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By Harriet Ernstsons Friday 11 January 2013 Updated: 11/01 15:53
MORE than a quarter of people will experience some sort of mental health issue in their lifetime.
The prevalence of these sorts of conditions is almost as high as illnesses such as cancer and heart disease but perhaps less is known about how mental health is treated and where the money intended for emotional rather than physical needs goes.
Worcestershire commissioning manager David Hitchen spoke to Standard reporter Harriet Ernstsons to explain the system.
IF THE national estimate of one in four is reflected in the population of the county, it would mean upwards of 125,000 Worcestershire residents have or will at some time feel vulnerable, depressed or stressed.
The first port of call for many of these residents will be to contact their GP which could see them referred on to a specialist for primary, secondary or acute care.
Many will be able to be treated through primary care while between 8,000 and 10,000 will need secondary care - more intensive forms of treatment. The numbers needing acute care - where they are admitted to hospital - are much smaller, with around 54 inpatient beds in the county spread across Worcester and Redditch and the option to place residents out of the county if needed.
Funding is given out on a county basis, rather than each area receiving a certain amount.
Mr Hitchen said: “We don’t specifically say we’ve got funding for Redditch, Bromsgrove or any other district. There is around £50 million available for Worcestershire, £41 million of that comes from the NHS and the rest from the county council.”
The job of the commissioners is then to purchase services based on the needs of the population.
Much of their work is done by talking to the groups involved, whether it is the clinicians who provide the services or the residents actually using them, and balancing what they say against national policies and guidelines.
The biggest provider of mental health services each year is the Worcestershire NHS Health and Care Trust, but there are a number of other smaller providers used across the county.
They also work in partnership with other organisations such as Clinical Commissioning Groups on projects such as enabling each GP practice to have its own mental health worker. A pilot in Evesham, which will be rolled out across the county, saw inappropriate referrals to other services drop by 80 per cent.
Liaison services are also being developed in the A&E departments at the Alexandra and Worcestershire Royal Hospitals. This would see patients being treated by psychiatric or alcohol liaison nurses when they attend A&E in a bid to stop them needing further treatment later on.
Commissioners and health professionals track the progress of those needing services on a chart which ranges from self help to secure and acute care, with the aim being to integrate the person back into the community no matter which of the treatments they are currently undergoing.
“There are a number of providers who help integrate people back into the community. They are coming back down [the chart] as they get better and eventually get out of the system and get discharged,” Mr Hitchen added.
“They are supported back into the community and there are a plethora of agencies and organisations helping them including those from the voluntary sector and housing associations. A holistic approach is needed for the individual to work well within the community.
“When we’re in a recession, a lot of people lose their homes or have marriage breakdowns and we do see higher incidents of people coming into the system and of suicides. We are looking at caring for people at home and putting preventative services in place to stop people going on to have more severe and enduring mental health problems. We deal with them at the point they need primary care so they don’t get as poorly which also helps with our costs as we are not going to get any more funding.”
The economic climate means funding has flatlined and around £20 million spent on mental health is needed to be saved nationally over the next five years.
This means commissioners are looking at ways they can work with the NHS Health and Care Trust to ensure there is no cut in services while savings are made.
Their priority at the moment is early intervention which, as well as hopefully helping a patient earlier and more effectively, is also a cheaper option than the more acute services.
Changes in the services are implemented following consultations with groups including service users. Currently around 300 people who have mental health issues provide feedback to commissioners to help develop and design services.
“The mental health strategy from the Government says there is no health without mental health and the key emphasis is on ‘no decision about me without me’.
“The principle within commissioning is we want to hear what people have got to say and want them to help us plan and make changes.
“It is critical for us as commissioners to hear the voice of the people and hopefully the right infrastructure is in place to do that.”
But how can Mr Hitchen and his team determine the success of the services they have commissioned?
“For me it’s about the outcomes for people. There are a whole series of mental health outcomes for individuals and these people being given the opportunity to take a journey and integrating back into the community shows how successful the system is.
“For those people who have got severe and enduring mental health problems and will take a long time to get better, it’s about providing them with a service that meets their needs.
“You are going to have people who are never going to recover, so the aim is to provide them with support to enable them to live well with mental health.
“It is all based around the service user and is about ensuring people live well with dementia or whatever they have.”
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