Breaking through the 17 year gap from discovery to implementation

geraldine_strathdee_smallDr Geraldine Strathdee
National Clinical Lead
Mental Health Intelligence Network 

Today is World Mental Health Day (10th October). This is a day when we can celebrate a new era of unprecedented awareness and support for mental health – support that comes from members of the Royal Family and the public, parliamentarians, public health planners, front line blue light services in all agencies and health and social care professionals.  For the first time in healthcare history, providing timely, evidence based care for the one in four people in our county who experience mental illness, is a national priority. The Five-year Forward View plan sets out the trajectory for the commissioning and delivery of the treatments and care needed, with standards as excellent as they are for physical health conditions.

But this is just the start for mental health. There are priorities that need to be focused on – critically reducing the stigma attached to mental health issues, making it easier for people to seek help early, when treatments will be most effective. Helping individuals and communities to understand the facts and the robust science behind how they can build their own, their friends’ and their families’ good mental health.

The science in mental health is robust, but implementation science is not in place

Mental health treatments have a sound basis. There are 50+ NICE Health Technology Appraisals, NICE guidelines and Quality standards for each of the major sixteen mental health conditions and pathways. But only one third of people get access to any care, and there is major variation in implementation of evidence based effective treatments across England. The science to floor timescale, from discovery of an effective intervention, to implementation in routine practice, is an average of 17 years.

Nowhere is this gap more prominent, with more horrendous consequences than in mental health. Our country has made excellent progress in recent decades in reducing premature mortality, except for people with mental ill health, who still have the life expectancy that their peers had in the 1950s. They die 14-20 years earlier. 35, 000 people with mental illness annually die of avoidable cardio metabolic conditions and cancer, and almost 5,000 annually from suicide. Tackling both is a major priority set out in the mental health taskforce implementation plan.

The mission of the AHSNs…to break through the 17 year implementation barrier

There is a major role for AHSNs to take the scientific facts, bring them to the attention of their local constituencies, lead the engagement and collaborations of patients, academics, clinicians, commissioner and provider networks, develop and evaluate locally tailored implementation plans, and disseminate across the country and world. They can encourage a holistic approach to dealing with patients who have both physical and mental health conditions. As the thinking and science moves forward, we can add the need to develop whole population public health strategies and prevention.

To fulfil their ‘mission’, the AHSNs need to tackle four pivotal enabling areas: building data and knowledge literacy, supporting workforce training during the transition to new models of care delivery, understanding and promoting proven implementation science and releasing the power of our digital world developments.

The AHSNs can play a major role in helping us develop intelligence literacy leaders. The benefits to local health economies are enormous, and these new data & intelligence scientists, can transform our ability to deliver sustainable systems that maximise social and economic wealth.

The digital revolution appeals to the mental health world: where we ‘think outside the box’ and where our treatments more often depend on verbal communication than on big buildings or expensive machinery. Mental health has advanced plans in telecare, M- and e-health, Bid data analytics, building exemplar electronic care records with interoperability and functionality to enable our community based model of care.

Dr Geraldine Strathdee: 2020 Vision

The Yorkshire and Humber AHSN is a shining example of an AHSN that has worked to the best of implementation science and has tackled one of the largest science to floor gaps: bringing access to physical health care for people with mental illness:

Case study

People with serious mental illnesses who do not access the physical assessment and treatments and die of cardiac, respiratory, diabetes, liver and cancer conditions 14-20 years earlier than peers, but before they do, they lead lives filled with ill health and distress. For no other patient groups would we leave a person breathless, wheezing, dizzy with high blood sugar, fearful of having chest pain, heart attacks, strokes and cancer pain.

Failure to provide this basic treatment has large humanitarian and economic impact. People who don’t get the basic physical health assessment and treatments have:

  • three-five times greater use of A/E, more expensive hospital admissions
  • longer lengths of stay when admitted as even the most experienced senior clinicians find improving mental states impacted by the confusion caused by e.g. high blood sugar, pain, disability, difficult.

The challenge of two or more untreated physical illnesses make it harder to rehabilitate, and prevent relapse. Escalation to high cost specialised commissioning beds is greater. The costs to carers are profound.

The Yorkshire & Humber AHSN has supported the roll out of a local ‘reducing physical health deaths’ initiative that took the evidence base on how improve physical health in mental health, originally piloted in Bradford by a mental health nurse champion Kate Dale and CCG GP mental health lead Angela Moulson. They developed a clinician decision digital template for primary care GPs and practice nurses, and a training and support programme, which is now being rolled out across the country. The results are impressive.

The Physical Health toolkit is now being rolled out across the country The Bradford Physical Health Assessment Template is now available nationally for Systm1 and EMIS web IT systems. In total 610 organisations nationally use a variation of the Systm1 template. This is over seven times as many organisations as the initial 80 GP practices in Bradford and Airedale. The Bradford Physical Health Assessment template has been completed over 2,600 times spanning 59 Clinical Commissioning Groups across the country.

If all patients with a serious mental illness and eligible for a physical health check received this simple intervention, health economics modelling indicates that it would save the NHS around £11 million over 10 years in the Yorkshire and Humber regions alone.

This is a great example of how AHSNs can help to promote consistent quality standards across mental health services and reduce the equality gaps we are seeing across the country at the current time.