Presentation is loading. Please wait.

Presentation is loading. Please wait.

Developing a Community Based Mental Health Service in a Rural Community Margaret Fleming RPN, FFNRCSI, MSc International Mental Health Collaborating Network.

Similar presentations


Presentation on theme: "Developing a Community Based Mental Health Service in a Rural Community Margaret Fleming RPN, FFNRCSI, MSc International Mental Health Collaborating Network."— Presentation transcript:

1 Developing a Community Based Mental Health Service in a Rural Community Margaret Fleming RPN, FFNRCSI, MSc International Mental Health Collaborating Network (IMHCN)

2 SETTING THE CONTEXT  Ireland  How Health Services are Delivered in Ireland  Cavan Monaghan Mental Health Service  Change Management/Whole Systems Working  Community Mental Health Teams  Home Base Treatment  Evaluation  The Question ?

3 Ireland Health Service Executive Areas

4 Health Service Executive Ireland

5 Cavan/Monaghan Mental Health Service

6 CAVAN/MONAGHAN MENTAL HEALTH SERVICE  POPULATION 119,000  TOTAL SQ. KM.3,300  DEPRIVATION RATE  CAVAN 10.7%  MONAGHAN 4.7%  BUGET 17 MILLION EURO  PER CAPITA 143 EURO

7 Change Management WHOLE SYSTEMS APPROACH

8 PRINCIPLES A specialist service A service with a single point of access that is easily accessible, available and responsive A service which has at it’s core the primacy of service users needs and rights A service which delivers an individualised effective treatment package in the setting of home and family

9 Core Elements of Service Structure 4 Functional Specialist Teams Monaghan Community Mental Health Team with Home Base Nursing Cavan Community Mental Health Team with Home Base Nursing Community Rehabilitation Team with Assertive Outreach Nursing Psychiatry of Later Life with Home Base Nursing

10 CAVAN/MONAGHAN MENTAL HEALTH SERVICE  POPULATION 119,000  TOTAL SQ. KM.3,300  DEPRIVATION RATE  CAVAN 10.7%  MONAGHAN 4.7%  BUGET 17 MILLION EURO  PER CAPITA 143 EURO

11 REFERRAL SYSTEM PRE 1998 REFERRING AGENTS CONSULTANT PSYCHIATRISTS OCCUPATIONAL THERAPY BEHAVIOURAL THERAPY SOCIAL WORKERS PSYCHOLOGISTS NURSES / CPN FAMILY THERAPY ADDICTION COUNSELLORS REFERRING AGENTS

12 Monaghan Cavan Carrickmacross Bailieborough COMMUNTIY REHABILITATION TEAM (POP. 119,000) PSYCHIATRY OF LATER LIFE ADDICTION SERVICES Community Mental Health Team

13 TEAM BUILDING  Meetings  Operational policies  HBTT /gatekeeper of Acute Beds  Single point of access  Multidisciplinary team  Service Directory

14 BIO PSYCHO SOCIAL MODEL  Mental distress does not occur in a vacuum but in the context of peoples’ lives.  Context gives meaning

15 Creating Partnerships  With Service-users  With Carers/Families/Significant others  With G.P’s  Reassurance  Action

16 COMMUNITY MENTAL HEALTH  Mental health is a community issue  A community resource based model has at its foundation  Housing  Employment  Education  Income

17 ELEMENTS OF CITIZENSHIP Rights to:  Equality of opportunity  Economic security.  Justice and respect.  Freedom of speech.  Freedom of choice.  To be an individual.  Self-determination.

18 Developing Collaborative Alliances Within the Community  Meetings  Interagency networking  Collaboration  Coalitions

19 BIO-PSYCHOSOCIAL MODEL OF CARE  Service-user centred  Service-user ownership  Importance of involving the family / significant others  Recognising social and personal resources  Community as a resource to encourage and promote normal social relationships  Empowerment  Participation  Collaboration / Interagency  Interdependence not independence

20 SERVICE USER CPN Acute inpatient Admin Addiction Family Therapy H.B.T. Medical Secretaries S.W. Psychology O.T. Behavioural Therapy Medical Team Management Health promotion Education Women’s Groups Voluntary groups Eemployment Housing Advocacy Solas Gardaí Community Care Primary care Self Help Youth Groups

21 Community Service user Family / carers Mental health professionals Primary care / social services Voluntary / statutory organisations National community

22 Community Mental Health Teams

23 Monaghan Cavan Carrickmacross Bailieborough COMMUNTIY REHABILITATION TEAM (POP. 119,000) PSYCHIATRY OF LATER LIFE ADDICTION SERVICES Community Mental Health Team

24 MONAGHAN Community Mental Health Team  1 Clinical Co-ordinator  2 Consultant psychiatrist  1 Senior Registrar  3 Registrar  6 Home based treatment team  1 Community support worker  3 Community psychiatric nurses  1 Secretary  1.5 Cognitive Behavioural Psychotherapists  2 Family therapists  1 Occupational therapist  1 Psychologist  1 Social worker  4 Addiction counsellors  Acute unit  Day Hospital  Service-user Resource Centre  Advocacy

25 REFERRAL PATHWAY COMMUNITY REHABILITATION TEAM

26 Clinical Coordinator CPN Acute inpatient Admin Addiction Family Therapy H.B.T. Medical Secretaries Social Worker Psychology O.T. Behavioural Therapy Medical Team Management

27

28 HOMEBASE TREATMENT

29 HOME BASED TREATMENT TEAM MISSION STATEMENT The Home Based Treatment Team aims to work intensively in a focused way with service-users and their families during the acute phase of their illness, incorporating a care programme approach to treatment and supporting clients in reaching their optimum level of recovery

30 Purpose of Home Based Treatment Gate Keepers of Acute Beds Alternative to Hospitalization 2 hour response time Crisis focused Facilitates Early Discharge from Hospital

31 RECIPROCAL PROCESS OF EMPOWERMENT Empowerment Information Choice Decision Making Control Responsibility Accountability Self Value Self Esteem Confidence

32 Home Based Treatment is Recovery Orientated 15% 30% 15%40%

33 HOME BASED NURSING IS BUILT ON PARTNERSHIPS  Service users  Families  Significant others  Choice  Participation  Collaboration / Interagency  Interdependence not independence

34 Core competencies  Respect for people experiencing mental distress and their families.  Understanding of the most effective approaches and of the societal, community, and system factors affecting recovery.  Knowledge of a variety of treatment and support strategies.  Ability to design and deliver individualized supports with an emphasis on (non mental health) resources and to access and employ those resources.  Holders of hope, self-respect and self-esteem.  Belief in recovery.  Determination, tenacity, persistence, faith and love.

35 Home Base Procedure  Referral to Community Mental Health Team  Joint assessment by HBT nurse and medical staff  Determine if HBT can be an option  Joint plan of care drawn up, incorporating supports i.e. family/carers  Level of support decided jointly with service- user/family/HBT and medical staff  Contractual arrangements with service-user and family/ carers agreed.

36 Arranges earliest possible home visit Builds a trustworthy relationship with service-user and family Meets with family and carers Maintains a proactive role throughout treatment Carries out assessment i.e. FACE products/assessment- tools/mental-health- assessment-toolset Service-user and relatives are also given verbal and written educational/self-help information Liaises closely with medical staff and team leader. HBT liaises with other disciplines to ensure follow up care after discharge HBTT meetings twice weekly HBTT Nurse Then:

37 There are three levels of support: Intensive Able to spend time flexibly with service-user and social network including several visits daily if required Less intensive alternative days, twice weekly Continual Care once weekly/fortnightly Housing Employment Benefits Medication management

38 CRITERIA FOR INTRODUCTION OF HOME-BASED TREATMENT  The service-user has been identified as being acutely mentally ill with a risk of further deterioration  There is a perceived need for admission to hospital  The needs of the service-user cannot be met by the key worker/ team because of increasing complexities  Service-user/family/carer is agreeable for Home Treatment nurse/team to implement a care programmed.

39 THIS WORK IS ACHIEVED BY PROVIDING A VARIETY OF SERVICES AND SUPPORTS INCLUDING  Quick response on referral – 2 hours  Joint assessment at home or at venue of choice  Discussion and planning of a care programme with service-user and significant others  Explanation, advice and support to service-user and family re nature of illness, treatment and expected outcomes  Intensive support to service-user and family  Encouragement of normal activities where possible

40  Crisis work with the service-user and family including coping strategies  HBT remains involved throughout the crisis until it’s resolution  Constant review of progress by involved disciplines  Gradual withdrawal with recovery and linking up to further continuing care

41 WHY HOME BASED TREATMENT? “Home based treatment is a safe, effective and feasible alternative to hospital care for up to 80% patients with acute psychiatric disorder and one that they and their carers generally prefer.” (Smyth & Hoult, 2000)  It provides a proven research based alternative to hospital admission  Avoids the trauma of admission on the service user and their family  Provides choice for service users  Upholds civil liberty  The clinical benefit is the same or better  It decreases the stigma attached to hospital admission  Assessment of needs are more social based

42  Assistance in addressing social issues surrounding the crisis from the beginning  Can provide practical problem solving help  Avoids lengthy hospitalization  Greater service-user satisfaction often resulting in better engagement and concordance  Greater family/carer satisfaction, education and support  Avoids residual symptomatology sometimes associated with hospital admission

43 GP Details Personal details Affix label here key worker's): Consultant; referral details treatment to date ICD 10 Diagnosis medications on discharge discharge plan

44 SERVICE USER CPN Acute inpatient Admin Addiction Family Therapy H.B.T. Medical Secretaries S.W. Psychology O.T. Behavioural Therapy Medical Team Management Health promotion Education Women’s Groups Voluntary groups Eemployment Housing Advocacy Solas Gardaí Community Care Primary care Self Help Youth Groups

45 EVALUATION

46

47

48

49

50 Rates per 100,000 of the Population Activities of Irish Psychiatric Hospitals 2009 HSE AreaAll AdmissionsInvoluntary Admissions HSE Dublin North East HSE South

51 Admission Rates per 100,000 of the Population Activities of Irish Psychiatric Hospitals 2009

52

53

54 1 st Admission Rates per 100,000 of the Population Activities of Irish Psychiatric Hospitals 2009 Monaghan44.6 Cavan81.2

55 Type: Website for this image The Matter of Culture » culture dejavouz.wordpress.com Full-size image 500 × 367 (Same sizex larger), 143KB More sizes Search by image Similar images to copyright.

56 Copyright - Cavan Monaghan Mental Health Service Go to the people Live among them Start with what they know Build on what they have Be of the best leaders When their task is accomplished Their work is done The people all remark We have done it ourselves THANK YOU

57 WHAT FACILITATES RECOVERY ? 15% 30% 15%40%

58 MANAGEMENT STYLE

59 LEADERSHIP MANAGEMENT STYLE

60

61 Citizenship Recovery Risk Leadership Belief Engagement Thinking outside the box Organisational Culture Management horizontal versus Bureaucratic Over managed Autocratic Mutual Respect Collaboration Partnership


Download ppt "Developing a Community Based Mental Health Service in a Rural Community Margaret Fleming RPN, FFNRCSI, MSc International Mental Health Collaborating Network."

Similar presentations


Ads by Google