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A Better Future in Mind Mental Health Services in the North West October 2008 Snapshot of the North West

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A Better Future in Mind Mental Health Services in the North West October 2008 Snapshot of the North West A better future in mind Mental health services in the North West October 2008 Snapshot of the North West Cumbria 487,000 people Includes: Carlisle Penrith Kendal Lancashire 1.4 million people Includes: Blackburn with Darwen Blackpool Burnley Chorley Merseyside Lancaster 1.5 million people Morecambe Preston Includes: Halton and St Helens Knowsley Liverpool Sefton Wirral Greater Manchester 2.5 million people Includes: Ashton, Leigh and Wigan Cheshire Bolton 864,000 people Bury Includes: Heywood, Middleton and Rochdale Chester Manchester Crewe Oldham Macclesfield Salford Warrington Stockport Tameside and Glossop Trafford 2 Contents Background Why have a Commission on mental health services? 5 What did we find? 7 Some long-standing problems 8 How have we been trying to address these long-standing problems? The engagement of service users, carers 11 and the public How can we make the voice of service users, carers 13 and the public more powerful? Commissioning and investment 16 How can we strengthen commissioning to 18 achieve more change? How can we change patterns of investment? 23 Developing staff 24 How can we enable staff to deliver better services? 24 Conclusion 26 Summary of recommendations 27 An electronic version of this report with active internet links is available at: www.northwest.nhs.uk/projects/mental_health_commission/ This webpage will also direct you to additional information, reports and references cited in this report. 3 A better future in mind mental health services in the North West Introduction A better future in mind NHS North West Commission on mental health services This report is the culmination of a that our recommendations will by a cross-section of bodies in year-long piece of work sponsored have a positive impact for them England; Sir Jonathan Michael’s by NHS North West, the region’s all. During our work we found independent inquiry into health strategic health authority (SHA), no shortage of passion and services for people with learning and shows its commitment to commitment for improvement disabilities and the Bradley advancing mental health services. but despite this, some significant Review and Dementia Strategy problems still persist. These Consultation currently under way It recognises the challenges problems predominantly relate will all need to be taken forward which people with mental health to the wider system within together to find ways to improve problems across the North which services are delivered, mental health services. West face and the difficulties of including the engagement of tackling these in the NHS and We commend this report to the those we should be seeking to other sectors. It also recognises SHA, the NHS and social care serve, choices and priorities for that much progress has been community, the independent investment and the focus of our made through the dedication sector and, most importantly, responses on treating illness rather and enthusiasm of staff and the people across the North West who than trying to avoid it. contribution of service users, their either are, or could be, affected carers and the wider community. We have looked at the way these by mental health problems. Much of this progress has been problems have been tackled Pursuit of our recommendations made as a result of the 10-year and reviewed the effectiveness can and will make a significant National Service Framework for of these approaches. We have contribution to ensuring that the mental health published in 1999. made recommendations which people of the North West access As the framework now nears will strengthen the system overall better services and have better its end it is time to evaluate its and be more effective in finding mental health for many years to impact and consider how best to lasting solutions to these come. take the agenda forward over the long-standing problems. John Boyington coming years. We have also tried to identify Chair Most of the money spent on some of the places and projects mental health goes through the where very different, innovative NHS and as such we have focused and imaginative things are our attention there. However, happening to demonstrate We have also tried we are very aware of the part what can be achieved. We have “ to identify some of played by a wide range of other included examples of these in an the places and organisations and have sought to electronic annexe to this report. projects where reflect this in our report. This report does not sit in isolation very different, We have tried to consider the nor can it be taken forward alone. innovative and needs of all client groups in the Locally and nationally, the past six imaginative things North West. Whilst the report months has seen the publication are happening to does not identify issues and of other relevant reports. Healthier demonstrate recommendations for each one Horizons published by NHS North what can be of these groups, we believe West; Vision 2015 produced achieved. 4 ” Background Why have a Commission on mental health services? Significant changes have been and healthy eating, the North mental illness. seen in mental health services West does consistently badly. Such a high level of population since the introduction of the It is not surprising, given this need requires investment, National Service Framework for relative deprivation, that the efficiency, innovation and quality Mental Health (DH, 1999). The psychological well-being of the from those who commission and SHA took a decision to review people of the North West is also provide mental health care and the impact of these changes substantially below the national services to prevent illness and in the North West and use the average. Relative to the other promote mental well-being. But findings to set a new agenda for regions of England the North is this the case in the North West mental health. West has: and what could be done not only Mental health problems are • the second-highest rate of to meet these challenges but to common. Nationally, one in people on incapacity benefit for make the North West’s mental six people has a mental health mental or behavioural disorders health and mental health services problem that requires treatment something to be proud of? • the second-highest suicide and one in four GP consultations rates for men and women under involves a mental health the age of 75 component of some kind. The Figure 1 cost of poor mental health to • the third-highest rate of drug the national economy has been misuse. • The North West has the estimated to be as high as £110 The high use of health services highest level of hospital billion a year in the UK is also a reflection on the poor admissions for depression and Friedli & Parsonage (2007) psychological well-being of the anxiety at 55 per cent and www.niamh.co.uk population www.nepho.org.uk 29 per cent above the national Personal costs can also be high (Figure 1). average respectively with people who experience Factors that can increase the risk • The region’s rate of hospital a prolonged mental health of mental health problems in the admission for schizophrenia problem or have a severe North West include a higher-than is also the highest nationally and enduring mental illness, -average unemployment rate and – 39 per cent higher than the often living in poverty and one of the lowest employment national average experiencing a lower quality of rates amongst people once they • It has a hospital admission life. have a mental health problem. rate for self-harm 26 per cent According to national statistics The recent review of the higher than the average for the North West of England health of Britain’s working age England is the second most socially population (Black, 2008) • It has the highest rate of deprived area of the country. www.workingforhealth.gov. hospital stays for alcohol- Data available on the North uk reported that initiatives to related problems West Public Health Observatory help people back to work, while website www.apho.org.uk successful overall, have had a show that on indices such as life limited effect for those whose expectancy, children in poverty main health condition is 5 A better future in mind mental health services in the North West Background What the Commission did The Commission was set service users, carers, family behalf with 35 groups of up in September 2007 to members and the general public. stakeholders from across the review mental health services We also received evidence region whose voices often go in the region and make from commissioners, service unheard. recommendations that would providers, voluntary and private We studied information ensure that world-class sector organisations, social collected on services including services are being consistently care and other local authority reports of bodies such as the provided for the people of service providers, criminal justice Healthcare Commission, the the North West. Further professionals, professional bodies Mental Health Act Commission, information on Commission and trade unions. the Commission for Social Care members is available at www. We held meetings across the Inspection and HM Inspectors of northwest.nhs.uk/projects/ North West to hear stakeholders’ Prisons and Probation. mental_health_commission/ views on current services, their Biographies.html We used information and data strengths and short-comings. from existing reports written The Commission was supported Particular attention was paid about mental health services in by a reference group made to reaching people whose the North West over the past five up of 43 regional and national views are often not gathered, years including the enquiries into stakeholders, at least a quarter including children, older people, homicides committed by patients of whom were service users or people with a learning disability, in the care of mental health carers.
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