The journey to a whole system approach on mental health, slide set by Piers Simey and Jim McManus to introduce a workshop on turning the Mental Health JSNA into action

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Hertfordshire Mental Health Needs Assessment
Follow up Workshop
13th April 2016
Piers Simey, Consultant in Public Health

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Aims of the session
• To build on the needs assessment
launch on 10/09/2015
– To consider how we can take forward
a systems based approach in Herts
– To focus on three core identified local
areas (with the potential for others to be
reviewed in the future)
– To start setting out what can happen
and how it can happen for these three
areas

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Running order
• 15 mins:
– Jim’s systems wide thinking
• 50 mins each:
– Suicide prevention
– Accommodation & Crisis
– Workplace
• Standard format:
– 15 mins – key issues & promising
ways to tackle them
– 30 mins panel & floor discussion
– 5 mins summary
• Wrap up: Maneka, Piers, Jim; (+write up)

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Think Intelligence, Think Intelligently
What does whole system look like? An
architecture…
• Promoting wellbeing – a
good & positive state
• Promoting psychosocial
resilience – skills to cope
with stressors & life
• Preventing ill-health –
spotting signs, intervening
early (basic interventions)
• Addressing & recovering
from mental ill-health –
best possible coping,
functioning & recovery
https://jimmcmanus.word
press.com/2016/01/08/a-
whole-system-approach-
for-mental-health/

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Think Intelligence, Think Intelligently
What does whole system look like?
Critical Success Factors
1. A clear shared view of the system
2. Ability to focus up and down from system to particular issues
3. Leadership across the system
4. Understand need using data and peoples knowledge
5. Agreed and set outcomes
6. Identified and prioritised interventions across the four domains
7. A balanced scorecard approach to this
8. Multiple actors, multiple partnerships, shared vision – a
programme approach
9. Evaluate and iterate

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Think Intelligence, Think Intelligently
HWBB Report
• HWB - a whole systems report out of this

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Think Intelligence, Think Intelligently
What does whole system look like ?
Interventions
1. Invest in good parenting – reducing the cost of conduct disorder
and other problems in later life
2. Maternal Mental Health during and after pregnancy, including
quick access to cognitive behavioural therapy as a priority
3. Ensuring the key role of schools in mental health is delivered
4. Primary School is key, and the first major external influence on
childrens’ resilience
5. The whole school approach is the most effective thing you can do
6. Ensure good adult resilience and early intervention
7. Workplace interventions pay off – the positive and supportive
psychosocial working environment is a key part of this
8. Early identification
9. Reducing loneliness – a big task for resilience as well as recovery

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Think Intelligence, Think Intelligently
What does whole system look like ?
Interventions
1. Address alcohol issues especially where it’s used for self-
medication. You could do the same on drugs and tobacco
2. Zero suicide – we have to be ambitious
3. Relapse Prevention especially for psychosis
4. Support Recovery , always and in every service
5. Ensure you address physical and mental health Identify and
address unmet need, especially in people with long term
conditions
6. Liaison Psychiatry in every Hospital
7. Smoking – get people off tobacco,
8. Make it happen using a system public health approach
9. Reduce stigma and increase awareness

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Think Intelligence, Think Intelligently
Startingwell
Promote good parental mental and
physical health to improve early child
development and wellbeing
 Universal routine enquiry and targeted treatment for women at risk of depression
 Home visiting programme and health visitor training for post-natal depression, as part
of a package of measures to improve perinatal mental health.
 Screening of all pregnant women in peri- and post-natal stage for low mood
and depression
Promote maternal wellbeing to reduce
adverse outcomes of pregnancy and
infancy
 Robust referral and treatment services set up to provide care to those screened
positive
Developingwell
Promote good parenting skills –
universal and targeted early
intervention programmes for common
parenting problems
 Universal access to training programmes:
a) community based group programmes; home based individual programmes,
b) pre-school/ early child education programmes, supporting development of home
learning environment.
c) prioritizing support for parents from higher risk groups and with children with emotional
and behavioural problems.
 Monitoring uptake and quality of service provision for commissioned and
developed services.
More intensive interventions for high
risk families to prevent conduct
disorders.
 Evidence of Service User and Carer consultation and involvement.
 PH Outcomes Framework - Numbers of children admitted with deliberate injuries
PH Outcomes Framework - Emotional well-being of looked after children -
Build social and emotional resilience of
children and young people through
whole-school approaches including
prevention of violence and bullying.
 School based Social and Emotional Learning (SEL) programmes achieving pupils’
core competencies.
 Self-management& social skills training and mentoring programmes
 School based violence prevention programmes incl sexual abuse and bullying.
Workingwell
Improving working lives:
a) support for unemployed
b) create healthy working environments
c) early recognition and intervention for
those with mental health problems
d) supported work for those recovering
from mental illness.
 Workplace screening for depression followed by CBT where indicated.
 Early intervention to reduce risks of unemployment through primary care and Job
Centres and early intervention to promote engagement and participation of those
who become unemployed.
 Stress management: tailor interventions to the needs of the particular worksite,
types of stressors etc.
 Supported work for those recovering from mental illness.
 Uptake and evaluation of information campaign resources
 PH Outcomes Framework - Self-reported well-being, Suicide Rate,
Employment
 Number of people attending annual GP health-check
I
Livingwell
Improving quality of life through
increasing opportunities for
participation, personal development and
problem-solving that enhance control
and prevent isolation.
 Access to social interventions in primary and community care pathways: through
social prescribing – specifically volunteering, including timebanks, exercise, arts
and creativity, learning and educational opportunities, green activity.
 Signposting to welfare advice, particularly employment, benefit uptake, debt
management, financial literacy and information and self-help.
 Debt counselling and advice.
 PH Outcomes Framework - Suicide rate
 PH Outcomes Framework - Under 75 mortality rate for people with severe
mental illness
Implementation of initiatives to prevent,
identify and respond to emotional,
physical and/or sexual abuse.
 Multi-agency information sharing on alcohol-related assaults
 School based violence prevention programmes including sexual abuse and bullying
prevention.

Integrating physical and mental
wellbeing through universal lifestyle
programmes to reduce smoking and
obesity, and to encourage exercise.
 Universal access to lifestyle programmes.
 Target people with long term conditions who are known to be at risk of depression.
 Encourage good nutrition and diet.
 Number of smoking cessation quit attempts.

Tackling alcohol and substance abuse,
including direct measures with those
abusing alcohol
 Target problem drinking and alcohol abuse through multi-sectoral action (health,
local authority, police, education etc.
 Screening and brief intervention in primary care.
 Reduce the prevalence of obesity in Hertfordshire
Community empowerment,
improvements in physical and social
environments, and strengthen social
networks.
 Include encouraging active travel, reducing effects of traffic, functionality of
neighbourhood, safe green environments, community arts and culture, volunteering.
 Measurement of population well-being through census

Ageing
well
Improve the quality of older people’s
lives through psychosocial interventions
and enhanced physical activity
 Physical exercise (dance, gym, walking) on prescription.
 Falls prevention through social support and education
 Opportunity for volunteering activities
 Opportunities for life long learning.
 Number of services becoming Dementia Friendly with a particular focus on
pharmacies, libraries, fire service and CSW Sport.
 PH Outcomes Framework – Dementia Diagnosis rate

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Think Intelligence, Think Intelligently
Key organisation that influence and
shape the mental health well being