Transforming mental health services.
Paul Midgley, of Wilmington Healthcare, explores the NHS Long Term Plan’s strategy for tackling mental health conditions
Mental health services have become a greater priority for the NHS in recent years, and they are increasingly seen as an area where demand can be reduced and greater efficiencies achieved.
Policy changes began with the publication of the Five Year Forward View for Mental Health (FYFVMH) in 2016 and the Next Steps on the FYFV, which was released the following year. Both documents stemmed from the 2014 Five Year Forward View (FYFV).
The January 2019 NHS Long Term Plan included significant policy updates on mental health as well as a pledge to continue to increase funding in a bid to transform services.
Mental health funding
Although the Long Term Plan is a general policy for the NHS, mental health and dementia are a very important element of it; the term ‘mental health’ appears 196 times in its 115 pages.
The importance attached to mental health is further underlined by the fact that the Plan pledges that funding for mental health services will grow faster than the overall NHS budget for the next five years.
As part of this investment, a ring-fenced local investment fund worth at least £2.3 billion a year by 2023/24 will provide faster access to community and crisis mental health services for adults, children and young people.
From April 2019, NHS England has also promised to introduce more accurate needs assessments for mental health services. These will take more account of health inequalities and unmet need and will be included in Clinical Commissioning Group (CCG) allocations.
Adult mental health
The Long Term Plan states that access to psychological therapies (IAPT) services will continue to expand so that 1.5 million people will be able to access treatment each year by 2020/21, with an increasing focus on those with long-term conditions who also require treatment for mild to moderate depression and anxiety.
More than half of patients who use IAPT services are moving to recovery, and nine out of ten people now start treatment in less than six weeks, highlighting solid progress in the field.
Some nine out of ten adults with mental health problems are managed in the community, including primary care, but this is set to increase. The Long Term Plan policy will see the new Primary Care Networks (PCNs) providing general mental healthcare in the community aligned with community mental health teams working across primary care and local hospitals to deliver urgent response and recovery support.
Severe mental health and physical health
There is a big emphasis on addressing both mental and physical health problems, and specific actions include initiatives to cut smoking in people with long-term mental health problems.
By 2020/21, at least 280,000 people living with severe mental health problems will have their physical health needs checked and met; by 2023/24 this number will increase to an additional 110,000 people per year.
Trusts are included in a new national maternal and neonatal mental health safety collaborative. Some 20 community hubs will work closely with local authorities to bring mental health services together with antenatal care, birth facilities, postnatal care, specialist services and health visiting.
The Plan also aims to improve access to perinatal mental healthcare by increasing access to evidence-based care for women with moderate to severe perinatal mental health difficulties and personality disorder diagnoses.
Care will be provided from preconception to 24 months after birth, instead of the 12 months currently offered. Access to psychological therapies will be expanded to include partners and families.
Children and adolescent mental health
Half of all mental health problems are established by the age of 14, but prompt access to appropriate support maximises prospects for a healthy life.
Under the Long Term Plan, the NHS is committed to increase funding for children and young people’s mental health services faster than total mental health spending.
Children and young people’s mental health services are being expanded under the FYFVMH. In 2017/18, an estimated 30.5% of children and young people with a mental health condition were able to benefit from treatment and support, up from 25% two years before.
Developments in digital technology, such as mobile apps, are also expected to play a big part in delivering mental healthcare, especially for children and young people.
Access to services for children and young people provided by the NHS, schools and colleges will be available to 345,000 more children and young people by 2023/24. A parliamentary Green Paper has set out proposals to improve mental health support in schools and colleges.
Eating disorders services for the same age group are also receiving a boost and will be subject to new standards of 95 percent of under-25s with an eating disorder receiving treatment within one week in urgent cases and four weeks for non-urgent cases from 2020/21.
A new approach to young adult mental health services for people aged 18-25 will support the transition to adulthood.
Through NHS 111, children and young people will be able to access crisis care 24 hours a day, seven days a week.
Local providers will be given control of budgets and expected to reduce avoidable admissions, enable shorter lengths of stay and end out-of-area placements and, where possible, enable people with a learning disability, autism or both to have a personal health budget (PHB).
There will be more than 1 million people with dementia in the UK by 2025. The Long Term Plan therefore aims to address some of the challenges of dementia and healthy and independent ageing.
From 2020/21, PCNs will use digital health records and health management tools to identify moderate frailty and detect and intervene to treat undiagnosed disorders, such as heart failure. Individuals identified as having the greatest risks and needs will be offered targeted support for physical and mental health needs, including dementia.
Home-based and wearable monitoring equipment will be used to enable the NHS to predict and prevent events that would otherwise lead to hospital admission. Carers will benefit from greater identification, and support.
The Plan aims to improve care for patients with dementia and delirium, in hospital and at home. Dementia patients are to benefit from the support of enhanced community multidisciplinary teams and the application of the NHS comprehensive model of personal care.
NHS England says it will continue working closely with the voluntary sector, including supporting the Alzheimer’s Society to extend its ‘dementia connect’ programme, which provides advice and support for people following diagnosis.
Frailty and dementia
PCNs will identify patients with moderate frailty who are potentially at risk and will offer support for physical and mental health needs, including musculoskeletal conditions, cardiovascular disease, dementia and frailty.
Meanwhile, the roll-out of personal health budgets (PHBs) – money to support the identified healthcare and well being needs of an individual, which is planned and agreed between the individual, or his/her representative, and the local CCG – will increase to 200,000 people by 2023/24 and will include mental health services and services for people with learning disabilities.
The government is currently considering Professor Sir Simon Wessely’s independent review of the Mental Health Act, which argues for better crisis services and improved community care for people with serious mental illness.
Elsewhere, specialist clinics for people with serious gambling problems will be greatly increased.
By 2023/24, new mental health transport vehicles, mental health nurses in ambulance control rooms and training for ambulance staff will improve services provided to people experiencing a mental health crisis.
There will also be investment in spreading innovation between organisations in mental healthcare via the Academic Health Science Networks, which are expected to continue to receive funding until 2023.
Mental health is central to the NHS Long Term Plan, which aims to make major changes to the ways in which services for people with mental health conditions are organised and promises to significantly increase funding.
An important change of direction is that many services are to be provided by the newly created PCNs, which are tasked with delivering holistic and preventative mental health care strategies that also address physical health needs.
To capitalise on the opportunities that are emerging from the Plan, pharma needs to develop a sound knowledge of how PCNs operate and the key decision-makers within them.
Industry also needs to consider how it can support the NHS in delivering more proactive and population-based care, by for example, helping to risk stratify groups of patients or supporting educational campaigns in schools to address mental health issues.
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