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Value based system of care in England: . Working together, mental health can deliver social and wealth capital for England . What Outcomes do our service users ask us to achieve in partnership with them. Professor Bruce Keogh, Medical Director of the NHS.

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What Outcomes do our service usersask us to achieve in partnership with them

Professor Bruce Keogh, Medical Director of the NHS


Parity and equalities: Benchmark October 2013

There is a disparity in the number of people with mental illness in contact with services, compared to physical health, yet it is a major cause of premature death & lives lived in distress and misery

Mental health problems are estimated to be the commonest cause of premature death

26% of adults with mental illness receive care

92% of people with diabetes receive care

nice guidelines 2013
NICE Guidelines 2013

Autism spectrum disorders in children and young people


Identification and care pathways for common mental health disorders

Psychosis with substance misuse

Self-harm (longer term management)

Public health guidance in development

Alcohol-use disorders (prevention)

Home-based approaches to promoting children's wellbeing

Looked after children

Personal, social and health education focusing on sex and relationships and alcohol education

Pre-school approaches to promoting children's wellbeing

Preventing domestic violence

Quitting smoking in pregnancy and following childbirth

School-based interventions to prevent smoking

Completed public health guidance

Brief interventions and referral for smoking cessation

Interventions to reduce substance misuse among vulnerable young people

Mental wellbeing and older people

Needle and syringe programmes

Preventing the uptake of smoking by children and young people

School-based interventions on alcohol

Smoking cessation services

Social and emotional wellbeing in primary education

Social and emotional wellbeing in secondary education

Workplace interventions to promote smoking cessation

Alcohol dependence & harmful use& clinical management

Antenatal and postnatal mental health

Antisocial personality disorder

Anxiety disorders

Attention deficit hyperactivity disorder (ADHD)

Bipolar disorder

Borderline personality disorder (BPD)


Depression in adults

Depression in children and young people

Depression with a chronic physical health problem

Drug misuse: opioid detoxification

Drug misuse: psychosocial interventions

Eating disorders

Medicines adherence

Obsessive compulsive disorder (OCD) and body dismorphic disorder (BDD)

Post-traumatic stress disorder (PTSD)

Schizophrenia (update)



When to suspect child maltreatment

value in mental health nice scie
Value in mental health NICE/SCIE
  • Right information
  • Right physical health care
  • Right medication
  • Right psychological therapies
  • Right rehabilitation, training for employment
  • Right care plan addressing housing, work, healthcare, self management
  • Right crisis care
  • Mental health : Is the problem that we have no evidence or value based guidance?
  • Mental health has over 100 NICE Health Technology appraisals, NICE guidelines, Public health related guidelines and Quality standards…..
  • The problem is not lack of guidance
  • The problem is that we have not focused on how we learn and disseminate from those that can and have implemented
  • Can the FT network lead a new NHS Change model?

“Crossing the Quality Chasm”


Ohio State Psychiatry Grand Rounds 12.05.2012

national audit of sschizophrenia
National Audit of Sschizophrenia

Physical Health

  • Significant premature mortality among those with a diagnosis of schizophrenia (M=20yrs; F=15yrs).
  • Only 29% had all 5 risk factors monitored only 25% had treatment for elevated BP


  • 10 fold variation among trusts in relation to adherence to safe, effective medicines practice

Psychological Therapies

  • The range of those offered psychological therapies varied from 0% to 94%.
what are the reasons for increased length of stay
What are the reasons for increased Length of stay
  • Comorbidities: physical ill health, substance misuse, PD
  • Detentions under the mental health act
  • Implementations of NICE/SCIE evidence based care
  • Workforce capacity and competence
  • People with SMI die 15-25 years younger due to 5-12 times increased levels of un assessed and untreated COPD, Diabetes, High BP, Cancer
  • Substance misuse is 6+ times more common in people with SMI
  • Workforce strategies and training programmes need to be provide training in evidence based treatments
co morbidity is the norm
Co-morbidity is the norm

Lancet, Barnett, Mercer et al 2012

5. Integrated physical and mental health care Long term conditions Mental health raises costs in all sectorsChris Naylor, Kings fund
  • Overall, international research finds thatco-morbid MH problems are associated with a 45-75% increase in service costs per patient

(after controlling for severity of physical illness)

  • Between 12% and 18% of all expenditure on long-term conditions is linked to poor mental health and wellbeing – at least £1 in every £8 spent on long-term conditions.
mental health has the capacity to improve england s social and wealth capital
Mental health has the capacity to improve England's social and wealth capital

Economic remodellingprogrammes

  • Unplanned care pathways
  • Psychosis pathways
  • Children and Young people pathways
  • Integrated physical and mental health care pathways
Prevention and Early intervention (Knapp et al, 2011)highly effective treatments: major economic benefit

For every one pound spent the savings are:

Parenting interventions for families with conduct disorder : £8

Early diagnosis and treatment of depression at work: £5in year 1

Early intervention of psychosis £18 in year 1

Screening & brief interventions in primary care for alcohol misuse £12Yr 1

Employment support for those recovering from mental illness: Individual Placement Support for people with severe mental illness results in annual savings of £6,000 per client(Burns et al, 2009)

Housing support services for men with enduring mental illness: annual savings: £11,000–£20,000 per client(CSED, 2010).