Transcript Birmingham: A Framework for developing community based

Crisis Resolution/Home Treatment
Developing Critical Components
Kevin Heffernan
Honorary Research Fellow
Centre for Community Mental Health
Birmingham City University
Kevin Heffernan
Nurse (RMN)
11 years leading HT developments in Birmingham services,
(National award winning beacon site)
Consultant for the World Health Organisation
National Institute Mental Health England (Regional
Implementation…5.5 M pop….39 HTT, 27 AOT)
Honorary Research fellow Birmingham City University
West Midlands Strategic Health Authority (Programme
Specialist service development)
Overview of Presentation
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Critical components or fidelity principles of CRHT in England
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Advantages of CRHT in English context

Community profile of 1 Birmingham area
Tomorrow

National/Regional Implementation of policy
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National Audit of CRHT in England

Important data collection for CRHT
Characters that represent
CRISIS
Danger/risk
and Adversity
Opportunity for
Personal Growth
Fidelity principles in CRHT
• Gatekeeper to all potential admissions
• Flexible visiting (duration/frequency/Intensity – protect
capacity)
• Rapid Response (1-4 hour variable by geography)
• 24 hour/7 day availability
• Operating a corporate caseload (utilising MDT skill mix)
• Clearly targeted caseloads (Acute – not all things to all men!)
• Time limited (average length of stay 4-6 weeks)
• Fully Integrated (not operating in isolation, whole system
responsibility)
Fidelity principles in CRHT
• Comprehensive Assessment
• Address social issues (in vivo)
• Medical staff involved/available
• Mobile not office based
• Practical problem solving approach
• Supervision and administration of medication
• Advice, support for Carers
• Early Discharge (not becoming discharge team)
• Effective communication and planning
Advantages of CRHT
Interrupt cycle of admission (change expectations…David)
Avoidance of admission (1st presentations….Zacch)
Facilitate early discharge
Reduced bed use - admissions and length of stay
Different framework for sustaining recovery focused engagement
Support can be perceived as;
•More Personal/Individualised
• Increased Negotiation leading to a sense of increased autonomy
• Potential to develop more true Partnership working (Trialogue can emerge)
• Narrative scrutiny (exploration of the why now and true
context becomes more possible)
Advantages of CRHT
• Can be more flexible/sensitive ethnic minority groups
• Extended Support for Carers
• Explanation and advice and post crisis planning
• Confront social problems directly
• Work closely with Dual Diagnosis issues
• Reduce stigma of hospitalisation
• Higher satisfaction users and carers
• Development of an acute team
Community teams in Birmingham
Caseload size and distribution in a locality of
150,000 population
Understandingyou can’t do it alone!
Understanding where you fit in the system!
High Caseload Low Intensity
Primary Care MH team
1:30
20 staff
600 Cases
Weekly - Monthly
Rehabilitation/Recovery
1:25
15 staff
370 Cases
Weekly - Fortnightly
Years
Days
Home Treatment
1:2
14 staff
25 Cases
Multiple daily - decreasing
Assertive Outreach
1:10
12 staff
123 Cases
Daily - Weekly
Low Caseload High Intensity
ACTIVITY
TEAM
CASELOAD/
Size/ Time
CMHT/
Primary Care
Liaison
≤ 1:30
Rehabilitation/
Recovery
≤ 1:25
Assertive
Outreach
≤ 1:12
Crisis/ Home
Treatment
≤ 1:2
VISITING
Availability/
Frequency
9am – 5pm 5 days
Up to 18 months Weekly – Monthly
Years
Years
Up to 3 months
INTENSITY
How long/where
Clinic or Home
Therapeutic Session
Up to 1 hour
9am – 5pm 5 days
Weekly - Fortnightly
Activity based
Home or community
0900-2100 6-7 days
Daily-Weekly
Minutes to Hours
Home or Community
24 hours, 7days
Multiple Daily – 3
times per week
Minutes to hours, as
required
Home or Community
Serious Mental Illness
Distribution of Cases
Assertive Outreach
12 staff
Rehab & recovery
15 staff
CMHT’s
20 staff
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123 cases
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370 Cases
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600 Cases
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Days
Years
Intensity of support & Length of stay in the service
Distribution of Cases
Serious Mental Illness
Crisis Resolution/Home
Treatment
14 staff
20 cases
Assertive Outreach
12 staff
Rehab & recovery
15 staff
CMHT’s
20 staff
************
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************************ 123 cases
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370 Cases
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600 Cases
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Days
Years
Intensity of support & Length of stay in the service
Serious Mental Illness
Distribution of Cases
Assertive Outreach
12 staff
Rehab & recovery
15 staff
CMHT’s
20 staff
Crisis Resolution/Home
Treatment Most Impact on diverting cases
From Hospital admission
14 staff
***********
20 cases
***********
************123 cases
************************
*************************
************************
******************************
************************
***************************
**********************
**************
370 Cases
*****************
*************************
*********************
*****************
*************************
*******************
*****************
******************
600 Cases
*****************
*****************
************
*****************
Days
Years
Intensity of support & Length of stay in the service
Distribution of Cases
Serious Mental Illness
Most Impact on diverting cases
From Hospital admission
Assertive Outreach
12 staff
***********
***********
123 cases
************
**************
***********************
**************
**************
**************
370 Cases
Rehab & recovery
*****************
**************
15 staff
*****************
*****************
600 Cases
**************
*****************
CMHT’s
**************
************
20 staff
**************
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Norway ACUTE
Days Teams
Years
Intensity of support & Length of stay in the service
Let today's collaboration be another important step to
inspiring and giving each other hope for the future
development of local community based mental health
services across Norway
This is your opportunity!
And not a danger or risk
How did the Department of Health support a national roll out of policy based
on some of the Birmingham success story?
From Policy to Implementation
The role of regional development centre’s.
National Institute of Mental Health in England (NIMHE) was
formed by the Department of Health in 2002 to help the mental
health system implement the National Service Framework for
Mental Health and the NHS Plan.
8 regional development centres were set up
One in the West Midlands covering a population of 5.5 million
Also regional centres in
East Midlands
London
South East
South West
Eastern region
North East
North West
The main aim of NIMHE was to help improve the quality of life of
people of all ages who experience mental distress.
Working beyond the NHS, it helped all those involved in mental
health to implement positive change, providing a gateway to
learning and development, offering new opportunities to share
experiences and one place to find information.
Through NIMHE's local development centre’s and national
programmes of work, it supported staff to put policy into practice
and to resolve local challenges in developing and sustaining new
mental health services.
Workstream examples within the Regional Development Centre's
Specialist mental health services
Acute Inpatient
Community teams (Crisis Resolution/Home Treatment, Assertive Outreach teams)
Child & Adolescent Mental Health
Dual Diagnosis
Early Intervention
Personality Disorder
Improving access to Psychological therapies
Improving access to psychological therapies for people with common mental health problems.
Equalities – Race, Gender & Age
Delivering Race Equality
Gender, Equality and Women's Mental Health Programme
Mental Health in Later Life
Well being and Inclusion
Social Inclusion Programme , mental health first aid training programme
Legislation
The Mental Health Legislation programme supported the implementation of service changes and
changes in roles that are required to meet any changes set out in the Mental Health Act
Day in the life of a staff member
Not official performance management/monitoring, but focus on service
Improvement and development , therefore viewed as honest brokers
Identify good practice areas
Link areas together
Protect and champion ‘fidelity’ and ‘values’
Develop regional network’s (e.g. CRHT, AO and EI)
Influence policy review and refinement
Strength in having a national profile (sharing across RDC’s)
Challenge with kindness!! (e.g. not if, but how!, rural v inner city)
Context
Part of my role was to offer support & guidance across the
West Midlands to
25 Assertive Outreach teams
39 Crisis Resolution/Home Treatment teams
Regional forums (organise& chair)
Specific developmental in vivo programmes to address local issues (not
‘off the shelf’)
Coaching & mentoring of managers/leaders
Ensure fidelity to the model
All staff were recruited based on their experience and/or commitment
to the new vision of services.
The values of staff were a critical factor, to embrace the complex and
unique issues of different areas who were at different stages of
evolution was an essential skill
Systems are systems the world over, getting the right people in the
right place at the right time is what makes it work!
You are the catalysts for change. Your role will be to inspire and give
people hope that things can change. How you get support will be
important
I hope you are the right people with all the commitment, energy,
passion, empathy, humour and perseverance required to move your
mental health system forward. This ultimately will lead to the
improvement in the quality of experience for Users and families that
access your services
Happy to take questions or to be contacted on
[email protected]