What is changing in mental health and dementia care?

Introduction

Although the Long-term Plan is a general policy for the NHS, mental health and dementia are a very important element of it; indeed, the term 'mental health' appears 196 times in its 115 pages.

In this article, we will explore some of the NHS’s plans to improve mental healthcare services for different sectors of the population and to deliver timely interventions for people with dementia.

Adult mental health

The Long-term Plan says thataccess to psychological therapies (IAPT) services will continue to expand so that 1.5m people will be able to access treatment each year by 2020/21, with an increasing focus on those with long-term conditions who also require treatment for mild to moderate depression and anxiety.

Some nine out of 10 adults with mental health problems are managed in the community, including primary care, but this is set to increase.  The Long-term Plan policy will see the new Primary Care Networks (PCNs) providing general mental health care in the community aligned with community mental health teams working across primary care and local hospitals to deliver urgent response and recovery support.

Maternity care

Trusts are included in a new national maternal and neonatal mental health safety collaborative. Some 20 community hubs will work closely with local authorities to bring mental health services together with antenatal care, birth facilities, postnatal care, specialist services and health visiting.

The Long-term Plan will improve access to perinatal mental health care by increasing access to evidence-based care for women with moderate to severe perinatal mental health difficulties and personality disorder diagnoses.

Care will be provided from preconception to 24 months after birth, instead of the 12 months currently offered. Access to psychological therapies will be expanded to include partners and families.

Severe mental health and physical health

There is a big emphasis on addressing both mental and physical health problems, and specific actions include initiatives to cut smoking in people with long-term mental health problems.

By 2020/21, at least 280,000 people living with severe mental health problems will have their physical health needs checked and met; by 2023/24 this number will increase to an additional 110,000 people per year.

Children and adolescent mental health

Under the Long-term Plan, the NHS is committed to increase funding for children and young people's mental health services faster than total mental health spending.

Children and young people's mental health services are being expanded under the Five Year Forward View for Mental Health, FYFVMH. In 2017/18, an estimated 30.5 percent of children and young people with a mental health condition were able to benefit from treatment and support, up from 25 percent two years before.

Developments in digital technology, such as mobile apps, are also expected to play a big part in delivering mental health care, especially for children and young people.

Access to services for children and young people provided by the NHS, schools and colleges will be available to 345,000 more children and young people by 2023/24.

Dementia

There will be more than 1m people with dementia in the UK by 2025. The Long-term Plan therefore aims to address some of the challenges of dementia and healthy and independent ageing.

From 2020/21, PCNs will use digital health records and health management tools to identify moderate frailty and detect and intervene to treat undiagnosed disorders, such as heart failure. Individuals identified as having the greatest risks and needs will be offered targeted support for physical and mental health needs, including dementia.

Home-based and wearable monitoring equipment will be used to enable the NHS to predict and prevent events that would otherwise lead to hospital admission. Carers will benefit from greater identification and support.

Frailty and dementia

PCNs will identify patients with moderate frailty who are potentially at risk and will offer support for physical and mental health needs, including musculoskeletal conditions, cardiovascular disease, dementia and frailty.

The roll-out of personal health budgets (PHBs) will increase to 200,000 people by 2023/24 and will include mental health services and services for people with learning disabilities.

Conclusion

Mental health and dementia are central to the NHS Long-term Plan, which aims to make major changes to the way in which services for people with these conditions are organised.

To capitalise on the mental health and dementia care opportunities that are emerging from the Long-term Plan, pharma needs to develop a sound knowledge of how PCNs operate and the key decision-makers within them as they will play an increasingly important role in service delivery.

Industry also needs to consider how it can support the NHS in delivering more proactive and population-based care by, for example, helping to risk stratify groups of patients or supporting educational campaigns in schools to address mental health issues.