Transcript The National Personality Disorder Development Programme

The National Personality
Disorder Development Programme
Personality People & Pathology
1 June 2005, Friends Meeting House, Oxford
Rex Haigh & Steve Pearce
The National Personality Disorder
Development Programme
Aims:
• To develop new approaches
to treatment and care of
people diagnosable with PD
• Strengthen the capabilities
of the workforce through
education and training
• Reduce social exclusion
Two Government publications
National Institute for Mental Health for England (NIMHE)
Government money: services
• Deliberate variety of
approaches
• All involve many
stakeholders
• Working together to
provide new type of
service
• Service users help in
planning
• Care pathways approach
• Very strong control over
finances & governance
• Emphasis on evaluation,
outcome & dissemination
• Results in 2005-7
The National Personality
Disorder Development
Programme
Rex Haigh
Consultant Psychiatrist in Psychotherapy, Berkshire Healthcare NHS Trust
Personality Disorder Development Consultant, NIMHE South East
Personality Disorder Service User Consultation Lead, Department of Health
Two Government publications
National Institute for Mental Health for England (NIMHE)
New Government Money
• Started as “crumbs from the DSPD table”
• Personality disorder: the “DSPD” units
– £128m (£100m capital + £28m revenue)
– For a few hundred people
– eg £0.5m per patient per year at Broadmoor
• Personality disorder: community programme
– £18m
– For ~5% of the population (3,000,000 people)
– Equals £6.60 each case per year
(or 33p per head of population)
• Intention to coordinate across 4 “silos”
Four “silos”
• New pilot projects
– 2 years funding thence PCT
• National specialist commissioning
– Henderson, Main House and Webb House
• DSPD units
– 4 in prisons, 6 in forensic and 4 womens units
• Training initiatives
– Divided amongst 8 NIMHE regions
What “No Longer a Diagnosis of Exclusion” is funding:
the 11 new community pilot services
• Deliberate variety of approaches
• All involve many stakeholders
• Working together to provide new
type of service
• Service users help in planning
• Care pathways approach
• Very strong control over finances
& governance
• Emphasis on evaluation, outcome
& dissemination
• Results in 2005-7
What “No Longer a Diagnosis of Exclusion” means
www.publications.doh.gov.uk/mentalhealth/personalitydisorder.pdf
• 2004-2007
• 11 new pilot projects
• Learning from diversity
–
–
–
–
–
4 “big ones”
2 managed networks
2 predominantly SU-led
1 early intervention
Different therapeutic models,
some mention none
The 11 pilots
• A quick tour, giving:
– Who submitted bid
– Who manages it
(=owns it?)
– Clinical model
– Distinguishing
features
Leeds
• Submitted by Tom Mullen, Leeds
Mentally Disordered Offender
Development Coordinator, Leeds
MHTT
• Provider: Leeds MHTT
• Managed clinical and service
network
• Core team working across
agencies
• Providing
– Assessment
– Clinical Services
– Care coordination
• Largest urban project
Nottinghamshire
• Submitted by Helen Scott, Executive
Director, Nottinghamshire Healthcare NHS
Trust (MHT)
• Provider: Nottinghamshire Healthcare NHS
Trust (MHT), and local advocacy groups
• Coordinated network with new clinical
services
• 3 levels of provision
– L1= advice and information
– L2= “stop and think” CBT
– L3= therapeutic community
•
•
•
•
With satellite services across the county
Integrated team
Wide range of stakeholders
Large population (>1m) and budget
Coventry
• Submitted by Coventry PCT
• Provider: Coventry PCT
• New clinical services
– “community psychotherapy team”
– group-based programmes for simple,
complex, & severe PD
• Integrated with new NSF-aligned
psychiatric services
• New building
• Most favourable funding to population
ratio
Thames Valley
• Submitted by Drs Rex Haigh & Steve
Pearce, consultant psychiatrists in
psychotherapy
• Providers: 3 MHTs - Berks, Bucks &
Oxon
• Hub and spokes
– 3 hubs
– Approx 10 spokes
• New 4 tier clinical services
–
–
–
–
Assertive assessment (XBX)
Local treatment provision
3 day TCs
Recovery tier (XBX-led)
• Multiple agencies involved
• Integrated with training
• Largest area & population (>2m)
Camden & Islington
• Submitted by Stephen Pilling, Consultant
Clinical Psychologist, Camden and
Islington Mental Health and Social Care
Trust
• Providers: Charitable Trust (“Umbrella
Ltd”), two PCTs and the MH/SC Trust
• Provision of two services:
– Primary care: early recognition and brief
treatment, DBT-based
– Voluntary sector: helping people to
reengage in work and be active citizens
• Small project
• Small population
• Inner city
NE London
• Submitted by Dr Janet
Feigenbaum, Consultant Clinical
Psychologist
• Provider: NE London MHT
• Dual Diagnosis Assessment and
response Team: “DDART”
• Dual diagnosis – PD & substance
misuse
• Provision of
– Assessment
– Interventions
• DBT based
• group & individual
• with outreach
– Case management
SW London
• Submitted by Dr Steve Millar,
Consultant Psychiatrist in
Psychotherapy
• Provider: SW London & St
Georges MHT
• Service User Network (SUN)
• To set up 4 local networks to
– Support SUs
– Improve access to services
• Large urban population
• Small staff numbers
Colchester
•
•
•
•
The Haven Project Ltd
Voluntary sector
Drop-in day services
Features of therapeutic
community
• Also short term crisis
beds
Cambridge & Peterborough
• Submitted by Annette Newton
(Area Director and MH Policy
Lead, MHT), Prof Geoff Shepherd
(Director of Partnerships and
Service Development, MHT) and
Dr Chess Denman (Consultant
Psychotherapist)
• Provider: Cambridge &
Peterborough Mental Health
Partnership Trust
• No theoretical approach specified
in bid
• Services provided in two “hubs”
– Assessment
– Interventions
– Case management
• Development workers = spokes,
to work across agencies and
promote recovery model
North Cumbria
• Submitted by Dr Mike Rigby,
Consultant Psychiatrist in
Psychotherapy
• Provider: North Cumbria MHT
• “Itinerant therapeutic
community”
–
–
Intensive day service model
Aspatria RC & Carlisle
• Closely integrated with
training programme
• Large rural area
• Low population
Plymouth
• Submitted by Phil Confue,
Director MH & LD, Plymouth
PCT
• Provider: Plymouth PCT
• Early intervention model
• Young people (<25) engaged
through youth enquiry service
• Social inclusion focus: “to
prevent career as psychiatric
patient”
• Delivered in partnership with
voluntary agencies
• Includes DBT treatment
Evaluation of the 11 pilots
• Local
– as described in individual bids
– cooperation emerging
• National
– Imperial College London
• Mike Crawford, Dorothy Griffiths, Tim
Weaver, Deborah Rutter,
Peter Tyrer
– Mental Health Foundation
• Iain Ryrie, Jan Wallcraft
– University College London
• Anthony Bateman, Gerhart Knerer,
Peter Fonagy
– Institute of Psychiatry
• Paul Moran
– University of Liverpool
• Jonathan Hill
Multi-method evaluation
– A macro-level organisational
evaluation of the context,
form, function and impact of
pilot services
– A micro-level cohort study
examining changes in health,
social outcomes and direct
costs of care among a cohort
of people using these services
– A micro-level qualitative study
of service quality from the
perspective of service users
– A Delphi exercise to examine
the level of consensus among
academics, service users and
providers about lessons that
can be learnt for future service
development
What do they cost?
• Smallest – SUN - £254,000
• Largest – Thames valley - £1,006,335
– Full year effect
– Including capital expenditure and management costs
– Excluding local contributions
Cost to NIMHE per project
Leeds
Notts
1000000
900000
Coventry
TV
Cam & Is
800000
700000
600000
DDART
SUN
500000
400000
300000
Haven
Camb & Pet
N Cumbria
200000
100000
0
1
Plym
How many new staff?
• In original bid (possibly amended since)
• Minimum: Carlisle = 6
• Maximum: Thames Valley = 30.5
Number of staff per project
Leeds
Notts
3 0 .1
30
2 7.0
2 3 .5
Coventry
TV
Cam & Is
2 2 .6
20
12 .2
11.5
10
8 .4
7.4
0
1
8 .5
6 .5
6 .0
DDART
SUN
Haven
Camb & Pet
N Cumbria
Plym
Population covered
• Less than half a million
–
–
–
–
–
–
Waltham Forest DDART
Coventry
North Cumbria
Essex Haven
Camden and Islington
Plymouth
• Over a million
– Thames Valley
(Berkshire,
Buckinghamshire and
Oxfordshire)
– Nottinghamshire
Population served by each project
2,500,000
Leeds
2,000,000
Notts
Coventry
1,500,000
TV
Cam & Is
DDART
1,000,000
SUN
Haven
Camb &
Pet
N Cumbria
500,000
Plym
0
1
projects
Calculation:
money spent per “case”
Assuming 5% of total population “have” PD:
•
•
•
•
MAXIMUM – Coventry - £56
MINIMUM – SW London SUN - £6.52
MEAN - £17.75
REST OF ENGLAND in PCT baselines - £4.01
Spend per case for each project
Leeds
Notts
60
Coventry
TV
Cam & Is
50
40
30
DDART
SUN
20
Haven
Camb & Pet
N Cumbria
10
0
1
Plym
Calculation:
“cases” per new staff member
• MAXIMUM – SW London SUN – 7662
– (14 minutes each per year = 19 sec weekly)
• MINIMUM – Coventry – 701
– (2hr 37mins each pa = 3 mins 25 sec weekly)
• MEAN - 2311
“Caseload” per project
8000
7000
6000
5000
4000
3000
2000
1000
0
Leeds
Notts
Coventry
TV
Cam & Is
DDART
SUN
Haven
Camb & Pet
N Cumbria
Plym
Calculation:
cost of each new staff member
• MAXIMUM – North Cumbria – £70,883
• MINIMUM – Leeds – £31,852
• MEAN - £41,038
– Note: does not include contribution of
volunteers, service users or ex-service users if
unpaid.
Cost per new staff for each project
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0
Leeds
Notts
Coventry
TV
Cam & Is
DDART
SUN
Haven
Camb & Pet
N Cumbria
Plym
Summary of “new money”
• For 11 new pilot projects from NIMHE:
– £6.8m for 7.5m population = £17.75 per case
• Into PCT baselines 2004-5
– £8m (England only) = £3.20p per case
• Into PCT baselines 2005-6
– £10m (England only) = £4.01 per case
• For training programme 2004-5 & 2005-6
– £2m = £250K per NIMHE region
More “new money”?
• To bring England up to average level of pilot projects
would cost
• £868m
• This represents increasing current funding by 52x
• Or current funding is 1.93% of what is needed
• Awaiting announcement from spending round (March 05?)
• But most will need to come from service remodelling
Forensic Service Developments
DSPD services
 2 new 70 bed units at Broadmoor and Rampton
operational from 2005/6
 Two new prison pilot sites at Frankland and
Whitemoor are operational from 2004
 Planned womens DSPD prison pilot at Lower Newton
 6 pilot forensic services for people with PD who
present a risk to others
 Women's high support community services (residential
core and cluster services for women leaving high
secure care)
Forensic Service Developments
Pilot services provided by:
–
–
–
–
–
–
–
South London and Maudsley
Nottingham Healthcare Trust (Rampton)
East London Mental Health Trust
West London Mental Health Trust (Broadmoor)
Oxleas Trust
Newcastle, North Tyneside and Northumberland Trust
Merseycare Mental Health Trust
Forensic Service Developments
Pilots include:
•
•
•
•
Dedicated PD units within high secure services
Dedicated PD units within medium secure
services
Associated hostels in three pilots
Community Team in six
Personality Disorder Capability Framework –
Breaking the Cycle of Rejection
• Comprehensive approach to
improving capabilities of
the workforce across many
agencies responding to
people diagnosable with PD
• Total of £2m for 2004/5
allocated to 8 NIMHE
Regional Development
Centres for new initiatives
to implement the
framework.
Personality Disorder Capability Framework –
Breaking the Cycle of Rejection
Training initiatives reflect
partnership between WDDs,
HEIs, NIMHE RDCs.
National bodies (NHS
University, Royal Colleges
etc.), committed to joint
work to establish training
initiatives consistent with
Capability Framework
Learning networks will ensure
dissemination of learning
from pilot services.
Training and education
programme will be
independently evaluated
Personality Disorder Capability Framework –
Breaking the Cycle of Rejection
Current training and education
initiatives include:
• mapping/scoping exercises and
training needs analyses
• stakeholder consultation
• “PD awareness cascade” courses
• PD basic training modules to be
incorporated in pre and post reg
training
• multi-agency modular training
approaches
• exploring training needs of
commissioners.
Local multi-agency training is also
included in many of the service
development pilots
TRRT
– training, research and recovery team
• 4th team of TVi
• TRAINING – to deliver this
course and other events
using XBXs and Agents
• RESEARCH – to undertake
national data collection and
local evaluation of TVi
• RECOVERY – to make service
user, ex-service user and
expert by experience
partnerships essential
• AND – external relations etc
etc…
TRRT: who, where, when?
• 3.3 wtes:
–
–
–
–
–
–
–
•
•
•
•
•
Sue Robinson Team Administrator 1.0wte
Clare Stafford Project Manager 0.5wte
Fiona Blyth Training Coordinator 0.5wte
[vacant] Team Researcher 0.5wte
Sheena Money Expert by Experience 0.3wte
Yolande Hadden Expert by Experience 0.3wte
Rex Haigh Programme Director 0.2wte
Managed by OMHT through CS
Located on Warneford site
Phase 1 – setup – y1
Phase 2 – provide – y2
Phase 3 – the future – y3+?
TRRT and training
• To coordinate all training
offered
• To “capacity-build” SU, XSU &
XBX involvement (STARS) for
training and clinical function
• To provide (very limited!)
funding for training activities
– alongside NIMHE funding
• To provide (more substantial)
funding for XBX input
• To get it onto secure financial
footing
SE Training Plan – aka “network course” – aka “awareness cascade”
Development of
new services
PD Treatment Facilities
police
Seminars,
conferences, short courses,
workshops, etc
Qualification
A&E
1 year PD
network
course
Awareness
cascade
Further
training
housing
police
probation
PD
agents
Primary
care
Voluntary
organisations
Voluntary
organisations
mental
health
services
A&E
probation
prison
s
Policy
makers
Dynamic
teams
Input into course
philosophy, structure and
content
Primary
care
commissoners
Service
advocacy
XBX
pool
mental
health
services
MH managers
prison
s
Social
services
Social
services
housing
Interested recruits
TRRT and research
• Two serious attempts at
recruitment July 04 and Feb 05
• Coordination with
– National team
– Nottingham
– Coventry
• Minimum dataset agreed across
TV = National + SCID2 + CORE +
• Awaiting ethical clearance
• Other local research (eg
qualitative and user-led) will
need to await appointment of
researcher
TRRT and recovery
• To make service user
partnership (+XSU +XBX)
essential
– Writing bid together
– Planning clinical policies together
– Two paradoxes emerging
• To administer fairly
– Systems, administration, payment
• Employment and life beyond
– Examples
– Other agencies
STARS
support, training and recovery system
•
•
•
•
XSUs and XBXs
Monthly meeting
Last Friday afternoon
Lunch - check-in – feedback –
planning & allocation – open
group – educational slot –
check-out
• Usual attendance about 20,
with 25 on our books
• In a central Reading
nightclub owned by lottery
winner, friend of an exservice user!
• Requests for involvement
taken through Sue
• Agreed at TRRT
• Includes Training, Clinical and
Service Advocacy
• Training and advocacy
activities in TV – we pay XBX
fees and expenses (if outside,
we charge)
• Agents would be welcome –
especially if they come and
tell us what they are up to, or
with requests for involvement
TRRT: other coordination
• Initially – recruitment
– eg polymorphous and nondisciplinary job profiles
•
•
•
•
Team building
In-house training structures
Coordination between teams
Annual Development
Conference – 6 July Kindersley
Centre
• Organisational links – PCTs,
MHTs, national team, learning
network, ATC, CofC, NIMHE,
BUK, RCPsych, multitude of
others
Morning session: TVi clinical pilot
Professionals’ session: 10am – 12noon
[Service user session running in parallel]
Oxford
• Presentation of case vignettes by Naomi Evans, Team leader – any questions.
• Discussion of the current service and focus on commissioning arrangements
from 2006/7
Berkshire
• Presentation of case vignettes and research findings by Davey Rawlinson,
Senior Psychotherapist. Any questions
• Discussion of current service, funding and commissioning arrangements
currently and from 2006/7.
Buckinghamshire
• Presentation of case vignettes by Marion Panchkowry and Alex Esterhuyzen,
programme leads.
• Discussion of the current service and focus on commissioning arrangements
from 2006/7
TRRT
• Presentation of TRRT development and activity by Rex Haigh, Programme
Director and Fiona Blyth, Training Coordinator
• Discussion of likely commissioning arrangements from 2006/7
Personality Disorder Capability Framework –
Breaking the Cycle of Rejection
• Comprehensive approach to
improving capabilities of the
workforce across many agencies
responding to people diagnosable
with PD
• Total of £2m for 2004/5
allocated to 8 NIMHE Regional
Development Centres for new
initiatives to implement the
framework.
Personality Disorder Capability Framework –
Breaking the Cycle of Rejection
Training initiatives reflect partnership
between WDDs, HEIs, NIMHE RDCs.
National bodies (NHS University, Royal
Colleges etc.), committed to joint
work to establish training initiatives
consistent with Capability Framework
Learning networks will ensure
dissemination of learning from pilot
services.
Training and education programme will
be independently evaluated by NU
(Peter Lewis is our link)
Personality Disorder Capability Framework –
Breaking the Cycle of Rejection
Current training and education
initiatives include:
• mapping/scoping exercises and
training needs analyses
• stakeholder consultation
• “PD awareness cascade” courses
• PD basic training modules to be
incorporated in pre and post reg
training
• multi-agency modular training
approaches
• exploring training needs of
commissioners.
Local multi-agency training is also
included in many of the service
development pilots
Training in the South-East
Developing a network of
“PD Agents”
AWARENESS
TRAINING
• Different staff
groups
• Geographical
spread
• Agent’s agency
• Various formats
• With service
user input
• Feedback
SERVICE ADVOCACY
NETWORKS
• In localities
• Involving all
interested parties
• Putting case
where needed
• Support from TV
& NIMHE
Four “network courses” in SE
Thames
Valley:
Oxford
base
Kent:
Maidstone
base
Hampshire
and Isle of
Wight:
Southampton
base
Surrey & Sussex:
Brighton base
Courses spec: 1 - philosophy
• Based on “Breaking the Cycle of Rejection”
Capabilities Framework
• Encourages patient/client autonomy and
development of individual responsibility
• Well-reflecting the views of users and carers
• Non-threatening
• Empowering learners to use what they already
know
• Finding common language
• Focus on attitude change and stigma reduction
Courses spec: 2 - structure
•
•
•
•
•
•
•
•
•
Starts September 2004, finish by June 2005
Between 20 and 40 course participants
Variety of teaching methods
Planned and run by multidisciplinary team, including
contributions from all significant services in SHA area
Service user or ex service user input to planning and
delivery
Inclusive and accessible (e.g. no disciplines excluded
through use of jargon)
Multi-professional
Multi-agency
Multi-sector
Cont…
• Mechanism for cascade of awareness training through
course participants
• Continuing support for course graduates wanting to
undertake further PD work
• Participation in SE-wide and national evaluation
• Use of IT and NIMHE KC for dissemination of course
material and widening reach of PD training
• Commitment to continuation and further development
beyond year 1
• Collaboration with other SE courses in annual
development conference
Courses spec 3 - content
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Minimum of seminars + work discussion + reflective component
Evidence-based, where it exists
Case formulation from different approaches
Explains PD phenomenology an continuum
Includes Aetiology
Interventions and evidence
Sociological and deviance perspectives
Eclectic with regard to therapeutic or theoretical models
Management principles: engagement, attachment and consistency
Stigma and education
Attend to team and organisational dynamics
Models of supervision
Skills: what to do and what not to do
Service design discussions
Courses spec 4 - admin
• Pamphlet to include
course aims, intended
audience, dates and
outline of content
• With SEDC logo
• Produced by end of
June
• Circulated widely
within all MH trusts in
SHA
• Circulated to other
agencies within SHA
area
(eg primary care,
voluntary sector,
social services etc)
• Course outlines using pro-formas
below to be received by SEDC by
June 11
• Approval for funding by end of June
• Supporting costs will be paid in three
parts: £10,000 in July for setting up
• Further £10,000 in December 2004
when evidence of course delivery,
including course brochures, number
of participants with their
professional backgrounds, work
settings and employing organisations
is received
• Final £10,000 in Summer 2005 when
number completing the course,
participants’ feedback and analysis,
and plans for future development
are received
mental
health
services
Primary
care
A&E
probation
prison
s
police
1 year PD
network
course
Voluntary
organisations
Social
services
housing
mental
health
services
Qualification
A&E
probation
prison
s
police
1 year PD
network
course
Voluntary
organisations
Social
services
housing
Further
training
PD
agents
PD Treatment Facilities (few and far between)
XBX
pool
PD Treatment Facilities
XBX
pool
mental
health
services
Dynamic
teams
Input into course
philosophy, structure and
content
Primary
care
Qualification
A&E
probation
prison
s
police
1 year PD
network
course
Voluntary
organisations
Social
services
housing
Further
training
PD
agents
PD Treatment Facilities
Service
advocacy
XBX
pool
mental
health
services
Dynamic
teams
Input into course
philosophy, structure and
content
Primary
care
Qualification
A&E
Awareness
cascade
probation
prison
s
police
1 year PD
network
course
Voluntary
organisations
Social
services
housing
Seminars,
conferences, short courses,
workshops, etc
Further
training
PD
agents
Development of
new services
PD Treatment Facilities
Dynamic
teams
Primary
care
Qualification
A&E
Awareness
cascade
police
1 year PD
network
course
Voluntary
organisations
Social
services
housing
Further
training
PD
agents
Policy
makers
Seminars,
conferences, short courses,
workshops, etc
Input into course
philosophy, structure and
content
probation
prison
s
commissoners
Service
advocacy
XBX
pool
mental
health
services
MH managers
SE Training Plan – aka “network course” – aka “awareness cascade”
Development of
new services
PD Treatment Facilities
police
Seminars,
conferences, short courses,
workshops, etc
Qualification
A&E
1 year PD
network
course
Awareness
cascade
Further
training
housing
police
probation
PD
agents
Primary
care
Voluntary
organisations
Voluntary
organisations
mental
health
services
A&E
probation
prison
s
Policy
makers
Dynamic
teams
Input into course
philosophy, structure and
content
Primary
care
commissoners
Service
advocacy
XBX
pool
mental
health
services
MH managers
prison
s
Social
services
Social
services
housing
Interested recruits
• 3 County clinical
services
• Plus “Umbrella”
function including
training
• …called TRRT
• In close partnership
with STARS
TRRT
– training, research and recovery team
• 4th team of TVi
• RH, SM, YH, CS, SR and --just--- FB. “TR” yet to be
appointed.
• TRAINING – to deliver this
course and other events
using XBXs and Agents
• RESEARCH – to undertake
national data collection and
local evaluation of TVi
• RECOVERY – to make service
user, ex-service user and
expert by experience input
essential
ROLE IN TRAINING
• To coordinate all training
offered
• To “capacity-build” SU, XSU &
XBX involvement (STARS) for
training function
• To provide (very limited!)
funding for training activities
• To provide (more substantial)
funding for XBX input
• To get it onto secure financial
footing
STARS
support, training and recovery system
•
•
•
•
XSUs and XBXs
Monthly meeting
Last Friday afternoon
Lunch - check-in – feedback –
planning & allocation – open
group – educational slot –
check-out
• Usual attendance about 20,
with 25 on our books
• In a central Reading
nightclub!
• Requests for involvement
taken through Sue
• Agreed at TRRT
• Includes Training, Clinical and
Service Advocacy
• Training and advocacy
activities in TV – we pay XBX
fees and expenses (if outside,
we charge)
• Agents would be welcome –
especially if they come and
tell us what they are up to, or
with requests for involvement
Aims of today
• To bring different parts of the training
and service initiative together
• To understand what we are all doing
• To know where to get help and
collaboration
• To start planning what else we want to
do
• To get at least 3 useful new email
addresses or phone numbers in our
address books …!
Thames Valley
• 3 hubs – Reading, Oxford
and Bucks
• Various satellites
• Numerous partners
• 4 tier model
• Working without county
boundaries
• TV-wide functions:
recruitment, induction,
training, staff support,
evaluation, XBX input,
awareness training,
service advocacy
Thames Valley Initiative service model:
outline of tier 1
• Tier 1 is similar to assertive
outreach in AMI services: not
“office-bound”.
• It needs to be organised with
numerous agencies at locality
level.
• Individual and joint
consultations
• Includes weekly nonexploratory group, drop-ins,
various formats
AKA…
•
•
•
•
Assertive Engagement
Facilitated Engagement
Active Assessment
Engagement &
assessment
• What is the best name
for it?...
Thames Valley Initiative service model:
choice & consent in tier 1
•
•
•
•
we will not take direct
referrals in the traditional
“passing on of
responsibility” way
the final common pathway
to all coming into the
services will be individuals’
choice (ie self-referral)
that will be as informed as
facilitated as possible
with particular emphasis on
employing ex-service users
in full collaboration, as XBXs
• To develop close liaison with
all relevant other agencies,
for example through “PD
Agents” network
• assessment and engagement
will be a two-way and
continuing process with
certain stages and decision
points
• this will be related to sharing
responsibility with other
clinicians, then taking full
responsibility in later part of
the programme
Thames Valley Initiative service model:
activities and aims for tier 1
• Telephone advice to members
of staff dealing with a
potential PDPs.
• Consultation and support
regarding individual clients.
• Support to clients who selfrefer
• Liaison with all relevant
agencies.
• Staff education, by telephone
or by TVi staff attending
others’ staff meetings.
• Drop-in sessions for potential
PDPs.
• Access groups, for PDPs to
understand the service and to
support them in engaging in
further therapeutic work.
• Providing care tailored to each
individual that takes account
of disabilities, gender, sexual
orientation etc.
• Ensuring that everyone can
access the service by
employing staff from a range
of ethnic and cultural
backgrounds
• Helping PDPs disengage with
other services they may be
receiving, as appropriate
Tier 1: Assertive engagement and active assessment
Various combinations
of different days for
different referral
groups, iin different
locations
Numerous activities in different
settings with different agencies,
statutory & voluntary.
Tier 2: Outreach, inreach and “access to therapy”
Could include
weekend
programmes for
those in full time
work or education
Definitive therapeutic activities at
different times in the week, for
different populations, in different
locations
Tier 3: Day programme: therapeutic community
Whole-time daily programme at service core,
with different activities, therapies and groups.
Admin centre, also training base.
Tier 4: Leaving process – support & recovery
Half day per week (or less), possibly with overlap into
last weeks/months of tier 2 or tier 3 programme. In
liaison with other agencies (eg college, employment).
Normally thence back to GP care only.
Tier 1: Assertive engagement and active assessment
Numerous activities in different settings, one
common weekly “drop-in” engagement group
for informal meeting and information sharing
Various combinations
of different days for
different referral
groups, iin different
locations
Tier 2: Outreach, inreach and “access to therapy”
Could include
weekend
programmes for
those in full time
work or education
Different activities at different times in the week,
for different populations, in different locations
Tier 3: Day programme: definitive treatment
Whole-time daily programme as service base, with different activities,
therapies and groups.
Considerable user-involvement. Also training base.
Tier 4: Leaving process – graded disengagement
Half day per week (or less), with overlap into last weeks/months of tier 2 or
tier 3 programme. In liaison with other agencies (eg college, employment).
Normally back to GP care only.
Samaritan
s
NHS
Direct
Selfreferral
CAMHS
eg parents
with PD
SSD
s
Univ & College
health &
counselling
Occupational
health
Liaison
psychiatr
y
A&
E
Prisons
HV
MAPPPs
PC
GP
SHs
Young offender
services
Court divert
schemes
Probation
Adult mental health:
CMHTs, IP, crisis
services, assertive
outreach
Forensi
c
stepdow
n
Drugs &
Alcohol
units
Homeless
services
Housing
MIND, RF
, etc
For those with specific issues, geographical or time
limitations, or not best served by daily programme
Unplanned
discharge
For those able to take
sufficient degree of
responsibility for themselves
Planned
discharge
Unplanned
discharge
For those able, willing, and likely to be
helped by going on to a more intensive
treatment programme
Planned
discharge
Referral to more suitable services:
occasionally to out-of-area
residential units (eg Henderson or
Cassel Hospitals) or to outpatient
psychology or psychotherapy,
when suitable.
PD service model:
coordination
between local services
MIND
Elmor
e
Social
Services
Grendon Prison
Milton Keynes
PCT /
Local Authority
CONNECTION
Oxfordshire
Local
Strategy
Forum
Oxon Axis 2 Service
Assessment
Wing F
Thames Valley
Strategy Forum
& ‘Axis 2 Institute’
-Training functions
only (grey arrows)
-Strategy fora to coordinate
services AND training functions
(blue arrows)
-Includes administration of service
user input (throughout)
-located in one trust or
as part of SEDC /
TVSHA
-strategic links with other regionwide agencies
-liaison with other regions
Therapy
Wings A,
B, C, D,
G
CONNECTION
Buckinghamshire
Local
Strategy
Forum
Parenting
Assessment
Project
Local MH
services
Bucks Axis 2 Service
Local MH
services
REA
P
Berkshire
Local
Strategy
Forum
NC(?
)
Berks Axis 2 Service
Local MH
services
Broadmoor
Hospital:
Psychotherapy &
DSPD units
Thames Valley Initiative service model:
XBX involvement
• 2 employees are XBXs
• Also use pool of ~20 with
sessional rates
• Tasks: training, planning and
clinical
– Training: almost autonomous,
across agencies (details later)
– Planning: local, regional, national
– Clinical: mostly tier 1 and tier 4 –
user-friendly introduction to
services and supportive network
and “getting a life”
“We would all have completed a
recognised treatment in order
that we have moved on enough to
achieve sufficient objectivity to
be able to look beyond our own
therapeutic needs. The support
and social element of the group
would be available to people
immediately after treatment,
but involvement in training,
planning and other paid work
would not occur until six months
after the end of treatment, in
order to support people to move
on from therapeutic
attachments.”
Onwards and Upwards:
Berkshire Group
• Climate change
• Central resources for
education
• Local radio
• Need to get something
concrete
• Awareness of what we
are doing – promotion &
awareness
• Getting involved in TVU
nurse training
• Work with CMHTs –
events / day conference
• Will work with next lot of
agents
• Using what else is within
the agents’ group
• NOW!
• XBX activity will need
more funding, non-NHS
possibilities
Onwards and Upwards:
Buckinghamshire Group
• Using agents to influence
managers
• Coming on course is more
than just the one year
itself
• Invite managers into the
course to see work being
done in project groups
• With TRRT help
• XBXs – how involvement
has benefitted
• Central resource of
training materials –
off-the-pegs
• PD agents y1 & y2 will
meet quarterly
• Need to get out to GPs to
support and educate
(mixed picture)
Onwards and Upwards:
Oxfordshire Group
• Sarah’s shopping list
• No we can’t do any more
– but we did
• How do we keep on
meeting?
• Need to connect up with
this year’s PD agents
• Pick up ones who have
dropped off the radar
• Rolling out training we
have already planned
• Getting help to do that
from others
• GPs, other key areas to
involve
• Rethink & Mind
• Detailed planning
involving TRRT & STARS
• Conference – fuzzy time
line – still intended
• PCT roadshows
• Reln agents-clin team
• Still need to think about
HOW to do it.
The National Personality
Disorder Development
Programme
Training plans for the South-East
Sue Earley (TVi), Kevin Emrys (TVi), Rex Haigh (SEDC),
Sheena Money (TVi), Sue Robinson (TVi)
14 February 2005
Wellshurst Golf Club, East Sussex
Ten Essential Shared Capabilities
• =update of CPF + mapping for WD
• shift in culture in services
towards Choice, personcenteredness and mental health
promotion is a key imperative
• were significant gaps in pre and
post qualification training of all
professional staff in their ability
to deliver the MHNSF and the
NHSP
• Being rendered helpless rather
than helped by service use
• embedded in induction and
continuing professional
/practitioner development
Essential Shared Capabilities 1 & 2
• Working in Partnership.
Developing and maintaining constructive working
relationships with service users, carers, families,
colleagues, lay people and wider community networks.
Working positively with any tensions created by
conflicts of interest or aspiration that may arise
between the partners in care.
• Respecting Diversity.
Working in partnership with service users, carers,
families and colleagues to provide care and
interventions that not only make a positive difference
but also do so in ways that respect and value diversity
including age, race, culture, disability, gender,
spirituality and sexuality.
Essential Shared Capabilities 3 & 4
• Practising Ethically.
Recognising the rights and aspirations of service users
and their families, acknowledging power differentials
and minimising them whenever possible. Providing
treatment and care that is accountable to service users
and carers within the boundaries prescribed by national
(professional), legal and local codes of ethical practice.
• Challenging Inequality.
Addressing the causes and consequences of stigma,
discrimination, social inequality and exclusion on
service users, carers and mental health services.
Creating, developing or maintaining valued social roles
for people in the communities they come from.
Essential Shared Capabilities 5 & 6
• Promoting Recovery.
Working in partnership to provide care and treatment
that enables service users and carers to tackle mental
health problems with hope and optimism and to work
towards a valued lifestyle within and beyond the limits
of any mental health problem.
• Identifying People’s Needs and Strengths.
Working in partnership to gather information to agree
health and social care needs in the context of the
preferred lifestyle and aspirations of service users their
families, carers and friends.
Essential Shared Capabilities 7 & 8
• Providing Service User Centred Care.
Negotiating achievable and meaningful goals; primarily
from the perspective of service users and their
families. Influencing and seeking the means to achieve
these goals and clarifying the responsibilities of the
people who will provide any help that is needed,
including systematically evaluating outcomes and
achievements.
• Making a Difference.
Facilitating access to and delivering the best quality,
evidence-based, values-based health and social care
interventions to meet the needs and aspirations of
service users and their families and carers.
Essential Shared Capabilities 9 & 10
• Promoting Safety and Positive Risk Taking.
Empowering the person to decide the level of risk they
are prepared to take with their health and safety. This
includes working with the tension between promoting
safety and positive risk taking, including assessing and
dealing with possible risks for service users, carers,
family members, and the wider public.
• Personal Development and Learning.
Keeping up-to-date with changes in practice and
participating in life-long learning, personal and
professional development for one’s self and colleagues
through supervision, appraisal and reflective practice.
More info on 10 ESC
• www.nimhe.org.uk/downloads/78582DoH-10 Essentials.pdf
• Or Google “Ten Essential Shared
Capabilities”