Hertfordshire and West Essex Joint Forward Plan 2023 - 2028

ICB Strategic Priority: Improve our residents’ mental health and learning disabilities outcomes

ICB Clinical Priorities:

• Reducing suicide rates and attendances/ admission rates for self-harm
• Reducing rates of A&E attendances involving substance misuse and violence
• Reduce the gap in life expectancy between people with a learning disability and Severe Mental Illness (SMI) compared to the general population.
• Reduce the impact of wider social determinants on outcomes for people with mental health and learning disability 
• Improving utilisation of population health management data in relation to mental health and learning disability and autism.  Ensuring data quality and robust local intelligence when there is a time lag in availability of national published data/information.

ICB Challenge:

• In Hertfordshire, the excess mortality rate for adults with a SMI is above the regional average and in Essex, the rate of premature mortality for those with a SMI is similar for cancer, cardiovascular disease, and respiratory illnesses. (HWE ICS Health Needs Analysis Overview, 2022).
• Mental health is a contributor to the gap in life expectancy between the most and least deprived areas, 6.9% for males in Hertfordshire and 2.9% in west Essex and 10.3% for females 7.6% in west Essex, (Hertfordshire Public Health Evidence and Intelligence, 2022 and Essex Joint Strategic Needs Assessment 2021-22).
• There has been an increase each year over the last 3 years in percentage of adults reporting a long-term mental health condition.
• People with a learning disability on average die 23 years younger for men and 27 years younger for women than the wider population.
• The relationship between drug use and mental health problems among young people is of particular concern. Research shows that mental health problems are experienced by 70% of drug users in community substance misuse treatment. Deaths by suicide are also common among those with a history of drug misuse, between 2008 and 2019 34% of deaths from suicide were amongst people known to be experiencing mental health problems.

Expected outcomes:    
We will provide early help to our residents to prevent mental illness and support the health and wellbeing of those with a Severe Mental Illness (SMI), learning disabilities or autism.

Governance Groups:  

• Hertfordshire MHLDA Health and Care Partnership
• Essex Mental Health Alliance

What our residents say:
A survey into Joint Forward Plan priorities, carried out in 2023 by the ICB and thematically analysed by Healthwatch Hertfordshire heard from 1,124 respondents, predominantly aged 50+.  

• 30% (136) of respondents said easier, quicker access to GP services would support them in getting the help they need for their mental health. Of these respondents, some also suggested that GP services should be more proactive in asking patients about their mental health and should be more aware of mental health issues.
• 24% (108) of respondents suggested that waiting lists are too long, with many noting they have had to wait months before they were offered an appointment or treatment. Some respondents also shared that they would like interim support while waiting for treatment.
• 10% (41) of respondents suggested that NHS staff need more training, particularly around how to support and interact with people with autism, people with learning disabilities, and people with sensory needs.

Healthwatch Essex research into the experiences of young people in secure MH unit (2018/19) involved 45 patients aged 12-17 on a secure inpatient mental health unit.  Themes that emerged included: 

• Majority of young people in the study had not self-referred for mental health care, even when this was an option. They first needed to recognise symptoms, and the trusted adult they confided in needed to understand mental health, to signpost them.
• Long waiting times for CAMHS led to deterioration, sometimes to the point of crisis. Many delayed speaking to someone through fear of stigma.
• Lack of consistency – service or providers changing without warning or explanation. High turnover of CAMHS staff led young people to feel they weren’t taken seriously and lost trust. Multiple agencies involved - young people unsure who does what & delays in one agency impact on work of others.
• Passive role in treatment – care done to them, not with them. Terminology and acronyms were confusing.
• Not resolving ‘social stressors’ like troubled home/school life is causing some young people to not recover in the longer term. Having more support in the community following discharge could prevent them reaching crisis again. This support did not necessarily have to come from mental health services.
• Being able to identify mental health issues early, and, where appropriate, know how and where to refer, improves the chance of identifying and treating issues before needs increase.
• Raising mental health literacy among relatives, teachers and peer groups will help young people to access care promptly.
• Moving towards a systemwide approach with a single coordinating professional, will have a better chance of addressing the root cause of illness and accelerating recovery.
• Young people told researchers: “My illness doesn’t fit in with a 9am- 5pm, Monday to Friday system.” 

Year 1 priority actions

In year 1 we are seeking to implement and fully deliver the national mental health strategy and have identified crisis support and early treatment as key system priorities along with the following actions:

1. Strengthen our CAMHS services and related processes including implementing a "no wrong door" approach and improving the transition from children and young people services to adult services.
2. Make improvements to pathways and services relating to neurodiversity, ADHD and ASD (and where they overlap)
3. Embed a community mental health transformation model in all PCNs
4. Review support for UEC users with co-occurring substance misuse and mental health issues
5. Develop / strengthen options for responding to those in a Mental Health crisis (at home, in UTCs, in EDs), including via capital development
6. Reduce unwarranted adult Out of Area (OOA) placements

For further details about key deliverables across the next five years, please refer to pages 65 - 69 of the PDF.