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Topic on a Page - Mental Health (Adults)

Data Sources:

Public Health England (PHE):

Public Health Profiles

Mental Health Dementia and Neurology

Data Profiles: Co-occurring Substance and Mental Health issues

Mental Health and Wellbeing JSNA

Supporting Information:

Mental Illness Health Needs Assessment (2016)

Mental Illness Health Needs Assessment for Lincolnshire (2014)

Investigation into the Prevalence of Mental Health Disorder and Patterns of Health Service Access in a Probation Population

National Institute for Health and Care Excellence (NICE):

NICE Guidance: Mental Health and Behavioural Conditions

Mental health of adults in contact with the criminal justice system [NG66] 2017

Violent and aggressive behaviours in people with mental health problems [QS154] July 2017

Multimorbidity [QS153] June 2017

Transition between inpatient mental health settings and community or care home settings [QS159] September 2017

Post-Traumatic Stress Disorder [NG116] December 2018

Pathway:

Common mental health disorders in primary care overview

Mental health problems in people with learning disabilities

Service user experience in adult mental health services overview

Antenatal and postnatal mental health overview

Coexisting severe mental illness and substance misuse: community health and social care services overview

Mental wellbeing and independence in older people

Promoting mental wellbeing at work overview

King's Fund:

Mental Health

Mental Health Foundation:

Mental Health Foundation

NHS England (NHSE):

Mental Health - Adults

A practice primer on Mental Health in Older People

NHS Evidence:

Mental Health and Wellbeing

Anxiety

Bipolar Disorder

Depression

Eating Disorders

Obsessive Compulsive Disorder

Panic Disorder

Personality Disorder

Post Traumatic Stress Disorders

Postnatal Depression

Psychosis

Schizophrenia

Seasonal Affective Disorder

Department of Health:

Mental Health Service Reform

Joseph Rowntree Foundation (JRF):

Mental Health

Social Care Institute for Excellence (SCIE):

Mental Health Problems Resources and Services

Mental Health Resources and Services

Lincolnshire Partnership NHS Foundation Trust

LPFT Home Page

Steps2Change

Public Health England

Prevention concordat for better mental health

Mental health services - Cost effective commissioning

Prevention concordat for better mental health: planning resource

Psychosocial pathways and health equity report

Better Mental Health: JSNA Toolkit

ACAS

Mental Health in the workplace

Institute for Alcohol Studies:

Institute of Alcohol Studies: Alcohol and Mental Health: Policy and Practice in England Published: April 2018

House of Commons Library Briefing Papers:

Mental Health Policy in England

Linked Topics:

Topic last reviewed: Dec-18

JSNA Topic: Mental Health (Adults)

Background

"Mental health problems are widespread, at times disabling, yet often hidden. One in four adults experiences at least one diagnosable mental health problem in any given year. People in all walks of life can be affected and at any point in their lives, including new mothers, children, teenagers, adults and older people. Mental health problems represent the largest single cause of disability in the UK. The cost to the economy is estimated at £105 billion a year – roughly the cost of the entire NHS."
(Source: The Five Year Forward View for Mental Health: A report from the independent Mental Health Taskforce to the NHS in England, Feb 2016.)

People in particular social groups for example; Black and Minority Ethnic, Lesbian, Gay, Bi-sexual, Transgender (LGBT), people that have some form of disability, veterans and members of the armed forces community or those in contact with the Criminal Justice System, are all at greater risk of developing mental health problems. For children and young people, 50% of mental health issues are established by the age of fourteen, rising to 75% by the age of twenty four (Source: Mental Health Foundation).

Research undertaken by the Mental Health Foundation shows that there are considerable links between homelessness, substance misuse and mental health. It is estimated that, in England, there are 58,000 people who experience multiple disadvantage of offending, substance misuse and homelessness, and 55% of these individuals also have a diagnosed mental health problem.

Parity of Esteem between mental and physical health, i.e. equality in how we think and value mental and physical health care, has been a priority for the Government since 2013. Whilst improvements have been made in mental health provision and follow-up, inequalities persist in access to good quality services. In England, mental health accounts for approximately 23% of activity within the NHS but only around 11% of the total expenditure.

This topic focuses on the needs of adults with mental health needs. Information relating to children and young people can be found in a separate topic - JSNA Mental Health and Emotional Wellbeing (Children & Young People) Topic.

Context

National Strategies, Policies & Guidance

The National Institute for Health and Care Excellence (NICE) provides 39 publications, covering the breadth of mental health and wellbeing subjects and includes guidance, advice, NICE Pathways and quality standards.

The Faculty of Public Health report, Better Mental Health for All: a public health approach to mental health improvement, (2010), sets out what can be done individually and collectively to enhance the mental health of individuals, families and communities by using a public health approach.

No Health without Mental Health – Mental Health Strategy for England (2011) sets shared objectives to improve people's mental health and wellbeing and improve services for people with mental health problems.

NHS England and the Department of Health jointly published "Improving access to mental health services by 2020" (2014). This set out a clear vision to ensure mental and physical health services are given equal priority in terms of timely access to high quality services.

Closing the Gap: Priorities for Essential Change in Mental health (2014), identifies 25 aspects of mental health provision where the government, health and social care commissioners, providers and other organisations can work together to improve outcomes for people.

The Mental Health Crisis Concordat (2014) is a national agreement between services and agencies involved in the care and support of people in crisis. It sets out how organisations will work together better locally to make sure that people get the mental health help they need when they are having a crisis.

Guidance for commissioning public mental health services: Joint Commissioning Panel for Mental Health (2015) was written by a group of mental health experts, in consultation with patients and carers.

The Five Year Forward View for Mental Health (2016) is the National Strategy for NHS in England covering care and support for all ages and provides a strategic approach to improving mental health outcomes across the health and care system. An implementation plan was published in July 2016.

Prevention concordat for better mental health (2017) aims to support local action around preventing mental health problems and promoting good mental health. Public Health England have developed and published a Mental Health Dashboard, which focuses on prevalence of mental health disorders, risk factors and protective factors for mental health, with the aim of supporting local systems with planning. The range of indicators within the dashboard cover the three approaches described in the Prevention Concordat for Better Mental Health: Prevention Planning Resource, which are whole population, life course and targeted prevention.

Also see current national policies and guidance in:
JSNA Autism Topic
JSNA Mental Health and Emotional Wellbeing (Children & Young People)
JSNA Dementia Topic
JSNA Suicide Topic

Local Strategies & Plans

The Mental Illness Health Needs Assessment for Lincolnshire was produced in December 2015. The aim of this health needs assessment was to identify the mental ill health needs of children, adolescents, and adults living in the County.

Key agencies in Lincolnshire collaborated to plan, develop and design a single approach aligned to the Lincolnshire Sustainability and Transformation Partnership (STP) to transform mental health and wellbeing services for people with mental health conditions in Lincolnshire through the Mental Health Crisis Care Concordat (MHCCC). The Priorities are to:

  • Commissioning to allow earlier intervention and responsive crisis services
  • Access to support before a crisis
  • Urgent and emergency access to care
  • Quality of care and treatment in a crisis
  • Recovery and staying well

Mental Health has been identified as a key priority in the Joint Health and Wellbeing Strategy for Lincolnshire approved by the Health and Wellbeing Board in June 2018.

A Memorandum of Understanding (MOU) has been agreed between Lincolnshire Partnership Foundation Trust (LPFT), Lincolnshire County Council (LCC), NHS Clinical Commissioning Groups in Lincolnshire, Lincolnshire Police, East Midlands Ambulance Service and the United Lincolnshire Hospital Trust. The MOU outlines the operational procedure for the management of places of safety and the detention of persons under sections 135 and 136 of the Mental Health Act (MHA) and includes those assessed within the community. The MOU also relates to actions taken under the following:

  • Mental Health Act 1983 (as amended by the Mental Health Act 2007 and the Policing and Crime Act 2017)
  • The Mental Health Codes of Practice 2015 (to be updated 2018/19)
  • The Mental Health Crisis Care Concordat and Lincolnshire's subsequent action plans 2015 and 2018
  • Care Quality Commission Report – A Safer Place to be (2014)

Multiagency Review of Mental Health Crisis Services in Lincolnshire was completed May 2018. It outlines 10 key recommendations to be implemented in order to improve mental health and maximise provision of mental health crisis services for people living in Lincolnshire.

Lincolnshire Armed Forces Covenant (2017) is a voluntary statement of mutual support between the civilian community and the local armed forces community. Supporting the health and wellbeing – including mental health and dementia - of veterans and members of the armed forces community is a key area of focus in the covenant.

The Working together to create safe, well communities – Policing and Mental Health Development Plan was commissioned by the Police and Crime Commissioner for Lincolnshire. It sets out opportunities for collaboration between mental health and policing.

Also see local strategies and plans in:
JSNA Autism Topic
JSNA Mental Health and Emotional Wellbeing (Children & Young People)
JSNA Dementia Topic
JSNA Suicide Topic

What is the picture in Lincolnshire

What the data is telling us

Estimates of mental ill health
Estimates of mental ill health for Lincolnshire have been calculated using national rates from the 2014 Adult Psychiatric Morbidity Survey (APMS) (Source NHS Digital), and applied to the latest ONS estimated population figures for Lincolnshire (2017) to estimate the number of cases of each mental health disorder in the County.

In addition, prevalence of GP diagnoses is shown for Lincolnshire, taken from the 2016/17 Quality and Outcomes Framework (QOF) dataset (Source: NHS Digital), which measures the proportion of patients within GP practices who are recorded on specific disease registers. For this topic, patients who are diagnosed and recorded on the mental health and depression registers are examined.

QOF allows practices to exclude specific patients from data collected to calculate achievement scores. Patients can be excluded from individual indicators if, for example, they do not attend appointments or where the treatment is judged to be inappropriate by the GP (for example; where medication cannot be prescribed due to side-effects).

  • It is estimated that 105,838 adults aged 16 and over suffer from a common mental disorder; this equates to 17% of the total adult population. Based on the APMS, women are more likely to suffer from a common mental health disorder than men.
  • Nationally, 4.4% of adults screened positive for post-traumatic stress disorder (PTSD), which would equate to 27,417 adults across Lincolnshire.
  • 3,113 people are estimated to have been living with a psychotic disorder during the past year.
  • There are around 20,545 people with an antisocial personality disorder and 14,942 with a borderline personality disorder.
  • It is estimated that 60,646 adults are considered a positive screen for Attention Deficit Hyperactivity Disorder (ADHD). Younger adults aged between 16 and 24 are more likely to be diagnosed with ADHD, compared to older adults.
  • Nationally, it is estimated that 2% of adults displayed seven or more characteristics of Bipolar Disorder, based on the Mood Disorder Questionnaire (MDQ); which equates to 12,213 adults in Lincolnshire.
  • 20.6% of all adults are believed to have had suicidal thoughts, however only 6.7% attempt suicide. These rates are more prominent in women than in men, and in adults aged 16 to 24. For further information see the JSNA Suicide Topic.
  • 2016/17 QOF data shows that 0.79% of GP registered patients (equating to 6,194 patients) are on the mental health register. This is a cumulative register of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses and other patients on lithium therapy.
  • Prevalence of mental health in Lincolnshire is below average at 0.79% (equating to 6,194 patients), compared to 0.92% nationally.
  • Prevalence of depression (Source: QOF) in Lincolnshire is above average at 10.06% (equating to 63,763 patients), compared to 9.09% nationally.

Hospital admissions
Data on admissions to acute hospitals are taken from the NHS Digital Hospital Episode Statistics (HES) dataset for the 2016/17 reporting year. Where rates are shown, numbers have been directly age and sex standardised, using the latest ONS estimated population figures for Lincolnshire (2017), as well as the 2013 European Standard Population (ESP). Please note this data does not include admissions to mental health units.

  • In Lincolnshire, there were 1,505 inpatient admissions due to mental ill health, representing 200.1 in every 100,000 residents. Admission rates in 2016/17 were higher for men (216.5 per 100,000 population) than for women (173.6 per 100,000 population). (Source: HES)
  • Hospital admissions due to mental ill health are 2.3 times higher for those living in the 20% most deprived areas of Lincolnshire (rate = 337 per 100,000 population) compared to those living in the 20% least deprived areas (rate = 146 per 100,000 population). This highlights a clear social inequality regarding linking mental ill health and deprivation.
  • In 2016/17 there were 277 inpatient admissions for mental and behavioural disorders due to alcohol, representing 39.1 in every 100,000 residents. This is significantly lower than the national rate of 72.3 per 100,000. (Source: PHE, Fingertips)
  • In 2016/17, there were 1,034 unplanned admissions to hospital due to intentional self-harm in Lincolnshire, which is a rate of 147.2 per 100,000 population. Rates of self-harm admissions in Lincolnshire are comparably lower than the national rate of 185.3 per 100,000. (Source: PHE, PHOF)

Mortality
Data for mental ill-health related deaths is obtained from ONS and looks at all deaths registered where mental health (ICD-10 codes F00- F99) was the underlying cause. As with hospital admissions, numbers of deaths have been directly age and sex standardised.

  • There were 827 registered deaths in 2017 as a result of mental health related causes. This is equivalent to 97.6 in 100,000 Lincolnshire residents. This is higher than the national equivalent mortality rate of 91.2 per 100,000 population.
  • More women (n=508) died from mental health related causes than men (n=319) in 2017, however due to the relatively small numbers, the mortality rates (male 95.9 per 100,000 population, female 98.9 per 100,000 population) are comparable. (Source: ONS via NOMIS)
  • Between 2015 and 2017, there were 195 registered deaths by suicide in Lincolnshire (9.8 per 100,000 population) of which 141 were male. Suicide rates in Lincolnshire are higher than the regional and national equivalents of 8.8 and 9.6 (per 100,000 population). (Source: PHE) For further information see the JSNA Suicide Topic.

Adult Care Short and Long Term (SALT) Return
Data from the 2015/16 SALT return stated that in Lincolnshire there were:

  • 3,450 requests for social care support from adults aged 18 to 64 presenting with mental health support needs
  • 175 people went on to receive longer term council funded support
  • 510 people aged 18 to 64 received long- term social care services during 2015/16, primarily as a result of their mental health needs; 140 of which required residential care.

Drug and Alcohol Misuse
Public Health England estimates there are 6,746 dependant drinkers (1.1% of the resident population) and 7,467 drug users requiring specialist substance misuse treatment in Lincolnshire with a further 22.1% (161,000) of the local population drinking at potentially harmful levels above 14 units per week (PHE 2018, commissioning support pack 2019/20).

During 2017/18 51.6% (643) (NDTMS) of clients entering drug and alcohol treatment were identified as having a mental health treatment need however research shows that 70% of drug users (1,437 in 2017/18) and 86% of alcohol users (559 2017/18) in treatment will be experiencing mental health problems yet there were only 26 referrals to local treatment services during this period from Primary Care, Hospitals and accident and emergency providers combined (PHE, 2018, Better care for people with co-occurring mental health and alcohol/drug use conditions) (PHE 2018, commissioning support pack 2019/20).

For further information see the JSNA Substance Misuse Topic.

Homelessness & Rough Sleepers

There are 639 households across the county who are accepted as being homeless and in priority need for accommodation. Lincoln (164) and South Kesteven (197) see the highest numbers in need (ONS, 2016/17).

In 2017, there were 62 reported rough sleepers in Lincolnshire, an increase of 88% on the 2016 figure (33). Government statistics suggests that of those who had a support needs assessment, 47% had mental health support needs. (Source: Ministry of Housing, Communities & Local Government).

For further information see the JSNA Housing and Health Topic.

Trends

Prevalence of mental health in Lincolnshire has risen slightly from 0.76% in 2015/16 to 0.79% in 2016/17 based on QOF registered outcomes. During the same period, prevalence of registered depression has also increased from 9.06% to 10.06%. Prevalence increases for both mental health and depression in Lincolnshire are in line with national increases.

The rate of hospital admissions due to mental ill health have decreased from 210.8 per 100,000 population in 2015/16 to 200.1 per 100,000 in 2016/17. During the same period, the rate of emergency hospital admissions due to self-harm has also decreased from 182 per 100,000 population in 2015/16 to 147 per 100,000 in 2016/17.

Year on year there has been a slight increase in the number of deaths due to mental ill health, from 738 registered in 2015 to 827 registered in 2017. This translates to a slight increase in the mortality rate from 86.3 per 100,000 in 2015 to 88.3 per 100,000 in 2016.

Deaths from suicide in Lincolnshire have remained relatively constant since 2010-12 when the rate was 10.5 per 100,000 population. The rate in 2014-16 has decreased slightly to 10.1 per 100,000 however rates continue to be comparable to nationally reported rates. For further information see the JSNA Suicide topic.

It is projected that between 2017 and 2035 (Source: POPPI and PANSI):

  • The number of adults aged 18-64 with a mental health problem will decrease by 1.1% from 69,343 to 68,611.
  • Cases of depression in people aged 65 and over will increase by 40% from 14,893 to 20,847.

Current Activity & Services

Specialist Mental Health Services are commissioned via a number of different arrangements. A number of specialist services including CAMHS tier 4 services and secure services for Adults are commissioned directly by NHS England. Outlined below are details of Specialist Mental Health services commissioned by local arrangement.

Service provision for adults - health
Services for adults are commissioned primarily through the four clinical commissioning groups through a contract with LPFT. South West Lincolnshire CCG acts as the lead commissioner on behalf of the 4 Lincolnshire CCG's.

Services provided by LPFT include; Mental Health inpatient beds, psychological therapies, psychology, psychiatry, occupational health, rehabilitation wards, and specialist support for those with an eating disorder, perinatal, crisis housing and memory assessment. There are also specialist services for adults with learning disabilities and autism (See LPFT website for full list of services provided). Social care for adults with a mental health problem is commissioned by Lincolnshire County Council Adult Services.

The Psychiatric Clinical Decisions Unit (PCDU) is available for people in severe mental health crisis. The service is based on the Lincoln County Hospital site at the Peter Hodgkinson Centre and provides a safe space for patients to have a thorough assessment of their needs for up to 48 hours. Patients work with professionals to help decide the best treatment and support for them, whether this is returning home with intensive support from professionals, or being admitted to a specialist mental health ward.

Psychiatric Intensive Care Unit at the Hartsholme Centre, based in Lincoln is a 10 bedded all male psychiatric intensive care service for people with acute mental health difficulties.

LPFT is working in partnership with other mental health services in the Midlands and East as part of the Midlands and East Veterans Service (MEVS). In conjunction with Mental Health Matters and charity Walking with the Wounded, the service aims to improve access to mental health services for Armed Forces, veterans, their families and carers.

The Perinatal Mental Health Services (PERIMNS) provides assessment, support and treatment for childbearing women with, or risk of serious mental illness who cannot be managed effectively by primary care or other mental health services. PERIMNS also offer advice and assistance to other professionals on the treatment and management of serious perinatal mental illness. Additional targeted services such as 'Birth after thoughts' (Lincoln based) support women who have had a difficult or traumatic delivery, and a ULHT service that works with families in the event of a miscarriage/stillbirth or neo-natal death. In 2018 LPFT were successful in securing funding via the NHS England Transformation Fund for the national expansion of Perinatal Mental Health services as part of the Five Year Forward View for Mental Health. For further information see the JSNA Maternal Health, Pregnancy and the First Few Weeks of Life

Service provision for adults – social care
Social care fulfils an essential role in meeting the needs of people with mental health problems who meet national eligibility criteria.

For working aged adults, Lincolnshire County Council (LCC) commission Adult Social Care services from LPFT via a Section 75 Agreement, which enables the Council to delegate its statutory social care functions to the Trust. Services commissioned include; Assessment and Care Management, Best Interest Assessments, Approved Mental Health Professionals (AMPH) and the Managed Care Network.

For Adults aged 65 and over adult social care support is provided or commissioned directly by LCC rather than via the LPFT Section 75 agreement.

Managed Care Network (MCN)
The Managed Care Network was formed in 2013 and is funded by the Mental Health Promotion fund which was established by Lincolnshire County Council and is managed by Lincolnshire Partnership NHS Foundation Trust. The aim of the network is to help prevent, manage and aid recovery from mental illness so people can enjoy the best possible quality of life. The network comprises a number of organisations from across Lincolnshire who provides a variety of activities including social and friendship groups, formal and informal learning, supported volunteering and community participation activities.

Managed Care Network for Autism
Lincolnshire County Council, under the Section 75 partnership agreement with Lincolnshire Partnership NHS Foundation Trust, has assigned £200k to the Managed Care Network which will specifically support the Autism agenda. For further information see the JNSA Autism topic.

Criminal Justice System
LPFT provide a Community Forensic Service in Lincolnshire. The countywide service provides care and treatment for individuals experiencing mental health issues who pose a potential risk to the public, by providing on-going assessment, treatment, support and risk management, and diversion at the earliest opportunity from the criminal justice system.

Nottinghamshire Healthcare NHS Trust provides a fully integrated mental health care service on behalf of the Prison Service in Lincolnshire, from initial assessment to the provision of services under the Care Programme Approach (CPA).

Housing Related Support
Lincolnshire County Council currently commissions various crisis housing support services around the county that support people, including those with mental health conditions funded through the CCGs. South Lincolnshire CCG fund the contract for mental health crisis house accommodation which is delivered by the Richmond Fellowship in Lincoln and Boston. Referrals come via the Mental Health Crisis Resolution and Home Treatment team and are as described to support service users for a short term in a crisis. The service aims are to provide a safe space in which to review the factors associated with a service user's emerging crisis with the aim of avoiding inappropriate hospital admissions and unnecessary dependence on other services. Staff will be there to listen and provide support; facilitating the individual to remain independent, but not to deliver therapy.

In addition, the County Council also commissions housing related support services comprising of emergency access accommodation based support, non-emergency accommodation based support, floating support, a rough sleeper outreach service, domestic abuse accommodation and mental health crisis housing. For further information see the JSNA Housing and Health Topic.

Drug and alcohol misuse
Lincolnshire Public Health commissions support for those that need help with drug and alcohol misuse. The service is currently provided by Addaction and Double impact. Many of the clients receiving these support services also suffer from mental health conditions. For further information see the JSNA Substance Misuse Topic.

Employment support for people suffering from mental ill health
Individual Placement Support (IPS) Scheme is a supported employment service for people with a mental health problem, whereby a beneficiary is helped to secure paid employment. Any support the beneficiary needs in order to sustain the employment can be provided both on and off the job and can include, if necessary, addressing skills and learning needs, and managing mental health problems. Pre-employment support can also be provided where required and this can include work experience if it is felt to be advantageous in helping a beneficiary to be 'job ready'.

The existing IPS scheme is managed and delivered by the Lincolnshire Partnership Foundation Trust (LPFT). LPFT were successful in securing funding via Wave 1 of the NHS England Transformation Fund for the national expansion of IPS services as part of the Five Year Forward View for Mental Health to enable the scheme to be rolled out across the whole county.

For services relating to children and young people see the separate JSNA topic on Mental Health and Emotional Wellbeing (Children & Young People).

Key Inequalities

Risk Factors
In relation to aspects of inequality there are a number of risk factors for the development of mental ill health. For example in childhood and adolescence key risk factors are; having a learning disability, being a looked after child, being homeless or sleeping rough, parental unemployment and lone parenthood. The risk factors in adulthood are numerous and include individual factors such as; loneliness, relationship difficulties and unemployment, social factors such as low socio-economic status, substance misuse and homelessness, and community and cultural factors such as ethnic minority group membership.

Parity of Esteem
This has been a priority for the Government since 2013 and is aimed at ensuring that mental and physical healthcare afforded the same importance. Mental health accounts for around 23% of activity within the NHS but only 11% of its expenditure. Some initiatives are contributing to this agenda, such as the introduction of maximum waiting times for psychological therapies. However, whilst improvements have been made, inequities persist in access to good quality services.

The message for service commissioners is that mental and physical health needs should be given parity, acknowledging that:

  • Individuals with poor mental health often do not have their physical health needs met.
  • Those with physical conditions, particularly long term, are at risk of developing mental illness.
  • Individuals with mental illness may require emergency assistance in the same way as someone with a serious physical condition, e.g. heart attack or stroke.

All of this has implications, not just relating to funding but also the need for a change in attitude and perception of the needs of people with mental health issues.

Gender disparities
According to the World Health organisation (WHO), gender is a critical determinant of mental health:

  • In the UK, 29% of women are likely to be treated for mental illness compared with 17% of men; this is not a reflection of actual prevalence
  • The lifetime prevalence rate for alcohol dependence is more than twice as high in men as in women
  • Men are three times more likely to be diagnosed with antisocial personality disorder than women
  • Recent data suggests that women are more likely to seek help at an early stage of mental ill health; and of those accessing psychological therapies, over 60% are female.

Gender specific risk factors for common mental health disorders that disproportionately affect women include; gender based violence, socioeconomic disadvantage, low income and income inequality, low or subordinate social status and rank and unremitting responsibility for the care of others. The higher prevalence of sexual violence to which women are exposed and the corresponding high rate of Post-Traumatic Stress Disorder (PTSD) following incidences results in women being the largest single group affected by this.

Social inequalities
The Marmot Report (Fair Society, Health Lives; 2010) argues that in order to reduce health inequalities, local authorities should invest both money and expertise in reducing socio-economic inequalities at a local level, with the direction of strategic planning based on findings from the ten key indicator comparators for England.

Rural and farming areas
Lincolnshire is a rural county with a large agricultural economy and with organisations such as Lincolnshire Rural Support Network; people working in the rural and farming areas are at risk of suffering from mental ill health that needs to be looked at in more detail.

There is considerable volatility in the market place for farmers, who rely heavily on the single payment supplement they receive via the Rural Payments Agency, which makes up around 75% of their profit. Any potential risk to this, therefore, will have a major impact on the finances of individuals and thus, it can be assumed, on their mental health.

During the year ending 31 March 2016, the Lincolnshire Rural Support Network (LRSN) helped 113 farming families with a range of issues, of which around 30% were stress related.

Substance misuse
Substance misuse is strongly associated with a range of mental health issues including depression, anxiety and self-harm. Research shows that more than half of suicides record alcohol or drug use as a contributing factor, while self-harming is often linked to alcohol dependence (Source: PHE, 2018, Better care for people with co-occurring mental health and alcohol/drug use conditions).

For further information see the JSNA Substance Misuse Topic.

Homelessness
The Mental Health Foundation reports that homelessness and mental health often go hand in hand. Having a mental health problem can lead to homelessness; equally poor housing or homelessness can increase the chances of developing a mental health problem or exacerbate an existing condition. The homeless population struggle to access healthcare and tend to rely on Emergency Departments at times of crisis which costs £85 million a year.

For further information on homelessness see the JSNA Housing & Health Topic

Unmet Gaps & Needs

Current data for the number of people registered with a GP, as having a mental illness does not reflect national estimates and cannot be assumed to be an accurate reflection of prevalence.

Good mental health promotion activities will help to maintain mental wellbeing. It is important that the signs and symptoms of all forms of mental illness are correctly identified and that the mental health register is fully and accurately completed and updated. The Quality Outcomes Framework (QOF) collects information on some mental illnesses, i.e. schizophrenia, bipolar affective disorder and other psychoses; however, those suffering from other forms of mental ill health need to be effectively identified to ensure that those in need can access appropriate treatment, services and support in a timely manner. It is also important to note that Secondary Care can categorise patients by clusters or disease coding which is used for reporting purposes nationally.

Some areas provide good treatment practice for those with co- existing mental health and substance misuse with joint meetings and coordinated care taking place however that has not been widely adopted across all mental health services and further work is required to ensure all those needing care receive it in a timely manner where a no wrong door approach is adopted across all services involved

Local Views & Insights

The review of mental health crisis services reported the following findings from service user and professional feedback:

  • Service users and professionals emphasise that people should be treated with compassion, empathy and kindness. People would like to come away feeling more positive.
  • Lived experience of mental health can help to build trust and understanding, and people are more likely to open up to someone who understands what it is like. Mental health awareness/customer service training should be provided for mental health staff and all initial points of contact, and the benefits of utilising peer support workers and volunteers was also noted.
  • Carers are key in supporting service users outside hospital, but they report a lack of support and information, and would like to be more involved in decisions regarding care provided.
  • Service users feel that a range of treatments and activities should be available as well as medication.

The Multiagency Review of Mental Health Crisis Services in Lincolnshire details the 10 recommendations as a result of the review.

Risks of not doing something

According to the Five Year Forward View for Mental Health 2016, mental health problems are widespread; one in four adults experience at least one diagnosable mental health problem in any given year. The cost to the economy is estimated at £105 billion a year. This demonstrates the financial implications of not taking mental ill health seriously.

Without appropriate support for those that are eligible for social care that also have mental health needs, plus universal preventative provision for those that do not meet the eligibility criteria, the likelihood is that the demand for specialist mental health services will increase.

Poor mental health is known to contribute to existing inequalities and can result in negative outcomes for those in need, particularly in relation to education, employment, housing, drug and alcohol dependence and the criminal justice system.

What is coming on the horizon?

Mental Health Hub
The Lincolnshire Mental Health Crisis Concordat was successful in securing capital funding in excess of £700K to develop ‘places of safety’ in both the Lincoln and Pilgrim Hospital Emergency Departments and to build a mental health hub. The new urgent mental health care hub will provide space for patients and carers to access advice and support from LPFT mental health services, alongside other supporting organisations such as housing and homelessness support, relationship advice, debt management, drug and alcohol services. This will include a 24/7 helpline.

Single System Mental Health Plan
The Five Year Forward View for Mental Health sets out mental health priorities to be delivered by 2021. In Lincolnshire these are detailed in the Sustainability and Transformation Partnership Single System Plan and system intentions. Work is underway to ensure that this aligns with justice and social care.

Managed Care Network
Lincolnshire County Council plan to host an event in early 2019 to recognise the amazing contributions and achievements of the Managed Care Network members over the last 5 years. Customers who have benefited from accessing projects and activities, along with key local businesses and public figures will be invited to attend and celebrate the successes of the Managed Care Network. As part of the event, one outcome is to develop the scope and breadth of the Managed Care Network to widen accessibility.

Employment support for people suffering from mental ills health
Lincolnshire County Council has expressed an interest to improve its performance against the Adult Social Care Outcome Framework (ASCOF) 1F indicator i.e. adults aged 18-69 in contact with secondary mental health services and on the Care Plan Approach (CPA) and in employment, and has made some funding available as a result in order to do some joint working with LPFT and provide some match funding for the IPS scheme. This would be on the basis that Lincolnshire County Council's contribution would only fund services for beneficiaries in the scope of ASCOF 1F. It is intended that the service level agreement for the delivery of the IPS on behalf of the Council will be managed through the Section 75 Agreement (LD) in the form of an additional schedule.

What should we be doing next?

  • Implement the recommendations from the Multiagency Review of Mental Health Crisis Services in Lincolnshire.
  • Deliver the JHWS Mental Health Priority Plan.
  • Data task and finish group – The multi-agency group will be set up to collate data from across the county on data relating to mental health. The group will also develop protocols for information sharing across organisations and facilitate the use of this data to improve access to mental health services.
  • Align mental health to integrated neighbourhood working
  • Train and develop a mental health workforce that can manage the needs of Lincolnshire's population

 

If you need to contact us about this topic, please email JSNA@lincolnshire.gov.uk

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