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Turning plans into reality

NHS England’s National Clinical Director for Mental Health looks at how NHS England will meet the challenges of the Mental Health Implementation Plan.

The Implementation Plan will help the public see what we have done and what we are going to do to improve mental health for people of all ages through to 2020-21.

Taking the impetus of the Five Year Forward View from the Mental Health Taskforce, we have created a plan which spans across delivery partners to ensure we all understand our roles in making the recommendations a reality.

There has already been progress.

Over the last few months we have launched the first ever waiting times in mental health. Our requirement for people experiencing their first episode of psychosis is that they are seen and treatment started within two weeks. By 2020/21, we anticipate that 60% of people will be receiving services which meet this evidence based approach.

Already, the money for child mental health is making a real difference in some places. I have heard, for example, of areas where teams are now offering treatment for eating disorders set out in the new guidance, based on evidence and are finding that children who would have been admitted to inpatient units are able to be supported successfully at home.

This is likely to be much better for their recovery – staying within their family can be part of the solution and means they can remain in school and continue to get on with their lives as much as possible.

From April 2017, we’ll be implementing the new waiting time for eating disorders in children and young people, which sets a pretty exacting ambition for local mental health services to achieve by 2020/21: that 95% of children and young people with an eating disorder should start a NICE-recommended treatment within one week from referral if it’s urgent and within four weeks for everyone else.

Both these groups of people – young people with eating disorders or people experiencing their first episode of psychosis – have very high levels of need, are often very distressed and benefit in the long run if treatment is started quickly.

We intend to help local healthcare communities reach standards like this for many other areas of mental health including for people with problems around the time of birth (perinatal services), and for people of all ages in crisis. For each standard, we expect that people will receive NICE recommended care in a timely way, wherever they live in England.

A big challenge but one the Implementation Plan will help us achieve.

The arguments as to how mental health services need to change have long been rehearsed. There is absolute consensus that clear standards around service levels and NICE concordant treatments are fundamental and are, to some extent, the initiatives that have helped to drive improvements in physical health care.

What the Implementation Plan also sets out is a trajectory for workforce training and numbers, and defines the financial allocations across the years to 2020/21. This is the essential information that we, working in the NHS, need in order to get on with the job of developing the responsive, accessible services that people should expect.

But, it not just about the classic notion of “parity of esteem” – an NHS operating effectively recognises  that mental and physical health are much more closely related and while high standards are critical in both aspects, bringing what are currently often seen as two separate strands of services together is the way we will move forward.

People with psychosis experience high rates of physical ill health and die much younger than other people by about 15 to 20 years, which is nothing short of outrageous. Long term conditions now take about 70% of all the investment in the NHS.  And if you have a long term condition, such as diabetes, heart or chest disease, you are much more likely to have a mental health problem.

So, if you have more than one long term condition your chance of having depression or anxiety, in particular, is 10% for one LTC, 26% for two LTCs and 45% for three!

The costs of treating a long term condition are increased by the mental health problem, and this is why we are planning to develop a much bigger primary care based service, integrated into secondary physical healthcare services, to provide therapeutic help for people with LTCs.

The good news is some services are already taking an integrated approach. Take a look at our case studies on the great work at Kings College Hospital and Leicester.

In the long run, treating the mental health problems of people with long term conditions may well save the NHS more than it costs to treat their mental health properly, with NICE recommended evidence based treatments. This is money we can potentially save in one year, to reinvest in the next.

As the Sustainability and Transformation Plans take form across the country, the aims of integrating mental and physical healthcare, primary, community and secondary healthcare, and bringing treatments much closer to people’s homes are becoming a joint commitment across every facet of health and care. All these plans will include mental health as a key part of what they do. So, hopefully soon you won’t need to go through a different door if you have a mental health problem from someone with a physical health problem!

Surely getting the right healthcare at the right time should be according to a person’s needs? And that means we need to fit our NHS around the people we serve, whatever their problems and wherever they turn up: properly person centred health care.

I am delighted that the Implementation Plan takes us much closer to achieving that ambition.

Tim Kendall

Professor Tim Kendall is NHS England’s National Clinical Director for Mental health. He has been Director of the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists for 15 years and Visiting Professor at University College London for the last 8 years.

Tim has also been Medical Director for 13 years and continues as Consultant Psychiatrist for the homeless at Sheffield Health and Social Care NHS Foundation Trust.

As Medical Director, Tim has set up a service user experience monitoring unit, led the reconfiguration of acute care and rehabilitation leading to the elimination of out of area treatments, the modernisation of the acute and crisis care pathways and initiated the development of NICE recommended personality disorder services within the community.

He chaired the first NICE guideline, launched in December 2002, on the management of schizophrenia and the first National Quality Standard (Dementia) for NICE.

Tim has published numerous articles and papers and often represents the NCCMH, NICE or the Royal College of Psychiatrists in the media. In 2004, he was awarded “Lancet Paper of the Year” for showing the impact of selective publishing by the drug industry about antidepressants in the treatment of childhood depression; and with others was awarded the Paper of the Year Award for the Health Economic Journal ‘Value in Health’ in 2012 for work on schizophrenia.