Transcript Slide 1

Service Planning Forum
Report of the Working Group
Mental Health Service Delivery Models and Inpatient
Capacity for Persons with Significant Intellectual
Disability and Mental Health Problems
Report of the Working Group
Working Group Representation
Health Service Executive Representation
Irish Medical Organisation Representation
Irish College of Psychiatrists Representation
Irish Hospital Consultants Association Representation
National Federation of Voluntary Bodies Representation
Heads of Psychology Services Ireland
Chairman: Mr Hugh Kane
Report of the Working Group
Terms of Reference of the Working Group
To explore options capable of creating immediate additional capacity
for the provision on a regional basis of inpatient facilities for persons
with a significant intellectual disability who require involuntarily
admission under Part 2, Section 8 of the Mental Health Act, (2001).
To identify the most appropriate, integrated and cost efficient models
which can provide HSE with readily accessible quality service
settings for the client group and make proposals to the Mental Health
Directorate of the HSE on options to be pursued to ensure interim
arrangements at commencement of the remaining sections of the
Mental Health Act, (2001).
Report of the Working Group
Definition of the Target Populations
Population 1 (individuals with general mental health problems)
Individuals with intellectual disability with significant mental health
problems
Population 2 (individuals with specific mental health problems
requiring involuntary admission)
adults with significant intellectual disability and mental health
problems who require involuntarily admission under Part 2 of the
Mental Health Act, (2001).
Report of the Working Group
Main Guiding Principles of the Working Group
Mental health services for people with intellectual disability must be reconcilable
with the Mental Health Act, 2001 and the current framework for mental health policy
(Vision for Change, 2006).
Mental health services for those with mild ID and less severe mental health
problems will be provided by generic services in accordance with the principle of
mainstreaming
Mental health services for people with intellectual disability (as defined in the target
populations) should be provided by a specialist mental health of intellectual
disability team.
Mental health services for individuals with intellectual disability must be coordinated
and draw on existing mental health and intellectual disability expertise. Maintaining
continuity of care and building on existing networks of support and expertise should
be a priority concern of the service-delivery system.
Mental health services for individuals with intellectual disability must be
underpinned by a recovery orientation.
Report of the Working Group
Proposed Model of Service Delivery
The Working Group Recommends……….
that the framework for specialist service provision be underpinned by the
Report of the Expert Group on Mental Health Policy “A Vision for Change,
(2006)”
that existing clinical resources in ID services be reconfigured to form
Community Intellectual Disability Teams on a catchment area basis
that a catchment area based specialist Mental Health Intellectual Disability
Team (MHID team) will be a core resource. (provided on the basis of two
teams per 300,000 population).
that the initial roll-out of the proposed model builds on the capacities and
resources currently deployed within statutory and non statutory sectors.
that in areas of the country where there is a recognized lack of existing
service an opportunity should be provided to the voluntary and private
sector to tender for the provision of services in those areas.
Report of the Working Group
Individual at homeno Intellectual
Disability Service
Individual at
home- day
Intellectual
Disability
Service
Individual
residing in
Intellectual
Disability Service
Intellectual Disability Services-Multidisciplinary Team,
providing comprehensive Health & Social Care
GP & PHCT
GP & PHCT
GP & PHCT
The Referral Pathway
Referral point to Team
Mental Health Intellectual Disability Team (MHIDT)
Multidisciplinary Team, providing Assessment, Treatment and Care
Acute, Assessment and Rehabilitation beds and Day Hospital places as appropriate
Report of the Working Group
Clinical and Service Governance
The Working Group Recommends……….
the implementation of a integrated framework of service delivery (part
of the mental health services for a defined catchment area) with
measures put in place to ensure that the same service and clinical
governance principles as outlined in Report of the Expert Group on
Mental Health policy apply to the MHID team. (Vision for Change, 2006,
p 172).
Report of the Working Group
Model of Service Governance
National Mental Health Service Directorate
National Care Group Manager Mental Health
Senior Management Staff
National Medical Director
National Director of Nursing
Representatives of other professions in Mental Health
Service User
Mental Health Catchment Area Management Team
(for population over 300,000)
Managers of 2-3 local health offices
Medical Director
Nursing Director
Heads of Discipline for Psychology, Social Work & Occupational Therapy
Service User
Mental Health Intellectual Disability Teams (MHIDT)
Team Leaders
Team Co-ordinators
Practice Managers
Report of the Working Group
Inpatient capacity and beds numbers
The Working Group Recommends……….
that a national review of mental health of intellectual disability acute inpatient bed capacity be undertaken prior to the 1st of November 2006.
that initially 5 acute in-patient mental health intellectual disability beds,
10-day hospital places and 10 rehabilitation beds per 300,000population catchment be made available. (Vision for Change, 2006, p
130).
that a spectrum of regionally based facilities be put in place to provide
a flexible and effective continuum of care based on need.
the National Intellectual Disability Database Committee incorporate
national statistics for individuals with intellectual disability & mental
health problems in its annual report..
Report of the Working Group
Acute Beds
LHO Area
Dublin Mid Lenister
Area 1 East Coast Dublin
Area 2 S.E. Dublin
Area 3 S.W. Inner City
Area 4 & 5 S.W, Dublin
Area 9 W Wicklow/ Kildare
Area 10 Wicklow
Longford / Westmeath
Laois / Offaly
Dublin Nth East
Area 6 N.W. Dublin
Area 7 Nth Inner City
Area 8 Nth County Dublin
Louth / Meath
Cavan / Monaghan
HSE West
Clare
Donegal
East Galway
Limerick
Tipperary (North)
Roscommon
Sligo / Leitrim
West Galway
Mayo
HSE South
North Cork
North Lee
South Lee
Kerry
Carlow / Kilkenny
Tipperary (South)
Waterford
West Cork
Wexford
Population Per Area**Acute Bed Requirement
181,670
107,738
142,012
258,865
190,476
106,812
112,033
130640
159,477
148,918
234,536
260,635
120,365
110,919
138,555
106,213
188,277
65,525
58,004
100,692
118,085
126,137
79,171
168,051
180,375
142,732
119,883
85,213
109,365
54,715
125,574
20.51
3.03
1.80
2.37
4.31
3.17
1.78
1.87
2.18
15.34
2.6
2.48
3.91
4.34
2.01
16.88
1.85
2.31
1.77
3.14
1.09
0.97
1.68
1.97
2.10
17.75
1.32
2.80
3.01
2.38
2.00
1.42
1.82
0.91
2.09
Report of the Working Group
Current Capacity Additional Capacity Acute Beds
Rehab Beds
LHO Area
Dublin Mid Lenister
Area 1 East Coast Dublin
Area 2 S.E. Dublin
Area 3 S.W. Inner City
Area 4 & 5 S.W, Dublin
Area 9 W Wicklow/ Kildare
Area 10 Wicklow
Longford / Westmeath
Laois / Offaly
Dublin Nth East
Area 6 N.W. Dublin
Area 7 Nth Inner City
Area 8 Nth County Dublin
Louth / Meath
Cavan / Monaghan
HSE West
Clare
Donegal
East Galway
Limerick
Tipperary (North)
Roscommon
Sligo / Leitrim
West Galway
Mayo
HSE South
North Cork
North Lee
South Lee
Kerry
Carlow / Kilkenny
Tipperary (South)
Waterford
West Cork
Wexford
Population Per Area**Rehab Bed Requirement
181,670
107,738
142,012
258,865
190,476
106,812
112,033
130640
159,477
148,918
234,536
260,635
120,365
110,919
138,555
106,213
188,277
65,525
58,004
100,692
118,085
126,137
79,171
168,051
180,375
142,732
119,883
85,213
109,365
54,715
125,574
41.11
6.06
3.60
4.74
8.62
6.43
3.56
3.74
4.36
30.68
5.2
4.96
7.82
8.68
4.02
33.73
3.7
4.62
3.54
6.25
2.18
1.94
3.36
3.94
4.2
35.5
2.64
5.6
6.02
4.76
4.00
2.84
3.64
1.82
4.18
Report of the Working Group
Current Capacity Additional Capacity Rehab Beds
Education
The Working Group Recommends……….
that staff educators examine educational and training opportunities and
develop innovative strategies that address shared multi disciplinary
learning and professional development.
the strengthening of linkages between service and the tertiary academic
and research communities not alone for the pursuit of scholarship but more
importantly to ensure that practice development is continually shaped by
the growing evidence base about the mental health needs of adults with
intellectual disability
Report of the Working Group
New Partnerships
The Working Group Recommends……….
that access to specialist service would be through one point-of-entry, the
MHID team.
the continued development of the national infrastructure of primary
multidisciplinary supports i.e. Community Intellectual Disability Team (as there
are many areas that lack such teams), which is a crucial element, to the
success of the proposed model and must be in place.
that all individuals with intellectual disability be registered with their General
Practitioners.
that a national mapping process be undertaken to align mental health
intellectual disability services with Local Health Office catchment area
designation.
Report of the Working Group
New Partnerships cont’d
The Working Group Recommends……….
the need for specific interface and management contracts, protocols &
service-level agreements between all agencies involved with the provision of
specialist mental health service to individuals with intellectual disability.
the development of fora and processes to facilitate integrated service
planning and coordination in order to assure quality and to ensure that
services and supports are coherent, linked and comprehensive.
Report of the Working Group
Critical Factors
Identification of current acute in-patient bed capacity
Audit of the national acute in-patient bed requirements
Identification of current resources Statutory & non Statutory
Establishment of the MHID teams
Continued development of the Community Intellectual Disability Teams
that will work in parallel with the primary care teams
Mapping process be undertaken to align mental health intellectual
disability services with Local Health Office catchment area designation.
Inclusion of all stakeholders, resolution of service & clinical governance
issues
Development of explicit joint-care protocols and service level
agreements
Utilisation of the Report of the Working Group to informs the “Vision for
Change” implementation team
Report of the Working Group
Options, choices and equivalence
• Organisation/funding is based on population service needs
– Agency needs to be associated with a geographic catchment area.
– Consultant Psychiatrists need to be associated with a geographic
catchment area (as per Vision for Change).
• Recognise higher vulnerability and specialist nature of access
– Same workload for consultant, same access for client (1 consultant
team per 150,000 population).
– Engage with psychiatrists to work through what service they currently
provide and distinguish mental health needs.
• ID Clients access to same level of service as rest of population
– Agencies to enhance existing services, supported by MHID team.
– Legislative impact on practice – currently detain/seclude without legal
framework in an intellectual disability setting. Not addressed under
disability act.
Report of the Working Group
Optionschoices
for inpatient
Options,
and capacity
equivalents
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The acute beds provided by HSE or designated provider.
The rehab beds, in a step-up and step-down capacity, remain within the
agencies.
Day hospital provided by HSE or by designated provider, in actual or virtual
capacity.
Who is best placed to do this? The current providers, however MHID team
is missing.
Report of the Working Group
What about children?
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For the immediate future presentations will be addressed on a case by case
basis.
Children with an intellectual disability and mental health problem are a small
cohort – a group within a group.
In crafting a solution on an individual basis we can draw on multiple
services, that is child and adolescent , id, childcare, etc.
Report of the Working Group
Inpatient capacity on 01.11.06
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Retain current status quo including provision within the existing adult mental
health services
Number of designated units, e.g. Stewarts Hospital & St. Josephs
Look at developing and/or enhancing current services
Address MHID team deficit
Option to buy capacity in private sector
Overseas treatment – preference to provide treatment here.
Report of the Working Group
What do we need to do now?
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We have overarching plan
Local plan between HSE & agencies; need to enter into discussion and
agree arrangements now
Ongoing development funding through mental health and disability services.
Sub-group of Implementation Team for Vision for Change to implement the
recommendations made by the MHID Service Planning Forum.
Reconfigure current resources - staff and infrastructure
Option exists to become an approved centre operating under a consultant
psychiatrist. The whole unit must be approved.
HSE through its Local Health Managers obliged to provide service to all
people in catchment area.
Report of the Working Group