organisations are commissioned to provide a range of services including supported housing, community support, advocacy and counselling and wellbeing services.
Significant improvements have been made to local mental health services including expansion of the hospital liaison team, development of a mental health triage service with Thames Valley Police and investment in Early Intervention in Psychosis Services. Further work is underway to develop the recovery services including those provided by the voluntary sector and support from GPs for people with mental health problems.
There is evidence of inequalities in mental health services locally similar to the national picture with indications that not all people with mental health needs are accessing primary care services. The treatment options in primary care can be accessed via self referral or a GP to a stepped psychological care model provided by Improving Access to Psychological Therapies (IAPT), for those people with mild to moderate mental health difficulties such as Depression and Anxiety. People experiencing a serious mental illness are assessed and triaged through a single point of access delivered by IAPT services and specialist Mental health services to ensure people access the right level of service at the right time.
In addition to this, although the premature mortality of people with serious mental illness is low, there is scope for improvement of the management of physical health of people with mental illness in all care settings.
Local priorities for mental health services include:-:
- Encouraging early recognition of symptoms and easy access to information and support
- Closing the gap in health outcomes between mental health and physical health services including investing in improved urgent and planned care for people with mental ill health and developing IAPT services for people with long term health conditions (LTC) and medically unexplained symptoms (MUS)
- Improving transitions for children and young people to adult mental health services. This includes developing an Autism Diagnosis Service for adults on the autistic spectrum who do not have learning disability
- Implementing a new mental health service model in primary care for people experiencing a serious mental health problem as part of the stepped care approach to mental health care locally.
Mental health interventions alone are unlikely to keep people well. In order to achieve sustainable positive health outcomes it will be vital to ensure the social aspects of poor mental health such as relationships, housing, employment and debt are tackled and prevention and early support initiatives prioritised. The challenge is to develop a resilient community where people are able to support their and their communities mental wellbeing, recognise early symptoms and have access to a range of tools to self manage whilst understanding the range of services they can access if they need specialist support.
Projected service use and outcomes
The increase in numbers of individuals predicted to have mental health problems in Milton Keynes suggests an ongoing need for a range of services. Planning assumptions about future capacity will need to take into account not only the predicted rise, but reflect the changing pattern of service delivery needed to meet the rise.
The Mental Health Partnership Board holds quarterly meetings open to service users carers and stakeholders in local mental health services. Priorities for commissioning and development of services have been informed by service users and carers views which include:
- Lack of clear, easy to find information available to the public on how to access mental health services particularly in times of crisis
- Long waiting times to access specific treatments e.g. Trauma
- Limited treatment options available, including a perceived dependence by both primary and secondary care clinicians on prescribing medication rather than exploring other options, Continued stigma attached to mental health issues
Evidence of what works and policy drivers
The national strategy for mental health, No Health without Mental Health: A cross-government mental health outcomes strategy for people of all ages (DH 2011), focuses on six key themes:
- More people will have good mental health
- More people with mental health problems will recover
- More people with mental health problems will have good physical health
- More people will have a positive experience of care and support
- Fewer people will suffer avoidable harm
- Fewer people will experience stigma and discrimination.
The strategic priorities do not only apply to statutory mental health services but across the whole mental health system in Milton Keynes including primary care, the voluntary and independent sector and in conjunction with service users and carers. To improve mental health and wellbeing in Milton Keynes there needs to be a greater focus on prevention, early intervention, keeping people well in the community and supporting recovery.
Improvements will be delivered through co-production of services where people are valued as experts by experience and work with commissioners and providers at all stages of planning, design, delivery and monitoring of services.
A range of NICE (National Institute for Health and Care Excellence) clinical and public health guidelines are available as well as a series of commissioning guidelines, produced by the Joint Commissioning Panel for Mental Health, to ensure commissioning of mental health and wellbeing services is based on the best available evidence and good practice.
In terms of public mental health, promoting mental wellbeing, preventing future mental health problems and recovery from mental health problems, Better Mental Health For All (Faulty of Public Health 2016) makes the case for enhanced prevention initiatives across a number of settings, focussing on what can be done individually and collectively to enhance the mental health of individuals, families and communities including communities such as workplaces.
What are the top five issues/priorities from the needs assessment or analysis and what are we going to do as a result?
Most of the current funding is spent in secondary care and there needs to be a shift towards prevention, and early intervention, targeting groups who are most at risk of poor mental health and where necessary offering swift access to high quality services.
The link between mental and physical health should be an ongoing consideration with the physical health needs of individuals with a mental health diagnosis prioritised and the mental health needs of those with long term health conditions addressed.
Specifically the following should be prioritised:-
- Promote positive mental wellbeing, early recognition of and support for mental health problems and ensure this information is easily accessible
- Build the confidence of frontline staff and the community to recognise early symptoms of poor mental health and signpost/refer appropriately through initiatives such as Mental Health First Aid Training
- Ensure people receive the right care at the right time and that there are clear care pathways where people can easily step up and down according to their needs
- Ensure people have access to support with social issues that are known to impact on of poor mental health including relationships, housing, unemployment and debt.
- Embed the 5 ways to Wellbeing initiative, particularly the elements ‘Keep Active’, Take Notice (mindfulness and awareness), Give and Connect. (to facilitate cohesion, community interaction and social isolation).
- Specifically undertake work to address mental wellbeing in the workplace.
- Ensure physical issues are considered for individuals with a mental health diagnosis in both commissioned mental health services and in primary care and the mental health needs of hose with long term health conditions are addressed.
- Increase understanding of mental health and wellbeing and reduce stigma of mental ill health.
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Last Updated: 7 May 2020