Transcript No Slide Title

Navigating Mental
Health Services
Manchester Mental Health &
Social Care Trust
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Aims of Session
To provide an overview of the professionals
involved in the delivery of mental health
services
To outline the development of the Care
Programme Approach and its role in planning
mental health services
To introduce the current Mental Health Act
(1983) and also review the plans for the
changes in Mental Health law
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Objectives of the
Session
For participants to have an increased
awareness of the components of the
delivery of mental health services and
how to use this knowledge in practical
situations.
For participants to be aware of the
implications of the use of the Mental
Health Act (1983)
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Who might be involved ?
General Practitioner (GP)
 It is essential to be registered with a GP - at
least as a ‘temporary resident’
 If the person is very unwell and deemed to be
an emergency the GP can be asked to
complete a home visit
 GPs should be involved in discharge plans, to
review repeat prescriptions, sick notes and
any physical problems that might arise (Sim
et al 2005)
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Who might be involved?
Psychiatrists
These are doctors who have trained to
specialise in mental health
It is the psychiatrist who will make an initial
diagnosis and manage treatment
A psychiatrist will see those who are admitted
to in-patient care but will also often see
people with a severe mental illness as outpatients
The psychiatrist might be a senior house
officer, registrar, a senior registrar or a
consultant
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Who might be involved?
Mental Health Nurses
Qualified nurses are often referred to as
RMNs (Registered Mental Nurses) or CPNs
(Community Psychiatric Nurses)
CPNs works in a community team. They
make home visits to assess, manage, coordinate care and treat those who are
referred to them
The CPN might also be involved in giving
medication and injections
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Who might be involved?
Social Workers (SWs)
In Mental Health Trusts the social workers and
health service workers often work very closely
together. A social worker might often be the
clients’ care coordinator
SWs are experts on social matters such as
money, benefits, housing issues & child care
Approved Social Workers have specific training
to assess those clients who might need to be
cared for under the Mental Health Act (1983)
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Who might be involved?
Occupational Therapists (O.T)
O.T.s will focus on developing and
maintaining individuals’ roles and personal
functioning in activities of daily living
OTs will often support clients to attain the
maximum level of independence, either in
supported or independent accommodation
The development of meaningful activities is
central in the role of the O.T.
The O.T might work from the in- patient unit
or from community teams
The O.T. might be the care-coordinator
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Who might be involved?
Clinical Psychologists
Psychologists have extensive training in
specific psychological treatments - cognitive
therapy, psychotherapy or family work
Psychologists generally arrange
appointments to see clients in clinics rather
than in their own homes
A few psychologists specialise in psychotic
illnesses but referrals to them are generally
for less serious mental health problems
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Who might be involved?
Support Workers
They support people with practical matters
such as shopping.
Sometimes they are someone for the client to
talk to. They often build up very important
relationships with clients
They generally visit every week and might be
employed by an NHS Trust or a voluntary or
independent mental health service
Supports workers often have a lot of
experience. They do not hold a professional
qualification but many of them have extra
training through the NVQ system
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Specialist Mental Health Services:
The Care Programme Approach
All specialist (sometimes called ‘secondary’)
mental health services MUST deliver coordinated mental health care using the Care
Programme Approach (CPA)
The aims of the CPA are to deliver a ‘holistic’
approach to organising care (Rethink 2005)
The aim of the CPA is to develop an organised
system to ensure that people with severe
mental illness are assessed, treated and
supported in the community (RCP 2004)
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The Care Programme Approach
The CPA is based on four principles:
Assessment – Of mental and physical health
needs, social and environmental needs and
also an an assessment of risk to self and/or
others or a risk of neglect
Allocation of a care co-ordinator - A
professionally qualified key worker
Development of a care plan - This is a cocoordinated plan of all the arrangements with
all those involved in the care of the individual
Regular review - The CPA is ideally reviewed
every six months in collaboration with the client
and involving all aspects of care
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Care Programme Approach
The CPA care plan can be delivered by a
range of ‘multi-disciplinary’ teams: e.g.
community mental health teams, early
intervention teams, assertive outreach (ACT)
teams or crisis resolution teams. These
teams specialise in intensive services for
different groups of people. They all aim to
work with people in the community
Often there is a need for the involvement of
more than one team as needs are complex
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Care Programme Approach
Care Coordinators Role
To develop, plan, manage, co-ordinate and
integrate an individual’s care between all
specialist services, social services and primary
care.
Must be a qualified professional in mental health
- nurse, occupational therapist, social worker.
Sometimes the role is undertaken by a
psychiatrist
Most often the role is assumed by a member of
the Community Mental Health Team (CMHT) as
they have a long term commitment to continuous
care of the client
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Specialist Mental Health
Services
Community Mental Health Teams (CMHTs)
CMHTs provide the core of local specialist
services. They offer assessment, treatment
and social care to adults in the community
with mental health problems
They tend to be based in local resource
centres away from hospitals, to be more
accessible to clients and families
In many areas the CMHT is the gateway to
more specialist services
Referrals to CMHTs are given an initial
assessment. The most suitable service is
then agreed by referrer, client and service
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Specialist Mental Health Services
Early Intervention Teams
These teams are specifically for those who
are experiencing a first episode of a psychotic
illness and are for people aged 14 – 35
They provide the best mix of specialist
medical, psychological, social, occupational
and educational interventions at the earliest
possible opportunity
Although not available yet in all areas, the
government proposes at least 50 services to
be developed (SCMH 2003)
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Early Intervention
Teams
Aims of Early Intervention Teams might
include the following:
• To reduce the duration of untreated psychosis
• To provide a comprehensive assessment,
treatment and rehabilitation
• To prevent relapse
• To minimise loss of functioning and social
skills
• To educate the young person and
family/carers
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Principles of Early
Intervention Teams
Early detection and assessment of psychosis
The team aims to instill optimism about each young
person’s chances of recovery
Acceptance that a clear diagnosis is not always
possible yet a wide range of pharmacological and
psychosocial interventions should be offered
Acknowledging that families need support as well as
clients
Services need to forge strong working partnerships
with a range of statutory and non-statutory services
(SCMH 2003)
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Specialist Mental Health Services
Assertive Outreach (Community) Teams (AOT or ACT)
Deliver intensive treatment and rehabilitation
in the community for the severely mentally ill
Provide rapid help in crisis and offer long term
support
Staff act as advocates and liaise with other
services (GP, social services)
These teams are specifically for those with
complex needs who are reluctant to engage
with mental health services (Philips et al
2001)
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Specialist Mental Health
Services
Crisis Resolution/ Home Treatment Teams
An alternative to hospital admission during an
acute phase of illness
Different service models exist throughout UK
A 24 hours / 7 day a week service to assess and
provide treatment by an Multi Disciplinary Team
(MDT) to clients and support to carers
CMHTs remain involved with clients
Often the first experience of mental health services
for those experiencing a first episode of psychosis
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Specialist Mental Health
Services
Acute In- Patient Care
When a rapid assessment and stabilisation
during an acute episode is necessary
Used for clients who need to be compulsorily
detained under the Mental Health Act (1983)
Admission period varies from a few days to
several months depending on need
MDT meets weekly on the ward to discuss
care plans with clients
Some in- patient care units detain clients in
secure environments
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Specialist Mental Health Services
Child & Adolescent Mental Health Services
(CAMHS)
Offer services for children and young people
in hospital settings, GP clinics, health centres
and sometimes in schools and further
education (McGlynn 2001)
CAMHS offer a wide range of interventions by
an MDT. They often include family therapy
(Charman 2004)
Age group depends on the model of service
delivery
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Specialist Mental Health
Teams
Other teams that might be involved:
 Substance misuse teams (alcohol & drugs
teams)
 Psychotherapy services
 Eating disorders services
 Self harm services
 Family Intervention Teams
 Voluntary or independent groups offering
support groups, drop-ins and counselling
 Employment projects and training schemes
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Pathways to Care
Access routes to Early Intervention Services
include :
Primary care
Youth services
Acute care (A&E, walk-in clinics etc)
Specialist early detection teams
Ideally a mixture of routes should be
available but service designs often mean
accessibility varies considerably
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Group Exercise
1.
2.
3.
Divide into small groups to represent all
stakeholders of care
Each group will be given one stakeholder:
either the client, carers and family, mental
health services or the general public
Each group is then asked to consider the
the advantages and disadvantages of the
mental health law in the UK
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Mental Health Act (MHA 1983)
Many people will enter hospital for treatment
voluntarily. The MHA is only used when
detainment in hospital is considered
necessary for the health and safety of the
person with psychosis or for the protection of
others
Often needed when people do not realise
they are ill – this is often termed ‘lack of
insight’ by professionals
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What is the Process?
 In order for anyone to be admitted to hospital
for admission and treatment under the MHA
the recommendations must be made by two
doctors – one of whom is often the GP . In
addition, a social worker with special training
to make the decisions is involved
 If the person or their relative is admitted to
hospital for assessment or treatment they can
appeal against the section to the Mental
Health Review Tribunal (MHRT)
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Terms used ……
The MHA is divided into a number of different
‘sections’. This is where the term to ‘section
someone’ is derived
Doctors, often the GP and a psychiatrist
must make medical recommendations for
the person to be detained
Once the recommendations have been made
an Approved Social Worker (ASW) must
then make an application to the hospital
manager to admit the person to hospital
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The Sections of the
MHA
Section 136 – The
moving of someone to a
place of safety made by the police
Section 2 – For the assessment of someone
for up to 28 days
Section 3 – To provide treatment following
assessment lasting for up to 6 months
Section 4 – An emergency admission lasting
for 72 hours, often transferred to a Section 2
Section 5 (2) – If a voluntary in-patient
needs to be detained and they wish to leave –
lasting for 72 hours
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The Mental Health Act
Sections 2 & 3 require that two medical
recommendations must be made,
usually from a consultant psychiatrist
and a GP
The medical recommendations should
know the patient already and can judge
what is ’normal’ for that person
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Section 117 - Aftercare
This section requires that when a client
is discharged from a ‘treatment section’
all their needs are provided for
Clients should agree to the plan prior to
discharge
The 117 meeting may include advising
the client where they should live
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Proposed Changes in the MHA
The draft Mental Health Bill was released for
consultation in 2004
Changes are to be made concerning the
duration of enforced admission. A period of
no longer than 28 days should elapse before
a review is conducted
Changes in support systems for detained
clients - a clinical supervisor will be appointed
to provide a care plan within 5 days of
allocation
Allows community teams to care for detained
clients as an alternative to inpatient
admission
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Changes that will affect
young people
Both 16 and 17year olds will be treated
as adults with a choice to agree or
refuse intervention which cannot be
overridden by parents
If children under 16yrs require treatment
and parental consent is not gained,
safeguards are in place to ensure they
obtain the treatment they need
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Case Study Exercise
1. In small groups read through section
one of the case study
2. Write the answers down in your group
3. As a large group discuss your answers
from the first section before moving
onto the next section
4. There are no ‘right or wrong’ answers,
just possibilities
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Conclusion
Mental health services involve a
comprehensive range of professionals and
support staff who have a wide range of skills
and experience
The CPA is the standard method of coordinating the services available to clients
and their carers
Government guidance shapes the
development of services locally and nationally
The MHA (1983) legislation also influences
the delivery of services. This legislation is
due to be modified
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