Population Mental Health

People with serious mental illness die on average 25 years earlier than the general population and there is evidence that much of this inequality is due to physical health rather than mental health issues.?

Those with schizophrenia, a serious mental health illness (SMI), and specifically those with treatment-resistant schizophrenia, are at a higher risk of early morbidity and mortality from physical health complications related to their mental ill health. In 2020 there were international warnings surrounding the side effect risks of antipsychotic drugs?and schizophrenia.? The risks were compounded with the arrival of the pandemic and the impact of social isolation on the health of people who were not able to continue their regular connections this their SMI team leading to a risk of non-compliance and variation which creates risks in A&E acute emergency care. ?

During the first UK lockdown A&E attendance in England dropped by c.60%, the Kings Fund analysis showed the remaining 40% were attendances for crises in?long-term conditions.??

Parts of the health system remain siloed and disconnected in its data. GP and acute data may be connected but more needs to be done to connected wider services across specialist and mental health care. For those with serious mental illness, there are gaps in data sharing across their different health and care teams and in the wider system clinicians understanding of the potential side effects and impact of antipsychotic drugs.??

The pandemic highlighted already existing inequalities and galvanized momentum for change, the lesson learnt from the data sharing for COVID-19 must continue to understand our populations deeper. We know people from more deprived areas were disproportionately affected by the pandemic, have more diagnosed serious mental ill-health, are impacted by digital poverty, and by the wider determinants of health contributing?to a detrimental impact on their healthy lives.??

Progress is?made by sharing the knowledge, sharing knowledge of antipsychotics, their side effects, and risks to premature mortality. This can accelerate work to reduce incidents relating to gaps in care across the system, and impact on the morbidity and mortality variances seen for those with and without SMI. For those who can’t articulate their story easily in an emergency sharing data about themselves at the system level can expedite their diagnosis and treatment. Working in conjunction with the professional development of the clinical workforce the side effects of complex medications are known, and lives can be saved.??

People taking antipsychotic drugs can suffer from severe constipation as side effect of the drugs and can be difficult to diagnose in an emergency. Impaction and bowel perforation can lead to death. Sharing information on medications and care plans can save people’s lives if the infrastructure (data sharing) can tell the basics of their story.??

By empowering our primary and secondary care clinicians to raise awareness of serious mental health and the benefits and risks of medication, risk can begin to be reduced when in contact with the health system, and this is key to ensuring parity of esteem in proactive and reactive care.??

Specialist mental health teams are in regular contact with patients, the wider health and care system can have a greater awareness of the physical ill-health risks for those with SMI.??

The risks can be spotted early in an emergency and mitigated if there is greater data sharing linked with professional development and?integrated care.?Delays in treatment from a fragmented systems result in poorer outcomes for people with SMI.???

Health systems should reach for parity and greater integrated care to ensure physical and mental health are hand in hand, systems need to be patient-centric; ‘what matters to you’, not ‘what’s the matter with you’.???

This is central to a population health approach for mental health. ??

Clinical leadership is key to engaging integrated care and a population health approach for mental health. Education is a key part of a transformation programme, and this includes executive leadership learning, partnership across a health and care system, and the acknowledgement that this is a group of people who receive inequitable care, and data can play an important role in identifying the cohort variation (inequity) and support improvement in their outcomes through population health management.??

The NHS has changed from the pandemic to a more integrated care system for patients being cared for across providers. Data needs to focus on the person, the neighbourhood they live in, the wider determinants of the Place they call home, and how the system works for them. We are being to see a system that asks, ‘What Matters to You’, not, ‘What’s the Matter with You’. There are green shoots of success, led locally through the integrated provider collaboratives, neighbourhoods with higher incidence of SMI, and leaders willing to work together differently across their teams. ?

Contracting and commissioning appear to be regressing (written 2023) towards an activity-driven model. The pandemic paused ‘PbR’, and it allowed integrated care to form. There is a risk without innovation in contracting and NHS finance departments we will return to an activity-driven health service. That focuses on process not outcomes. This is not inevitable, financial stability is possible without burdensome activity-driven care management, we can commission for outcomes, but a new model requires trust between leadership, government and those delivering care.?????

Data is key in the approach, population segmentation that uses longitudinal data and statically split the population into groups is a start to understanding who utilises health and care, what are their risks and how should care be delivered closer to them to meet their needs. The resources and variation across the population can be unjust and it’s where the inverse care law is impacting health locally. Developing the infrastructure for both technology and professional development is needed to mitigate inverse care and further widening of inequalities. ??

A PHM approach is about deconstructing the siloed healthcare to ensure parity of esteem for mental health and SMI. Starting with the person, what are their concerns, what issues do those with SMI face, and how can the neighbourhood change to meet their needs, this is the development of a future roadmap of integrated care for those with SMI.??

Taking the learning from work in schizophrenia?can show that being data-focused can improve outcomes over the short term. Applying this in life-long conditions like Diabetes, COPD, and Asthma can reduce their morbidity and early mortality. I believe our approach to long term conditions and multi morbidity needs to be data-driven, outcomes-focused, and person-centric in approach.??

Equality has been driven further apart in 2010-20's. A new post-pandemic approach is needed which seeks health-in-all-policies across government to be supported by the digital infrastructure.??

Data should be shared.??

#DataSavesLives. ??

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