the national personality disorder development programme personality people & pathology 1 june...

The National Personality Disorder Development

Programme

Personality People & Pathology

1 June 2005, Friends Meeting House, OxfordRex Haigh & Steve Pearce


ProgrammeAims:

• To develop new approaches to treatment and care of people diagnosable with PD

• Strengthen the capabilities of the workforce through education and training

• Reduce social exclusion

Two Government publicationsNational Institute for Mental Health for England (NIMHE)

• Deliberate variety of approaches

• All involve many stakeholders

• Working together to provide new type of service

• Service users help in planning

• Care pathways approach• Very strong control over

finances & governance• Emphasis on evaluation,

outcome & dissemination• Results in 2005-7

Government money: services


Programme

Rex HaighConsultant Psychiatrist in Psychotherapy, Berkshire Healthcare NHS Trust

Personality Disorder Development Consultant, NIMHE South East Personality Disorder Service User Consultation Lead, Department of Health

Two Government publicationsNational Institute for Mental Health for England (NIMHE)

New Government Money

• Started as “crumbs from the DSPD table”• Personality disorder: the “DSPD” units

– £128m (£100m capital + £28m revenue)– For a few hundred people– eg £0.5m per patient per year at Broadmoor

• Personality disorder: community programme– £18m– For ~5% of the population (3,000,000 people)– Equals £6.60 each case per year

(or 33p per head of population)

• Intention to coordinate across 4 “silos”

Four “silos”

• New pilot projects– 2 years funding thence PCT

• National specialist commissioning– Henderson, Main House and Webb House

• DSPD units– 4 in prisons, 6 in forensic and 4 womens

units

• Training initiatives– Divided amongst 8 NIMHE regions

What “No Longer a Diagnosis of Exclusion” is funding:

the 11 new community pilot services

• Deliberate variety of approaches

• All involve many stakeholders• Working together to provide

new type of service• Service users help in planning • Care pathways approach• Very strong control over

finances & governance• Emphasis on evaluation,

outcome & dissemination• Results in 2005-7

What “No Longer a Diagnosis of Exclusion” means

www.publications.doh.gov.uk/mentalhealth/personalitydisorder.pdf

• 2004-2007 • 11 new pilot projects• Learning from diversity

– 4 “big ones”– 2 managed networks– 2 predominantly SU-led– 1 early intervention– Different therapeutic

models, some mention none

http://www.publications.doh.gov.uk/mentalhealth/personalitydisorder.pdf

http://www.publications.doh.gov.uk/mentalhealth/personalitydisorder.pdf

The 11 pilots

• A quick tour, giving:– Who submitted bid– Who manages it

(=owns it?)– Clinical model– Distinguishing

features

Leeds• Submitted by Tom Mullen,

Leeds Mentally Disordered Offender Development Coordinator, Leeds MHTT

• Provider: Leeds MHTT• Managed clinical and service

network• Core team working across

agencies• Providing

– Assessment– Clinical Services– Care coordination

• Largest urban project

Nottinghamshire

• Submitted by Helen Scott, Executive Director, Nottinghamshire Healthcare NHS Trust (MHT)

• Provider: Nottinghamshire Healthcare NHS Trust (MHT), and local advocacy groups

• Coordinated network with new clinical services

• 3 levels of provision– L1= advice and information– L2= “stop and think” CBT– L3= therapeutic community

• With satellite services across the county

• Integrated team• Wide range of stakeholders• Large population (>1m) and budget

Coventry• Submitted by Coventry PCT• Provider: Coventry PCT• New clinical services

– “community psychotherapy team”– group-based programmes for simple,

complex, & severe PD

• Integrated with new NSF-aligned psychiatric services

• New building• Most favourable funding to

population ratio

Thames Valley

• Submitted by Drs Rex Haigh & Steve Pearce, consultant psychiatrists in psychotherapy

• Providers: 3 MHTs - Berks, Bucks & Oxon

• Hub and spokes – 3 hubs– Approx 10 spokes

• New 4 tier clinical services– Assertive assessment (XBX)– Local treatment provision– 3 day TCs– Recovery tier (XBX-led)

• Multiple agencies involved• Integrated with training• Largest area & population (>2m)

Camden & Islington• Submitted by Stephen Pilling,

Consultant Clinical Psychologist, Camden and Islington Mental Health and Social Care Trust

• Providers: Charitable Trust (“Umbrella Ltd”), two PCTs and the MH/SC Trust

• Provision of two services:– Primary care: early recognition and

brief treatment, DBT-based– Voluntary sector: helping people to

reengage in work and be active citizens

• Small project• Small population• Inner city

NE London• Submitted by Dr Janet

Feigenbaum, Consultant Clinical Psychologist

• Provider: NE London MHT• Dual Diagnosis Assessment

and response Team: “DDART”

• Dual diagnosis – PD & substance misuse

• Provision of– Assessment– Interventions

• DBT based• group & individual • with outreach

– Case management

SW London

• Submitted by Dr Steve Millar, Consultant Psychiatrist in Psychotherapy

• Provider: SW London & St Georges MHT

• Service User Network (SUN)

• To set up 4 local networks to– Support SUs– Improve access to services

• Large urban population• Small staff numbers

Colchester

• The Haven Project Ltd

• Voluntary sector• Drop-in day services• Features of

therapeutic community

• Also short term crisis beds

Cambridge & Peterborough• Submitted by Annette Newton

(Area Director and MH Policy Lead, MHT), Prof Geoff Shepherd (Director of Partnerships and Service Development, MHT) and Dr Chess Denman (Consultant Psychotherapist)

• Provider: Cambridge & Peterborough Mental Health Partnership Trust

• No theoretical approach specified in bid

• Services provided in two “hubs”– Assessment– Interventions– Case management

• Development workers = spokes, to work across agencies and promote recovery model

North Cumbria

• Submitted by Dr Mike Rigby, Consultant Psychiatrist in Psychotherapy

• Provider: North Cumbria MHT

• “Itinerant therapeutic community”– Intensive day service

model– Aspatria RC & Carlisle

• Closely integrated with training programme

• Large rural area• Low population

Plymouth

• Submitted by Phil Confue, Director MH & LD, Plymouth PCT

• Provider: Plymouth PCT

• Early intervention model• Young people (<25)

engaged through youth enquiry service

• Social inclusion focus: “to prevent career as psychiatric patient”

• Delivered in partnership with voluntary agencies

• Includes DBT treatment

Evaluation of the 11 pilots• Local

– as described in individual bids– cooperation emerging

• National– Imperial College London

• Mike Crawford, Dorothy Griffiths, Tim Weaver, Deborah Rutter, Peter Tyrer

– Mental Health Foundation • Iain Ryrie, Jan Wallcraft

– University College London • Anthony Bateman, Gerhart

Knerer, Peter Fonagy– Institute of Psychiatry

• Paul Moran– University of Liverpool

• Jonathan Hill

Multi-method evaluation– A macro-level organisational

evaluation of the context, form, function and impact of pilot services

– A micro-level cohort study examining changes in health, social outcomes and direct costs of care among a cohort of people using these services

– A micro-level qualitative study of service quality from the perspective of service users

– A Delphi exercise to examine the level of consensus among academics, service users and providers about lessons that can be learnt for future service development

What do they cost?

• Smallest – SUN - £254,000• Largest – Thames valley - £1,006,335

– Full year effect– Including capital expenditure and management

costs– Excluding local contributions

0

100000

200000

300000

400000

500000

600000

700000

800000

900000

1000000

1

Leeds

Notts

Coventry

TV

Cam & Is

DDART

SUN

Haven

Camb & Pet

N Cumbria

Plym

Cost to NIMHE per project

How many new staff?

• In original bid (possibly amended since)

• Minimum: Carlisle = 6• Maximum: Thames Valley = 30.5

27.0

23.522.6

30.1

8.47.4 6.5

11.5

8.5

6.0

12.2

0

10

20

30

1

Leeds

Notts

Coventry

TV

Cam & Is

DDART

SUN

Haven

Camb & Pet

N Cumbria

Plym

Number of staff per project

Population covered

• Less than half a million – Waltham Forest

DDART– Coventry– North Cumbria– Essex Haven– Camden and

Islington– Plymouth

• Over a million– Thames Valley

(Berkshire, Buckinghamshire and Oxfordshire)

– Nottinghamshire

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

1

projects

Leeds

Notts

Coventry

TV

Cam & Is

DDART

SUN

Haven

Camb &PetN Cumbria

Plym

Population served by each project

Calculation: money spent per “case”

Assuming 5% of total population “have” PD:

• MAXIMUM – Coventry - £56• MINIMUM – SW London SUN - £6.52• MEAN - £17.75• REST OF ENGLAND in PCT baselines - £4.01

Spend per case for each project

0

10

20

30

40

50

60

1

Leeds

Notts

Coventry

TV

Cam & Is

DDART

SUN

Haven

Camb & Pet

N Cumbria

Plym

Calculation: “cases” per new staff member

• MAXIMUM – SW London SUN – 7662– (14 minutes each per year = 19 sec weekly)

• MINIMUM – Coventry – 701– (2hr 37mins each pa = 3 mins 25 sec weekly)

• MEAN - 2311

“Caseload” per project

0

1000

2000

3000

4000

5000

6000

7000

8000 Leeds

Notts

Coventry

TV

Cam & Is

DDART

SUN

Haven

Camb & Pet

N Cumbria

Plym

Calculation: cost of each new staff member

• MAXIMUM – North Cumbria – £70,883• MINIMUM – Leeds – £31,852• MEAN - £41,038

– Note: does not include contribution of volunteers, service users or ex-service users if unpaid.

Cost per new staff for each project

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000Leeds

Notts

Coventry

TV

Cam & Is

DDART

SUN

Haven

Camb & Pet

N Cumbria

Plym

Summary of “new money”

• For 11 new pilot projects from NIMHE: – £6.8m for 7.5m population = £17.75 per case

• Into PCT baselines 2004-5– £8m (England only) = £3.20p per case

• Into PCT baselines 2005-6– £10m (England only) = £4.01 per case

• For training programme 2004-5 & 2005-6– £2m = £250K per NIMHE region

More “new money”?

• To bring England up to average level of pilot projects would cost

• £868m

• This represents increasing current funding by 52x• Or current funding is 1.93% of what is needed

• Awaiting announcement from spending round (March 05?)

• But most will need to come from service remodelling

Forensic Service Developments

DSPD services 2 new 70 bed units at Broadmoor and Rampton

operational from 2005/6 Two new prison pilot sites at Frankland and

Whitemoor are operational from 2004 Planned womens DSPD prison pilot at Lower

Newton 6 pilot forensic services for people with PD who

present a risk to others Women's high support community services

(residential core and cluster services for women leaving high secure care)


Pilot services provided by:

– South London and Maudsley– Nottingham Healthcare Trust (Rampton)– East London Mental Health Trust– West London Mental Health Trust (Broadmoor)– Oxleas Trust– Newcastle, North Tyneside and Northumberland

Trust– Merseycare Mental Health Trust


Pilots include:

• Dedicated PD units within high secure services

• Dedicated PD units within medium secure services

• Associated hostels in three pilots • Community Team in six

Personality Disorder Capability Framework – Breaking the Cycle of

Rejection

• Comprehensive approach to improving capabilities of the workforce across many agencies responding to people diagnosable with PD

• Total of £2m for 2004/5 allocated to 8 NIMHE Regional Development Centres for new initiatives to implement the framework.


RejectionTraining initiatives reflect

partnership between WDDs, HEIs, NIMHE RDCs.

National bodies (NHS University, Royal Colleges etc.), committed to joint work to establish training initiatives consistent with Capability Framework

Learning networks will ensure dissemination of learning from pilot services.

Training and education programme will be independently evaluated


Rejection

Current training and education initiatives include:

• mapping/scoping exercises and training needs analyses

• stakeholder consultation• “PD awareness cascade” courses• PD basic training modules to be

incorporated in pre and post reg training

• multi-agency modular training approaches

• exploring training needs of commissioners.

Local multi-agency training is also included in many of the service development pilots

TRRT – training, research and recovery

team • 4th team of TVi• TRAINING – to deliver this

course and other events using XBXs and Agents

• RESEARCH – to undertake national data collection and local evaluation of TVi

• RECOVERY – to make service user, ex-service user and expert by experience partnerships essential

• AND – external relations etc etc…

TRRT: who, where, when?

• 3.3 wtes:– Sue Robinson Team Administrator 1.0wte– Clare Stafford Project Manager 0.5wte– Fiona Blyth Training Coordinator 0.5wte– [vacant] Team Researcher 0.5wte– Sheena Money Expert by Experience 0.3wte– Yolande Hadden Expert by Experience

0.3wte– Rex Haigh Programme Director 0.2wte

• Managed by OMHT through CS

• Located on Warneford site• Phase 1 – setup – y1• Phase 2 – provide – y2• Phase 3 – the future – y3+?

TRRT and training

• To coordinate all training offered

• To “capacity-build” SU, XSU & XBX involvement (STARS) for training and clinical function

• To provide (very limited!) funding for training activities – alongside NIMHE funding

• To provide (more substantial) funding for XBX input

• To get it onto secure financial footing

PD agents

XBX pool

1 year PD network course

prisons

Primary care

probation

police

mental health services

A&E

Voluntary organisations

housing

Social services

PD Treatment Facilities

Dynamic teams

Awareness cascade

Input into course philosophy, structure

and content

Service advocacy

Further training

Qualification

Primary care


A&E

prisons

probation

police


housing

Social services

commissoners

MH managers

Policymakers

Interested recruits

Development of new

services

Seminars, conferences, short courses,

workshops, etc

SE Training Plan – aka “network course” – aka “awareness cascade”

TRRT and research• Two serious attempts at

recruitment July 04 and Feb 05

• Coordination with – National team– Nottingham– Coventry

• Minimum dataset agreed across TV = National + SCID2 + CORE +

• Awaiting ethical clearance• Other local research (eg

qualitative and user-led) will need to await appointment of researcher

TRRT and recovery

• To make service user partnership (+XSU +XBX) essential– Writing bid together– Planning clinical policies together– Two paradoxes emerging

• To administer fairly– Systems, administration,

payment

• Employment and life beyond– Examples– Other agencies

STARSsupport, training and recovery

system• XSUs and XBXs• Monthly meeting• Last Friday afternoon• Lunch - check-in –

feedback – planning & allocation – open group – educational slot – check-out

• Usual attendance about 20, with 25 on our books

• In a central Reading nightclub owned by lottery winner, friend of an ex-service user!

• Requests for involvement taken through Sue

• Agreed at TRRT• Includes Training, Clinical

and Service Advocacy• Training and advocacy

activities in TV – we pay XBX fees and expenses (if outside, we charge)

• Agents would be welcome – especially if they come and tell us what they are up to, or with requests for involvement

TRRT: other coordination

• Initially – recruitment– eg polymorphous and non-

disciplinary job profiles• Team building• In-house training structures• Coordination between

teams• Annual Development

Conference – 6 July Kindersley Centre

• Organisational links – PCTs, MHTs, national team, learning network, ATC, CofC, NIMHE, BUK, RCPsych, multitude of others

Morning session: TVi clinical pilot

Professionals’ session: 10am – 12noon[Service user session running in parallel]

Oxford• Presentation of case vignettes by Naomi Evans, Team leader – any questions.• Discussion of the current service and focus on commissioning arrangements

from 2006/7Berkshire• Presentation of case vignettes and research findings by Davey Rawlinson,

Senior Psychotherapist. Any questions• Discussion of current service, funding and commissioning arrangements

currently and from 2006/7.Buckinghamshire• Presentation of case vignettes by Marion Panchkowry and Alex Esterhuyzen,

programme leads.• Discussion of the current service and focus on commissioning arrangements

from 2006/7TRRT• Presentation of TRRT development and activity by Rex Haigh, Programme

Director and Fiona Blyth, Training Coordinator• Discussion of likely commissioning arrangements from 2006/7


Rejection

• Comprehensive approach to improving capabilities of the workforce across many agencies responding to people diagnosable with PD

• Total of £2m for 2004/5 allocated to 8 NIMHE Regional Development Centres for new initiatives to implement the framework.


Rejection

Training initiatives reflect partnership between WDDs, HEIs, NIMHE RDCs.

National bodies (NHS University, Royal Colleges etc.), committed to joint work to establish training initiatives consistent with Capability Framework

Learning networks will ensure dissemination of learning from pilot services.

Training and education programme will be independently evaluated by NU (Peter Lewis is our link)


Rejection

Current training and education initiatives include:

• mapping/scoping exercises and training needs analyses

• stakeholder consultation• “PD awareness cascade” courses• PD basic training modules to be

incorporated in pre and post reg training

• multi-agency modular training approaches

• exploring training needs of commissioners.

Local multi-agency training is also included in many of the service development pilots

Training in the South-East

Developing a network of “PD Agents”

AWARENESS TRAINING

• Different staff groups

• Geographical spread

• Agent’s agency• Various

formats• With service

user input• Feedback

SERVICE ADVOCACY

NETWORKS

• In localities• Involving all

interested parties

• Putting case where needed

• Support from TV & NIMHE

Four “network courses” in SE

Thames Valley: Oxford base

Hampshire and Isle of

Wight: Southampto

n base

Kent: Maidstone

base

Surrey & Sussex: Brighton base

Courses spec: 1 - philosophy

• Based on “Breaking the Cycle of Rejection” Capabilities Framework

• Encourages patient/client autonomy and development of individual responsibility

• Well-reflecting the views of users and carers • Non-threatening• Empowering learners to use what they

already know• Finding common language • Focus on attitude change and stigma

reduction

Courses spec: 2 - structure

• Starts September 2004, finish by June 2005• Between 20 and 40 course participants• Variety of teaching methods• Planned and run by multidisciplinary team,

including contributions from all significant services in SHA area

• Service user or ex service user input to planning and delivery

• Inclusive and accessible (e.g. no disciplines excluded through use of jargon)

• Multi-professional• Multi-agency• Multi-sector

Cont…

• Mechanism for cascade of awareness training through course participants

• Continuing support for course graduates wanting to undertake further PD work

• Participation in SE-wide and national evaluation• Use of IT and NIMHE KC for dissemination of

course material and widening reach of PD training• Commitment to continuation and further

development beyond year 1• Collaboration with other SE courses in annual

development conference

Courses spec 3 - content• Minimum of seminars + work discussion + reflective

component• Evidence-based, where it exists• Case formulation from different approaches• Explains PD phenomenology an continuum• Includes Aetiology• Interventions and evidence• Sociological and deviance perspectives• Eclectic with regard to therapeutic or theoretical models• Management principles: engagement, attachment and

consistency• Stigma and education • Attend to team and organisational dynamics• Models of supervision• Skills: what to do and what not to do• Service design discussions

Courses spec 4 - admin• Pamphlet to

include course aims, intended audience, dates and outline of content

• With SEDC logo• Produced by end of

June• Circulated widely

within all MH trusts in SHA

• Circulated to other agencies within SHA area (eg primary care, voluntary sector, social services etc)

• Course outlines using pro-formas below to be received by SEDC by June 11

• Approval for funding by end of June• Supporting costs will be paid in

three parts: £10,000 in July for setting up

• Further £10,000 in December 2004 when evidence of course delivery, including course brochures, number of participants with their professional backgrounds, work settings and employing organisations is received

• Final £10,000 in Summer 2005 when number completing the course, participants’ feedback and analysis, and plans for future development are received


prisons

Primary care

probation

police


A&E


housing

Social services

PD agents


prisons

probation

police

A&E


housing

Social services

Further training

Qualification


XBX pool

PD Treatment Facilities (few and far between)

PD agents

XBX pool


prisons

Primary care

probation

police


A&E


housing

Social services


Dynamic teams


and content

Further training

Qualification

PD agents

XBX pool


prisons

Primary care

probation

police


A&E


housing

Social services


Dynamic teams

Awareness cascade


and content

Service advocacy

Further training

Qualification


workshops, etc

PD agents

XBX pool


prisons

Primary care

probation

police


A&E


housing

Social services


Dynamic teams

Awareness cascade


and content

Service advocacy

Further training

Qualification

commissoners

MH managers

Policymakers

Development of new

services


workshops, etc

PD agents

XBX pool


prisons

Primary care

probation

police


A&E


housing

Social services


Dynamic teams

Awareness cascade


and content

Service advocacy

Further training

Qualification

Primary care


A&E

prisons

probation

police


housing

Social services

commissoners

MH managers

Policymakers

Interested recruits

Development of new

services


workshops, etc

SE Training Plan – aka “network course” – aka “awareness cascade”

• 3 County clinical services

• Plus “Umbrella” function including training

• …called TRRT • In close

partnership with STARS

TRRT – training, research and recovery

team • 4th team of TVi• RH, SM, YH, CS, SR and ---

just--- FB. “TR” yet to be appointed.

• TRAINING – to deliver this course and other events using XBXs and Agents

• RESEARCH – to undertake national data collection and local evaluation of TVi

• RECOVERY – to make service user, ex-service user and expert by experience input essential

ROLE IN TRAINING• To coordinate all training

offered• To “capacity-build” SU, XSU

& XBX involvement (STARS) for training function

• To provide (very limited!) funding for training activities

• To provide (more substantial) funding for XBX input

• To get it onto secure financial footing

STARSsupport, training and recovery

system• XSUs and XBXs• Monthly meeting• Last Friday afternoon• Lunch - check-in –

feedback – planning & allocation – open group – educational slot – check-out

• Usual attendance about 20, with 25 on our books

• In a central Reading nightclub!

• Requests for involvement taken through Sue

• Agreed at TRRT• Includes Training, Clinical

and Service Advocacy• Training and advocacy

activities in TV – we pay XBX fees and expenses (if outside, we charge)

• Agents would be welcome – especially if they come and tell us what they are up to, or with requests for involvement

Aims of today

• To bring different parts of the training and service initiative together

• To understand what we are all doing• To know where to get help and

collaboration• To start planning what else we want

to do• To get at least 3 useful new email

addresses or phone numbers in our address books …!

Thames Valley

• 3 hubs – Reading, Oxford and Bucks

• Various satellites• Numerous partners• 4 tier model• Working without

county boundaries• TV-wide functions:

recruitment, induction, training, staff support, evaluation, XBX input, awareness training, service advocacy

Thames Valley Initiative service model: outline of tier 1

• Tier 1 is similar to assertive outreach in AMI services: not “office-bound”.

• It needs to be organised with numerous agencies at locality level.

• Individual and joint consultations

• Includes weekly non-exploratory group, drop-ins, various formats

AKA…• Assertive Engagement• Facilitated

Engagement• Active Assessment• Engagement &

assessment• What is the best name

for it?...

Thames Valley Initiative service model: choice & consent in tier 1

• To develop close liaison with all relevant other agencies, for example through “PD Agents” network

• assessment and engagement will be a two-way and continuing process with certain stages and decision points

• this will be related to sharing responsibility with other clinicians, then taking full responsibility in later part of the programme

• we will not take direct referrals in the traditional “passing on of responsibility” way

• the final common pathway to all coming into the services will be individuals’ choice (ie self-referral)

• that will be as informed as facilitated as possible

• with particular emphasis on employing ex-service users in full collaboration, as XBXs

Thames Valley Initiative service model: activities and aims for tier 1

• Telephone advice to members of staff dealing with a potential PDPs.

• Consultation and support regarding individual clients.

• Support to clients who self-refer

• Liaison with all relevant agencies.

• Staff education, by telephone or by TVi staff attending others’ staff meetings.

• Drop-in sessions for potential PDPs.

• Access groups, for PDPs to understand the service and to support them in engaging in further therapeutic work.

• Providing care tailored to each individual that takes account of disabilities, gender, sexual orientation etc.

• Ensuring that everyone can access the service by employing staff from a range of ethnic and cultural backgrounds

• Helping PDPs disengage with other services they may be receiving, as appropriate

Various combinations of different days for different referral groups, iin different locations

Numerous activities in different settings with different agencies, statutory & voluntary.

Tier 1: Assertive engagement and active assessment

Definitive therapeutic activities at different times in the week, for different populations, in different locations

Could include weekend

programmes for those in full time

work or education

Tier 2: Outreach, inreach and “access to therapy”

Whole-time daily programme at service core, with different activities, therapies and groups.Admin centre, also training base.

Tier 3: Day programme: therapeutic community

Half day per week (or less), possibly with overlap into last weeks/months of tier 2 or tier 3 programme. In liaison with other agencies (eg college, employment). Normally thence back to GP care only.

Tier 4: Leaving process – support & recovery

Various combinations of different days for different referral groups, iin different locations

Different activities at different times in the week, for different populations, in different locations

Could include weekend

programmes for those in full time

work or education

Whole-time daily programme as service base, with different activities, therapies and groups.Considerable user-involvement. Also training base.

Numerous activities in different settings, one common weekly “drop-in” engagement group for informal meeting and information sharing

Tier 1: Assertive engagement and active assessment

Tier 2: Outreach, inreach and “access to therapy”

Tier 3: Day programme: definitive treatment

Half day per week (or less), with overlap into last weeks/months of tier 2 or tier 3 programme. In liaison with other agencies (eg college, employment). Normally back to GP care only.

Tier 4: Leaving process – graded disengagement

Referral to more suitable services: occasionally to out-of-area residential units (eg Henderson or Cassel Hospitals) or to outpatient psychology or psychotherapy, when suitable.

Unplanned discharge

Unplanned discharge

Liaison psychiatry

Planned discharge

Young offender services

Planned discharge

For those able, willing, and likely to be helped by going on to a more intensive treatment programme

For those able to take sufficient degree of responsibility for themselves

For those with specific issues, geographical or time limitations, or not best served by daily programme

MIND, RF , etc

CAMHS eg parents

with PD

A&E HV

PCMAPPPs

Prisons SHs

GP

SSDs

Drugs & Alcohol

units

Housing

Homeless services

Univ & College health &

counsellingNHS DirectSelf-

referral

Samaritans

Adult mental health: CMHTs, IP, crisis services, assertive

outreach

ProbationCourt divert

schemes

Forensic

stepdown

Occupational health

PD service model:coordination between local services

Parenting Assessment

Project

Berkshire Local

Strategy Forum

Oxfordshire Local

Strategy Forum Bucking-

hamshire Local

Strategy Forum

Thames Valley Strategy Forum

& ‘Axis 2 Institute’-Training functions only (grey arrows)

-Strategy fora to coordinate services AND training functions

(blue arrows)-Includes administration of service

user input (throughout)-located in one trust or as part of SEDC / TVSHA

-strategic links with other region-wide agencies

-liaison with other regions

Broadmoor Hospital: Psychotherapy & DSPD units

Bucks Axis 2 Service

Berks Axis 2 Service

Oxon Axis 2 Service

Grendon PrisonMilton Keynes PCT / Local

Authority

Local MH services

Local MH services

Local MH servicesREAP

Elmore

Social Services

MINDAssessment Wing F

Therapy Wings A, B, C, D, G

CONNE-CTION

CONNE-CTION

NC(?)

Thames Valley Initiative service model: XBX involvement

• 2 employees are XBXs• Also use pool of ~20 with

sessional rates• Tasks: training, planning

and clinical– Training: almost autonomous,

across agencies (details later)– Planning: local, regional,

national– Clinical: mostly tier 1 and tier 4

– user-friendly introduction to services and supportive network and “getting a life”

“We would all have completed a recognised treatment in order that we have moved on enough to achieve sufficient objectivity to be able to look beyond our own therapeutic needs. The support and social element of the group would be available to people immediately after treatment, but involvement in training, planning and other paid work would not occur until six months after the end of treatment, in order to support people to move on from therapeutic attachments.”

Onwards and Upwards: Berkshire Group

• Climate change• Central resources for

education• Local radio• Need to get something

concrete• Awareness of what we

are doing – promotion & awareness

• Getting involved in TVU nurse training

• Work with CMHTs – events / day conference

• Will work with next lot of agents

• Using what else is within the agents’ group

• NOW!• XBX activity will need

more funding, non-NHS possibilities

Onwards and Upwards: Buckinghamshire Group

• Using agents to influence managers

• Coming on course is more than just the one year itself

• Invite managers into the course to see work being done in project groups

• With TRRT help• XBXs – how

involvement has benefitted

• Central resource of training materials – off-the-pegs

• PD agents y1 & y2 will meet quarterly

• Need to get out to GPs to support and educate (mixed picture)

Onwards and Upwards: Oxfordshire Group

• Sarah’s shopping list• No we can’t do any

more – but we did• How do we keep on

meeting?• Need to connect up

with this year’s PD agents

• Pick up ones who have dropped off the radar

• Rolling out training we have already planned

• Getting help to do that from others

• GPs, other key areas to involve

• Rethink & Mind• Detailed planning

involving TRRT & STARS

• Conference – fuzzy time line – still intended

• PCT roadshows• Reln agents-clin team

• Still need to think about HOW to do it.


Programme

Training plans for the South-EastSue Earley (TVi), Kevin Emrys (TVi), Rex Haigh (SEDC),

Sheena Money (TVi), Sue Robinson (TVi)

14 February 2005Wellshurst Golf Club, East Sussex

Ten Essential Shared Capabilities

• =update of CPF + mapping for WD

• shift in culture in services towards Choice, person-centeredness and mental health promotion is a key imperative

• were significant gaps in pre and post qualification training of all professional staff in their ability to deliver the MHNSF and the NHSP

• Being rendered helpless rather than helped by service use

• embedded in induction and continuing professional /practitioner development

Essential Shared Capabilities 1 & 2

• Working in Partnership. Developing and maintaining constructive working relationships with service users, carers, families, colleagues, lay people and wider community networks. Working positively with any tensions created by conflicts of interest or aspiration that may arise between the partners in care.

• Respecting Diversity. Working in partnership with service users, carers, families and colleagues to provide care and interventions that not only make a positive difference but also do so in ways that respect and value diversity including age, race, culture, disability, gender, spirituality and sexuality.


• Practising Ethically. Recognising the rights and aspirations of service users and their families, acknowledging power differentials and minimising them whenever possible. Providing treatment and care that is accountable to service users and carers within the boundaries prescribed by national (professional), legal and local codes of ethical practice.

• Challenging Inequality. Addressing the causes and consequences of stigma, discrimination, social inequality and exclusion on service users, carers and mental health services. Creating, developing or maintaining valued social roles for people in the communities they come from.


• Promoting Recovery. Working in partnership to provide care and treatment that enables service users and carers to tackle mental health problems with hope and optimism and to work towards a valued lifestyle within and beyond the limits of any mental health problem.

• Identifying People’s Needs and Strengths. Working in partnership to gather information to agree health and social care needs in the context of the preferred lifestyle and aspirations of service users their families, carers and friends.


• Providing Service User Centred Care. Negotiating achievable and meaningful goals; primarily from the perspective of service users and their families. Influencing and seeking the means to achieve these goals and clarifying the responsibilities of the people who will provide any help that is needed, including systematically evaluating outcomes and achievements.

• Making a Difference. Facilitating access to and delivering the best quality, evidence-based, values-based health and social care interventions to meet the needs and aspirations of service users and their families and carers.


• Promoting Safety and Positive Risk Taking. Empowering the person to decide the level of risk they are prepared to take with their health and safety. This includes working with the tension between promoting safety and positive risk taking, including assessing and dealing with possible risks for service users, carers, family members, and the wider public.

• Personal Development and Learning. Keeping up-to-date with changes in practice and participating in life-long learning, personal and professional development for one’s self and colleagues through supervision, appraisal and reflective practice.

More info on 10 ESC

• www.nimhe.org.uk/downloads/78582-DoH-10 Essentials.pdf

• Or Google “Ten Essential Shared Capabilities”

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