Nottinghamshire has been an early mover in the transition from Sustainability and Transformation Partnerships (STP) to Integrated Care Systems (ICS) within the NHS in England. As part of that transition, it made a conscious commitment to prioritise the transformation of mental health and wellbeing across the system, through a process involving the whole range of system partners – NHS organisations, Local Authorities, voluntary and community sector organisations and, above all, people with lived experience of mental ill health. We were delighted to be selected to support the STP in developing an integrated, all-age mental health strategy. It gave us a wonderful opportunity to build on the innovative analysis we had undertaken for all 44 STPs, making the case for integrating physical and mental health services. The STP told us that our bid ‘very much stood out in the crowd’ because of its system focus and our breadth of understanding of mental health issues. In conducting the project, we provided some key inputs – baseline data packs, a summary of the relevant evidence-base and a report on stakeholder views – and facilitated a series of design workshops with up to 100 people contributing.
Our work, in partnership with local stakeholders, provided the STP with a set of key strategic pillars that are designed to support the STP’s journey towards a transformed future for the mental health and wellbeing of the Nottinghamshire population.
This work was very timely because the last decade has been very challenging in MH services:
- Use of the Mental Health Act increased by 40% 2005-16.
- On some days only a handful of acute MHLD beds are available across England.
- Young people with MH problems have been placed in beds far from home, dislocating family contact and making continuity of care very challenging.
- Slow progress in meeting Transforming Care target of closing all LD inpatient beds .
- Increasing numbers of adults with MH problems sent out of area for treatment which is costly and increases subsequent suicide risks.
- Increasing demand for NHS MH services resulting from significant Local Authority financial pressures
We already knew from our previous analysis that men in Nottinghamshire with a MH problem die 17 years before other men, women 15 years; and mortality rates from all physical causes of death are much higher in MH service users. This, and the imbalance in resource utilisation, makes a powerful case for integrating mental and physical health services. For example, MH service users in Nottinghamshire are 7% of the population but make up 19% of all A&E attendances, 26% of emergency admissions and 15% of all diagnostic tests. Re-balancing the use of acute healthcare in this population to the levels of the general population could enable the repurposing of £32m in the Nottinghamshire system towards prevention (e.g. through health checks), early intervention and lifestyle support. In addition to RAID and liaison services there is a role in Primary Care for increased screening, identification and referral to supportive early stage MH services of people with long-term health conditions who may be developing anxiety/depression.
There have been major developments in building services which bridge the physical health/mental health divide. Psychiatric Liaison services such as RAID have proved both the clinical and cost effectiveness of new service models, and there are new models for IAPT services for people with long term conditions and dealing with mental health problems in primary care. The developing organizational models - bridging social care and health care, primary and secondary health care, and physical and mental health - create unique opportunities for the integration of services and for developing comprehensive services designed around individuals. The new strategy addresses the full range of mental health need across the whole population.
The STP reported that it was extremely satisfied with the resulting draft strategy and that our work provided excellent value for money. This strategy represents Nottinghamshire’s commitment to reshape services and other interventions so that they better respond to the needs of the population.
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