Edinburgh’s Intensive Home Treatment Team – Shifting the

balance of acute mental health care from hospital to community

Kathleen Stewart & Tony Tan

Winners of:Scottish Health Awards ‘Care at Home’, 2011Royal College of Psychiatrists ‘Psychiatric Team of the Year’, 2010

Before 2009 – traditional care model, multiple routes to admission and delays to discharge

REHPET

CMHT

A&EGP

Police

RehabCMHTCommunity support

“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)

The Vision: Intensive Home Treatment Teams (IHTT)

Creating the conditions for IHTT

Mental Health (Care and Treatment) (Scotland) Act 2003

HEAT Targets &

Commitments

Crisis Standards

Scottish Recovery Indicator

‘Kaizens’

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)

Creating the conditions: Pre-operational period

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

Implementing the change: Key components of IHTT

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

How IHTT works

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

Outcomes

Service user feedback

“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.”

Service improvement is a continuous

process – having data helps

Multi-professional working effects better outcomes for people

in crisis

A whole system approach is needed

to improve acute mental health care

3 Lessons Learned