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11 lucy

  1. 1. <ul><li>How Can a Mental Health Service be Good for Your Health? </li></ul><ul><li>Professor James V. Lucey </li></ul><ul><li>Medical Director </li></ul><ul><li>St. Patrick’s University Hospital, Dublin </li></ul><ul><li>National Mental Health Conference – September 14 th , 2011 </li></ul>
  2. 2. How Can a Mental Health Service be Good for Your Health? <ul><li>Can we solve the problems in our mental health care system. </li></ul><ul><li>Is quality of service the answer? </li></ul><ul><li>Examples of a mental health service dedicated to Quality ? </li></ul>
  3. 3. 20 th Century Mental Health Care
  4. 4. 21 st Century Health Care
  5. 5. In Health Care Politics the debate is still dominated by questions of location Primary Care Vs Community Care Vs Residential Care Vs Secondary Vs Regional Centre of Excellence
  6. 6. Hospital Care
  7. 7. Home Care
  8. 8. Community Care
  9. 9. Residential Care in “Castlebeck”
  10. 10. Primary Care
  11. 11. What is Mental Health Care? <ul><li>A pseudo-science? </li></ul><ul><li>A craft informed by science? </li></ul><ul><li>A pill for all ills? </li></ul><ul><li>A social or political construct? </li></ul><ul><li>A myth? </li></ul>
  12. 13. Mental Health Vs Mental Health Disorder
  13. 14. Home Work Balance
  14. 15. The Existential Question?
  15. 16. Complexity of Mental Health Diagnosis Co-morbidity of Anxiety and Depression 32% of OCD patients have depression 31% of SP patients have depression GAD 59% of GAD patients have depression 50% of panic disorder patients have depression 49% of PTSD patients have depression Source: National Comorbidity Survey 69,400 patients 34% of specific phobia patients have depression Panic Disorder Specific Phobia PTSD Social Phobia OCD Depression
  16. 18. Low High Certainty Consensus High Low CHAOS STANDARDISATION ZONE OF COMPLEX JUDGEMENT Consensus Chaos Standardize Zone of Complex Judgment Low High Certainty High Low
  17. 19. Obsessive Compulsive Disorder
  18. 20. “ There's a very strong view with a lot of people that depression and mental illness is not a medical condition, that it's part of life's events that people get depressed or get unhappy. Years ago people were unhappy, they weren't depressed, they weren't given the name depressed…I was aware that unlike other areas of health like cholesterol, diabetes, or coronary care, where you can measure the results of taking medication, in mental health, it is impossible to measure, scientifically, the results ” Minister Tim O`Malley, Pharmacist and Minister for Mental Health Irish Medical News , November 2006
  19. 23. Dr. Steeven's Hospital 1901 Census   <ul><li>Mean Age 26.5 (23.5 women, 27.5 men) </li></ul><ul><li>Female/Male     34/86   </li></ul><ul><li>Religion C O I / COE: 17; Pres: 5, Refused: 1, </li></ul><ul><li>RC: 97 </li></ul><ul><li>Fully 50% of the 120 patients had infectious </li></ul><ul><li>diseases readily curable now   </li></ul><ul><li>  </li></ul>
  20. 24. “ Arguably by the standards of 1901, no-one outside of the Cancer Care Unit and ICU is sick. Modern infections or fractures are treated within a week. Myocardial infarcts are surveilled and thombolysed or stented. The age curve in hospital has changed dramatically and one century later our illnesses are completely different. Modern illnesses were unseen in 1901, because these disorders were either already fatal, or like Diabetes, untreatable. No one who attends an Orthopaedic Surgeon with knee pain would be accused of malingering, if there is a demonstrable irregularity on MRI, but that same patient would not have been admitted in 1901. They would have been dismissed as a waste of time unless their leg was infected or broken off.   Mental health suffering is exactly the same. Active treatment in all its professional and societal forms (Psychotherapy, Pharmacology, Milieu, a more tolerant welfare state) has enabled community care for Mental Disorder. We now witness service users with more subtle illnesses or illnesses at earlier stages, but that doesn’t mean mental health suffering is not real.   These are not sicknesses if you judge them by the standards of 1901 or those who operate today within those standards”. Dr Ross Dunne TCD/HRB Research Fellow
  21. 29. Historical Fight for Mental Health <ul><li>&quot;He gave the little Wealth he had, To build a House for Fools and Mad: And shew'd by one satyric touch, No Nation wanted it so much: That Kingdom he hath left his Debtor, I wish it soon may have a Better.” </li></ul><ul><li>J Swift (1667-1745) </li></ul>
  22. 31. National Cancer Strategy
  23. 33. No New Drugs, No Silver Bullets and No More Money
  24. 34. Team Work in Health Care
  25. 37. The Ideal Mental Health Service <ul><li>Model </li></ul><ul><li>Mission </li></ul><ul><li>Vision </li></ul><ul><li>Strategy </li></ul><ul><li>Organisation </li></ul><ul><li>Structure </li></ul><ul><li>Governanace </li></ul><ul><li>Rewards </li></ul><ul><li>Responsibilities </li></ul><ul><li>Culture </li></ul><ul><li>Principles </li></ul><ul><li>Ethos </li></ul><ul><li>Excellence </li></ul>
  26. 38. Perfect Storm <ul><li>Perception of service as too medically driven </li></ul><ul><li>Government policy driving a move to community care </li></ul><ul><li>Hospital struggling to meet regulatory standards </li></ul><ul><li>Occupancy dropping </li></ul><ul><li>Financial difficulties </li></ul><ul><li>Entering a domestic and global recession </li></ul>
  27. 39. MHM Phase 1
  28. 40. MHM Phase 2
  29. 41. Process of Strategy Development <ul><li>Consulted with service users and staff </li></ul><ul><li>Focused on the Mission and Culture not the financials </li></ul><ul><li>Worked to obtain buy-in to the mission </li></ul>
  30. 42. Key elements of strategy <ul><li>Highest quality mental health care </li></ul><ul><li>Promoting Mental Health </li></ul><ul><li>Advocating for the rights of those suffering from mental illness </li></ul>
  31. 43. Actions we took <ul><li>Quality Standards and strong Clinical Governance </li></ul><ul><li>Restructured and enhanced existing services </li></ul><ul><li>New services in community Dean Clinics and Technology based supports </li></ul><ul><li>Invest in staff retention and training </li></ul>
  32. 44. St Patrick's TCD- Evolution
  33. 45. St. Patrick’s University Hospital Services
  34. 48. No. Of Admissions
  35. 50. Average Length of Stay
  36. 51. Occupancy and Readmission
  37. 52. The CGI Explained <ul><li>Clinical global impression scale* </li></ul><ul><li>Baseline score – before treatment – patients have often been in hospital for some time, refractory to medication </li></ul><ul><li>Outcome score – after treatment </li></ul><ul><li>Usually 3-4 weeks (average 7 treatments with ECT) </li></ul>CGI Outcome Scale *Despite seeming crude, this scale has good inter-rater reliability and good face validity
  38. 53. Clinical Global impression scores for 83 patients CGI Outcome Scale Patients treated with ECT for 3-4 weeks (6-8 sessions)
  39. 54. Clinical global impression scores for 83 patients Patients treated with ECT for 3-4 weeks (6-8 sessions) Outcome Baseline *For example 11 patients who started out moderately ill were judged “much better” after ECT Very much better Much better Minimally better No change Minimally worse Much worse Borderline ill 1 Mildly ill 2 Moderately ill 11* 5 1 Markedly ill 2 16 6 3 Severely ill 3 15 8 5 Extremely ill 2 2 1
  40. 55. Nothing acts faster than Anadin
  41. 58. Service User Satisfaction
  42. 59. Compliance with Mental Health Commission Regulations and Standards
  43. 60. St Patrick's Dean Clinic Network
  44. 63. Wellness and Recovery Centre
  45. 66. Deliberate Self Harm
  46. 68. Financial Information 2004-2011
  47. 69. Cost per Treatment Episode
  48. 70. St. Patrick`s University Hospital Mental Health Service <ul><li>Model </li></ul><ul><li>Mission Independent </li></ul><ul><li>Human rights based </li></ul><ul><li>Vision National MDT </li></ul><ul><li>Strategy Not-for-profit </li></ul><ul><li>Organisation </li></ul><ul><li>Structure - Dedicated </li></ul><ul><li>Governance - Charter </li></ul><ul><li>Rewards - Responsibilities </li></ul><ul><li>Culture </li></ul><ul><li>Principles – Recovery </li></ul><ul><li>User-centred involvement </li></ul><ul><li>Ethos – Non-Denominational </li></ul><ul><li>Academia - Excellence </li></ul>