wandsworth assertive outreach & recovery team dr gunam kanagaratnam, associate specialist &...
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WANDSWORTH ASSERTIVE OUTREACH & RECOVERY TEAM
Dr Gunam Kanagaratnam, Associate Specialist&Dave RamkhelawonTeam Manager
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BACK GROUND
• Merger of two clinical management concepts• Intensive care in the community• Rehabilitation services in the community
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Recovery Model
• Enable and establish remission
• Sustain remission
• Enable recovery
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Wandsworth Assertive Outreach & Recovery Team
• Assertive Community Team
• Community Rehabilitation Programme – Residential facilities in the community, Peripatetic homes – managed by the POSH Team – partial hospitalization and support at home
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Patient Characteristics
• Adults with severe and ongoing mental illness
• Problems as a result of their mental illness and needs associated with it
• Current number of patients 143
• In the borough of Wandsworth
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Referrals
– this is a tertiary servicefrom the
• Community Mental Health Teams
• Acute in patient units
• Forensic Services
• Rehabilitation Services
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Referral Process
• Comprehensive referral from the team to include the following:
• Detailed psychiatric history, forensic history, risk assessment, physical health -medication history
• History of associated substance and drug abuse
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Referral process (ii)
• Family history, social history
• Accommodation / housing
• Employment
• Income / statutory benefits
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Assessment
• Bio – psycho – social assessment
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Intervention
• Needs lead
• Bio – psychosocial intervention
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Management by the team
• Multidisciplinary
• Psychiatrist
• Community Psychiatric Nurses
• Social workers
• Occupational therapists
• Support Workers
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Daily meetings
• Attended by all the members of the Team• Hand over• Zoning• Discuss clinical and management problems
All patients in the red zone are discussed• Then the Clinical Case Managers proceed to visit
their patients
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• Activities by the Clinical Case Managers – • Supervised medication• Psycho social intervention• Psycho education• Resolving their existential needs• Monitor mental state • Arrange clinical reviews
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Some notable achievements
• CPA
• Physical health monitoring
• Clozapine treatment
• “Direct payment”
• Safeguarding vulnerable adults
• Carers groups
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Safeguarding vulnerable adults
• All persons have the right to live their lives free from violence and abuse’.
• This right is underpinned by the duty on public agencies under the Human Rights Act (1998) to intervene proportionately to protect the rights of citizens.
These rights include • Article 2: ‘the Right to life’; • Article 3: ‘Freedom from torture’ (including humiliating and
degrading treatment); and • Article 8: ‘Right to family life’ (one that sustains the
individual).
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Remission criteria in Schizophrenia
• The patient achieves PANSS level of mild or less
- ( score of 1 to 3) • On all 8 symptom items - P1 Delusions - P2 Conceptual disorganisation - P3 Hallucinatory behaviour - G9 Unusual thought content - G5 Mannerisms and posturing - N1 Blunted affect - N4 Social withdrawal - N6 Lack of spontaneity / flow of conversation
Duration of at least 6 months
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Definition of recovery
• The process in which people are able to live, work, learn and participate fully in the community.
• For some individuals recovery is the ability to live a fulfilling and productive life despite a disability.
• For others recovery implies a reduction or complete remission of symptoms.
• Science has shown that having hope plays an integral role in an individuals recovery.
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Recovery Criteria
• Recovery criteria must be met in each of the 4 domains.
• Improvement in each domain must be sustained concurrently for at least 2 years.
• Level of recovery in these 4 domains is measured by symptom remission, appropriate role function, ability to perform day to day living tasks without supervision and social interaction.
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Notable achievements -
• Throughput of about 15%
• Robust discharge protocol
• Joint working with referrers
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Addenda
• CPA Form
• Transfer of care