1 JANE MARLOW SERVICE MANAGER CITY ADULT MENTAL HEALTH SERVICE COMMUNITY AND RESIDENTAL SERVICES

2 NOTTINGHAMSHIRE HEALTHCARE NHS TRUST Chief Executive Mike Cooke Chair Dean Fathers Executive and Non-Executive Directors General Managers / Clinical Directors Forensic Directorate Specialist Services Directorate Child & Adolescent; Learning Disability Drug and Alcohol; Eating Disorders; Gender Personality Disorder service Mental Health Services for Older People Adult Mental Health Directorate (County) Adult Mental Health Directorate (City)

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4 Referral Pathway to City Adult Mental Health Services NHS NOTTINGHAM CITY PRIMARY CARE SERVICES Single Point of Access Gateway to Secondary Mental Health Services (Admin Referral Point) CAT _ Community Assessment and Treatment Service Early Intervention In Psychosis Service CRISIS Resolution Home Treatment Acute Inpatient Services Deaf ServicesCity Recovery Service City Assertive Outreach Services Residential Rehabilitation Services

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6 Nottingham City Demographics Nottingham City Population approx: 300,000 Indices of Deprivation April 2011  Nottingham ranks 20 th out of 326 districts in England.  Nottingham ranks 4 th of the core cities behind Liverpool (1 st ); Manchester (4 th ); Birmingham (9 th ).  In the Index of Multiple Deprivation; 45 of the City Super Output Areas (SOA’s) fall amongst the 10% most deprived in the country. 91 fall in the 20% most deprived.  The lowest ranking SOA in the City is Aspley, which ranks 97% nationally out of 32,482 and is the only City SOA ranking in the most deprived 100 SOA in the country.

7 Mental Illness General Stats  Psychosis affects 0.5 % of the population of England  Prevalence of psychotic disorder higher amongst black men  Nottingham Prevalence of psychotic illness 8.4 per 1,000  Approximately 30 suicides per year in Nottingham (higher in men) (drug poisoning, hanging, common methods)  Physical health; mental health clients have higher rates of morbidity and premature life expectancy : high rates of Heart disease; High blood pressure; Stroke; Cancer  Many mental health clients have co-existing drug and alcohol problems  Mental health clients experience problems in accessing appropriate housing, employment and education opportunities

8 Community Assessment and Treatment Service ○Single Point of Entry for Primary Care Services (GP’s etc) ○Moderate to Severe mental illness ○Depressive illnesses ○Anxiety and Panic disorders ○Assessment of significant risk of self harm ○Co-ordination of Safeguarding assessments ○Mental Health Act assessments ○Health and social care assessments

9 Early Intervention in Psychosis Service ○18-35 years ○Early detection and treatment of First presentation of psychosis (hallucinations, delusions, thought disorder) ○Three year programme of intervention, focusing on reducing social isolation, developing employment, education, and occupational opportunities and pharmacological and psychological treatment ○Family Education and training programme ○Working closely with schools, colleges and universities ○Work closely with CAMHS ○Smaller caseload – intensive work ○High risk of suicide in early years of psychotic illness

10 Recovery Service ○Severe and persistent mental disorders with significant disability (Psychoses – Schizophrenia / Bipolar Disorder). ○Longer term disorders of lesser severity characterised by poor treatment adherence requiring proactive follow –up. ○Complex cases requiring management and engagement such as requiring interventions under Mental Health Act. ○Severe disorders of personality – where these are shown to benefit by continued contact and support. ○Any disorder where there is significant risk of self harm or harm to others (Psychosis). ○Dual diagnosis (drug and alcohol use) ○Co-ordination of City Wide Mental Health Act assessments ○Health and social care assessments ○Focus on Recovery; defining individual goals and outcomes

11 Assertive Outreach Service ○Multi-disciplinary team pro-active and comprehensive service ○Unable or unwilling to engage with other community mental health services. ○A severe and persistent mental disorder (e.g. schizophrenia, major affective disorders) associated with a high level of disability ○A history of high use of inpatient or intensive home based care (for example, more than two admissions or more than 6 months inpatient care in the past two years) ○Multiple, complex needs including a number of the following: ○History of violence or persistent offending ○Significant risk of persistent self-harm or neglect ○Poor response to previous treatment ○Dual diagnosis of substance misuse and serious mental illness ○Detained under Mental Health Act (1983) on at least one occasion in the past 2 yrs ○Unstable accommodation or homelessness

12 Mental Health Act 1983 (2007 Amendment) Mental Health Act 1983 (2007 amendment) ○the Act concerns “the reception, care and treatment of mentally disordered patients  Definition of mental disorder: ○Mental disorder is defined for the purposes of the Act as “any disorder or disability of the mind”.  MHA sections: ○Section 2 Admission for assessment ○Section 3 Admission for treatment ○Section 35 Remand to hospital for Report (court remand) ○Section 36 Remand to hospital for Treatment (court remand) ○Section 37 Hospital Order (court order) ○Section 41 Restriction order (court order)

13 Mental Capacity Act 2005  Mental Capacity Act 2005 ○A presumption of capacity; every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise; ○The right for individuals to be supported to make their own decisions; people must be given all appropriate help before anyone concludes that they cannot make their own decisions; ○That individuals must retain the right to make what might be seen as eccentric or unwise decisions; ○Best interests; anything done for or on behalf of people without capacity must be in their best interests; and ○Least restrictive intervention; anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms