www.nmhdu.org.

uk

ISSUE 4 OCTOBER 2010

• WELCOME
• OCTOBER SPOTLIGHT
Welcome to the latest edition of the National Mental Health Development Unit (NMHDU)
news briefing on programme developments and related policy and practice news.
• THEMED FOCUS
• Quality and productivity
If you would like to know more about our work, contact Alison Cooley or Tony Jameson-Allen.
in mental health (QIPP)
For more information go to our website. Click here to subscribe or unsubscribe to future editions.
• Mental health and the QIPP
agenda – some facts and figures
• Acute Care Pathways
• Out of Area Placements
• Mental/physical interface
OCTOBER SPOTLIGHT
• POLICY AND PRACTICE
Key developments:
Ian McPherson, NMHDU Director
• NMHDU series of evidence
factsheets available "The National Mental Health Development Unit is working alongside The NMHDU is committed to providing a vital bridge between
• Royal Colleges join forces to meet policy colleagues to inform and shape the new mental health strategy, policy and practice and has an ambitious work programme that runs
the commissioning challenge which the Minister for Care Services announced earlier in September. to March 2011.
• Triangle of Care guidance launched While no-one can credibly underestimate the scale of the challenges While our funding arrangements and future are subject to review
• Dual diagnosis programme final ahead, it is possible to implement real, measurable improvements in and to the major changes across the public sector, key mental health
report and training resources mental health care provision and in the wellbeing of communities, stakeholders are in discussions with the DH about what type of policy
published families and individuals, if we take an evidence-based, whole systems implementation function would be required, and could be achieved,
• The role of local government approach to the task. beyond March 2011. The outcome of those discussions are expected to
in promoting wellbeing become clearer towards the end of this calendar year.
The NMHDU is working closely with key partners, such as the NHS
• Users try out personal mental
Confederation and ADASS to give local commissioners and providers In the meantime, we welcome your continued interest and involvement
health budgets
a strong, well evidenced case for driving cost-efficiency in a way that to ensure we achieve the goals we have committed to in our current
• Equalities programme develops
improves outcomes in the lives, hopes, and expectations of the end work programme."
new resources
user. With this issue in mind, this edition of our stakeholder briefing
• Let’s Respect toolkit focuses on the work we are doing with DH and our partners to promote
• Developing financial capability QIPP (Quality, Innovation, Productivity and Prevention) in the mental
• EVENTS health system.
> SPOTLINE continued

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ISSUE 4 OCTOBER 2010

• WELCOME SPOTLIGHT continued

• OCTOBER SPOTLIGHT
• THEMED FOCUS
• Quality and productivity
in mental health (QIPP)
• Mental health and the QIPP
agenda – some facts and figures
• Acute Care Pathways
• Out of Area Placements
• Mental/physical interface
Intention to launch new mental health strategy announced
Care services minister Paul Burstow plans to launch a new mental
health strategy towards the end of this year. The strategy is expected to
maintain New Horizons’ lifespan approach and emphasis on promoting
mental health and wellbeing and the important contribution to mental
health of factors such as employment and housing. It will also continue
to support the development of talking-based therapies across the NHS.

• POLICY AND PRACTICE Paul Burstow has signalled a new, equal emphasis on mental health
outcomes in assessing quality of NHS and social care. The new strategy
Key developments: will expect patients’ mental health to be considered alongside their
• NMHDU series of evidence physical health outcomes following NHS treatment.
factsheets available
"The fact is we can no longer accept that curing someone of cancer,
• Royal Colleges join forces to meet
then leaving them to struggle with depression afterwards, is a true mark
the commissioning challenge
of success," he told Community Care magazine.
• Triangle of Care guidance launched
• Dual diagnosis programme final "The NHS should deal with the full parameters of a patient's recovery,
report and training resources including helping them return to work and get their life back after illness.
published That's what the new outcomes framework should deliver."
• The role of local government The full report is available on the NMHDU website.
in promoting wellbeing
• Users try out personal mental
health budgets
• Equalities programme develops
new resources
• Let’s Respect toolkit
• Developing financial capability
• EVENTS

2

• WELCOME
• OCTOBER SPOTLIGHT
• THEMED FOCUS
• Quality and productivity
in mental health (QIPP)
• Mental health and the QIPP
agenda – some facts and figures
• Acute Care Pathways
• Out of Area Placements
• Mental/physical interface
• POLICY AND PRACTICE
Key developments:
• NMHDU series of evidence
factsheets available
• Royal Colleges join forces to meet
the commissioning challenge
• Triangle of Care guidance launched
• Dual diagnosis programme final
report and training resources
published
• The role of local government
in promoting wellbeing
• Users try out personal mental
health budgets
• Equalities programme develops
new resources
• Let’s Respect toolkit
• Developing financial capability
• EVENTS
3
www.nmhdu.org.uk
ISSUE 4 OCTOBER 2010
THEMED FOCUS
Quality and productivity in mental health (QIPP) The programme is supported by Dr Hugh Griffiths, the Department
of Health’s Interim National Clinical Director, and is managed by Jim
Mental health accounts for around 13.8% of England's health budget . 1
Symington, NMHDU Deputy Director. A central focus of NMHDU
One in six of the population has some form of common mental health
activity is enabling the key stakeholders to work together at national
problem at any one time2 and up to one in 100 people live with a serious
and local level to achieve improvements in these three areas.
mental illness2. Mental health has a successful track record in redesigning
services to improve quality and productivity, particularly in the adult The three projects are already working towards a number of products,
mental health sector. However there remain areas of significant variation including guidance on best practice and evidence-based outcomes,
in quality across the country, including awareness of the links between implementation toolkits for regional/ local commissioners and providers,
mental health and physical health. benchmarking information for SHAs, commissioners and providers,
In coordinated work with partners in DH, the SHAs, the NHS
and joint NHS Confederation / NMHDU / ADASS briefing materials.
Confederation and the Audit Commission, NMHDU has developed
a potential national Mental Health QIPP workstream to support
Mental health and the QIPP agenda
the national Quality, Innovation, Productivity and Prevention (QIPP)
– some facts and figures
initiative. The workstream comprises three projects:
• Mental health problems account for 23% of all lost
• acute care pathways – to reduce variations across the country in
years of healthy life in high-income countries3.
mental health bed day usage so that all areas move closer to the
upper quartile of national performance. This will be achieved by • Mental illness represents the single largest cause of
improving use of evidence based interventions to reduce admissions, disability in the UK. NHS, social and informal care costs
lengths of stay and delayed discharges £22.5 billion per annum in England4.
• out of area placements, including medium secure services – to reduce
the numbers of people with mental ill health and related conditions
placed outside their PCT area and to improve the outcomes where
these placements are used
• physical and mental health – to reduce the inappropriate use
of primary and acute hospital services by people with medically
unexplained symptoms (MUS) and people with long-term physical
health conditions and co-morbid mental health issues by use of
evidence-based psychological treatments. > PRACTICE AND POLICY continued

• WELCOME
• OCTOBER SPOTLIGHT
• THEMED FOCUS
• Quality and productivity
in mental health (QIPP)
• Mental health and the QIPP
agenda – some facts and figures
• Acute Care Pathways
• Out of Area Placements
• Mental/physical interface
• POLICY AND PRACTICE
Key developments:
• NMHDU series of evidence
factsheets available
• Royal Colleges join forces to meet
the commissioning challenge
• Triangle of Care guidance launched
• Dual diagnosis programme final
report and training resources
published
• The role of local government
in promoting wellbeing
• Users try out personal mental
health budgets
• Equalities programme develops
new resources
• Let’s Respect toolkit
• Developing financial capability
• EVENTS
4
THEMED FOCUS
Acute Care Pathways
• Improved early intervention and home treatment could yield
significant savings (some through reduced acute hospital admissions,
shorter lengths of hospital stay, and less use of high-cost intensive
interventions5.
• Crisis teams reduce length of stay and hospital costs and cost
up to an estimated £600 less per crisis admission6.
Out of Area Placements
• Out of area placements cost the NHS and local authorities in
England an estimated £356 million a year7.
• Out of area placements cost 65% more than in-borough placements
– and 22% residential and nursing care placements for people with
mental health problems are out of area8.
Mental/physical interface
• 11% of adult health care costs in the UK are attributable to physical
symptoms caused or exacerbated by mental health problems.
Between 20% and 30% of consultations in primary care are with
people who are experiencing medically unexplained symptoms and
have no clear diagnosis9.
• Cognitive therapy can reduce use of GP and secondary care services
and prescriptions for antidepressant medication – saving an estimated
9%– 53% in costs, especially when it is available in primary care10.
• Patients with a physical illness are at three to four times greater risk
of developing a mental illness. Up to 28% of patients admitted to
acute hospital may also have a diagnosable mental illness11.
www.nmhdu.org.uk
ISSUE 4 OCTOBER 2010
References:
1. Mental Health Strategies (2008). The 2007/08 national survey
of investment in adult mental health services. London: Department
of Health
2. ONS 2000. Psychiatric morbidity among adults living in private
households in Great Britain.
3. World Health Organisation (2004). The World Health Report 2004:
Changing History. WHO.
4. McCrone P, Dhanasiri S, Patel A et al (2008). Paying the price: the
cost of mental health care in England to 2026. London: King’s Fund.
5. NHS West Midlands (2010). QIPP workstream (early intervention
and community teams). Version 2. Birmingham: NHS West Midlands.
6. National Audit Office (2007). Helping people through mental health
crisis: the role of Crisis resolution and home treatment services.
London: National Audit Office.
7. Mental Health Strategies (2005). Out of area treatments 2004/5
– a market out of control? London: Mental Health Strategies
8. Royal College of Psychiatrists (2009) New Horizons consultation
response. London: RCPsych.
9. Improving Access to Psychological Therapies (2008).
Medically unexplained symptoms: positive practice guide.
London: Department of Health.
10. Cited in Department of Health (2009). Quality and productivity
examples: psychological management of long term conditions,
including medically unexplained symptoms. London:
Department of Health www.library.nhs.uk/qipp/ViewResource.
aspx?resID=330623&tabID=289
11. NHS Confederation (2009). Healthy mind, healthy body. London:
NHS Confederation.

• WELCOME
• OCTOBER SPOTLIGHT
• THEMED FOCUS
• Quality and productivity
in mental health (QIPP)
• Mental health and the QIPP
agenda – some facts and figures
• Acute Care Pathways
• Out of Area Placements
• Mental/physical interface
• POLICY AND PRACTICE
Key developments:
• NMHDU series of evidence
factsheets available
• Royal Colleges join forces to meet
the commissioning challenge
• Triangle of Care guidance launched
• Dual diagnosis programme final
report and training resources
published
• The role of local government
in promoting wellbeing
• Users try out personal mental
health budgets
• Equalities programme develops
new resources
• Let’s Respect toolkit
• Developing financial capability
• EVENTS
5
www.nmhdu.org.uk
ISSUE 4 OCTOBER 2010
POLICY AND PRACTICE
Key programme developments
NMHDU series of evidence factsheets available Triangle of Care guidance launched
NMHDU has produced a series of evidence factsheets on a range New best practice guidance to ensure carers are involved as equal
of mental health related area such as employment, stigma and partners in the care planning and treatment of people with mental health
discrimination, public mental health and wellbeing, housing and problems has been published jointly by NMHDU with The Princess Royal
equalities, to highlight the hard-hitting features, impact and Trust for Carers. The Triangle of Care – Carers Included: A Best Practice
consequences of mental ill health and wellbeing in the UK. These Guide in Acute Mental Health Care is aimed at acute services, inpatient
are available to download on the DH and NMHDU websites. and crisis resolution home treatment (CRHT) staff and their managers,
and also to inform carers, service users and carer groups.
The guide was developed by carers and staff to improve carer
Royal Colleges join forces to meet
engagement in acute inpatient and home treatment services. It is one
the commissioning challenge
of the practical outputs of the Acute Care Declaration, launched in June
With an eye to the radical changes heralded by the Government 2009 with the aim to bring together all the key stakeholders to work to
NHS White Paper, NMHDU’s mental health commissioning programme, improve acute mental health services. For further information on related
in partnership with the NHS Confederation, is supporting an programme areas go to the NMHDU website.
unprecedented coming together of the Royal College of Psychiatrists
and the Royal College of General Practitioners to discuss the future
commissioning of mental health services. The two Royal Colleges met
at a seminar on 14 September at which service users were also present
and which was attended by Dinesh Bhugra, president of the RCPsych,
and Clare Gerada, chair elect of the RCGP.
The aim of the seminar was to agree the fundamental values and
principles that should underpin commissioning for mental health.
A full report on the seminar will be available later in October.
The Royal Colleges have agreed to continue to work together
on GP-led commissioning for mental health. The hope is that this
initiative at national level will provide a model for similar discussions
and joint working between GPs and mental health professionals at
> POLICY AND PRACTICE continued
regional and local level.

• WELCOME
• OCTOBER SPOTLIGHT
• THEMED FOCUS
• Quality and productivity
in mental health (QIPP)
• Mental health and the QIPP
agenda – some facts and figures
• Acute Care Pathways
• Out of Area Placements
• Mental/physical interface
• POLICY AND PRACTICE
Key developments:
• NMHDU series of evidence
factsheets available
• Royal Colleges join forces to meet
the commissioning challenge
• Triangle of Care guidance launched
• Dual diagnosis programme final
report and training resources
published
• The role of local government
in promoting wellbeing
• Users try out personal mental
health budgets
• Equalities programme develops
new resources
• Let’s Respect toolkit
• Developing financial capability
• EVENTS
6
POLICY AND PRACTICE continued
Dual diagnosis programme final report
and training resources published
The NMHDU’s dual diagnosis programme, which concluded its
five-year programme of work earlier in the year, has published a final
report summarising the programme’s achievements. The report notes
in particular the valuable involvement of users and carers in motivating
and contributing to the work, and the support of the PROGRESS group
of nurse consultants who worked to ensure that services for people with
dual diagnosis and their carers and families remain at the forefront of
clinical policy and practice at local and national levels.
Responsibility for developing dual diagnosis strategies and improvements
passes to the regional SHAs, and to commissioners and providers at local
level. The wealth of guidance and good practice produced over the last
five years will continue to be available on the NMHDU website and the
Progress dual diagnosis website.
The Dual diagnosis team training resource, recently published, is a
bespoke compendium of training materials for clinical care teams
working with people with this diagnosis. The training resource is
designed to meet the needs of the workforce more generally by
helping to integrate clinical knowledge and skills in dealing with mental
health and substance use. It is also intended to raise awareness and
understanding of the particular issues facing this client group across
a range of care settings and help people to work together in clinical
practice to improve outcomes. Go to the NMHDU website to
download the resource.
www.nmhdu.org.uk
ISSUE 4 OCTOBER 2010
An online awareness raising resource, produced for the NMHDU
Improving Care Pathways programme by the PROGRESS group of
consultant nurses and Coventry University has also been published.
The aim of the resource is to promote awareness of the issues faced by
people who have both mental health and drug and alcohol use problems
and their care and treatment needs. The course can be accessed from
the University of Coventry website.
The role of local government in promoting wellbeing
A key report on The Role of Local Government in Promoting Wellbeing
will be published later this month. The report was commissioned jointly
by the NMHDU Wellbeing and Population Mental Health Programme
and the Healthy Communities Programme within Local Government
Improvement and Development. It was written by the New Economics
Foundation (nef), with contributions from leading experts and agencies
working across the UK on wellbeing, public health and
health improvement.
The report highlights the importance of wellbeing for local government,
showcases what local government is already doing in some parts of the
country, and sets out what the potential challenges and opportunities
are and why this is a good time to be thinking in more depth about the
future role of local government in wellbeing and wider public health and
health improvement.
The report will be available through NMHDU website.
> POLICY AND PRACTICE continued

• WELCOME
• OCTOBER SPOTLIGHT
• THEMED FOCUS
• Quality and productivity
in mental health (QIPP)
• Mental health and the QIPP
agenda – some facts and figures
• Acute Care Pathways
• Out of Area Placements
• Mental/physical interface
• POLICY AND PRACTICE
Key developments:
• NMHDU series of evidence
factsheets available
• Royal Colleges join forces to meet
the commissioning challenge
• Triangle of Care guidance launched
• Dual diagnosis programme final
report and training resources
published
• The role of local government
in promoting wellbeing
• Users try out personal mental
health budgets
• Equalities programme develops
new resources
• Let’s Respect toolkit
• Developing financial capability
• EVENTS
7
POLICY AND PRACTICE continued
Users try out personal mental health budgets
People with mental health problems are, for the first time ever,
now ‘buying’ their own mental health care, using the new personal
health budgets (PHBs). The Coalition government has signalled its
ongoing support for the use of PHBs across the NHS. A total of 63 sites
are piloting the use of PHBs across the healthcare sector, approximately
a third of which are mental health focused. Of these 63, 20 are being
formally evaluated over three years by the University of Kent, and eight
of these are mental health projects. These evaluated pilot sites
are receiving £100,000 funding a year each from the Department of
Health to support the development and introduction of PHBs. Go to
the personal health budgets learning network for further information.
So far, people have spent their PHBs on services like gym membership and
personal health care assistance, although the way is now open to more
ambitious uses, such as paying for residential care. NMHDU is funding a
national learning set involving all 23 personal mental health budget pilot
sites so that people involved in the implementation can come together
to learn from each others’ successes and share good practice. Go to the
NMHDU website for further information on the personalisation in mental
health programme.
www.nmhdu.org.uk
ISSUE 4 OCTOBER 2010
Equalities programme develops new resources
The mental health equalities programme has produced a number of
new web-based resources.
Spirituality and mental health
NMHDU has developed a new website section on religion and belief.
The page contains links to numerous resources and websites related
to spirituality and mental health. To suggest other links and resources
to consider including on this page, contact Hari Sewell, NMHDU
programme lead.
Podcast explores LGB issues
Being lesbian, gay or bisexual (LGB) is not in itself a mental health
problem; homosexuality was removed from the World Health
Organisation International Classification of Diseases (ICD) in 1990.
However, discrimination, isolation and homophobia can be very
damaging to the mental health of a lesbian, gay or bisexual person.
Research shows that LGB people are at significantly higher risk of mental
disorder, suicidal ideation, substance misuse and deliberate self-harm
than heterosexual people. In a new podcast available on the NMHDU
website, mental health and social care researcher Sarah Carr discusses
the experiences of LGB people in mental health services, and the stigma
and assumptions she has encountered personally. The website page also
contains further information to read and download.
> POLICY AND PRACTICE continued

• WELCOME
• OCTOBER SPOTLIGHT
• THEMED FOCUS
• Quality and productivity
in mental health (QIPP)
• Mental health and the QIPP
agenda – some facts and figures
• Acute Care Pathways
• Out of Area Placements
• Mental/physical interface
• POLICY AND PRACTICE
Key developments:
• NMHDU series of evidence
factsheets available
• Royal Colleges join forces to meet
the commissioning challenge
• Triangle of Care guidance launched
• Dual diagnosis programme final
report and training resources
published
• The role of local government
in promoting wellbeing
• Users try out personal mental
health budgets
• Equalities programme develops
new resources
• Let’s Respect toolkit
• Developing financial capability
• EVENTS
8
www.nmhdu.org.uk
ISSUE 4 OCTOBER 2010
POLICY AND PRACTICE continued
Let’s Respect toolkit
A free toolkit to support work with older people with mental health
needs is now available from NMHDU. The Let's Respect Resource
Box uses powerful images and case studies to provide information and
practical suggestions of how to better meet the mental health needs of
older people, with a particular focus on acute care settings. The toolkit
is free but you do need to pay the cost of postage. Download an order
form from here.
Developing financial capability
The NMHDU, in partnership with the NHS Confederation, is supporting
a programme that aims to tackle issue around financial capability, which
is being led by the Consumer Financial Education Body (CFEB). CFEB
is an independent body, created in April 2010 by the Financial Services
Act 2010. It is responsible for helping consumers understand financial
matters and manage their finances better.
It’s well known that money problems can worsen people's mental health,
and that people with mental illness are more likely to experience financial
problems and debt. Research shows that improving people's ability and
understanding of money matters can assist their recovery and support
their mental wellbeing. CFEB is therefore working in partnership with
the National Mental Health Development Unit to raise awareness of the
links between money worries and mental ill-health. This is particularly
important in the light of the increase in people holding individual health
and social care budgets. Go to the CEBR’s website and its consumer site,
Money Made Clear, for further information.
 www.nmhdu.org.uk

ISSUE 4 OCTOBER 2010

• WELCOME EVENTS
• OCTOBER SPOTLIGHT
Upcoming events with NMHDU programme involvement include:
• THEMED FOCUS
• Quality and productivity Meeting the challenge: driving quality and
in mental health (QIPP)
productivity through mental health commissioning
• Mental health and the QIPP
agenda – some facts and figures Venue: Manchester Conference Centre
• Acute Care Pathways Date: 20th October, 2010
• Out of Area Placements
• Mental/physical interface Where is faith in mental health?
Venue: The International Centre, Telford
• POLICY AND PRACTICE Date: 22nd October, 2010
Key developments:
• NMHDU series of evidence Trauma and adult mental health:
factsheets available taking steps on the road to recovery
• Royal Colleges join forces to meet Venue: ORT House Conference Centre, London
the commissioning challenge Date: 30th November, 2010
• Triangle of Care guidance launched
• Dual diagnosis programme final Psychological Therapies in the NHS
report and training resources
Venue: Savoy Place, London
published
Date: 2-3 December, 2010
• The role of local government Web: Click here
in promoting wellbeing
• Users try out personal mental
Further events are listed on the events section on the NMHDU site
health budgets
• Equalities programme develops
new resources
• Let’s Respect toolkit
• Developing financial capability
• EVENTS