Commissioning mental health services in primary care

Of primary importance: commissioning mental health services in primary care  | NHS Clinical Commissioners

This report highlights projects where CCGs and their partners are delivering better care for patients, working across the boundaries between physical and mental health, as well as health and social care, while at the same time reducing pressure on GPs and hospitals.

Developed by NHS Clinical Commissioner’s Mental Health Commissioners Network, the report aims to share learning and good practice from these projects to help support others looking to implement projects across primary care.

Case studies in the report include:

  • Community Living Well in West London which helps those with long-term mental health conditions and covers a full range of psychological therapies from guided self-help, through to sessions of short-term psychodynamic or CBT, carers therapy and a wellbeing service.
  • Work in Sheffield where IAPT workers are attached to each of the CCG’s individual 85 practices, and are incorporated as part of the practice multidisciplinary team.
  • The Well Centre, a primary care health centre in Lambeth for young people aged 13 to 20 offering support with all areas of health including mental wellbeing.

Full report available here

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Depression in children and young people

NICE has published a guideline on identifying and managing depression in children and young people aged between 5 and 18 years.

This guideline covers identifying and managing depression in children and young people aged between 5 and 18 years. Based on the stepped care model, it aims to improve recognition and assessment and promote effective treatments for mild, moderate and severe depression.

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Image source: www.nice.org.uk

This guideline includes recommendations on:

Full guideline: Depression in children and young people: identification and management

Children and Young People’s Mental Health and Wellbeing Profiling Tool

This tool has been developed to support an intelligence driven approach to understanding and meeting need| PHE

It provides commissioners, service providers, clinicians, services users and their families with the means to benchmark their area against similar populations and gain intelligence about what works.  It collates and analyses a wide range of publically available data on: prevalence, protective factors, primary prevention (adversity and vulnerability) and finance. It provides commissioners, service providers, clinicians, services users and their families with the means to benchmark their area against similar populations and gain intelligence about what works.

Tool structure – indicators are presented in 5 domains:

  • Identification of need
  • Protective factors
  • Primary prevention: Adversity
  • Primary prevention: Vulnerability
  • Finance

Within this domains, indicators are grouped by geography (predominantly county and local authority but also Clinical Commissioning Group) and then ordered by topic (e.g.adversity associated with poverty, abuse and neglect, family difficulties and parental difficulties).

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Mental health services: cost-effective commissioning

Return on investment resources to support local commissioners in designing and implementing mental health and wellbeing support services. | Public Health England

Public Health England has produced a series of resources around mental health services.

The commissioning report summarizes the evidence on promoting good mental health and reducing the impact of poor mental health, generated through a rapid evidence review.

The return on investment (ROI) tool and user guide:

  • builds on the evidence in the commissioning report
  • can be adapted to local conditions
  • presents results showing the economic benefits of each intervention
  • show you how to use the ROI tool

The barriers and facilitator report identifies issues that can make the commissioning of mental health and wellbeing interventions easier or more difficult in a local area.

Local authorities, clinical commissioning groups, Health and Wellbeing Boards and their local partners (for example schools, employers, police) can use these set of resources to improve the provision of mental health services.

The documnets can be accessedd via Public Health England

Involvement of people with experience of mental illness in CCG commissioning

Little is known about the extent to which CCGs are involving people with experience of mental illness in the commissioning of mental health services | Rethink

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Image source: Rethink

CCGs told us that with enormous pressure on resources and very full remits, it was difficult to prioritise implementing new ways to involve experts-by-experience.

Information gathered by Rethink Mental Illness through a Freedom of Information (FOI) request, in which 196 out of 209 CCGs responded, uncovered that:

  • Only 15% of CCGs who responded told us they had used a co-production approach at least once in mental health commissioning
  • Only 1% of CCGs explicitly stated an ambition for co-production in mental health that was aligned to the vision in the Five Year Forward View for Mental Health – that co-production will be a standard approach to commissioning.
  • Only 14% of CCGs had plans to do more to involve people with experience of mental illness in their work.

Rethink Mental Illness’ research showed that there are some good examples of CCGs involving people with experience of mental illness in the design of services. CCGs told us that co-producing services has ensured focus on the day-to-day experience of people who use services.

This report recommends that bodies such as NHS England provide national leadership, advice and support for CCGs, and hold CCGs to account by establishing mechanisms to monitor progress. It also recommends that CCGs use tools such as the Rethink Mental Illness ‘Commissioners Co-production Grid’, and NSUN’s 4PIs to facilitate steps towards embedding co-production as the norm.

Full report here

People with co-occurring conditions: commission and provide services

Better care for people with co-occurring mental health and alcohol/drug use conditions: A guide for commissioners and service providers | Public Health England

This Public Health England (PHE) guide, developed with the support of NHS England,  should be used by the commissioners and providers of mental health and alcohol and drug treatment services, to inform the commissioning and provision of effective care for people with co-occurring mental health and alcohol/drug use conditions. It also has relevance for all other services that have contact with people with co-occurring conditions, including people experiencing mental health crisis.

The guidance has been co-produced with members of the expert reference group for co-existing substance misuse with mental health issues, and in consultation with experts through experience, service providers, practitioners, commissioners and policy leads.

It aims to support local areas to commission timely and effective responses for people
with co-occurring conditions. It encourages commissioners and service providers to
work together to improve access to services which can reduce harm, improve health
and enhance recovery, enabling services to respond effectively and flexibly to
presenting needs and prevent exclusion.

Full document available via Public Health England

Nearly six in ten CCGs missing talking therapies targets

Almost six in ten clinical commissioning groups are missing targets on access to talking therapies, according to official figures | OnMedica

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Mental health charity Mind said this morning that the “unacceptable” figures reflect years of mental health services being “woefully underfunded”, and insisted that it is vital that quality, timely services must be in place to meet increasing demand.

Mind said the new data, from NHS England’s mental health dashboard on how CCGs are performing with regard to delivering talking therapies, highlight the proportion of CCGs meeting and missing their targets. These most recent available data, which are for Q3 (October-December) 2016, showed that 120 out of 209 CCGs in England (57%) are failing to meet the target for the proportion of people in their area that should be accessing talking therapies – currently set at 15.8% of the local population who have been identified as being able to benefit from talking therapies. By 2021, this target is set to rise to 25%.

The figures also revealed that barely half (52%) of CCGs met the recovery rate target for talking therapies – 101 out of 209 CCGs missed the current recovery target, which is set at 50%.

Mind pointed out that these data specifically focus on therapies available through the Improving Access to Psychological Therapies (IAPT) programme, which is supposed to increase accessibility of talking treatments to those identified as potentially benefitting from receiving them (typically, people with common mental health problems such as depression and anxiety disorder).