Transcript Mental Health Nursing Award for Innovative practice

Award Winning Crisis
Resolution Service
Presentation for
18th Jan 2008
BACKGROUND TO TEAM
• Intermediate services were developed within
Glasgow following the modernising Mental Health
Initiative to improve the quality of Psychiatric care
in the UK (Dept of Health, 1998).
• Intermediate teams were multi-disciplinary and
multi agency in nature, with the main aims of
providing an alternative to hospitalisation where
possible, to promote early discharge from hospital,
and to stabilise mental mental health within the
home environment.
Service Re-Design
• Service Re-design group established in 2005
• Drivers for change are Mental health Care
and Treatment Act 2003 and OMIG group.
• Crisis Teams developed and CMHT teams
reconfigured as a result.
• Rights Relationship Recovery based nursing
review (National Review Of Nursing)
The Core Concepts of Crisis Work
• To facilitate and promote early discharge from
psychiatric in-patient care where appropriate.
• To provide short-term intensive community based
care as a viable alternative to hospital admission,
where appropriate.
• To engage service users and their families/ carers
in tailored programmes of care and promote the
stabilisation of an individual’s mental health within
their home environment.
Core Function
• Be available 24 hours a day and over 7 days a week
• Provide alternative to hospital admission and
provide an early discharge function
• Provide home assessment and treatment as an
alternative to hospital admission for people
experiencing an acute mental health crisis
• Provide support to the gate keeping and care
coordination function of Community Mental
Health Teams to ensure appropriate referral and
management of acute relapse in either inpatient
settings or through the crisis service
Core Function
• Provide short term interventions and management of an
individuals care during the period of acute relapse
• Remain involved until the crisis has been resolved whilst
maintaining robust communication with the integrated
care manager within the CMHT who will retain this
function.
• The service will also engage with service users who are
discharged against medical advice or boarded out from
their own Community Health and Care Partnership inpatient area.
• Where inpatient admission is necessary, be actively
involved in admission, discharge planning and provide
intensive care and support at home to enable early
discharge
ELIGABILITY CRITERIA
• Adults over the age of 18 including individuals under 18
who are receiving Adult MH services (e.g. ESTEEM) who
are at risk of being admitted to Hospital and who are
experiencing acute crisis and/or relapse
• 4.1 Eligibility Criteria – Facilitating Early Discharge
• The Crisis Team will play a major role in ensuring an
effective interface between in-patient and community
services. The Crisis Team will have an active role,
providing input to MDT review meetings within the inpatient service
• Adults within acute in-patients services who require
immediate intensive follow-up to facilitate early discharge
ELIGABILITY CRITERIA
• In-patients who require home assessment whilst
on pass from hospital as part of the discharge
planning process
• Patients who are discharged against medical
advice
• Patients boarding out of CHCP who can be
discharged from the boarding hospital with
intensive follow-up
EARLY DISCHARGE
• 4.1 Eligibility Criteria – Facilitating Early
Discharge
• The Crisis Team will play a major role in ensuring
an effective interface between in-patient and
community services. The Crisis Team will have an
active role, providing input to MDT review
meetings within the in-patient service
• Adults within acute in-patients services who
require immediate intensive follow-up to facilitate
early discharge
EXCLUSION CRITERIA
Exclusion Criteria -Crisis
• The team will not engage with service users while
their function is so impaired by drugs and alcohol
that they cannot participate in therapeutic
dialogue
• Service users with a primary diagnosis of Learning
Disabilities
Exclusion Criteria – Facilitating Early discharge
• Patient where another service has been identified
as more appropriate to meet their individual needs
i.e. D.A.R.T/Addictions
• Delayed discharge patients
How Crisis team incorporates New
MH act
Non- discrimination
Equality
Respect for diversity
Reciprocity
Informal care
Participation
How Crisis team incorporates new
MH act
Respect for carers
Least restrictive alternative
Benefit
Child welfare
Team Composition
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1 Team Leader (Band 7)
2 Senior Crisis Practitioners (Band 6)
1 Senior 1 Occupational Therapist
4 Crisis Practitioners (Band 5)
2 Associate Practitioners (Band 4)
0.5 Staff Grade Psychiatrist
0.5 wte Clinical Psychologist ( A grade)
1 wte Senior Social Work Practitioner
1 wte Social Work Practitioner
2 Flexi Support workers
Innovation award for Specialist
Team
• Mental Health Nursing Forum For Scotland
• Judging panel is independent from the
Nursing Forum
• Care Commission for Scotland
• NES (NHS Education Scotland)
• SRN (Scottish Recovery Network)
Comments on Submission
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The service demonstrated excellent understanding
of the Milan Principles and how to translate them
into practice
The judges scored the submission 10 out of 10
with regard to its links with national standards
The service demonstrated effective user and carer
involvement at service delivery level
The submission was clearly evidenced based and
well referenced
The service clearly demonstrated effective use of
Staying Well Plans
Client Comment
 I found the service very inclusive. My thoughts and
views regarding my treatment were taken seriously
and incorporated into a programme of support. My
views were sought at regular intervals, this I found
very enabling
 CTT very helpful and understanding without them
I have no doubt I would have ended up in hospital
Performance Indicators Heat
Targets
• Reduce the annual rate of increase of
defined daily dose per capita of
antidepressants to zero by 2009/10
• Reduce Suicides in Scotland by 20% by 2013
(existing target)
• We will reduce the number of readmissions
(within one year) for those who have had a
hospital admission of over 7 days by 10% by
the end of December 2009