The paper reviewed here is the Department of Health consultation document ‘New Horizons. Towards a Shared Vision for Mental Health’ and freely available here. This is a lengthy document running to 130 pages and with a foreward by Phil Hope, MP and Minister of State for Care Services. The New Horizons framework follows on from the National Service Framework for Mental Health which had a ’10-year lifespan’. Louis Appleby then identifies the main themes – prevention and public mental health, stigma, early intervention, personalised care, multi-agency commissioning/collaboration, innovation, value for money and strengthening transition. There are two pages about ‘our vision’ which includes the following
‘In 2020 most adults will understand the importance of mental well-being to their full and productive functioning in society, to their physical health, and to their ability to make healthy lifestyle choices‘
The vision contains references to equality, personalised services, stigma and understanding, high-quality care for all and no health without mental health. In terms of physical health it is stated in the vision that
‘In 2020 people with mental health problems will no longer be at greater risk of physical ill health than the rest of the population. For example, rates of smoking, obesity, cardiovascular disease and diabetes will have reduced to levels closer to those of the general population‘
In the introduction and executive summary, there is a reference to the financial constraints that will operate during the period to which New Horizons refers and the need to maximise the use of resources during this time. From my understanding, this fits in with several principles of good clinical governance and it will be interesting to see how the role of clinical governance within services develops over this period. The Productive Ward series (see this podcast review) also springs to mind as a means to making efficient use of resources and perhaps this has already been rolled out in anticipation of ‘New Horizons’. In this section, it is also encouraging to see that the WHO concluded that mental health services in England have performed favourably within Europe on a number of measures. I particularly liked this quote which is described as being at the heart of the NHS constitution
‘The NHS belongs to the people. It is there to improve our health and well-being, supporting us to keep us mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limit of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matters most‘
Within the summary it is also noted that New Horizons will take forward the National Service Framework for Mental Health and ‘support the delivery of the NHS Next Stage review’. The Vision is displayed in a diagram showing several layers which read as
‘Promote meaning and purpose’
‘Develop sustainable, connected communities’
‘Integrate physical and mental health and well-being’
‘Build resilience and a safe, secure base’
‘Ensure a positive start in life’
I couldn’t help but think of some of the principles outlined in a book on positive psychology (reviewed here) on reading through the above.
The remainder of the document is divided into several sections:- Guiding values, laying the foundations, transition from adolescence to adulthood, better mental health and well-being for adults, older adults, how we will get there and consultation questions.
In the section on guiding values, these are described as
‘equality, justice and human rights’
‘reaching our full potential’
‘being in control of our lives’
These are expanded on further in this section.
In ‘Laying the Foundations’, the aim is described as ‘To promote the mental health of all children by providing universal and targeted support for families and at-risk groups’. Risk factors for ‘poor mental health’ in children are discussed as is the prevalence of a number of psychiatric conditions. A number of documents including ‘Every Child Matters’ are discussed. There is then a detailed discussion of strategies in this area including a look at good parenting skills, development of social and emotional skills and at-risk children and young people.
In ‘Transition from Adolescence to Adulthood’, there is a discussion of some of the difficulties that can be encountered in this transition period as the adolescent moves between child and adult services and the benefits of youth mental health services that span this period. A number of specific services are mentioned including Uthink which focuses on providing services to young people at risk of psychosis.
In ‘Better Health and Well-Being for Adults’ there is a detailed discussion around a number of areas including promoting mental health, looking at at-risk groups, Lifelong Learning, debt, physical health, suicide prevention, violence and abuse, veterans, people with trauma. A number of specific services are described within this section demonstrating the diversity of approaches that have been used to meet these various needs.
In ‘Better Mental Health Care for Adults’ the aim is described as a move ‘towards high quality, inclusive mental health care that respects the autonomy and dignity of individuals, families and carers and supports recovery’. At the beginning of this section there is a very useful overview of the ‘foundations for mental health care services’. There is a detailed discussion of a recovery philosophy including the use of a ‘recovery star’. What I found interesting here is that each person who accesses services will have different values and personalising healthcare will need to take these values into consideration. The values should be finite and while the full range of values cover a wide variety of possibilities, the recovery star focuses on some practical areas, areas that services have developed relevant skills for. So the recovery star looks to be a patient-rated tool for assessing their journey towards various goals (which although categorised are denoted by non-specific titles such as self-care). This rating has the potential to be influenced by a large number of factors which can influence validity and it will be interesting to see if the star will be modified in due course or will remain as it is. There was also a discussion of the various adult services including Early Intervention Services and Crisis Resolution and Home Treatment Teams. With regards to the inpatient environment I found the Star Wards and Protected Engagement Time ideas to be particularly interesting. There is a look at other areas including social inclusion, individualised budgets, delivering race equality, alcohol and drug misuse, physical health and offender mental health care, NICE and IAPT.
In the section on older adults the aim is described as a move towards ‘high-quality, non-discriminatory mental health care that respects the autonomy and dignity of the individual, families and carers, and supports recovery’. In this section some of the difficulties experienced by older adults are discussed and there is a focus on age discrimination, poverty and debt, physical health and addressing the needs of high-risk groups. There is also a discussion of older adult liaison services, a look at the Let’s Respect campaign and the ‘early and effective diagnosis and treatment of dementia’.
In the section ‘How We Will Get There’ there is a broader discussion of how such goals can be achieved and Figure 11 shows how goals are achieved at different levels including legislation, regulation and service provision. In this section, a number of published strategies are cited which the ‘New Horizons’ programme will build on. Leadership is also discussed with requirements for good clinical and professional leadership as well as ownership by the local community. There is also a look at commissioning and outcome measures which includes the use of the HoNoS as well as mention of a useful resource – the Outcomes Compendium for identification of outcome measures relevant to services.
On page 123 of the document there are details on the consultation process and how to respond with a closing date for the responses of October 15th 2009. Options are given for postal correspondence or an online questionnaire.
The New Horizons programme is described as the successor to the National Service Framework and therefore this consultation document forms an important part of the transition process. While I found this document lengthy (which is understandable given the scope of the document) there is a summary document on the Department of Health website.
The details for responding to the consultation document are to be found in the document as per the link above.
The Royal College of Psychiatrists also has a response from President Dinesh Bhugra which can be found at this link
You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast).
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