IMPs – Intermediate Mental & Physical Health Care Team Kashif Munir (Physiotherapy Lead) 28th June 2013

“It was said they wanted one door to knock on … and to this very day they might have one but I don’t know where the door is.” (Alison Petch, 2003)

Background to Service Review of Westminster Intermediate Care Services. Initial development across partner organisations: NHS Westminster, CNWL, Local Authority and Acute Care. Influenced by: Local audit – adults & older adults with mental health problems were staying longer in acute hospitals & difficulty in accessing rehab pathways. NSF for Older Adults: Standards 3 & 7

Locality and Hours Currently: Vauxhall Bridge Road 3rd Floor With Older People’s and Healthy Ageing Westminster Services CMHT, HTT, JHTT, ABT, Recovery Team. Memory Service and Liaison Psychiatry, Mon – Fri 0800 – 1630 Referrals are screened within 24 hours (Mon – Fri) Assessment 3 working days assess if urgent or 10 working days for non-urgent

Senior Physiotherapist IMPS Structure Service Manager Team Manager Mental Health Clinical Nurse Specialist RMN Associate Practitioner Physiotherapy Physiotherapy Lead Senior Physiotherapist Physiotherapist Occupational Therapist Rehab. Assistants Rehab. Assistant Psychology Clinical Psychologist Administrator Psychiatric Cover

The Role of the Team Short term (Target 8 weeks) rehabilitation to clients whose physical health rehab is impeded by mental health problems or their physical health is impeding their mental health recovery. Prevent unnecessary admission to an acute setting and reduce avoidable use of long-term care. We provide a multi-faceted service encompassing; holistic assessment, community rehab, discharge support and prevention of admission where possible.

Acceptance Criteria Westminster residents only. Medically stable with rehabilitation potential. Age: Adult 18 + Current mental health function condition is affecting their physical rehabilitation. Physical condition is affecting their mental health resulting in challenges/ in their rehabilitation. Clients to engage with Mental Health and Physical Care Practitioners to enable holistic, goal specific, time limited interventions to effectively optimise recovery. Clients cognitive impairment has deteriorated significantly or is resulting in prevention of realistic rehabilitation due to complex needs/condition.

Referrals Accepted from: All health and social care professionals Paperwork: Accessible via the IMPS webpage SAP form Basic risk assessment For the those within CNWL a referral letter is acceptable

Patient Referral Pathway

Assessment and Care Planning Case manager is identified according to the client’s key issues. A single assessment framework is carried out with two different disciplines in attendance After assessment and acceptance onto the caseload a MDT Goal Orientated Treatment Plan is formulated jointly with the client. Single professional records and shared protocols are kept. Clients are frequently reviewed (either daily, weekly or monthly according to needs and issues identified) within the team.

Treatment/Interventions Providing Comprehensive Assessment, resulting in a structured individual care plan that involves active therapy, treatment or opportunity for recovery. A planned outcome of maximising independence and typically enabling people to resume or continue living at home. Cross professional working, Intense, frequent input with flexible durations to suit and meet the needs of each individual. Psychological Therapies Psychosocial Interventions Environmental Assessment & Support Review & Rehab of ADL’s Medication Review Functional Assessment Financial Guidance and Referral Family and Carer Support Motivational Interviewing Diagnosis Physiotherapy Assessment and Treatment. Facilitate access to community services Social Inclusion

Community Activity- Year 4 (2011-12) Number of referrals during year: 244 No of contacts: 2175 Average time on caseload: 11.93 weeks Gender: Female 66%: Male 34% Age range: 80+ Years 57.7%; 60-80 Years 29.5%; Under 60 Years 3.6% Referral source: Social Services: 19.3%; St Mary’s 16.9%; WRS 12.4%; CMHT 9.9%; GP 6.3%; St Thomas 4.8%; Main physical reason for referral: Falls/ mobility issues: 78.7 % Main mental health reasons for referral: Dementia/ cognitive impairment: 52%; Depression: 21%; Schizophrenia: 7.5%

Future developments Promotion of IMPS service: Presentations; Revamped Leaflet; GP mailing Continued development of an evidence based service: recovery model and social inclusion; CBT and counselling; improved physical and mental health goal setting Enhanced working between health and social care teams: Intermediate Care Project; maintain close links with CNWL Teams. Community Independence Service – 1st April 2013

How To Contact Telephone: 02078544151 Fax: 020 79318087 Email: imps@nhs.net Webpage: http://www.cnwl.nhs.uk/imps.html Address: 3rd Floor 190 Vauxhall Bridge Rd London SW1V 1DX