News from The New Savoy Conference: Psychological Therapies 2016
News and updates from today's conference focusing on; getting the balance right between access targets and high quality evidence based therapy, and staff wellbeing - with the launch of a new charter.
OPENING SESSION: The roadmap to compassionate mental health
Jeremy Clarke CBE opened todays conference highlighting the focus on staff wellbeing this year.
A personal and professional view was given by Dr Chris Manning who discussed his own experience of depression as a GP, followed by GP Dr Lise Hertel who discussed her experience of bullying and the impact on psychological wellbeing.
The session was chaired by Prof SimonWessely, President of the Royal College of Psychiatrists introduced Paul Farmer and Jacqui Dyer Chair and Vice Chair of the Mental Health Taskforce who discusssed the forthcoming Mental Health Taskforce findings which is due to report soon. Jacqui emphasised that people with lived experience has been involved collaboratively and co produced the Taskforce.
Karen Turner, Director of Mental Health at NHS England talked abbout the roadmap to compassionate mental health care. Karen's slides are available here Karen discussed the likely taskforce recommendations stating that:
-promote good practice in managing staff to prevent stress and mental health problems
-ensure managers are competent to support staff affected by stress or mental health problems
-access mental health expertise within occupational health services
-anxiety and depression for people with long term physical conditions, co located teams
Karen said that the Charter which will be released today and is available here is an important development.
Karen stated that the next steps for psychological therapies were:
-Continue to expand choice of therapies
-Greater use of digital platform
-Expansion of employment advisers
Recognise the benefits of IAPT for people with SMI:
-Staff trained in NICE recommended treatments
-Outcome and reporting monitoring for all patients
The conference continued with a presentation from Dr Matthew Patrick, Chief Executive at South London and Maudsley NHS Foundation Trust who picked up on the issue of staff describing the NHS as a living breathing human entity, Matthew said we are expecting a huge amount from the people who are delivering our services and we need to support them, listen and understand what its like for them. We have got to make space for the role that psychological therapies and psychological mindfulness has in the changes we need to deliver.
Questions discussed the role of integration of physical and mental health services, the role of GPs and primary care, the role of the workforce, shortages and limitations on training the quantity of psychologists and IAPT professionals that are needed to deliver an effective service. Prof David Clark National Clinical Lead IAPT at NHS England discussed new monies coming on board to train new IAPT therapists which will be discussed in more detail later today.
The issue of supporting peoples mental health when in work was discussed, and the crucial role of the GP in ensuring prompt treatment and referral. Paul Farmer said "we need to make sure that where there are evidence based approaches recommended by NICE we have to ensure people get access to them."
John Pimm, Clinical Lead for Psychological Therapies in Buckinghamshire questioned the panel on ensuring the investment gets to the psychological therapies services when commissioners are so short of money. Karen Turner responded to say that it should get there eventually, that data is critical. Karen said its hard in a devolved NHS and the way to manage this has to be through accountability and transparent data to ensure we see what local people are getting for their money. The money saved through IAPT should be quite considerable - reduction in medication etc should go back into services. Karen said "We need time to understand the evidence really does work and we need to make this a reality". Matthew Patrick said CCG baselines are not always the safest place for dedicated spend. Paul Farmer stated that we have to look at local communities and devolution gives us that opportunity, the risk with devolution is that other priorities will overtake mental health. The key is to unlock the voice and engagement so that mental health becomes priority. We are going to create a framework with clear ambitions but local communities can really run with it to meet local needs. Jacqui Dyer emphasised the importance of experts by experience, and people with a passion for mental health having a voice at the table where these decisions are being made locally.
SESSION 2: QUESTION TIME- THE GOVERNMENT PLAN FOR PSYCHOLOGICAL THERAPIES
Mark Easton, Home Editor at the BBC opened the sesson and introduced Luciana Berger, Shadow Cabinet Member for Mental Health. Luciana said "I hope you will agree that we have seen mental health rise up the political and public agenda", but that despite progress that has been made there is still much work to do, and highlighted that GPs often have to treat people with medication rather than talking therapies due to limitations on availability and quoted the statistics on prescribing of antidepressants. Luciana talked about marked differences in psychological therapies across the country. She said "we know that waiting lists for specialist treatments are still too long". Luciana quoted a 30 week wait for students needing psychological therapy in her own area, and also discussed concerns around drop out and recovery rates.
Anecdotally we know from professionals that cases are much more complex than anxiety and depression where CBT is not appropriate. More and more therapist are reporting seeing a revolving door as people who do not get what they need are coming back to services. Luciana also discussed issues around childrens services, services for older people and for black and ethnic minority communities.
Luciana stated that "I very much welcome the charter for psychological well being and resilience" which is launched at this conference. The New Charter for Wellbeing is available here . I am looking forward to the publication of the long awaited taskforce report, which is expected to identify a funding gap in mental health. Luciana concluded by discussing the NHS Constitution, "if we are serious about addressing parity of esteem, and the bias in the system against mental health we must look at a right to psychological therapies in the constitution".
Highlighs from Alastair Burt Speech - Full speech to follow shortly : Alastair Burt MP, Minister of State for Community and Social Care then talked about the development of mental health services. He opened by saying "we have seen a dramatic shift in the way mental health is treated in this country", he discussed a parity between mind and body in terms of key area to hold the NHS to account. The IAPT programme recieved an investment of over £400m which led to increased accessibility, IAPT remains one of the great successes, over £1.7m people have completed treatment with 700k in recovery. IAPT is helping people to move on with their lives and make changes, moving off sick pay and benefits, making a real difference. The IAPT data set represents the gold standard in data collection. Your expertise and dedication is exemplary and thank you.
Alistair continued to say we need this development to continue as IAPT isnt without its problems - there are huge variations around the country and such wide variaton is unacceptable. On rates of recovery the national average has improved over time to 45.7%, we have to ask how we reach the 50% target set for March 2017. There are some key groups under representated - black and ethnic minority populations and older people. We need to understand why and make improvements.
I do want to put an end to the variation of quality and access, we want to raise quality to those of the best. We've seen great progress over the life of the IAPT programme and I fully expect this to continue. It is shocking that up until now specific waiting times didnt exist for mental health.. so we are correcting this, mental health waiting times have been introduced. We will always give patients a choice on how they want to be treated.
On serious mental illness - we need to intervene as early as possible. For psychosis the aim is 2 weeks.
We are investing in the IAPT workforce. We are making sure we are giving more funding than ever before - in the recent spending review we announced an extra £600M for mental health. We are also awaiting the taskforce report for the next few weeks. I look forward to the next stages of IAPT - we have achieved great things through IAPT in a relatively short space of time. Improvements wont be made unless you feel valued - I am very interested in the charter and need to discuss it with Simon Stevens at NHS England. There is no doubt that the issue of who cares for the carers is a constant issue. I take really seriously the reports of the survey and the charter - I have to go away and talk to Simon Stevens but we have to ensure that people are getting the care and support they need to deliver the care effectively. I am very interested in taking this forward and discussing what we need to do.
Dr Amra Rao from the British Psychological Society then discussed the findings from the staff wellbeing survey of psychological professionals. She said the findings are really alarming. Psychological therapists are reporting low levels of job satisfaction in relation to other NHS staff. Amra said she would like to know how the Minister will hear these voices. "We had almost 1400 people responding to our survey, they are definately telling us that they are in trouble". In my view and view of working group that are sitting here we have put together the case for the charter, these findings should alarm us. Amra said we are not getting the balance right for supporting our staff. Amra quoted Simon Stevens "we need to put our house in order first". We need to embody the values of compassion and collaboration ourselves. The question to the minister and shadow minister are "Do you support us taking on this challenge, what is your offer, what needs to happen to reset the balance?".
Questions and Discussion
Mark asked what people are reporting in the survey that is causing these issues. Amra stated that key issues were autonomy and not being able to use their clinical decision making and targets.
Mark questioned Jacqui on the taskforce and autonomy on how the money is spent. Jacqui said the thinking is to try to make decision making more transparent at CCG level. There is an element of recommendations on improving transparency in decision making. The well being of the workforce is one of the key themes that informed the taskforce strategy. If the workforce isnt treated with care and compassion then they cannot deliver care effectively.
The panel was questioned on
- Suicide in men. Alastair Burt said there tends to be 3 to 1 in terms of men compared to women, there has been a slight increase, we are aware of it, it is likely to be in the taskforce recommendations
- Education and training in IAPT - with announced changes to non medical training budgets post 2017 to the HEE budget, how will the IAPT training programme going to be preserved post 2017. Alastair Burt said "we have to as we want to expand and it does have specific money attached to it, if we want to expand we have to carry the workforce with us". I've got to make sure some of the dedicated money for IAPT goes to workforce. Alastair said he was very dissapointed with the BPS survey results - he said I cant be on platforms talking about a Rolls Royce Service if it is rusting underneath me. I take the survey so very importantly. That is my commitment to look at that.
Mark Easton said "dont you just have to tell the CCG - spend the money on mental health". Alastair said we have told CCGs they have ensure that they have increased their spend on mental health in line with the increased percentage in funding. Luciana stated that there is still huge variaton in percentage spending on mental health by area.
SESSION 3: LEADING THE WORLD IN EVIDENCE BASED THERAPIES
UPDATE FROM NHS ENGLAND - ADULT AND CHILDREN AND YOUNG PEOPLE IAPT
Prof Jamie Hacker Hughes President of the British Psychological Society opened this session.
Prof David Clark, National Clinical Lead for Adult IAPT at NHS England delivered an update on IAPT services, lessons from national data and recovery rates.
David said services with higher recovery rates have:
•Higher average number of sessions
•Use stepped care appropriately
•Core of experienced staff
•NICE compliant treatment
•High problem descriptor (ICD-10 code) completeness
•High paired outcome completeness rates
•Low DNA rates
•Shorter wait times
David said leadership is crucial particularly whether leaders were focused on whether the patient got better rather than simply access or numbers.
An NHS England workshop with some high recovery rate services found consistent themes of:
–Leadership focused on recovery and reliable improvement data in an inquisitive and staff supportive manner
–Staff get personal feedback benchmarked against service average or other therapists
–Personalized CPD programmes for staff
Prof Peter Fonagy, National Clinical Lead for CYP-IAPT discussed the Children and Young Peoples IAPT Programme.
Kathryn Pugh, CYP Mental Health Programme Lead discussed the Future in Mind Report available here and implications for IAPT services and updated delegates on the IAPT programme - see above slides. Kathryn also discussed the my mental health services passport programme and an online toolkit with young minds to help services to work with parents and involve parents more.
BREAK OUT SESSIONS - FURTHER INFORMATION TO FOLLOW
CLOSING DEBATE SESSION
Norman Lamb MP, Former Minister for Mental Health chairs the final session where Prof David Healy, Psychiatrist and Director of North Wales Department of Psychological Medicine at Cardiff University who discussed evidence on depression.
OPENING KEYNOTE: DEFENDING QUALITY SO THAT VULNERABLE PEOPLE DON'T LOOSE OUT
Chaired by Paul Burstow, Chair of Tavistock and Portman NHS Foundation Trust, Dr Clare Gerada gave an honest and open account of her own experience and the "loneliness of leadership" and the vital role of supervision in building resilience of staff.
Prof David Haslam CBE Chair and NICE opened Day 2 of the New Savoy Conference looking at the new NICE Guidelines for Depression.
Prof David Haslam's powerpoint presentation is available here
Prof Haslam gave a brief history of NICE and the Depression in Adults Guidance which is due for publication in May 2017. Information on the developing Guideline and register as a stakeholder here. Project documents to date can be accessed here
Prof Haslam went on to note specific recommendations from the guidance
SESSION 2: ANY QUESTIONS? THE GOVERNMENT PLAN TO PROVIDE EVIDENCE BASED WELFARE SUPPORT TO THOSE WITH MENTAL HEALTH PROBLEMS
Mark Easton, Home Editor at the BBC returns to chair this session welcoming Theresa Grant, Chief Executive of Trafford Council, representing the Manchester Trailblazer, and Lord Freud, Minister for Welfare and Reform.
Lord Freud announced that the new joint work and health unit will invest £150m in integrating health and mental health and employment support for people who have barriers returning to employment.
Eating Disorders: Developing a Gold Standard Service
Towards Zero Suicide: Preventing Suicide, Saving Lives
Smoking Cessation in Mental Health
Improving the Quality of Perinatal Mental Health Services
Improving Services & Outcomes for People who Self Harm
Improving Mental Health Services for Men
Download: Full event programme
3 February 2016