How do Mental Health Services Work? Sara Saunders Occupational Therapist Mind & Soul Network Co-ordinator for Leeds & Bradford

Aims of session: To provide general overview of mental health services including: Access to the services General pathways through the services What to expect from services & it’s professionals How to get the most from the services

London …. central London has a minimum of 5 N.H.S. trusts providing care for a range of people of all ages, problems & diagnosis’ including…..

*Forensics *Acute’s *Talking Therapies *Eating Disorders *Chronic Fatigue *Personality Disorder *Counselling Services *Primary care C.B.T. *Services catering for ethnic minorities *Community Mental Health Services *Liaison Psychiatry *Mother & Baby units *Crisis teams *Assertive Outreach *Learning Disability *Older Adult Services *Child & Adolescent *Prison Services *Gender Identity *Women’s Services *Rehab Services *Addiction/ dual diagnosis services

Services based on Age Groups: Child & Adolescence: up to yrs Adult: – 65 yrs Older Adult: 65 yrs +

Service Structure Tertiary Care Secondary Care Primary Care Friends / Family /CHURCH

General Services – for Adults 16 – 18+ Primary Care First point of contact e.g. G.P, N.H.S. Direct, A&E No referral required Secondary Care General M.H. Services ~ referral required Tertiary Care Specialist Services referral required (from within general services)

Primary Care G.P. Services May provide a number of consultations Prescribe medication (Anti – depressants, Mood – stabilisers) Recommend: –Self Help Initiatives (AA, MIND, CRUISE, RELATE) –Support Groups –Telephone Help Lines Refer to Secondary Services/ Crisis

Secondary Care Primary Mental Health Worker ~ for C.B.T. or Counselling –( Nurse, O.T, Psychologist, C.B.T. Therapist, Counsellor) C.M.H.T’s Crisis Team (for Acute Services) Psychology / Psychotherapy Liaison Psychiatry Mother & Baby Services Addiction Services Voluntary Sector

Other Secondary Care Services (requiring Referral) Forensics Prison Services Via the legal system

Community Mental Health Teams Nurses (C.P.N’s) O.T’S, Social Workers, Support Workers, Psychiatrists Provide weekly to monthly support from general monitoring to intensive community rehabilitation.

Intensive Care Options Crisis Resolution Teams –Gatekeepers to acute services –Out of hours assessment & treatment –Some teams provide home based treatment Acute Community Day Services (A.C.D.S.) –An alternative to in-patient admission (Extended opening hours, 365 days a year). In-patient Care –Acute Wards – for sectioned clients, clients needing 24 hour care & monitoring, clients with minimal social support, increased risk

Tertiary Services Specialist Services Eating Disorders Chronic Fatigue Personality Disorder Gender Identity Assertive Outreach Rehabilitation Services

HELP!! *What’s happening to me? *Is this normal....or am I ill? *If I tell anyone, will I end up in hospital ? *I know I need help, but where do I go & what do I say to whom?

Access to Services G.P N.H.S Direct A & E (in an emergency) Crisis Centres If already within the service – contact with the Key worker in order to seek their support & advice

Routes through the system G.P. ACUTES C.M.H.T. G.P. SPECIALIST ACUTES

What can you expect from the Services Comprehensive Holistic Assessment (multi-disciplinary – in secondary & tertiary). Holistic Treatment Psychological (C.B.T.) & Psycho-social Interventions Relapse Prevention & Health Promotion Information & Support for Carers Advocacy & Chaplaincy Services Care Programme Approach (Standard or Enhanced)

On Discharge day follow–up – upon transfer from old service to new. Minimum Support – back to G.P (Primary Care). Maximum Support – to be maintained by: Assertive Outreach, Personality Disorders Network, Community Rehab Services, Community M.H. Teams, with: regular 3-6 monthly out patient psychiatric reviews & 6 – 12 monthly C.P.A’s. Day Centre’s, support groups & supported living - hostels, sheltered housing, housing support workers. (main provision through voluntary, social & private sectors).

C.P.A (Care Programme Approach) Introduced in 1992, to ensure: 1)No one fall’s ‘through the net’ – upon transfer or discharge from services 2)To ensure a plan is put in place to address all needs 3)To ensure ALL individuals involved in a persons care are aware of care plans, who is responsible for what & that a consistent approach is taken, by all.

C.P.A. What areas does the C.P.A. cover? Benefits/ finances Support to claim benefits & debt support Housing Needs Occupation/other identified Activity /productivity) Daily structure, including: Paid/ voluntary employment, educational courses, day centres Mental Health Regular psychiatric review, monitoring of mental health, medication & side- effects, relapse prevention, psychological work

C.P.A. cont... Physical Health Needs Action to be taken if early warning signs of relapse show/ crisis occurs Also: Management of any risk factors Interventions such as P.S.I. (Family Work) or C.B.T. (graded exposure plans) Carers Needs Referrals required to other services

Professionals Psychiatrists: Diagnose, refer, monitor, prescribe medication. Psychologists : ‘Talking’, cognitive therapies to address current & past issues – e.g. phobia’s, anxieties, entrenched depression. Assess for diagnosis where I.Q. & early childhood development relevant (e.g. Learning Disability, Autistic Spectrum). Psychotherapists: ‘Talking therapies’ to address issues from past & present (e.g. childhood abuse). Nurses: M.H. assessment & monitoring, relapse prevention, care co-ordination, medication.

Professionals cont.... O.T’s: Activity towards recovery – developing skills to return to independent living, through graded 1:1 & group work. Social Workers: Assessment for sections, funding for accommodation, support with benefits & debts. Child & Adult Protection. Support Workers (voluntary, social & health sectors) To support professionals to carry out care required – whether M.H. monitoring, housing, rehabilitation skills.

Roles Care Co-ordinator: The professional who co-ordinates the individuals care (& C.P.A. process) even if the individual may be in a different service to that of the Care Co-ordinator, at any given time. Key Worker: Key person working with the individual at the present time (this does not necessarily have to be the Care Co-ordinator but often is). Co – worker: Co- works alongside the key-worker, as the secondary worker & can sometimes be an unqualified worker. The co – worker will often ‘stand in’ when the key-worker is not available.

Challenge How can you get more involved in the C.P.A. Process, with those you support? If you’re wondering about ways to impact the M.H. Services, then come along to the session this afternoon, entitled: ‘Working in the Mental Health Service’ Thank you for listening