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See Me Presentation - Data-led Mental Health Transformation
- 1. Data-ledMentalHealth Transformation ?Benjamin McElwee – See Me Scotland
- 2. www.seemescotland.org What we’ll talk about today… •Stigma •Outcomes •Perverse Incentives •Measuring what matters •Missing opportunities
- 3. www.seemescotland.org The phenomenon wherebyan individual with an attribute which is deeply discredited by his/her society is rejected as a result of the attribute. Stigma is a process by which the reaction of others spoils normal identity. - Erwing Goffman What we talk about when we talk about stigma….
- 4. www.seemescotland.org “Societal-level conditions, cultural norms, and institutional practices that constrain the opportunities, resources, and wellbeing for [people with mental health issues]” Hatzenbuehler,M.L.etal(2014)StructuralStigmaandAll-CauseMortalityinSexualMinorityPopulations,JournalofSocialScience andMedicine,103:33-41 What we talk about when we talk about stigma….
- 5. www.seemescotland.org • Institutional policies and practices are stigmatising or discriminatory; • Lead to restrictions and reduced choice; • Curtail human rights and freedoms; • Reduced opportunities. What we talk about when we talk about stigma….
- 8. www.seemescotland.org ‘mental health problems’ including persistently low moods or levels of stress that affect how you think or feel…. ….through to conditions which have been diagnosed (such as depression, anxiety, bipolar disorder, schizophrenia)
- 9. www.seemescotland.org What we talk about when we talk about stigma…. MENTAL HEALTH RECEIVES of total Scottish health spend 8%
- 14. www.seemescotland.org Outcomes Matter Source: Health and Care Experience Survey 2017/18 2015/16 2013/14
- 15. www.seemescotland.org Source: Health and Care Experience Survey 2015/16 Outcomes Matter …Measures should too
- 17. www.seemescotland.org National Health and Wellbeing Outcomes (Indicators) •Overly focused on acute? •Overly focused on ill health? •Overly focused on elderly health? •Overly focused on health? •Not sensitive enough in GP survey? •Not disaggregated enough in GP survey?
- 20. www.seemescotland.org (Some) Perverse Incentives •Acute Targets (LDPs) •National Health and Wellbeing Outcomes •Brief interactions incentivised •Prioritisation given to physical health •Habitual behaviours => Lack of parity of esteem
- 21. www.seemescotland.org Beyond activity and mortality data • Patient experience • Outcomes (clinical and non-clinical) • Patient journey • Data linkage (HSC and beyond) • Equalities and demographic data • Absent and seldom heard data • High Health Gain
- 22. www.seemescotland.org As: 559 Gs: 202 As: 559 Gs: 283
- 23. www.seemescotland.org What’s missing and why does it matter? •Context matters •Missed opportunities? (39%) •Make measures matter
- 24. www.seemescotland.org Distress Brief Intervention • IndividualsDeclining Referrals & Support • LongitudinalOutcomes (clinical and non-clinical) • Staff analysis(training, job group, referrals) • Data linkage – e.g. - A & E? - Mental Health Services? - Prescribingdata? - Primary Care? • Person-centred data capture
- 25. www.seemescotland.org National Links Worker Programme •Additional treatment options •Fewer symptoms of anxiety and depression •Increased self-reported exercise levels •Less prescribed medications => Positive outcomes worth capturing
- 26. www.seemescotland.org Moray •Moray Wellbeing Centre – first 10 weeks of operation: 40 individuals. •Primary Care (6 link workers) – first 21 weeks of operation: 397 referrals. => Differences due to stigma and discrimination?
- 27. www.seemescotland.org When all you’ve got is a hammer, every problem begins to look like a nail
- 28. www.seemescotland.org If we continue to capture what we’ve always captured… • Joint Strategic Needs Assessments • Strategic Plan Indicators • Level 4 Indicators … • Strategic Plans • Primary Care Improvement Plans • Annual Reports
- 29. www.seemescotland.org If so inclined, how can you… •Act as advocates for different ways of measuring? •Influence health and social care transformation?
Editor's Notes
- What’s missing? mental health… This is the official poster on the Know Who to Turn To website hosted by NHS 24
- What was shown in the history made slide was outputs and system stats… But the outcome
- Focus on delayed discharge, on admissions and readmissions Focus on care homes, last 6 months of life, Within GP survey, doesn’t focus on what the care was for – if we’re a developed country that provides reasonably good care, yet not specific, how can we improve? All that tells me is must do better – not what to prioritise, or how to do so. Equalities data for these? What about mental health specific information?
- The stats I showed about the Barcelona Levante game didn’t show that their talisman Messi wasn’t playing Nor the reason why
- Having to hit waiting times targets diverts resources away from perhaps more sensible courses of action Having to report on National Health and Wellbeing Outcomes… similar. In A & E there is the incentivisation to keep interactions brief – (e.g. 4 hour waiting time) short-termism in action. Perhaps someone who is presenting in distress would benefit from a longer interaction. Within Primary Care, there is the same issue, and demonstrable results can be seen by interventions that have removed this arbitrary limitation (such as the Govan SHIP project where appointments could be up to 30 minutes) Physical health as we have seen maintains priority in terms of spending, but also in terms of training – broadly speaking, the majority of staff get longer and more in-depth training on physical health than they do on mental health. Mental health literacy simply isn’t there for many staff. Diagnostic overshadowing - People with mental health issues often have their physical health issues overlooked – put down to all in their heads. Person at Lanarkshire Links told me a story about stigma. Daughter died at 41 one 3 days after a GP consultation for shortness of breath People stick to what they know best, they prescribe medication instead of finding alternative treatments – because they want to feel like they’ve helped someone or done something.
- Patient reported outcomes measures and patient reported experience measures (PROMS and PREMS) Patient experience consistently linked with efficacy, quality and safety Care Opinion? Minor complaints being ignored has been consistently linked with bigger health and social care failures As well as non-clinical outcomes – e.g. is this health and social care service supporting people into employment (integration) and thus engaging in truly preventative work? And look at them in the context of the bigger picture. I remember being particularly struck by a workshop about recovery from drug abuse - opiate replacement programme – Jimmy’s death was a success. Patient journey – being able to explore what treatments or signposting patients have been offered before being prescribed medication. For example at the public petitions committee… moving beyond anecdata. Data linkage looking at services accessed etc. How deprivation impacts on service use and options People not reached by services? Beyond the 100 individuals that consume the 2%
- It’s not just the goals… it’s the opportunities that have been squandered. E.g. shooting accuracy is 39%; the amount of big chances missed, the amount of small chances missed. Context matters including Local context – is this good for this area? How are other similar areas doing? E.g. who are people playing for similarly placed clubs doing? What is their investment in training like? What is the rest of their workforce like? It’s important to know how many opportunities he has had. His shots to goal ratio is 39%. But that doesn’t tell us about the shots he didn’t take or the times he was tackled when he had an opportunity or where he missed out on assists. Glasgow Royal Infirmary discharged 39% of people who attended A & E with suicidal attempt, suicidal ideation, or intentional self-harm with no follow-up Patient pathways or journeys - Antidepressant prescribing - If we analyse where antidepressant prescribing is less, perhaps this is because preventative work has taken place Need to link up Primary Care data in a systematic way “Waiting until things meet our threshold” People in Inverness saying they would turn down support that might enable them to fully recovery from their mental health condition due to concerns it would be temporary and all future support would be ripped away (maintaining a constant state of distress) If that’s a negative experience great, because it allows us to improve
- Find out find people why they have declined support – is it because they deemed it unnecessary or because of how it was offered to them? How are people getting on after they have had their 2 weeks – is there a need for ongoing support; have they been able to solve whatever their issue was, e.g. gain employment, no longer isolated, etc. After initial training has there been a drop off in referrals – is there an optimal time for a refreshment of the training; are there particular job groups that may need extra support e.g. because people are declining referrals, or because they are not referring people; Are there irregularities in referrals? E.g. particular staff members referring too many, too little Inappropriate referrals? Are there referrals that fit the criteria but which Level 2 Providers feel unable to support – this is already the case in two of the areas. How has this service helped you manage your distress? NO! Should be how well can you manage your distress and what has helped you?
- Data capture was a headache
- Thinking about the typical treatment for mental health – e.g. medication. Or the typical solution – investment in mental health services. When actually what might be needed is to be linked into your community, or to be given opportunities for volunteering that may lead to employment, or to join a peer support group for people who are recently bereaved. And so on. Or to work more closely with employability services, or with housing associations. Arguably, by linking in with other credible data sources such as the indicators used within the National Performance Framework, the Scottish Surveys Core Questions, Household Survey, Health Survey, etc. and other local data sources and consultations we can get a fuller understanding of what intervention might be necessary.
- If not accurately capturing the needs of a population, or the incidences of mental ill health, or the risk factors within a community that may contribute to future ill health… Indeed we may take Quality Improvement approaches endlessly, whilst missing out on the bigger picture, and not feeding into strategic commissioning and actual preventative work. Arguably, QI limits opportunities for radical transformation. What are Strategic Plan Indicators indicative of? The whole point of health and social care integration is to move care to the community, to improve outcomes for individuals by moving towards shared decision making, and so on. Therefore, if when coming up with strategic plan indicators that do not reflect the new context Level 4: a range of indicators will be developed by locality and service teams, supporting the setting of priorities and inputting to the planning process. Some opportunities for influence with data. If anyone is working with Practice Adminstrative Staff Collaborative
- Different ways of measuring including lived experience and moving away from predominantly hospital focused measures?