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Our plans for mental health are focus on two areas; making sure we can help prevent the onset of mental health problems, and, supporting those living with a mental illness to manage their condition and recover.

In Bradford, Airedale, Wharfedale and Craven, mental health issues with affect approximately 155,000 people during their lifetime. This is equivalent to 1 in 4 people living in the area*. At any one time, 6,200 people will need specialist mental health services. We expect the number of people in our area with mental health needs will rise at a similar rate to the increase in the general population. 

There is national recognition that mental health should be treated with the same importance as physical health - commonly termed 'parity of esteem'. A number of recent national policies have recommended areas for development, including new standards, these policies include:

The work we are doing here in Bradford has been quoted in Implementing the Five Year Forward View. Specifically highlighted are our mental health liaison service and the resdesign of the acute care pathway to eliminate out of area placements. We are also responding to these national policies by making changes that address local need and meet these new standards, this includes:

Effective treatments can prevent or reduce distress to individuals and families. That's why we are working to design services to meet acute needs when they occur, and prevent milder problems from becoming more serious conditions. 

Bradford, Airedale, Wharfedale and Craven is considered a system leader - specifically for crisis care, dementia care and the design of innovative services which meet both mental health and physical health needs. 

We are currently working on the development of our mental health strategy for the next five years. This is due to be published in Autumn 2016. The strategy will set out how we will continue to address specific areas of need for our local population and improve mental health and wellbeing across Bradford and district. 

*determined by population statistics from the Bradford and Airedale Joint Strategic Needs Assessment.

How are we doing? 

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Improving access to psychological therapies (IAPT)

Around one in every six adults in England suffers from a common mental health problem - two of the most common are depression or anxiety. The improving access to psychological therapies (IAPT) programme is a key part of improving treatment for people with depression or anxiety.

Research indicates that half of people treated with cognitive behaviour therapy (for depression or anxiety) recover during treatment. The IAPT programme was first targeted at people of working age but in 2010 was opened to adults of all ages.

The success of the IAPT programme is measured using a combination of three indicators; access, recovery rate and waiting time. All figures below are representative of 2015/16.. 

IAPT access

  • the standard is for 15% of the prevalent population to a first treatment,
  • in our CCG this 14.8%

IAPT recovery rate

  • in our CCG, 33.6% (one in every three patients) who accessed the IAPT programme moved to recovery. This is in the worst quartile nationally and show the greatest need for improvement.
  • the 2015/16 recovery rate appears to be low, however we believe that this is through a lower level of data capture and recording of patients receiving psyhcological therapies. 
  • from the 1st April 2017, we expect that these figures will show an improvement. This is due to the move to a lead provider model, the implementation of a new patient case management information system (PCMIS) and the development of a full training plan. 

IAPT waiting time standard

  • the new IAPT waiting time standards state that 75% of people with common mental health conditions referred to the IAPT programme are treated within six weeks of referral. 95% of people should be treated within 18 weeks.
  • in our CCG, 80.7% of people with a common mental health condition are treated within six weeks.
  • for people treated within 18 weeks of referral to the IAPT programme, we have a local trajectory of 70.1%, our current position is 91.2%.

Source: HAWD report

First episode of psychosis

This indicator looks at improving access to evidence based care for people with a first episode of psychosis. Early intervention is classed as the following in NHS England's mandate commitments for 2016/17:

"More than 50% percent of people referred to the psychosis service experiencing first episode of psychosis or at “risk mental state” start the NICE-recommended care package within two weeks of referral."

Since introduced in 2004, early intervention in psychosis services have demonstrated that they can significantly reduce the rate of relapse, the risk of suicide and the number of hospital admissions. Early intervention is cost-effective and improves employment, education and wellbeing outcomes. 

Our CCG began reporting on the standards for early intervention in psychosis in January 2016. To date we have achieved the 50% threshold for both January and February 2016.

Further figures on how Bradford is doing with the new waiting time for first episode of psychosis will be released soon.

Children and young people's mental health service transformation

Three quarters of lifelong mental health disorders (excluding dementia) present by the age of 18. In Autumn 2015, extra funding was announced by the government to transform mental health servics for children and young people. We welcomed this announcement as an opportunity to move forward with our plans for transforming mental health services for children and young people in Bradford at pace and at scale. 

As part of this transformation, CCG's are asked how much working with partners contributed towards sustainable, system-wide transformation, to improve outcomes for children and young people. 

The way in which we measure outcomes for children and young people is changing and currently being agreed. We are aiming to outline these outcomes and publish data by September 2016.

Crisis care and liaison mental health services transformation

The mental health crisis care concordat, an agreement between 20 national bodies, has been established to transform crisis care and liaison mental health services. The concordat specifies the care and support that people in crisis need. This means that people are placed in the right place following a crisis. It also prevents vulnerable people finding themselves inappropriatley staying in police cells.

The crisis care concordat has the biggest impact on liaison mental health for people of all ages within acute hospitals and on crisis resolution for home treatment teams. 

Data on how the crisis care concordat is doing will be published in September and updated each quarter. 

Out of area placements for acute mental health inpatient care transformation

When people are placed out of area to receive treatment for acute mental healthcare, this can often result in poorer care and further complications. These placements can often disrupt relationships with families and carers and lead to slower recovery, with higher costs.

As a result, we have a local plan to significantly reduce the use of out of area placements. 

Data on how we are doing with reducing the number of out of area placements will be published in September and then updated each quarter.

Experience of services, the friends and family test

The friends and family test is a national measure of patient satisfaction on the service received whilst under the care of the NHS. The test simply asks how likely you are to recommend the service to your friends and family if they needed similar care or treatment. 

Since 1st January 2015, all providers of mental health services have been required to gather feedback using the friends and family test. This information is provided to NHS England every month. 

For 2015/16, 1.6% of people who received care from Bradford Districts Care NHS Foundation Trust responded to the friends and family test. Of these, 88.3% would recommend the service. 

More information about the friends and family test can be found on the NHS England website

Experiences of services, the community mental health inpatient survey

The community mental health survey is an annual survey which looks at the overall experience of care and how people would rate the service provided by health and social care workers. 

In 2015 for Bradford District Care NHS Foundation Trust, overall experience was rated as 7.3/10. For health and social care workers, the trust was rated 8.2/10 which compares favourably with other trusts. 

What you have told us

We make sure that we are listening, engaging and involving patients in the planning and design of their local NHS.

To do this, each programme of work has the infrastructure to engage and collect information from people through:

Mental health service experience

We make sure that the insight and feedback we get is not just collected - we proactively use it to inform our commissioning activity and to improve quality. Insight and feedback is collected in a system that we call Grass Roots. This brings together intelligence from the services we commission, individual and public activity to provide us with an understanding of what local patients, carers and stakeholders are saying about their experiences of the local NHS services.

In addtion, for each programme of work, we tailor our approach to engagement to make sure that we are reaching those people who use services.

The mental health delivery board oversees our engagement in this area. The board ensures that we can take a 'deep dive' to understand the experiences of people using mental health services and how our strategy and approach can be shaped to meet the needs of services users and our population as a whole.

We have a robust approach to our engagement work around mental health services. Patient and public feedback is collected in the following ways: 

Grass Roots

Grass Roots collects the information that is given by patients and the public (through NHS Choices, Patient Opinion, Healthwatch, complaints, local groups, staff and direct patient, family and community feedback) to inform our planning and decision making

In 2015, we received 1,949 entries relating to patient feedback from 3,987 individuals. The number of responses received relating specifically to mental health services was 26 which relates to patient feedback from 209 indivduals (patients, carers and 30 staff).

Mental health - grassroots

Patient stories

 

2015/16 - what have we done?

We have worked with a wide range of organisations across Bradford, Airedale, Wharfedale and Craven, including the local authority and Bradford District Care NHS Foundation Trust, to develop a joint action plan to improve care for people experiencing a mental health crisis. 

The joint action plan forms part of the mental health crisis care concordat which will improve access to, and the response from services.

The crisis care concordat focuses on: 

  • access to support before crisis point – so if you are living with a mental health problem, you can get help 24/7, and when you ask for help are taken seriously, 
  • urgent and emergency access to crisis care - making sure that a mental health emergency is treated with the same urgency as a physical health emergency, 
  • quality of treatment and care when in crisis - making sure that you are treated with dignity and respect, 
  • recovery and staying well - preventing future crises by referring you to appropriate services.

The work we have done during 2015/16 focused on the following areas: 

What we are doing in 2016/17

Over the next year, we will continue to increase our investment in mental health services. There are two main areas that we will be focusing on - continuing to implement the crisis care concordat and the Future in Mind plan for children and young people. 

Continuing to implement the crisis care concordat

We are continuing to implement many of the actions set out as part of our crisis care concordat. These actions will also help to acheive our goal of parity of esteem between physical and mental health. 

Crisis care:

We will be developing links to the crisis care pathway in primary care services - so if you present to a primary care service when in a mental health crisis - you have access to the right care and support to help with recovery. We will also be developing the use of tele-support systems to help reduce the onset of a future crisis. 

We are developing a 'haven' to provide an alternative to attending A&E in a mental health crisis. This will utilise established resources at Cellar Trust to help de-escalate a crisis. We are hoping for this service to open in August 2016. 

We are also working on achieving zero suicides in mental health settings and reducing the rates of suicide in community settings. 

Supporting recovery:

The tele-support systems that we are developing to reduce the onset of a future crisis will also be utilised to help support you in recovery from a crisis. Recovery from a crisis can also be supported by local voluntary and community services, we will therefore be engaging more with these services to see how you can be best supported. 

Children and young people:

By supporting children and young people when they experience a mental health crisis, we can help them recover and better manage a crisis in the future.

One of the first steps is to ensure children's mental health specialists are installed in the existing 24/7 First Response service and Intensive Home Treatment team, so that when in a crisis, children and young people have access to specialist help.

The same motive is behind the development of a a crisis service in A&E. This will form part of the emergency duty team, the First Response service, children's social care and the urgent and emergency care vanguard

As an alternative to crisis care and hospital admission, we are creating a 'safe space' for children and young people. This service is being developed through investment from the urgent and emergency care vanguard and collaboration between health, the local authority,  the police and voluntary and community sector organisations. 

Improving your experience:

Experiences when in a mental health crisis can play a big part in whether it can be de-escalated or will escalate further. You could experience a crisis at any time, so we are speeding up access to adult mental health professionals out of hours, especially in police stations and A&E departments. Improved training and guidance for police officer and mental health professionals will also mean you can access professional and appropriate advice quicker. 

There is continued focus on reducing the number of people (including a zero target for young people) who are detained by the police under the section 136 act (where someone is taken to a place of safety in crisis). Once a person has been detained under a section 136 act, we are looking to implement faster response times for assessements. 

Part of improving experiences will be the development of our strategy to reduce seclusion, restrictive care, chemical and physical restraint in the instances where inpatient care may be needed. 

We are also looking at the better care and management of people who are intoxicated when presenting to a service in crisis.

Further to this, we are also enhancing the mental health training and guidance for police officers and mental health professionals.

Children and young people - Future in Mind

This year, the key areas of focus for our Future in Mind work are:

What we are doing over the next five years

We are currently developing a formal mental health strategy across Bradford, Airedale and Craven.

Our new mental health strategy will include people of all ages and is being developed through collaboration between commissioners (our CCG, Bradford City CCG and Airedale, Wharfedale and Craven CCG) alongside provider organisations (such as Bradford District Care NHS Foundation Trust). 

The strategy will cover further work to improve the parity of esteem (where mental health is viewed with the same importance as physical health), for older people and perinatal mental health services.

We will be connecting what we are doing locally across our area with what is happening across West Yorkshire. This will help to establish a single operating model with agreed shared outcomes. It will also connect wiyth the pathways for specialist mental health services which are currently commissioned by NHS England. 

In addition to the development of the mental health strategy, there are a number of short and medium term programmes which are already progressing, supported by the crisis care concordat. You can read about these on the 'what we have done in 2015/16'  and 'what we are doing in 2016/17' pages. 

Our strategy will cover the milestones that we hope to achieve over the next five years, these include:

MH - next five years