Breaking the cycle Sarah Robinson, Director of Delivery at Eastern AHSN, explains how we are addressing health inequalities by improving mental health outcomes. There are many determinants in our lives that influence our mental health and are strongly connected to social inequalities: from positive parenting and a safe place to live, to experiencing abuse or trauma, oppression or discrimination, or growing up in poverty1. People with severe and enduring mental illness are at greater risk of poor physical health and reduced life expectancy compared with the general population2. They may also be less able to work and, as such, more likely to face financial hardships and be less able to access social activities, which can further compound the problem. If health inequalities can contribute to mental health illness, and mental health illness entrenches health inequalities, how do we break the cycle? This year, we have been tackling this issue through programmes aimed at helping people to receive treatment for mental health sooner, to reduce the impact it has on their lives. Giving ADHD the attention it deserves The AHSN Networks FOCUS ADHD programme looked to enable NHS mental health and community paediatric services across England to improve how they assess children and young people for ADHD. In our region, weve supported the rollout of QbTest an objective test for ADHD created by Qbtech which measures all three core components of ADHD (attention, impulsivity and activity) and compares against age and gender-matched normative controls to inform clinicians decisions on whether the young person has ADHD or not. Eastern AHSN provided funding and project support to spread QbTest across four trusts in our region. A total of 1,209 patients benefitted from receiving an assessment, providing significant system savings by reducing the number of consultations required in the diagnostic pathway by 878 appointments. We started the process of having our 10-year-old daughter assessed for ADHD in early 2022. Its an incredibly long and fraught experience, with multiple questionnaires, assessments and consultations, months apart, involving teams of teachers, doctors, and specialists. This programme is making the most of technology to reduce the amount of time taken to get a diagnosis and the stress it causes. A diagnosis is not the end of the journey, but helps us to support our children and young people in learning how to maximise their ADHD superpowers. Max, parent Eastern AHSNs involvement in the programme has supported an increase in equity of access across the region, with tests now available in seven locations, while also supporting the NHS commitment to reaching carbon net zero by reducing emissions by eliminating the need to travel so far. FOCUS ADHD won the Innovative Mental Health Intervention Award at A national evaluation of FOCUS ADHD found that 92% of clinicians said the results helped them understand patients symptoms and that it released 19% of clinical time in paediatric services and 9.2% in child and adolescent mental health services. the National Mental Health and Wellbeing Awards, as well as Best Mental Health Partnership with the NHS in the Health Service Journal Partnership Awards 2022. Such recognition, coupled with data showing that the test frees up clinical time, is seeing more trusts looking to adopt objective testing for ADHD across England. A diagnosis is not the end of the journey but helps us to support our children and young people in learning how to maximise their ADHD superpowers Max, parent Enabling young people with eating disorders to get help sooner Eating disorders are severe disorders with high levels of disability and mortality. Onset is often during adolescence and early adulthood, a developmentally sensitive time when the brain is still developing. Ensuring that young people access effective treatment within three years of onset leads to better outcomes and can prevent symptoms becoming chronic and harder to treat3. The AHSN Network has been supporting the adoption of early intervention models of care across England. In our region, we are embedding the First Episode Rapid Early intervention for Eating Disorders (FREED) service model. The service offers young people with suspected anorexia nervosa, bulimia nervosa or binge eating disorder, who have had their condition for less than three years, to be triaged within 48 hours of their referral and begin treatment within four weeks. This gives the best chance of improving their quality of life, reducing the severity and longer-term impact of eating disorders on patients and families, as well as reducing patient admissions and bed days. We have successfully launched early intervention services across Norfolk and Waveney, Hertfordshire and West Essex, Suffolk and North East Essex, and Cambridgeshire and Peterborough integrated care systems, meaning that young people across the Eastern region can be referred to a FREED service. While the two-year programme has come to a close as of April 2023, we have worked closely with providers to ensure that the FREED services continue. To date, in the two years in which Eastern AHSN has been involved in the adoption and spread of this programme, 817 people nationally, and 183 people in the East of England, have benefitted from FREED. The impact, not only on the individual suffering from the eating disorder, but also on their parents and carers, cannot be overstated. Feedback from these groups provides valuable insight into the pressing need for early intervention in eating disorder programmes to continue to be spread throughout the country. Further investigation into the role of Child and Adolescent Mental Health Services (CAMHS) and adult eating disorders services, and the patient transitions therein is providing valuable insights and discussion points around how the FREED programme can continue to act as a catalyst in transforming the lives of those suffering from eating disorders, and the role of early intervention in mental health Watch: Simon Brown, expert by experience and chairman of the eating disorders nursing charity Personalised Eating Disorder Support (PEDS) as a whole. A national evaluation found that FREED treatment has an expected return on investment of 4,166 per patient. Overcoming anxiety in young people through digital therapeutics In 2022, 18.0% of children aged 7 to 16 years and 22.0% of young people aged 17 to 24 years in England had a probable mental disorder4. However at present, the majority do not get access to treatment5. A surge in demand, and services feeling under pressure and having to prioritise high-severity cases, has resulted in families being put on waitlists up to 18 months long or dropping off resulting in a situation where children grow up with the risk of lifelong mental health problems. Children from poorer and ethnic minority backgrounds are also less likely to access care for their anxiety than other children. The awkward space between development and implementation: Jess Garner, principal advisor, explores why there is a gap between digital mental health tools being developed and them being implemented in services. Read the blog At Eastern AHSN, we are working with the research team at Norfolk and Suffolk NHS Foundation Trust (NSFT) to evaluate Lumi Nova, a digital therapeutic game developed by BfB Labs, offering NICE-recommended psychoeducation and graded exposure therapy for children aged 7-12 years with anxiety disorders. We supported the successful application for a grant of around 150,000 from the NIHR Invention for Innovation programme. As well as understanding the difference Lumi Nova makes to childrens anxiety, the evaluation will capture broader views on how digital health technologies for child mental health are implemented and what practical steps should be taken to address the barriers that exist. While NSFT is still analysing the evaluation data with a view to publishing a paper on the results, we have already learned a lot by convening technology developers and commissioners through a series of workshops, to understand the key barriers to the adoption of digital innovation for child mental health, as well as their impact on health inequalities. Watch the trailer for Lumi Nova: Tales of Courage by BfB Labsvideo Eastern AHSN was central in helping us secure the funding for this research, but is also a really valuable partner in delivering it, providing project management, supporting with data interpretation, and convening key stakeholders. Together, we hope to understand how we can apply what we learn to get the best possible impact from mental health innovations in the future Dr Jon Wilson, consultant psychiatrist FRCPsych, research director (NSFT), clinical senior lecturer (University of East Anglia) and professor of psychiatry (St Georges University School of Medicine) Supporting research to understand treatment-resistant depression This year, we had two clinical papers published arising from informing Valuesbased practice in persistent Depression (i-VALiD), our work to understand which outcomes matter to service users who experience persistent depression. This included a review of how outcomes are being measured, or could be measured, to aid values-based commissioning in the implementation of specialist services, as well as a systematic review of economic evaluations for interventions for treatment-resistant depression. The project was delivered in partnership with Cambridgeshire and Peterborough NHS Foundation Trust, the University of Cambridge Department of Psychiatry, and the NIHR Applied Research Collaboration East of England, to investigate the biological, psychological and social factors underlying persistent depression and how to help people recover. QbTest, an objective test for ADHD created by Qbtech. Share this article Return to About Us If you want to learn more about any of these programmes or how we can support you to improve services, contact sarah.robinson@eahsn.org. Up next: Read the personal stories of individual innovators who have been supported by Eastern AHSN, how they developed their product and the challenges they faced. References Centre for Mental Health. (2020). Mental Health Inequalities: Factsheet. [Online]. Centre For Mental Health. Last Updated: 11 November 2020. Available at: https://www.centreformentalhealth.org.uk/publications/mental-health-inequalities-factsheet [Accessed 20 November 2022]. 2 GOV.UK. (2018). Health matters: reducing health inequalities in mental illness. [Online]. GOV.UK. Last Updated: 18 December 2018. Available at: www.gov.uk/government/publications/health-matters-reducing-health-inequalities-in-mental-ill [Accessed 22 May 2023]. 3 Treasure, J. Stein, D. Maguire, S. (2015). Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence. Early Intervention in Psychiatry. (9) p.17384. 4 Reardon, T., Harvey, K. and Creswell, C., 2020. Seeking and accessing professional support for child anxiety in a community sample. European child & adolescent psychiatry, 29(5), pp.649-664 5 NHS Digital. (2022). Mental Health of Children and Young People in England 2022 - wave 3 follow up to the 2017 survey. [Online]. digital.nhs.uk. Last Updated: 29 November 2022. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-y Accessed 23 May 2023