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Our plans for mental health are focus on two areas; making sure we can help prevent the onset of mental health problems, and, supporting those living with a mental illness to manage their condition and recover.

In Bradford, Airedale, Wharfedale and Craven, mental health issues with affect approximately 155,000 people during their lifetime. This is equivalent to 1 in 4 people living in the area*. At any one time, 6,200 people will need specialist mental health services. We expect the number of people in our area with mental health needs will rise at a similar rate to the increase in the general population. 

There is national recognition that mental health should be treated with the same importance as physical health - commonly termed 'parity of esteem'. A number of recent national policies have recommended areas for development, including new standards, these policies include:

The work we are doing here in Bradford has been quoted in Implementing the Five Year Forward View. Specifically highlighted are our mental health liaison service and the resdesign of the acute care pathway to eliminate out of area placements. We are also responding to these national policies by making changes that address local need and meet these new standards, this includes:

Effective treatments can prevent or reduce distress to individuals and families. That's why we are working to design services to meet acute needs when they occur, and prevent milder problems from becoming more serious conditions. 

Bradford, Airedale, Wharfedale and Craven is considered a system leader - specifically for crisis care, dementia care and the design of innovative services which meet both mental health and physical health needs. 

We are currently working on the development of our mental health strategy for the next five years. This is due to be published in Autumn 2016. The strategy will set out how we will continue to address specific areas of need for our local population and improve mental health and wellbeing across Bradford and district. 

*determined by population statistics from the Bradford and Airedale Joint Strategic Needs Assessment.

How are we doing?

Our data shows that our CCG is performing well with regards the two national mental health access standards:

  • nearly 9 in 10 in people who experience a first episode of psychosis will commence treatment with a NICE approved  care package within two weeks of referral,
  • our CCG has ensured 85.7% of people experiencing a first episode of dementia commence treatment with a NICE approved care package within two weeks of referral. The standard is 50%,
  • over 9 in 10 in people with a common mental health condition receive their first treatment within six weeks and everyone receives treatment within 18 weeks of referral,
  • our CCG has ensured 93.3% of people with a common mental health condition receive their first treatment within six weeks (above the 75% national standard) and 100% do so within 18 weeks (above the 95% standard). 
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Improving access to psychological therapies (IAPT)

Around one in every six adults in England suffers from a common mental health problem - two of the most common are depression or anxiety. The improving access to psychological therapies (IAPT) programme is a key part of improving treatment for people with depression, anxiety and other common mental health problems.

Research indicates that half of people treated with cognitive behaviour therapy (for depression or anxiety) recover during treatment. The IAPT programme was first targeted at people of working age but in 2010 was opened to adults of all ages.

The success of the IAPT programme is measured using a combination of three indicators; access, recovery rate and waiting time.

IAPT access - April - June 2016

12.5% of the estimated number of people who have common mental health problems received psychological therapies.  This is below the national standard of 15%.

We are working to increase the number of people with common mental health problems who receive psychological therapies from IAPT services.  People can now access IAPT directly through My Wellbeing College, and we expect this change to expand access.

IAPT recovery rate - November 2016

43.5% of people who completed IAPT therapy were assessed as ‘moving to recovery’. This is below the national standard of 50%.

Recovery rates show signs of improvement since November  following the implementation of a new IT system enabling clinicians to record more accurately the numbers of people moving to recovery.  We know that IAPT is successful in treating common mental health problems and will continue to work with the service provider to achieve a good rate of recovery.

First episode psychosis

Psychosis is characterised by hallucinations, delusions and a disturbed relationship with reality.  It can cause considerable distress to the person involved and their family or carers.  People who experience psychosis can and do recover, and recovery is more likely if treatment begins without delay.

Bradford City CCG will continue to work with service providers to increase the percentage of people experiencing a first episode of psychosis or at risk mental state receiving a NICE-recommended care package within two weeks of referral, including care for physical health land specialist support in other areas such as employment.   We commission specialist EIP workers to work within the Children and Young People’s Mental Health Service to identify at the earliest stage young people experiencing a first episode of psychosis.

Children and young people's mental health service transformation

Three quarters of mental health disorders (excluding dementia) occur for the first time by the age of 18. In Autumn 2015, extra funding was announced by the government to transform mental health services for children and young people. We welcomed this announcement as an opportunity to work with partners in the Local Authority, NHS and in the community to transform mental health services for children and young people in Bradford. 

Future in Mind, the local transformation plan for Bradford, is published here.

Crisis care

Partners from the NHS, Local Authority, Police and community organisations work together under the Crisis Care Concordat to ensure that people who experience a mental health crisis receive the care they need from the service best placed to provide it.  Good communication between mental health services, hospitals, social and community services, ambulance and the police is essential to ensure that people receive the right care at the point of crisis and once the immediate crisis is resolved.

We commission a 24/7 open access First Response Service which provides skilled intervention for people of all ages experiencing mental health crisis. This service has been nationally recognised for its multi-agency approach to addressing and dealing with people experiencing mental health crisis.

We also commission ‘safe havens’ (The Sanctuary, The Haven) and a safe space for children and young people from Voluntary and Community Sector (VCS) organisations.  These offer a warm and supportive place to stay for people experiencing a crisis but who do not need to be admitted to hospital, providing care in the least restrictive environment possible.

Out of area placements for acute mental health inpatient transformation

In general it is much better if any inpatient care can be provided locally.  When people are placed outside the CCG area, relationships with families and local services can be disrupted and recovery may be slower.

As part of our work to reduce the use of out of area placements, we commission ‘safe havens’ from the VCS and Intensive Home Treatment Teams to provide care in the community for people with a high level of need.  People are only admitted to hospital if this is the only place where they can receive the care they need.  This reduces reliance on inpatient services and increases the availability of local beds.

Small numbers of people in need of psychiatric intensive care still receive care outside the Bradford area, but all acute inpatient care for mental health is provided locally.  NHS England’s Implementing the Five Year Forward View for Mental Health gives Bradford as an example of successful pathway redesign to reduce the number of people receiving treatment outside the area.

Experiences of services, the friends and family test

The Friends and Family Test is a national measure of patient satisfaction on the service received whilst under the care of the NHS. The test asks people if they would recommend the services they have used. 

Since 1st January 2015, all providers of mental health services have been required to gather feedback using the Friends and Family Test. This information is provided to NHS England every month. 

In December 2016, 92% of 113 people responding to the Friends and Family Test for a service received from Bradford District Care Trust said that they would recommend the service.

More information about the friends and family test can be found on the NHS England website

Experiences of services, the community mental health patient survey

The community mental health survey is an annual survey which looks at the overall experience of care and how people would rate the services provided by health and social care workers. 

In 2016 255 of 850 people responded to a questionnaire about community mental health services at Bradford District Care NHS Foundation Trust.  Overall experience was rated as 7.0/10, similar to the rating at other mental health providers.

More details of the 2016 survey results are published here.

What you tell us about mental health services

We make sure that we are listening, engaging and involving patients in the planning and design of their local NHS.

To do this, each programme of work has the infrastructure to engage and collect information from people through:

Mental health service experience

We make sure that the insight and feedback we get is not just collected - we proactively use it to inform our commissioning activity and to improve quality. Insight and feedback is collected in a system that we call Grass Roots. This brings together intelligence from the services we commission, individual and public activity to provide us with an understanding of what local patients, carers and stakeholders are saying about their experiences of the local NHS services.

In addtion, for each programme of work, we tailor our approach to engagement to make sure that we are reaching those people who use services.

The mental health delivery board oversees our engagement in this area. The board ensures that we can take a 'deep dive' to understand the experiences of people using mental health services and how our strategy and approach can be shaped to meet the needs of services users and our population as a whole.

We have a robust approach to our engagement work around mental health services. Patient and public feedback is collected in the following ways: 

Grass Roots

Grass Roots collects the information that is given by patients and the public (through NHS Choices, Patient Opinion, Healthwatch, complaints, local groups, staff and direct patient, family and community feedback) to inform our planning and decision making

In 2015, we received 1,949 entries relating to patient feedback from 3,987 individuals. The number of responses received relating specifically to mental health services was 26 which relates to patient feedback from 209 indivduals (patients, carers and 30 staff).

Mental health - grassroots

Patient stories

What we have we done in 2016/17?

Find out what we have done over the last year towards our plans for mental health and wellbeing in Bradford:

  • worked with the Local Authority and community organisations to commission safe places for adults and young people who are experiencing mental health crisis but do not need hospital care, 
  • Worked with the Local Authority public health colleagues to update information in the Mental Health Joint Strategic Needs Assessment to inform the Mental Wellbeing Strategy, including recent evidence on the wider determinants of mental health, 
  • worked closely with all relevant partners to develop a Mental Wellbeing Strategy for Bradford district and Craven and establish groups to lead its implementation, 
  • selected metrics to assess whether the strategy is successful in achieving its intended outcomes,
  • funded the development of a network of mental health champions in schools to influence school culture, reduce stigma, and support children and young people to access care before serious problems arise,
  • extended the 24/7 First Response Service (crisis care) to care for people of all ages, including children, young people and older people,
  • commissioned specialists in children and young people’s mental health to work with social care services for vulnerable groups, 
  • worked with the Local Authority to include young people’s mental health specialists in social care access points, 
  • commissioned and publicised Thrive Bradford, a website which helps young people navigate their teenage years, designed by children and young people in Bradford working with Barnardo’s
  • commissioned a community eating disorders service for children and young people to provide evidence based care at home including intensive support for those who are severely unwell,
  • worked with colleagues in public health, NHS providers, social care and other teams on actions to reduce suicides,
  • commissioned mental health specialists to screen inpatients at Bradford Royal Infirmary and St Luke’s Hospital for mental health care needs, aiming to provide support before problems become serious,
  • commissioned training for police staff in mental health issues,
  • with the Local Authority, commissioned evidence-based employment support for people with mental health care needs,
  • expanded the Primary Care Wellbeing Service, which uses targeted mental health interventions with people experiencing medically unexplained symptoms. The service has been successful in alleviating distressing physical symptoms and reducing ineffective and frustrating tests and treatments.

What we are doing over the next two years

This West Yorkshire wide programme focuses on six all age outcomes and developing shared standards and expectations across West Yorkshire. The six outcomes are;

  1. reduce mental health in-patient admissions
  2. eliminate all out-of-area mental health acute placement
  3. reduce unnecessary attendance at A&E for crisis episodes
  4. reduce all inappropriate emergency service responses
  5. reduce Mental Health Act detention in police cells
  6. reduce number of suicides across West Yorkshire

We have done a significant proportion of work in this area through our Crisis Care Concordat and other mechanisms which is being shared across West Yorkshire but we will continue to support this work over the next two years by aiming to (please note this is not an exhaustive list):

Our plans for the next five years

The implementation plan for Mental wellbeing in Bradford district and Craven: a strategy 2016-2021 is centred on three workstreams:

They include nationally mandated actions and priorities we have decided on locally. These are our commitments for the next five years.

In Bradford district and Craven we actively promote mental wellbeing through addressing social and environmental factors and offering support before problems lead to mental ill-health.

For more on our approach please see Mental wellbeing in Bradford district and Craven: a strategy 2016-2021

Our strategy will cover the milestones that we hope to achieve over the next five years, these include:

MH - next five years