Transcript Veterans Mental Health Pathways Wayne Kirkham National Lead National Veterans Mental Health Network NHS England www.england.nhs.uk March.

Veterans
Mental Health Pathways
Wayne Kirkham
National Lead
National Veterans Mental Health Network
NHS England
www.england.nhs.uk
March
2015
Armed Forces Network – How it Looks
www.england.nhs.uk
Ex - Armed Forces Community
The size of the Adult ex-Service community is estimated to be 4.9m
(Veterans & Dependents)
www.england.nhs.uk
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Ex - Armed Forces Community – cond
The size of the UK veterans community is estimated to be 2.8m
(88.9% male / 11.2% female)
The size of the veterans community in England is estimated to be 2.3m
• Transition from serving to veteran is key to good health
• CCG is lead commissioner
NHS England has inherited £5M for 3 Veteran Mental Health commissioning roles:
• Online national support (the Big White Wall)
• Regional bespoke veteran services (NVMHN x 10 Regions – 12 providers )
• Residential PTSD services (specialised commissioning) (Combat Stress 6wk
programme)
www.england.nhs.uk
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Veterans Engagement – 2013/15
Total = 23,342 (NHS)
“The Challenge"
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Mental Health is Everybody’s Business - It’s Time to Change.
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The Mental Health Crisis Care Concordat
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The right quality of treatment and care when in crisis
Recovery and staying well, and preventing future crisis
Parity of Esteem
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Together we can make a difference, but to make the most difference to the most people, we
need to look beyond mental health services into wider public services; then beyond public
services into our society as a whole.
Better data and information for the public, commissioners and providers
Addressing the physical health of people with serious mental illnesses
Addressing and improving crisis care
Closing the Gap
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Mental health must have equal priority with Physical Health
Involvement of many partners from across the voluntary sector, from national charities to local
community groups.
www.england.nhs.uk
Wayne Kirkham, National Lead, National Veterans Mental Health Network, NHS England - [email protected] - 07918368472
North East
Yorkshire & the Humber
Symon Day
[email protected]
01388 646800
www.tewv.nhs.uk/veterans
Jennie Ormerod
[email protected]
01482 617771 / 594
[email protected]
Hull, East Riding & North Lincolnshire (formerly Humberside) South West & North Yorkshire
County Durham, Darlington, Teesside, Hartlepool, North East Yorkshire
North West
Helen Lambert
[email protected]
0161 7783991 - 0161 2536638
www.penninecare.nhs.uk/military-veterans
East Midlands
Paula Jelly
[email protected]
01522 526827 – 07500984890
Greater Manchester, Cheshire, Wirral & Warrington, Merseyside, Lancashire & Cumbria
Derbyshire, Lincolnshire, Leicestershire, Milton Keynes & Rutland,
Nottinghamshire, Northamptonshire
West Midlands
East of England (North Essex)
Jeremy Newell
[email protected]
07887 823010
Diane Palmer
[email protected]
01206 228759
www.nevmhn.org.uk
North Essex, East Essex, Mid Essex, West Essex,
Bedfordshire, Cambridgeshire, South Essex,
Hertfordshire, Norfolk & Suffolk
Birmingham & the Black Country, Coventry & Warwickshire, Dudley & Walsall,
Herefordshire & North Gloucestershire, Staffordshire, Shropshire, Worcestershire
South West
David Wilcox
[email protected]
0300 5550112
www.swveterans.org.uk
South East Coast
Sussex
Bath & NE Somerset, Bristol, Cornwall, Devon, Dorset, Gloucestershire,
South Gloucestershire, Somerset, Wiltshire, Swindon
Kate Parkin
[email protected]
07770864394
South of England (South Central)
Dr Deborah Lee
[email protected]
0118 9296426
[email protected]
Berkshire, Buckinghamshire, Hampshire, Oxfordshire,
Southampton, Isle of Wight, Portsmouth
London
Dr Nick Hawkes
[email protected]
020 3317 6826
www.candi.nhs.uk/veterans
Camden, Islington, Maudsley, South London
Surrey
Vacant
Kent & Medway
Belinda Simpson
www.armedforcesnetwork.org
07976 563 338
Helpline 01303 856 499
Innovative & Collaborative
Working in Veterans Mental
Health
Our Armed Forces carry out many
different roles
Then they come home
Some with Physical injuries
Some with Invisible wounds
‘Veterans First Service’
Our Story
In the beginning…
• Concerns were raised by the MOD about the
local provision of mental health services for
Veterans in Essex and the need to ensure that
the Armed Forces Covenant is upheld.
• The Armed Forces Covenant states that
Military Veterans, anyone who has served 1
day or more in HM Armed Forces, should:
• Not be disadvantaged by their Military Service
• Should receive Priority Treatment for Service
Related Conditions.
The concerns…
• Veterans rarely fit neatly into secondary care
criteria due to nature of their MH Condition.
• Often excluded by IAPT as considered to be
too high risk
• Long waiting lists for Psychology services
• Lack of understanding of MOD culture and
language
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Lack of shared medical records
Stigma- Difficulty to engage
Prevalence of alcohol and substance misuse
Contact with criminal justice
Action taken…
• They formed the NORTH ESSEX VETERANS
MENTAL HEALTH NETWORK, an alliance
between the MOD + NHS + COMBAT STRESS
• The Network promoted collaborative
working, shared learning, held 2 conferences
and set up a website for Veterans and
Professionals.
• The Network won the ‘Care of Veterans’
category in the Military and Civilian Health
Partnership Awards 2013.
Funding
• The NEVMHN put in a bid for DH Funding
• £130 K received for first year. £150k allocated
for further 3 years until March 2016.
• Money paid via NHS England to the NEP.
• Veterans First was created as a ‘Specialist
Secondary Care CMHT’ for those in transition
and Veterans in North Essex and became
operational in May 2012
Staffing
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Area Team Manager
Clinical Nurse Specialist
1 x Band 4 (1 day a week)
1 x Band 3 (1 day a week)
Full time Administrator
2 Honorary Therapists
1 Psychiatrist on interest placement
Process
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Accept self referrals
All professionals can refer
Triaged
Urgent cases prioritised
All patients receive extensive information pack
and invited to support groups
• Care co-ordinated if service related.
• Give specialist advice to other staff if needs
best met by another team IE. Eating Disorder,
Dementia or Psychosis.
Assessment & Support
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Diagnosis
Medication- Prescribe, monitor, review
Psychological therapy
Physical Health and Mobility
Substance misuse
Safeguarding
Offending behaviours
Domestic abuse
Immigration
Housing
Debts
Finances
Benefits
Compensation
Resettlement, education and training
Employment
• Wider family needs
• Social inclusion
• Carers Assessments
and anything else that is causing the Veteran to
be distressed or impairing their functioning
personally, socially and occupationally.
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Assessed and treated 300+ Veterans
Majority have PTSD/Depression/Anxiety
Offer specialist care co-ordination (CPA)
Multi-agency approach to support those with
anger management issues, violent and sexual
offending, domestic abuse, child protection
issues, substance misuse and co-morbid
physical injuries and conditions.
• We work in partnership with a multitude of
agencies, using the CPA as a framework.
• We work closely with Military Units, including
the Departments of Community Mental
Health, Personnel Recovery Units, Personnel
Recovery Centres, Occupational Health and
Unit and Specialist Welfare services in the
MOD.
• We obtain military records and military
medical notes.
• We work with many Military Charities,
including Combat Stress, Help for Heroes and
the Royal British Legion.
• We work with specialist resettlement and
employment advisors, housing officers, social
care, the Police, Probation, the Courts,
Prisons, Immigration and generic mental
health and substance misuse services,
including DUTY, crisis resolution home
treatment and in-patient services.
Support Groups
• We run 3 Multi-agency Veterans support
Groups and a carers group each month.
• These are run in partnership with Combat
Stress and the RBL, with attendance from up
to 10 professionals per group. These include
staff from Veterans UK, Healing Hands, the
Warrior Programme, Invicta Foundation, IAPT,
Social Care, Help for Heroes and The Soldiers
Charity.
Advice Clinic
• We are currently in the Process of setting up a
multi-agency clinic one day a month with H4H
• Veterans First and Combat Stress clinicians will
make up half the staff running the clinic.
• Offering set appt times for assistance with a
specific matter that could be resolved in up to
1 hour. For example, medication query, advice
about housing or debts, to look over a CV,
request financial help.
Crisis
• All patients are risk assessed and have a risk
management plan.
• In working hours patient are seen by the
Veterans Team. Veterans Team staff often stay
late to facilitate crisis support.
• Out of hours- Have access to the wider trust
Crisis Team
• Combat Stress 24hr Helpline
• A+E Psych liaison- run by NEP
• Big White Wall
• If picked up by the Police they may end up in
the 136 suite at NEP
• Any Veteran accessing crisis care within our
Trust will be told about the Veterans Team and
offered a service.
• We also work closely with in-patient services
to facilitate a timely discharge and arrange
appropraite post discharge support.
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We facilitate student placements.
Have produced an E learning package
Delivered over 200 training sessions
Presented at local, regional and national
conferences.
• Raised awareness through media (appeared in
BBC East ‘Afghanistan- the Homecoming’)
and multiple radio interviews, newsletters,
posters and leaflets.
• Chair of the Armed Forces Clinical Reference
Group (Mental Health Sub Group) for NHS
England.
• Member of the Armed Forces CRG
• Member of the National Veterans Mental
Health Network
• Chair of the NEVMHN
• Specialist Clinical Working Groups
• Member of Crisis care concordat
• Honorary Fellow of Anglia Ruskin University
Veterans and Families Institute.
• Member of East of England Clinical Senate
• Developing PREVENT WRAP training case
studies for Armed Forces and Veterans.
• Developing Veterans Universal Passport
• Proud of our 100% patient satisfaction on
friends and family test.
• Supported other mental health trusts, councils
and charities to develop services.
• Attracted National recognition from MP’s,
Ministers, the Deputy Prime Minister, HRH
Prince Charles and the Shadow Defence Team.
Shadow Defence Team Visit
Awards
• 3rd Place in Trust Positive Practice
Achievement Awards 2012
• Winner-Military and Civilian Health
Partnership Awards 2013 for Care of Veterans
• Great British Care Awards- Winner of ‘Care
Innovator Award 2013 for EoE and 2nd Place
for ‘Outstanding Contribution to Social Care.
• Finalist for the Nursing Times Mental Health
Award 2013 and Team of the Year 2014.
• Winner-Nursing Standard, Mental Health
Award 2014
• Finalist in Military and Civilian Health
Partnership Awards 2014
• Finalist in the National Social Work Award for
Innovation.
Combat Stress
24 Hour Helpline
0800 138 1619
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Focusing on Veterans
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Our work
We are:
• Accessible through our 24-hour Helpline,
We Provide:
• Individually-tailored ‘recovery pathways’
• Substance Misuse Case Management Service
• Outpatient services
• Community and Outreach Teams
• Three residential treatment centres
• Recovery & Social Reintegration Breaks
Our services are enhanced by:
• Working in Partnership
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5,954
Veterans are
currently being
supported.
2,193
Total of new
referrals in the
year.
1,168
Number of
Veterans
discharged.
Stigma
• We are working to combat the stigma that so often prevents
Veterans from seeking help.
• Many Veterans have reported their perception that the NHS and
other providers lack the understanding, knowledge and
expertise to treat them.
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Over 93% of Veterans who responded to a Combat Stress survey
revealed they are ashamed or embarrassed about their mental
health problems.
Partnerships That Work
• The Royal British Legion
Break Centres
‘Pop-in’ Centres
• Poppy Scotland
• Help for Heroes
• The Armed Forces Health
Partnership Working Group
• The Warrior Programme
• The Department of Health/
National Health Service/
Public Health England
• Kings Centre for Military Health Research (KCMHR)
• Rethink Mental Health (Helpline)
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Demographics
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Army 84%
Merchant Navy 0%
Royal Air Force 7%
Royal Marines 3%
Royal Navy 6%
• Majority - lower ranks
• 97% male and 3% female
• Average time from leaving Military Service to seeking help from
Combat Stress is 13.1 years
• The average time is 2.2 years for those who have served in Afghanistan
and 3.9 years for Iraq.
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CS Recovery Model
Assisting Veterans in their Journey of Recovery
Engagement
Working with the
Veterans to
stimulate their selfbelief and develop
their commitment
to recovery.
Resource
Building
Builds on the
Veterans resilience
to effectively
engage in more
intensive in-patient
or out-patient
treatment options.
Implementing
Change
Builds on the
capabilities of
Veterans to change,
to strengthen skills
and to improve
psychological
resilience through
active and intensive
treatment.
Reintegration
Consolidates the
skills acquired
through
treatment
enabling these
Veterans to
improve social reintegration into
families and their
communities.
Self
Maintained
Recovery
Empowers the
Veterans to
continue to live
their lives
independently.
Relapse
Management
Acknowledges
the potential for
relapse and
focuses on the
obstacles that
are still
preventing
recovery.
Combat Stress Treatment Centres and facilities
Audley Court is in Newport, Shropshire. It has 27
beds, including a small number of rooms for carers.
Total upgrade completes Easter 2014.
Hollybush House is in Ayrshire, Scotland. It has
25 beds and can accommodate a small number
of accompanying carers.
Tyrwhitt House is in Leatherhead, Surrey. It
has 33 beds – 4 of which can also
accommodate a partner or carer.
Residential Programmes
Currently Delivered
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Transdiagnostic
Stabilisation
Anger Management
PTSD Intensive Treatment Programme
Bespoke individual treatment
The Recovery and Social Reintegration
Programme
• A stepped care approach to rehabilitation
• Structured Occupational Therapy timetable including :
- Behavioural activation exercises
- Skills training
- Relapse management
• Self esteem
• Identity
• Peer support
• Taking personal responsibility
• Family and carers support groups
Our Community Services
• RWOs are first contact for Veterans
• In addition the RWOs provide follow up welfare visits.
• Our Community Clinicians provide support group sessions and individual
therapy sessions.
Veterans in
Support
Group, 178
Client
Liaison,
196
Outreach Team Activities
Individual Service
Therapy Liaison,
Session, 60 133
Follow up, 1041
First Visit, 378
• Client Liaison includes communication with the veteran e.g. Triage, war
pension, housing support etc.
• Service Liaisons include, communication on behalf of the veteran with external
organisation such as Social services, GP’s, funding Bodies etc.
The First Rule of War...
There are many challenges involved whilst working with survivors of trauma
and there may be a potential for vicarious trauma to the staff or even
destabilising the individual by reliving past incidents. The National
Institute for Health and Clinical Excellence (NIHCE) guidelines highlights the
need for experienced and appropriately trained and competent staff to work
with individuals who may have trauma-related issues, including military
veterans.
Clinicians should be supervised by those with the appropriate knowledge and
experience of working with Veterans.