Birmingham Health & Wellbeing Board Summit - July 2012
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  • We probably have to live with a debate about language and the use of different terms Language also reflects debates in field of mental health – terms like positive mental health and mwb are used to distinguish mental health from mental illness – can’t be separated from wider politics – still important in user survivor and recovery movements, history of struggle There are also cultural debates – and concerns about dominance of western (esp. north american) philosophical traditions which privilege individual over the collective – I over We Debate about language reflects different disciplines, different sectors, professional boundaries and different research traditions – we probably have to live with some fluidity – as we’ll see in webinar three, this is also reflected in a range of different wellbeing measures – capturing different dimensions
  • At just a few hours old, the human baby is already making valiant efforts to mimic the expression on her mother’s face (just as new born babies cry in their mother tongue) - to establish the social connections, the social cues, on which her survival will depend. Recognise me, I’m like you. That baby’s efforts are a reminder – that we depend on each other – and that human beings are profoundly, quintessentially, social. Hence the importance of the social determinants – both societal – how power, privilege and resources (income and wealth) are distributed – and social – the impact of this distribution – on human relationships. mh and wellbeing debates, movement – played important role in reminding us of the Social nature of human beings – importance of designing population health around that
  • An underlying question is how does thinking about wellbeing shape the story ? Does it shift our perspective if we look at the pressing challenges of our times - economy, education, employment, crime, social justice - through a wellbeing lens? what can a ‘wellbeing lens’ contribute to addressing persistent inequalities and complex issues of welfare and public sector reform
  • Before moving on – reflect on what we all need for our own wellbeing Insights from neuroscience and also work of Sen and others on capabilities – attempt to identify what people need from others in order to function well We all need – heard, believed, understood, respected – but profound inequalities in whose story is heard, believed The greatest (and most painful) inequality may be inequalities in the distribution of respect – and how these are linked to material inequalities – and the impact of both - inequalities in respect and material inequalities - on wellbeing
  • Overwhelming theme emerging internationally is growing importance of mental health – the domain of think/feel/relate/make meaning - across many different disciplines and in relation to wide range of health and social problems the profound importance of mental health to life chances and life outcomes And that mental health influences so many outcomes Because of the Social nature of human beings – Impact of mind on body Contribution of mental health to inequalities
  • Mh - the social, emotional and spiritual - has deepened understanding of the social determinants of health International comparative studies suggest that status – the respect we receive from others – control - influence over the things that affect our lives/ - and r elatedness - affiliation, sense of belonging - are universal determinants of wellbeing and we need to pay more attention to the impact of injuries to these needs We need to pay much greater attention to the factors that injure these needs and to the impact of injuries to these needs – lack of status, lack of control, lack of affiliation – primary causes of stress - undermining what Sen has called ‘freedom to live a valued life’. But in these accounts – the distribution of economic assets is still of fundamental importance. There’s a link between living conditions and dignity. The idea of justice is paramount. What’s fair?
  • This also involves understanding the wider structural factors that influence individual mental illness journeys – individual and collective experiences of pain, anger, demoralisation, despair an enduring perception that mental illness is a random misfortune it is the poorest and most deprived families who bear the main burden of mental distress. Lone parents, those with physical illnesses and the unemployed make up 20% of the population, but 51% of those with disabling mental disorders How we explain inequalities is a mental health issue.... Fix the individual? Or fix society?
  • What’s come from epigenetics is a body of evidence on how : Social Processes can influence gene function What Clyde Hertzman has described as experience that gets under the skin and alters human bio-development In other words: systematic differences in social experience lead to different bio-developmental states the differences are stable and long-term; they influence health, well-being, learning, and/ or behaviour over the life course What’s emerging is the importance of paying much greater attention to the factors that injure these needs and to the impact of injuries to these needs – what epigenetics demonstrates is that social determinants stretch back in time
  • We see from this very powerful meta analysis based on around 145 studies the importance of social support/social integration on mortality risk The size of this effect (someone to turn to, sense of belonging) is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity) Received support is less predictive of mortality than social integration facilitating patient use of naturally occurring social relations and community-based interventions may be more successful than providing social support through hired personnel
  • That means identifying barriers to recovery Public mental health can support recovery goals by asking what kind of communities support recovery and by investing in community based support that: builds community capacity reduces need and demand for specialist secondary mental health services alleviates the risk of crises LAC makes social care services and supports more personal, local, flexible and accountable, and thereby to build and strengthen informal support and community self sufficiency
  • Where do we turn for the ideas, resources, creativity that are needed There’s received wisdom -
  • Pull out a few key themes Wellbeing is an important factor in understanding differences in outcome/in risk Wellbeing can help to account for the unexplained excess – so whether we look at crime, education, health, issues like alcohol, drugs – classical risk factors – behaviour or material factors – don’t account for level of variation – wellbeing has been an unexplored determinant – as we’ll see There’s a broad understanding of link between mental illness and poorer outcomes = but absence of wellbeing – what Tom Hennel and others have called ‘ill-being’ – also influences outcomes
  • We have the evidence – what we don’t have is a clear framework setting out the pathway between mental health and wellbeing and other outcomes separates health from other important aspects of life such as work, family and community. It prioritises professional expertise over the experience of individuals, despite the fact that effective management of chronic diseases depends more on individuals than professionals
  • Scope of action might look like this Meaningful activity – issues of livelihood are crucial and urgent, especially for young people, but we also need more ways to recognise and reward those who contribute outside the money economy Include social outcomes – the quality of relationships matters – commissioning for social value – commissioning that supports family life, household production, creates local jobs, empowers communities, strengthens control, uses local resources or skills, builds connections, strengthens networks Some of the most promising initiatives bring together: Involving children and young people Making the most of natural heritage Social enterprise Arts and culture
  • It’s not an exact science, but best buys for wellbeing would include a combination of interventions where there is very robust evidence family support – parenting, but also partnerships between pre-school/primary school and families that support the home learning environment – reading initiatives – books for babies, reading recovery school, workplace and education/training – with the latter targetted at increasing positive destinations for young people leaving school And where evidence is emerging but promising: Environmental improvements Always in the context of a localised analysis of need
  • Number of debts and source of debt impacts on mental health
  • Many different models that support knowing about, drawing on, building, identifying new opportunities – in communities From walking groups to literacy and numeracy classes, from learning English to managing debt, finding out about sources of low cost credit, tenancy maintenance, cookery classes and gardening projects, green space, blue space and places to ‘stop and chat’, all neighbourhoods will have assets that support recovery and many are rich in community and voluntary organisations. Commissioning that supports and protects these sources of support, as well as identifying gaps and barriers to access, makes good economic sense (DH 2010b; Knapp et al 2010) but may be vulnerable to short term thinking in the current financial climate
  • Commissioning for social value – sometimes called SROI – organised around trusted local sources of support/valued resources - means asking how each intervention £ also protects or enhances the social – supports family life, creates local jobs, empowers communities, strengthens control, uses local resources or skills, builds connections addressing outcome clusters involves whole community or total place approaches – Mental health is an important factor in explaining the clustering of disadvantage and the urgent need for public health to move away from single issue, single outcome interventions. Not least because of substitution – if we fail to address the underlying issues, even if everyone stops smoking, stops drinking – tobacco, alcohol, will be replaced by something else and health inequalities will remain. “
  • We’ve seen a recognition of the social nature of wellbeing : Social – core economy Solidarity – identifying common interests and mutual responsibility Collective – coming together (to change things, improve things, protect things) Which raises questions about what protects the social – the role of Equity and Social Justice but also the nature of the relationship between professionals and disadvantaged communities 1.Social justice 2. Opportunities for advancement 3. Financial resources 4. Access to and quality of work (Christian Kroll – four priorities for social democratic priorities)

Transcript

  • 1. Birminghams Way to Wellbeing Birmingham’s Joint Health and Wellbeing and Social Inclusion Process Summit Thursday 12th July, 9am to 2pm The Bordesley Centre, Birmingham@bhwbb #bhwbb bhwbb.net
  • 2. Welcome and introductions Cllr. Steve Bedser Cabinet Member for Health and Wellbeing, Birmingham City Council@bhwbb #bhwbb bhwbb.net
  • 3. Definitions and concepts - what does it all mean? Dr Neil Deuchar Medical Director (Mental Health) NHS Midlands and East@bhwbb #bhwbb bhwbb.net
  • 4. West Midlands Strategic Health Authority Wellbeing –What does it all mean? Neil DeucharAssociate Medical Director NHS Midlands and East NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil McKay CB
  • 5. What’s in a name..... West Midlands Strategic Health Authority mental positive quality of health mental health life mentalhappiness capital wellbeingemotional resiliencewellbeing flourishing NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil McKay CB
  • 6. West Midlands Strategic Health AuthorityWellbeing is the subjective experience ofmental, social and spiritual healthIt is not merely the absence of illnessIt involves a sense of purpose, fulfillment,agency, belonging and connectedness NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil McKay CB
  • 7. West Midlands Strategic Health AuthorityWellbeing is similar to quality of lifeWellbeing derives from and conferspsychological resilienceWellbeing in enough individuals producesmental and social capital acrosscommunitiesPsychological resilience reduces bothmental and physical illness NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil McKay CB
  • 8. West Midlands Strategic Health AuthorityThere are "Five Ways to Wellbeing" (Foresight/NEF) – Connect Give Notice Learn Be ActiveProsocial behaviour enacts the "Five Ways"This means active citizenship (personal rights andresponsibilities to each other) NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil McKay CB
  • 9. West Midlands Strategic Health AuthorityPublic Mental Health is the promotion ofMental Health / Wellbeing in communitiesand the prevention of mental illnesses inpeople at riskAddressing public mental health reducesphysical illnesses, alcohol and drugs useAdopting the "Five Ways" improves publicmental health NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil McKay CB
  • 10. Understanding the determinants and what works Dr Lynne Friedli Mental Health Promotion Specialist World Health Organisation@bhwbb #bhwbb bhwbb.net
  • 11. Mental health and wellbeing: understanding the determinants and what works Dr Lynne Friedli Wellbeing Summit Birmingham Health & Wellbeing Birmingham 12th July 2012
  • 12. Source: Ingram Pinn, Financial TimesBirmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 13. Summary how we feel about & • Mentally flourishing communities experience our lives • Recovery Oriented Communities • Social Justice, Citizenship & Human Rights • Commissioning for social value • Health topics: RIPBirmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 14. What we all need.... To be: • Heard • Believed • Understood • Respected Picture Source: http://sarahdrummond.wordpress.com/2010/12/13/an- assets-alliance-scotland/Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 15. Mental health, and the factors that influence mental health, have never been more important Mental Social S Determinants HealthBirmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 16. Commission on the Social Determinants of HealthSome living conditions deliver to people a life that is worthy ofthe human dignity that they possess, and others do not. Dignitycan be like a cheque that has come back marked ‘insufficientfunds’ Martha Nussbaum •material requisites •psycho-social (control over lives) •political voice (participation in decision making) Status Control RelatednessBirmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 17. Best start Quality work Healthy places Income Prevention Education & skills
  • 18. Explaining the social gradient: mental illness journeys... Most of the experiences that cause mental distress are directly linked to a lack of money....... powerlessness linked to poverty Peter Campbell Beyond the Water Tower 2005 • Adverse childhood experiences/stressful life events • Racism and other forms of discrimination • Contact with criminal justice system • Socio economic status – parental income, tenure, education, occupation • Institutional care in childhoodBirmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 19. Social Epigenesis: biological embedding * Status Control RelatednessBirmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 20. Meta analysis: comparative odds ofdecreased mortality The relative value of social support/ social integration Birmingham Wellbeing Summit Source: Holt-Lundstad et lynne.friedli@btopenworld.com al 2010
  • 21. Recovery oriented communities They are saying that they are missing from the community, they want to give and contribute and that the community is missing out on their contribution. PFG Doncaster People with mental Full health problems Quality of have access to citizenship everyday activities, life resources, Human relationships and opportunities rightsBirmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 22. Why bother? What works?Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 23. Austerity solutions....Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 24. Because it’s worth it.... While there are multiple barriers to economic growth, the growth of human potential is unlimited Coote and Franklin 2010 •Contribution mental wellbeing and mental illness make to wide range of outcomes •The ‘unexplained excess’ – classical risk factors do not account for level of variation in outcomes •Improving wellbeing saves (a lot of) money •Improving wellbeing delivers social (as well as economic) returns •Improving wellbeing reduces inequalitiesBirmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 25. Reduce pressure here NO HEALTH PUBLIC ADULT WITHOUT HEALTH NHS SOCIAL CARE MENTAL OUTCOMES OUTCOMES OUTCOMES HEALTH FRAMEWORK FRAMEWORK FRAMEWORK MENTAL HEALTH AND Get it WELLBEING right hereUsing data and evidence from: Delivering better mental health outcomes;Economic Casehttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123766; See also Champs Birmingham Wellbeing Summit lynne.friedli@btopenworld.comwww.champspublichealth.com
  • 26. Scope of Action Material resources Relationships andIncreasing equitable access Respect to assets that support Social support, collectivity, mental wellbeing respect for people experiencing Interventions misfortune to promote mental wellbeing Inner resources Meaningful Opportunities to activity develop senses, Opportunities imagination, to contribute reason, thought (Martha Nussbaum Capabilities) Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 27. ‘best buys’•Supporting family life: parenting; HLE; reading ; infant sleep•Supporting lifelong learning: h/p schools; SEAL; anti-bullyingcontinuing education; reading recovery•Improving work: employment/ workplace•Lifestyle/screening/brief interventions (diet, exercise,alcohol) social support/integration Befriending, volunteering, Timebanks, community development•Supporting communities: environment/environmentaljustice; green space; bridge safety; debt services Source: Friedli & Parsonage 2009 Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 28. Net return on investmentSource: Knapp, McDaid & Parsonage 2011
  • 29. Tentative analysis of economic case:workplace 400 Extension of Flexible £s millions per annum avoided 300 Working Arrangements Integration of 200 Occupational and Primary Health Implementing Stress 100 and Wellbeing Audits 0Source: Mental Capital & Wellbeing: Foresight 2008 – Overhead DavidMcDaid
  • 30. Mental health risk and debt(OR) risk of poor mental health Unadjuste d Income adjusted Adjusted for income and socio- demographic variables Number of debts Source: Jenkins R et al 2008 Debt, income and mental disorder in the general Population Psychological Medicine 38:1485–1493.
  • 31. Routes to partnership/joined up delivery Wild NHS Commissioning Health & swimming (for social value) Wellbeing Boards club Health & Wellbeing Food Primary Strategies Train Care Time Link Integrated bank workers Wellness•Referral Service Communitycriteria Garden•Feedback Community Referral Hubloops Local Area Debt advice/•Extended Coordination credit unionconsultation Language Social and Midnight literacy Care football Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 32. Priorities for moving forwardInnovation is hard. And social innovation is doubly hard. The system willoften absorb new ideas, and then spit them out in forms that theiroriginators would not recognise... Simon Duffy ommission for social value – each £ spent also produces wider community wellbeing nd health topics: whole life/total place /wellbeing services oin up delivery: wellbeing, recovery, resources for citizenshipBirmingham Wellbeing Summit lynne.friedli@btopenworld.com evelop an inequalities imagination (Angie Hart)
  • 33. Return to the social.... •Wellbeing is produced socially •Quality of social relationships has a material context • I am, because we are...Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 34. Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 35. Select bibliographyWarwick-Edinburgh Mental Well-being Scale www.healthscotland.com/documents/1467.aspxCooke, A., Friedli, L., Coggins, T., Edmonds, N., O’Hara, K., Snowden, L., Stansfield, J., Steuer, N. and Scott-Samuel, A. (2010) The mental well-being impact assessment toolkit. 2nd ed., London: National Mental Health Development Unithttp://www.apho.org.uk/resource/item.aspx?RID=95836Friedli L (2009) Mental health, resilience and inequalities WHO Europe London/ Copenhagen http://www.euro.who.int/document/e92227.pdfFriedli L and Parsonage M (2009) Promoting mental health and preventing mental illness: the economic case for investment in Wales Cardiff: All Wales Mental Health Promotion Network http://www.publicmentalhealth.org/Documents/749/Promoting%20Mental%20HBirmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 36. Select bibliographyKnapp M, McDaid D and Parsonage M (2011) Mental health promotion and mental illness prevention: the economic case Department of HealthCampbell F (2010) Social determinants and the role of local government http://www.idea.gov.uk/idk/aio/17778155Newbigging K and Heginbotham C (2010) Commissioning mental wellbeing for all : a toolkit for commissioners UCLAN http://www.nmhdu.org.uk/news/commissioning-wellbeing-for-all-a-toolkit-for-commDH (2011) No Health Without Mental Health: A Cross-Government Mental Health Strategy for people of all ages (Feb 2011) gateway reference 14679Solar O and Irwin A (2011) A conceptual framework for action on the social determinants of health Geneva: WHODept of Health (2011) The economic case for improving quality and efficiency in mental health http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitOECD 2011 Divided we stand: why inequality keeps rising http://www.oecd.org/document/51/0,3746,en_2649_33933_49147827_1_1_1_1,0Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
  • 37. What makes us healthy? Jane Foot Independent Public Policy Adviser@bhwbb #bhwbb bhwbb.net
  • 38. What makes us healthy?Birmingham Wellbeing Summit12 July 2012Jane Footwww.janefoot.co.uk www.janefoot.co.uk 38
  • 39. Reframing our thinkingWhen we work with people andcommunities we focus too much on theirfailings, deficiencies, problems and needs.And we prescribe services to fix thoseproblems.We don’t actively look for what createshealth and sustains wellbeing, the thingsthat are working, the potential for people toconnect their own and others’ assets toimprove their lives. www.janefoot.co.uk 39
  • 40. What are health assets ? An asset can be defined as any factor or resource which enhances the ability of individuals, communities and populations to maintain and sustain health and well-being. These assets operate at the level of the individual, family or community as protective and promoting factors to buffer against life’s stresses.  Skills, capacity or knowledge of individuals  Passion of families and neighbours that give them energy for change  Networks and connections in a community – place, identity, interest  Effectiveness of community associations  Resources of institutions – public, private or third sector  Physical, environmental and economic resources www.janefoot.co.uk 40
  • 41. What is the evidence? Resilience – what are the social factors that support resilience Social networks make you healthier and happier. Stress and isolation are bad for you. Mental wellbeing and psychosocial factors – both a cause and a consequence of inequality Good wellbeing makes it possible to ‘get ill better’. Evaluative task is to understand assets and the dynamics that link assets to change www.janefoot.co.uk 41
  • 42. An assets approach People are a resource rather than a problem Identifies and connects the assets that can enhance wellbeing Values what works well in an area and what has the potential to improve health Sees citizens and communities as co-producers of their health rather than recipients of services Promotes community networks, relationships and friendships that can provide caring, mutual help and empowerment Supports individuals health and wellbeing through self esteem, coping strategies, resilience skills, networks, knowledge, Empowers communities to control their futures – capacity releasing Creates tangible resources such as services, funds, buildings www.janefoot.co.uk 42
  • 43. 1. Health & Wellbeing Boards Shared understanding of health as a positive state and its determinants as those things that protect and promote good health Prioritise the ‘causes of the causes’ Whole system – everyone who contributes to health assets Whole life course Shift from targeting to whole community Commissioning framework – redesign, support, procurement www.janefoot.co.uk 43
  • 44. 2. Asset mapping & mobilising  Makes us learn to ask what communities have to offer and care about  Improves our understanding of HOW people understand wellbeing and what helps them cope  It makes explicit the knowledge, skills, resources and capacities that already exist  Helps to make best use of individual skills , physical and organisational resources within the community  It helps to build trust between professionals and the local community  Assets are a resource to meet needs – influences commissioning www.janefoot.co.uk 44
  • 45. 3. Community development – buildsocial capital Core health and wellbeing asset Intentional community building Work with existing community networks and activities Release the capacity and strengths Do not undermine networks and social support www.janefoot.co.uk 45
  • 46. 4. Co-production Professionals, service users, families, neighbours are involved in an equal and reciprocal relationship Planning, design and delivery of agreed outcomes Services do not produce positive health outcomes – people do An awareness of assets in the area means that residents are valued for their contribution Pooling of different knowledge and skills www.janefoot.co.uk 46
  • 47. www.janefoot.co.uk 47
  • 48. 5. JSNA + Assets A better balance of information between needs and assets. Explore ways of collecting analysing and understanding assets – not just the what but also the how. Align with data on needs and resources Commission to sustain the health assets www.janefoot.co.uk 48
  • 49. 5. Commissioning for outcomes The potential of co-production and asset approaches is not best served by our current procurement models Co-production + asset-rich communities – requires a new commissioning framework Require providers to identify and build on assets in the families and neighbourhoods. Intentionally support community development and social capital Do our services undermine health assets? www.janefoot.co.uk 49
  • 50. Health inequalities are driven by underlying social factors and action is required to address these ‘causes of the causes’.“the health and wellbeing of people is heavily influenced by their local community and social networks. Those networks and greater social capital provide a source of resilience. The extent to which people can participate and have control over their lives makes a critical contribution to psychosocial wellbeing and to health” Professor Sir Michael Marmot, Foreword to What makes us healthy? www.janefoot.co.uk 50
  • 51. WHAT MAKES US HEALTHY ? The asset approach in practice: evidence, action and evaluationFree download atwww.janefoot.co.ukwww.assetbasedconsulting.net Foot (2012) ISBN 978-1-907352-05-08 www.janefoot.co.uk 51
  • 52. Integrating Primary Care Mental Health and Well Being Services Dr Ian Walton Clinical lead for Primary Care Mental Health Services SWB CCG@bhwbb #bhwbb bhwbb.net
  • 53. ‘Integrating Primary Care MentalHealth and Well Being Services’Dr Ian WaltonGP, PEC chair and mental health lead for Sandwelland West Birmingham Clinical Commissioning GroupIan.walton@nhs.net
  • 54. Complex Patients or complex services Low Aspirations ◦ Patients ◦ Clinicians ◦ Statutory sector Dealing with Individuals and their families not Populations High level needs analysis Silo Approach to commissioning and provision NICE had led to a disease focussed model Wrong care, wrong service, wrong person, wrong time
  • 55. Needs Analysis Breadth and depth of need at whole population level ◦ GP population and individual Large amount of sick people and their carers ◦ Correlated with poor and inadequate housing ◦ Worklessness ◦ Physical and Mental Ill Health and Addictions
  • 56. The Challenge – To improve theoutcome of the whole populationincluding…… Frequent attendees Complex needs Medically Unexplained Symptoms Prevention and early detection Those not meeting ‘psychiatry ‘ criteria – sub threshold Emotional distressed Socially Excluded Homeless Diverse needs Not mentally ill but emotionally distressed eg Sadness , grief, loneliness– crisis v crysis Services did not fit the patient
  • 57. Targeted groups Young people at risk of mental ill health/asbo Deaf population South Asian women Carers Men People with existing mental health problems
  • 58. How did we do it? Listened Asset mapped locally National and international best practice that works Identified a series of pre and post outcome measures Quantitative and Qualitative approaches Sourced funding Established benchmarksMore pilots than British Airways.......
  • 59. Human Needs Security-a safe territory-a space to grow Attention (to give and receive) Having a sense of Autonomy and Control Emotionally connected to others-intimacy Being part of a wider community The need for privacy to reflect and consolidate experience Self esteem – via confidence and achievement The need to be stretched which comes from a sense of meaning and purpose. Compassion
  • 60. Books on prescriptionA Social Prescribing projectAfter a successful pilot in Cardiff in 2003, similar schemes have been taken upacross many areas in the UK.Sandwell first piloted Books on Prescription in 2006, and the service becamemainstreamed across all Sandwell libraries and GP surgeries in 2007.
  • 61. National Findings Patients get more information and a greater understanding of their condition Helps them recover from the problems they are experiencing Helps them make informed choices and take a proactive part in improving their health Anecdotal evidence indicates that there has been a low rate of people returning to their GP once taking up the book prescription Patients prescribed books whilst on the waiting list for psychological therapy resulted in 50% reduction in the number of sessions they then required
  • 62. But no-one reads in Sandwell! Approximately 1100 book issues per year Patients are more likely to access if a GP refers them to the scheme Majority of our current referrals are self- referrals 83% of B.O.P. users have applied the techniques they learnt by reading the books 83% report improvements in their general wellbeing and mood as a result of accessing the scheme
  • 63. Health Improvement ProgrammesSince the services started we have hadover 4,000 people complete prevention,  64 Long Term Conditionswellbeing and health improvement  58 Relationshipsprogrammes this equates to £800,000  57 Self Defence and Empowermentprevention costs.  56 Workplace Wellbeing  50 cCBT  47 Wellbeing Awareness Training 1007 Stress Awareness  35 Relaxation  33 EFT - Emotional Freedom Technique 769 Health Improvement programme  25 Make Friends with a Book 351 Food and Mood workshops  22 Yoga (FLW) 333 Laughter Yoga  17 Stress and Relaxation (FLW) 305 Happiness and Wellbeing  16 Flourish  15 Redundancy 218 Chin-up  12 Laughter Yoga (FLW) 102 Music and Wellbeing  11 Food and Mood Workshops (FLW) 89 Yoga  7 Capnography 70 Positive Mental Training  2 Maternal Mental Health HIP 67 Tai Chi Plus over 3,000 people access talking therapies which using the same formulae 64 Happiness and Wellbeing (FLW) would be £600,000
  • 64. Chin up programme Aimed at youngsters “at risk of offending” Originally given 8 teenage girls They told 20 of their mates.. You can’t have the lads they really are too much trouble Top of our league tables for improving wellbeing
  • 65. Conditions Management Programmes Long term conditions Capnography Positive Mental Training Wellbeing programmes Emotional Freedom Technique www.confidenceandwellbeing.co.uk
  • 66. Local outcomes 3,468 sessions run 2011 -12 for 1,640 patients all programmes show a measurable difference clinically and also in their wellbeing and social needs Welfare Rights - 240 cases gains of £157,544, Reduction in referral to crisis services Frequent attenders managed in partnership with probation and A and E at SWBH Access pathways to health for refugees and asylum seekers, homeless people 59.5% average recovery rates for IAPT one of top IAPT services nationally Other services are showing comparable results and impact on wellbeing
  • 67. Outcomes - corenet data
  • 68. Outcomes – wemwbs data
  • 69. Training GPs basrse www.primhe.org.uk 70
  • 70. The magic formula Assets V needs Starfish Collaborative care - warm hands. Integrated budgets Co- location Integrated care across all conditions Education and training for all
  • 71. Conclusion Invest in prevention and not in sick people Money talks and there is a business case for thisKNAPP Martin; MCDAID David; PARSONAGE Michael; (eds.); Mental health promotion and prevention: the economic caseLondon: Personal Social Services Research Unit, 2011. 43phttp://www2.lse.ac.uk/businessAndConsultancy/LSEEnterprise
  • 72. Thanks With particular thanks to Lisa Hill, Primary Mental Health Improvement Lead Sandwell PCT. lisa.hill@sandwell-pct.nhs.uk www.confidenceandwellbeing.co.uk www.primhe.org.uk ian.walton@nhs.net
  • 73. Question and Answer Session Plenary Panel@bhwbb #bhwbb bhwbb.net
  • 74. Key Line of Enquiry: Preliminary Findings Karen Jerwood Head of Sport and Physical Activity Birmingham City Council@bhwbb #bhwbb bhwbb.net
  • 75. Introduction to table-top workshop Dr. Jerry Tew Senior Lecturer, Institute of Applied Social Studies University of Birmingham@bhwbb #bhwbb bhwbb.net
  • 76. Health and Wellbeing Update- 12th July 2012 Summit Alan Lotinga Director of Health and Wellbeing@bhwbb #bhwbb bhwbb.net
  • 77. Ongoing Top Joint Priorities• Making the transition to new health and care systems and structures – Keeping eye on whole system consequences of change : so many things starting from April 2013• Joining up transformation programmes – e.g. frail elderly, childrens services, personal budgets• Massive efficiency and productivity challenges - recurring savings – e.g. joint commissioning@bhwbb #bhwbb bhwbb.net
  • 78. Ongoing Top Joint Priorities• Maintaining and improving where possible service quality, safety and performance, with particular emphasis on personal experience• Health inequalities@bhwbb #bhwbb bhwbb.net
  • 79. Some important opportunities to build on• Year 3 of biggest pooled budget, mental health/learning disabilities. Highly successful – savings, better services. 10% of total City health and care spend• Health and care partnership Compact agreed• “Frail Elderly” transformation programme to build on (and others commencing)• Strong support for place-based budgeting approach – e.g. Troubled families• Big push towards integration with primary care• City Council’s Leader’s Policy Statement – “Promoting health and wellbeing so that older citizens, children and young people are active and healthy, and live with dignity and independence. We will use the transfer of public health responsibility…to eliminate health inequality between the rich and poor and working through the Health and Wellbeing Board to achieve this.”• Wellbeing Key Lines of Enquiry - the work and next steps from today.@bhwbb #bhwbb bhwbb.net
  • 80. Next Steps with our Health and WellbeingBoard• Next meeting 24 July• March 2012 review by existing members – what works, what to improve. Purpose, membership, network of relationships (many new).• Labour Council, “no” vote for Mayor, localisation agenda and determination to address inequality.• Strategic guide to our health and care system.• A number of areas where better links sub-structures need creating, co-opted, to support the work programme eg 3rd Sector generally, MH/LD joint commissioning, Childrens Services, NHS Provider Forum, Quality and Safeguarding, Enterprise and Jobs, Crime and Safety.• Importance of informal meetings and discussion.@bhwbb #bhwbb bhwbb.net
  • 81. Purpose of the Board• Hold the “centre ground” to prioritising and applying resources across all agencies, not a magnet for all issues and not a scrutiny function• Little direct infrastructure available, therefore need strong members and networks• Deliver Marmot objectives, e.g. service integration and joint commissioning are key means to deliver these ends• Strategy based on the “big issues” of the city (as defined by the JSNA), and deliver• Keep close eye on big changes (Public Health transfer, CCG set up, Healthwatch) and whole system issues (de-commissioning, prevention and enablement activity, QIPP activity)@bhwbb #bhwbb bhwbb.net
  • 82. Health and Wellbeing Board – Network of relationships• National - Department of Health - NHS Commissioning Board - Public Health England - Care Quality Commission - HealthWatch England - Monitor - NICE@bhwbb #bhwbb bhwbb.net
  • 83. Health and Wellbeing Board – Network of relationships• Sub National - Regional “arms” of above - Clinical Networks and Senates - Possible HWB federations - Joint Scrutiny• Local (providers, partnerships, communities) - NHS Provider Trusts - Private Sector - voluntary and community providers - other partnerships – children, enterprise, crime and safety, safeguarding, environment - Council departments - Patients, service users, carers, the public@bhwbb #bhwbb bhwbb.net
  • 84. Birmingham DraftJoint Health and Wellbeing Strategy• This strategy is an opportunity for us to be clear about our vision for the health and wellbeing of our City, and identify what the key partners – the City Council, NHS and others – will do together to achieve it. We want our citizens to be able to live healthier and happier lives, and for the services we commission to be better at supporting this.@bhwbb #bhwbb bhwbb.net
  • 85. Birmingham Draft Joint Health and WellbeingStrategy• The Strategy is not a statement of everything we need to do in health, public health and social care in Birmingham but a statement of what the most important priorities in health and care should be. Many of the most challenging health issues in Birmingham are significantly affected by educational attainment, standard of living (good employment) and other factors like the places we live in. This strategy seeks to reflect that.Making better use of community assets, co-production, more involvement of local communities, as well as agencies working better together, will be crucial to delivery (key themes from today).@bhwbb #bhwbb bhwbb.net
  • 86. Respond by :7th September 2012Online at• http://bhwbb.net/joint-strategic-needs-assessment/healthEmail by requesting from• Birmingham.Phi@nhs.netOr Phone Birmingham Public Health• Kulwant Ghaleigh, 0121 465 8029@bhwbb #bhwbb bhwbb.net
  • 87. Feedback, conclusions and proposals Karen Jerwood Head of Sport and Physical Activity Birmingham City Council@bhwbb #bhwbb bhwbb.net
  • 88. All presentations for today can be found at: http://bhwbb.net/download/BHWBB%20Sum@bhwbb #bhwbb bhwbb.net