Award Winning Crisis Award Winning Crisis Resolution ServiceResolution Service

Presentation for Presentation for

1818thth Jan 2008 Jan 2008

BACKGROUND TO TEAMBACKGROUND TO TEAM

• Intermediate services were developed within Intermediate services were developed within Glasgow following the modernising Mental Glasgow following the modernising Mental Health Initiative to improve the quality of Health Initiative to improve the quality of Psychiatric care in the UK Psychiatric care in the UK (Dept of Health, (Dept of Health, 1998).1998).

• Intermediate teams were multi-disciplinary Intermediate teams were multi-disciplinary and multi agency in nature, with the main and multi agency in nature, with the main aims of providing an alternative to aims of providing an alternative to hospitalisation where possible, to promote hospitalisation where possible, to promote early discharge from hospital, and to early discharge from hospital, and to stabilise mental mental health within the stabilise mental mental health within the home environment. home environment.

Service Re-DesignService Re-Design

• Service Re-design group established Service Re-design group established in 2005in 2005

• Drivers for change are Mental health Drivers for change are Mental health Care and Treatment Act 2003 and Care and Treatment Act 2003 and OMIG group.OMIG group.

• Crisis Teams developed and CMHT Crisis Teams developed and CMHT teams reconfigured as a result.teams reconfigured as a result.

• Rights Relationship Recovery based Rights Relationship Recovery based nursing review (National Review Of nursing review (National Review Of Nursing)Nursing)

The Core Concepts of Crisis The Core Concepts of Crisis WorkWork

• To facilitate and promote early discharge To facilitate and promote early discharge from psychiatric in-patient care where from psychiatric in-patient care where appropriate.appropriate.

• To provide short-term intensive community To provide short-term intensive community based care as a viable alternative to based care as a viable alternative to hospital admission, where appropriate.hospital admission, where appropriate.

• To engage service users and their families/ To engage service users and their families/ carers in tailored programmes of care and carers in tailored programmes of care and promote the stabilisation of an individual’s promote the stabilisation of an individual’s mental health within their home mental health within their home environment.environment.

Core FunctionCore Function• Be available 24 hours a day and over 7 days Be available 24 hours a day and over 7 days

a weeka week• Provide alternative to hospital admission Provide alternative to hospital admission

and provide an early discharge functionand provide an early discharge function• Provide home assessment and treatment as Provide home assessment and treatment as

an alternative to hospital admission for an alternative to hospital admission for people experiencing an acute mental health people experiencing an acute mental health crisiscrisis

• Provide support to the gate keeping and Provide support to the gate keeping and care coordination function of Community care coordination function of Community Mental Health Teams to ensure appropriate Mental Health Teams to ensure appropriate referral and management of acute relapse referral and management of acute relapse in either inpatient settings or through the in either inpatient settings or through the crisis servicecrisis service

Core FunctionCore Function• Provide short term interventions and Provide short term interventions and

management of an individuals care during the management of an individuals care during the period of acute relapseperiod of acute relapse

• Remain involved until the crisis has been Remain involved until the crisis has been resolved whilst maintaining robust resolved whilst maintaining robust communication with the integrated care communication with the integrated care manager within the CMHT who will retain this manager within the CMHT who will retain this function.function.

• The service will also engage with service users The service will also engage with service users who are discharged against medical advice or who are discharged against medical advice or boarded out from their own Community Health boarded out from their own Community Health and Care Partnership in-patient area.and Care Partnership in-patient area.

• Where inpatient admission is necessary, be Where inpatient admission is necessary, be actively involved in admission, discharge actively involved in admission, discharge planning and provide intensive care and planning and provide intensive care and support at home to enable early dischargesupport at home to enable early discharge

ELIGABILITY CRITERIAELIGABILITY CRITERIA• Adults over the age of 18 including individuals Adults over the age of 18 including individuals

under 18 who are receiving Adult MH services under 18 who are receiving Adult MH services (e.g. ESTEEM) who are at risk of being admitted (e.g. ESTEEM) who are at risk of being admitted to Hospital and who are experiencing acute crisis to Hospital and who are experiencing acute crisis and/or relapseand/or relapse

• 4.1 Eligibility Criteria – Facilitating Early 4.1 Eligibility Criteria – Facilitating Early DischargeDischarge

• The Crisis Team will play a major role in ensuring The Crisis Team will play a major role in ensuring an effective interface between in-patient and an effective interface between in-patient and community services. The Crisis Team will have an community services. The Crisis Team will have an active role, providing input to MDT review active role, providing input to MDT review meetings within the in-patient servicemeetings within the in-patient service

• Adults within acute in-patients services who Adults within acute in-patients services who require immediate intensive follow-up to facilitate require immediate intensive follow-up to facilitate early dischargeearly discharge

ELIGABILITY CRITERIAELIGABILITY CRITERIA

• In-patients who require home In-patients who require home assessment whilst on pass from assessment whilst on pass from hospital as part of the discharge hospital as part of the discharge planning processplanning process

• Patients who are discharged against Patients who are discharged against medical advicemedical advice

• Patients boarding out of CHCP who Patients boarding out of CHCP who can be discharged from the boarding can be discharged from the boarding hospital with intensive follow-uphospital with intensive follow-up

EARLY DISCHARGEEARLY DISCHARGE

• 4.1 Eligibility Criteria – Facilitating Early 4.1 Eligibility Criteria – Facilitating Early DischargeDischarge

• The Crisis Team will play a major role in The Crisis Team will play a major role in ensuring an effective interface between ensuring an effective interface between in-patient and community services. The in-patient and community services. The Crisis Team will have an active role, Crisis Team will have an active role, providing input to MDT review meetings providing input to MDT review meetings within the in-patient servicewithin the in-patient service

• Adults within acute in-patients services Adults within acute in-patients services who require immediate intensive follow-up who require immediate intensive follow-up to facilitate early dischargeto facilitate early discharge

EXCLUSION CRITERIAEXCLUSION CRITERIAExclusion Criteria -CrisisExclusion Criteria -Crisis

• The team will not engage with service The team will not engage with service users while their function is so impaired users while their function is so impaired by drugs and alcohol that they cannot by drugs and alcohol that they cannot participate in therapeutic dialogueparticipate in therapeutic dialogue

• Service users with a primary diagnosis of Service users with a primary diagnosis of Learning DisabilitiesLearning Disabilities

Exclusion Criteria – Facilitating Early dischargeExclusion Criteria – Facilitating Early discharge

• Patient where another service has been Patient where another service has been identified as more appropriate to meet identified as more appropriate to meet their individual needs i.e. their individual needs i.e. D.A.R.T/AddictionsD.A.R.T/Addictions

• Delayed discharge patientsDelayed discharge patients

How Crisis team How Crisis team incorporates New MH actincorporates New MH act

Non- discriminationNon- discriminationEqualityEqualityRespect for diversityRespect for diversityReciprocityReciprocityInformal careInformal careParticipationParticipation

How Crisis team How Crisis team incorporates new MH actincorporates new MH act

Respect for carers Respect for carers Least restrictive alternativeLeast restrictive alternativeBenefitBenefitChild welfareChild welfare

Team CompositionTeam Composition

• 1 Team Leader (Band 7)1 Team Leader (Band 7)• 2 Senior Crisis Practitioners (Band 6)2 Senior Crisis Practitioners (Band 6)• 1 Senior 1 Occupational Therapist1 Senior 1 Occupational Therapist• 4 Crisis Practitioners (Band 5)4 Crisis Practitioners (Band 5)• 2 Associate Practitioners (Band 4)2 Associate Practitioners (Band 4)• 0.5 Staff Grade Psychiatrist0.5 Staff Grade Psychiatrist• 0.5 wte Clinical Psychologist ( A 0.5 wte Clinical Psychologist ( A

grade)grade)• 1 wte Senior Social Work Practitioner1 wte Senior Social Work Practitioner• 1 wte Social Work Practitioner1 wte Social Work Practitioner• 2 Flexi Support workers2 Flexi Support workers

Innovation award for Innovation award for Specialist TeamSpecialist Team

• Mental Health Nursing Forum Mental Health Nursing Forum For ScotlandFor Scotland

• Judging panel is independent Judging panel is independent from the Nursing Forumfrom the Nursing Forum

• Care Commission for ScotlandCare Commission for Scotland• NES (NHS Education Scotland)NES (NHS Education Scotland)• SRN (Scottish Recovery Network) SRN (Scottish Recovery Network)

Comments on Comments on SubmissionSubmission

• The service demonstrated excellent The service demonstrated excellent understanding of the Milan Principles understanding of the Milan Principles and how to translate them into practice and how to translate them into practice

• The judges scored the submission 10 out The judges scored the submission 10 out of 10 with regard to its links with of 10 with regard to its links with national standards national standards

• The service demonstrated effective user The service demonstrated effective user and carer involvement at service delivery and carer involvement at service delivery level level

• The submission was clearly evidenced The submission was clearly evidenced based and well referenced based and well referenced

• The service clearly demonstrated The service clearly demonstrated effective use of Staying Well Planseffective use of Staying Well Plans

Client CommentClient Comment

I found the service very inclusive. My I found the service very inclusive. My thoughts and views regarding my thoughts and views regarding my treatment were taken seriously and treatment were taken seriously and incorporated into a programme of incorporated into a programme of support. My views were sought at regular support. My views were sought at regular intervals, this I found very enablingintervals, this I found very enabling

CTT very helpful and understanding CTT very helpful and understanding without them I have no doubt I would without them I have no doubt I would have ended up in hospitalhave ended up in hospital

Performance Indicators Performance Indicators Heat TargetsHeat Targets

• Reduce the annual rate of increase of defined daily dose per capita of antidepressants to zero by 2009/10

• Reduce Suicides in Scotland by 20% by 2013 (existing target)

• We will reduce the number of readmissions (within one year) for those who have had a hospital admission of over 7 days by 10% by the end of December 2009