1.1 edinburgh's intensive home treatment teams

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  • Vision / aim – shifting balance of acute mental health from hospital to community, establish IHTT as alternative to hospital admission, least restrictiveAlternative
  • Context in Edinburgh’s acute mental health
  • 7 yrs discussion re setting up rapid response team in EdinburghDrivers – mental health policy and legislation, Kaizen - rapid improvement event Feb 2008, stakeholders agreed high fidelity modelKaizen Japanese for "improvement", or "change for the better" refers to philosophy or practices that focus upon continuous improvement of processes5 elements of kaizen are: TeamworkPersonal disciplineImproved moraleQuality circlesSuggestions for improvement
  • Creating the conditions before going live
  • Pop 495,000 across 100 square miles, alignment to GP PracticesReferral criteriaAge 18-65Resident within EdinburghSignificant risk to self/others due to mental illnessAdmission to hospital being consideredSeen by referrer on same dayReferrals from MHAS, CMHT/PCLT, wards, Edinburgh Crisis Centre, RIE, MHOs (no GP or self referrals)
  • Making the improvement – implementation / what we doIHTT a ‘one stop shop’ – more holistic form of care and treatment, Working collaboratively with service users and carers – balance of power different/involvement /more autonomy & controlWillingness to engage with teams a pre-requisite
  • Impact on REHIn 2010 498 people taken on by IHTT (385 avoided hospital admission, and 113 had a shorter length of stay in hospital with early discharge support from the teams.
  • Qualitative comments giving a better indication of the ‘lived experience’ of being with IHTT
  • Data collection from day 1Holistic approach takes into account mental health, social situation, employment, housing, financial sitnQuicker access to right support at the time it is neededStaff from different professions learning from each otherIntroduction of IHTT significant change in acute mental health in Edinburgh – domino effect – need a whole system approach to make it work

Transcript

  • 1. Kathleen Stewart & Tony TanWinners of:Scottish Health Awards „Care at Home‟, 2011Royal College of Psychiatrists „Psychiatric Team of the Year‟, 2010
  • 2. A&E GP CMHT PET Police REHCommunity CMHT Rehab support
  • 3. “rapid response and assessment of mental health crisis in the community with the possibility of offering acute care at home until the crisis is resolved. Acute care is delivered by a specialist team providing an alternative to hospital admission for people with serious mental illness who are experiencing acute difficulties”(National Institute for Mental Health in England, 2004)
  • 4. Mental Health (Care andTreatment) (Scotland) Act2003
  • 5.  Funding from Mental Heath & Well-being Strategy, bed closures, loss of „extra payments‟ for medical consultants Recruitment of staff Visits to established teams 4 weeks induction: team building, operational & policy issues, risk assessment, roles within the teams, service user and carer input, Edinburgh Crisis Centre, advocacy, Birmingham‟s „Shared Perspectives‟ Development of Integrated Care Pathway (ICP)
  • 6.  North IHTT & South IHTT Multi-professional team – nurses, doctors, mental health officers, OTs, psychologist, support workers 24/7 availability, rapid response, mobile Clearly targeted caseloads Gatekeeper to all potential admissions Comprehensive assessment, address social issues (in vivo) Flexible visiting, remain involved throughout the crisis Advice & support for carers In-reach to wards, facilitating early discharge
  • 7.  Triage by shift coordinator Comprehensive assessment by 2 staff Initial visits in pairs, up to 3 times daily, reduce gradually Continuous assessment of risk & sharing positive risk taking Support / involvement of service users & carers, psycho-education, practical help Regular medical reviews Use PGDs (Patient Group Directions) Integration of psychologist, OT and MHO within IHTT effects better outcomes Liaise with other professionals during home treatment Promote development and use of crisis plans Data collection, including service user and carer feedback
  • 8.  Facilitated 30% planned reduction in REH acute beds Admissions & readmissions both down by 32% Length of stay shortened by 6 days Mean occupied bed days fallen from 89% pre- IHTT to 77% Admissions under detention reduced by 28% in 2009/ 2010 (consistently 22% of admissions) High service user and carer satisfaction
  • 9.  “Had I not had input from IHTT I would have been admitted to hospital, which would have set my recovery much further back and increased my feelings of being unable to manage my mental health.” “Although I find it difficult to trust people I do not know I found all staff who visited me aware of this and they were very good at helping me feel safe.”
  • 10. Service Multi- A wholeimprovement professional system is a working approach is continuous effects better needed to process – outcomes for improve acute having data people in mental health helps crisis care