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1.1 edinburgh's intensive home treatment teams
1. Kathleen Stewart & Tony Tan
Winners of:
Scottish Health Awards „Care at Home‟, 2011
Royal College of Psychiatrists „Psychiatric Team of the Year‟, 2010
2. A&E
GP
CMHT
PET Police
REH
Community
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)
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 whole
improvement 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
Editor's Notes
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
