Transforming mental health: A plan of action for London

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The government’s mandate for achieving parity of esteem between physical and mental health has put the spotlight on mental health provision. In London, meeting the mental health needs of the large and diverse population poses major challenges, and the London Health Board has identified improving the mental wellbeing of Londoners as a priority. But so far, there has been little consideration of what is required to meet the future mental health needs of London’s population and how this can be achieved.

This report describes a vision for the future of mental health provision in London, generated through a process of engagement with key stakeholders in the capital. The vision is based on a collaborative, integrated approach towards mental health that is relevant in London and elsewhere.

Key findings

A number of key steps have been identified to support systemic implementation of this vision:

  • developing a process of collaborative commissioning to facilitate change
  • driving change through collective systems leadership
  • ensuring that service users and clinicians are at the core of provision
  • using contracting systems to support integration
  • building a public health approach to mental wellbeing
  • developing pan-London solutions to increase impact
  • improving the availability of meaningful outcomes data
  • utilising London’s academic infrastructure to disseminate best practice
  • creating a new narrative for mental health.

These steps reflect the strengths of individual stakeholder groups but also the importance of working collaboratively and adopting a shared agenda. Commissioners and providers are at the heart of this process, drawing together key organisations around the voice of service users, carers and clinicians in order to deliver improved outcomes. Other organisations have an important role to play in creating the infrastructure to do this, including Public Health England, NHS England, academic health science networks and centres, Collaborations for Leadership in Applied Health Research and Care and strategic clinical networks.

Policy implications

Achieving this vision will require the many and diverse stakeholders working on improving mental health in London to adopt new ways of working. The main stakeholders need to take the lead in bringing different groups together to develop a shared agenda and plan of action. They will need to address and overcome barriers to collaborative working, including different political and historical agendas, and unconstructive communication.

On the ground, certain approaches can support better integration of care and better outcomes. These include adopting collaborative leadership strategies, supporting and strengthening commissioning, and using contracting tools to facilitate integration. The strategic dissemination of evidence and development of data and outcomes can help ensure that change is systemic.

Comments

paul coombes

Position
trustee academy of medical royal colleges,
Organisation
AOMRC
Comment date
25 September 2014

Cynthia Joyce

Position
CEO,
Organisation
MQ: Transforming Mental Health
Comment date
25 September 2014
Great title!
Applaud the focus on care and care commissioning. Our organisation is working on the evidence-base supporting interventions and health care practices. We look forward to contributing to the changes recommended here!

john Kapp

Position
director,
Organisation
Social Enterprise Complementary Therapy Company (SECTCo)
Comment date
25 September 2014
I agree, and see that people need to be taught how to better look after themselves, which would improve their mental and physical health. In equalities are caused by the rich doing this through complementary therapy (such as yoga classes) , so to reduce them we should make them free at the point of use, by enabling GPs to prescribe the NICE recommended Mindfulness Based Cognitive Therapy (MBCT) 8 weeks as easily as (and instead of ) Prozac. That is the only way to 'end the Prozac nation (which was the objecting of IAPT) but antidepressant prescribing has since doubled. See my papers on section 9 of www.reginaldkapp.org, or e mail me at johnkapp@btinternet.com

Julia Brown

Position
Director,
Organisation
Achievingoals
Comment date
25 September 2014
Agree. We need to assist individuals and families to look after themselves and better understand their physical and mental health needs. Health Care professionals need to understand the importance of integrating physical and mental health care. It is too separated. Coaching and mindfulness are absolutely key in helping people to live healthier and happier lives.

Roslyn Byfield

Position
Psychodyanmic counsellor,
Organisation
Roslyn Byfield Counselling
Comment date
26 September 2014
Cross-sectoral working is very important as too many organisations still work in silos. Also encouraging people and showing them how to look after themselves better, for example using the 5 wellbeing principles, one of which is noticing (this can equate to mindfulness practice). One of the keys is encouraging self-directed action rather than thinking of health interventions as something done to them by a professional.

Rekha Elaswarapu

Position
Associate Fellow,
Organisation
ILC-UK
Comment date
26 September 2014
Culture is a must but this needs to happen more broadly in the society. The stigma surrounding mental health and lack of understanding about the need to see physical and mental health together for a person centered care is a real barrier. GPs need to be more aware about mental health and should pick it up early enough. Most mental health patients enter the system in crisis. Simple talking therapies can do wonders. Medication is not always the answer.

George Coxon

Position
Chair of the MHNA,
Organisation
various
Comment date
28 September 2014
I have been asked to write a short summary key message piece for the MHNA practitioner journal on this report - The MHNA is the mental health nurse association with circa 3,000 members.
Our publication is widely read and will have an influence on attitudes and opinion on the content and contribution the report will have.
My initial thoughts prior to my second reading is it misses the essential point about funding pressure and squeeze on MH services overall and needs a bit more punch in being seen as a commissioning template for service support and change - the lack of enough headline on integration also I feel is a missed opportunity for emphasising one of the King's Funds loudest messages of the moment - my re read may modify my views however

Rebecca

Organisation
MHPF
Comment date
29 September 2014
The barriers to improvements to mental health care must be addressed to provide more consistent, joined up support for people with mental health difficulties. It is right to place collaborative working at the heart of the needed culture change and it is something we fully support as a national alliance of voluntary mental health care organisations. The voluntary sector can be looked to for support in service provision, for specialist services, but also for support to get mental health on the agenda with local authorities and CCGs. Many voluntary organisations are working at a local level and can better inform local service provision. They should be looked to for that knowledge and expertise.

Linda Dobraszczyk

Position
Public Health Pharmacist,
Organisation
Healthwatch/NHS England specialist commissioned services member
Comment date
02 October 2014
We definitely need to educate and empower the public due to limited professional capacity and funding. But we must ensure it starts with an awareness and knowledge of child development, secure attachment and positive parenting skills.

Pearl Baker

Position
Independent Mental Health Advocate and Advisor/Carer,
Organisation
Community Advocate and Advisor
Comment date
04 October 2014
Until the realisation that 'Integration' is not just the latest 'buzz' work' it has to understand that the meaning of what 'integration' means and what agencies are involved in the process to this end.

There has to be a 'tool' bar for agencies to refer to: and the process of how this programme works in reality is achieved.

The CQC could do more!

The CQC inspect GP Surgeries, why do thy not inspect the medical records of those subject to section 117. this would be a good starting point.

The CQC would be the 'Masters' and have at their disposal all the tools required to ensure that these particularly vulnerable patients are receiving all their entitlements as per the relevant laws including the Care Act 2014, and 'crisis and emergency assessments' the latest to come out of the DOH.

The MONITOR the other half of the coin, are completely inactive when it comes to Monitoring NHS Patients. Do they know patients are being discharged from Section 117 while still receiving care and treatment, left in 'limbo' I think not.

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