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Crisis Resolution/Home Treatment Developing Critical Components

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)

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Crisis Resolution/Home Treatment Developing Critical Components

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  1. Crisis Resolution/Home TreatmentDeveloping Critical Components Kevin Heffernan Honorary Research FellowCentre for Community Mental HealthBirmingham City University

  2. 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)

  3. Overview of Presentation • Critical components or fidelity principles of CRHT in England • Advantages of CRHT in English context • Community profile of 1 Birmingham area Tomorrow • National/Regional Implementation of policy • National Audit of CRHT in England • Important data collection for CRHT

  4. Characters that represent CRISIS Danger/risk and Adversity Opportunity for Personal Growth

  5. 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)

  6. 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

  7. 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)

  8. 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

  9. Community teams in BirminghamCaseload size and distribution in a locality of 150,000 populationUnderstandingyou can’t do it alone!Understanding where you fit in the system!

  10. 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 Assertive Outreach 1:10 12 staff 123 Cases Daily - Weekly Home Treatment 1:2 14 staff 25 Cases Multiple daily - decreasing Low Caseload High Intensity

  11. ACTIVITY

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

  13. Crisis Resolution/Home Treatment 14 staff 20 cases Distribution of Cases ************ *********** ************************************************ Assertive Outreach 12 staff ************************************************ ******************************************************************************************************** ***************** 123 cases ************************************************************************************************ ************************* 370 Cases Rehab & recovery 15 staff Serious Mental Illness ******************************************************************************** ***************** 600 Cases *** ** CMHT’s 20 staff Days Years Intensity of support & Length of stay in the service

  14. Crisis Resolution/Home Treatment 14 staff 20 cases Most Impact on diverting cases From Hospital admission Distribution of Cases *********** ************************************************ Assertive Outreach 12 staff ************************************************ ******************************************************************************************************** ***************** 123 cases ************************************************************************************************ ************************* 370 Cases Rehab & recovery 15 staff Serious Mental Illness ******************************************************************************** ***************** 600 Cases CMHT’s 20 staff Days Years Intensity of support & Length of stay in the service

  15. Most Impact on diverting cases From Hospital admission Distribution of Cases *********** ********************************************** Assertive Outreach 12 staff 123 cases ******************************************************** ************** 370 Cases Rehab & recovery 15 staff Serious Mental Illness ******************************************************************************** ***************** **************************** ************** 600 Cases CMHT’s 20 staff Norway ACUTE Teams Days Years Intensity of support & Length of stay in the service

  16. 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

  17. From Policy to Implementation The role of regional development centre’s. How did the Department of Health support a national roll out of policy based on some of the Birmingham success story?

  18. 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 (1999) for Mental Health and the NHS Plan (2000). Policy Implementation guidelines for CRHT were published in 2002The DH said 335 CRHT teams delivering 100,000 contacts by 20058 regional development centres were set upOne in the West Midlands covering a population of 5.5 millionAlso regional centres inEast MidlandsLondonSouth East South WestEastern regionNorth East North West

  19. 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.

  20. Workstream examples within the Regional Development Centre'sSpecialist mental health servicesAcute InpatientCommunity teams (Crisis Resolution/Home Treatment, Assertive Outreach teams)Child & Adolescent Mental HealthDual DiagnosisEarly InterventionPersonality DisorderImproving access to Psychological therapiesImproving access to psychological therapies for people with common mental health problems.Equalities – Race, Gender & AgeDelivering Race EqualityGender, Equality and Women's Mental Health ProgrammeMental Health in Later LifeWell being and InclusionSocial Inclusion Programme , mental health first aid training programmeLegislationThe 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

  21. Day in the life of a staff memberNot official performance management/monitoring, but focus on service Improvement and development , therefore viewed as honest brokersIdentify good practice areasLink areas togetherProtect and champion ‘fidelity’ and ‘values’Develop regional network’s (e.g. CRHT, AO and EI)Influence policy review and refinementStrength in having a national profile (sharing across RDC’s)Challenge with kindness!! (e.g. not if, but how!, rural v inner city)

  22. Context Part of my role was to offer support & guidance across the West Midlands to25 Assertive Outreach teams39 Crisis Resolution/Home Treatment teamsRegional forums (organise& chair)Specific developmental in vivo programmes to address local issues (not ‘off the shelf’)Coaching & mentoring of managers/leadersEnsure fidelity to the modelAll 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

  23. 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 importantI 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

  24. Happy to take questions or to be contacted onkevin.heffernan@westmidlands.nhs.uk

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