H o m e T r e a t m e n t E x p e r i e n c e

C h o i c e & A l t e r n a t i v e

Kevin Heffernan Nurse 11 years leading HT developments in Birmingham Consultant for the World Health Organisation National Institute Mental Health England (Regional Implementation…5.5 M pop….39 HTT, 27 AOT) Research fellow Birmingham City University West Midlands Strategic Health Authority (Service Development) [email protected]

Characters represent

CRISIS Danger/risk and Adversity Opportunity for Personal Growth

Fidelity principles

• Gatekeeper to all potential admissions • Operating a corporate caseload (utilising MDT skill mix) • Rapid Response (1-4 hour variable) • 24 hour/7 day availability • Flexible visiting (duration/frequency/Intensity) • Clearly targeted Caseloads (acute) • Time limited (average length of stay) • Fully Integrated (not operating in isolation, whole system

responsibility)

Fidelity principles

• Comprehensive Assessment • Address social issues (in vivo) • Medical staff involved/available • Mobile • Practical problem solving approach • Supervision and administration of medication • Advice, support for Carers • Early Discharge (not becoming discharge team) • Effective communication and planning

Advantages

•

Intensive monitoring of complex cases

• 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

Advantages Avoidance of admission (1 Interrupt cycle of admission (change expectations…David) Facilitate early discharge engagement st presentations….Zacch) Reduced bed use - admissions and length of stay Different framework for sustaining recovery focused 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)

I hope this conference is inspiring and gives you

hope

for the future development of local community based mental health services

This is your opportunity! And not a danger or risk

Home Treatment

H

ope

O

ptimism

M

otivation

E

xploration

T

emperance

R

ecovery

E

mpowerment

A

utonomy

T

ruth

M

eaning

E

mpathy

N

egotiation

T

rust

Values of Home Treatment working Support Client’s to acknowledge and value the uniqueness of their experience, personal narrative exploration allows intervention to be less stigmatising and medicalised Become a catalyst for inspiration Encourage personal responsibility Clients can begin the journey of recovery and not become passive victims of illness

Community teams in Birmingham Caseload size and distribution in a locality of 150,000 population

Distribution of Cases

Assertive Outreach 12 staff Rehab & recovery 15 staff CMHT’s 20 staff ***************** ***************** ***************** ***************** ************ ***************** ************ *********** *********** ************ ************** ************** ************** 600 Cases 123 cases *********************** 370 Cases Days Years Intensity of support & Length of stay in the service

Distribution of Cases

Assertive Outreach 12 staff Rehab & recovery 15 staff CMHT’s 20 staff Home Treatment 14 staff 20 cases ************ ***********

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***************** ***************** ************ ***************** 370 Cases 600 Cases 123 cases Days Years Intensity of support & Length of stay in the service