The Modernisation of Mental Health Day Care using Occupational Therapy Principles Lorna Akroyd Principal Occupational Therapist for Mental Health Western Trust NI

What? A comprehensive review of 5 statutory Mental Health Day Centres in the Western Trust. 2013-2014

 

Why? Ageing population of users Younger clients not interested Poor ‘flow’ Outdated programmes Poor value for ££: at risk of closure Impact on OT caseloads

People with mental illness can be empowered when they are given support to structure their daily life, and offered the opportunity to engage in a variety of activities. (Becker and Kilian 2008)   Even some involvement in activity results in increased quality of life, especially when the person is satisfied with their involvement (Kelly et al 2001) and “whilst occupation requires motivation, it also generates it in greater abundance.” (Fieldhouse 2012)

“Day Centres have the potential to provide empowering occupations and rehabilitation for people with mental health problems and to help them towards a more participatory life.” (Tjornstrand, Beijerholm and Eklund 2013)   They can play a vital role in providing a non-threatening social network and supporting people who require daily occupation and would otherwise be socially isolated. (Catty et al 2005)

Research shows that service users may become dependent on a day centre and have little motivation to progress to “mainstream” activities in the wider community. (Bryant et al 2004)  Most people with serious mental illness live within their own communities , but remain separate from them by engaging in specialist mental health day care; this can be considered as a form of segregation which limits inclusion and opportunity.(From segregation to inclusion 2006)  Service users often have unmet needs for day structuring beyond the centre (Becker and Kilian 2008) and for independent living skills. They often have unmet hopes and aspirations for life.

A day centre attendee is offered structured activity, social interaction and a sense of belonging, but may become dependent on the centre and its staff, and with no encouragement, make no effort to progress beyond.   Bryant et al (2004) identified day centres as potentially fostering dependency, counteracting empowerment and preventing integration. They used the analogy of a plant, safe in a greenhouse, but vulnerable outside.

1. Comprehensive Review of existing attendees A. Require ongoing attendance to maintain wellbeing B. Potential and wish to progress from MHDCs C. Groups with unmet needs that MHDCs could fill **Considerable Occupational Therapy input

2. Ongoing continuous assessment of client needs/monitoring progress Day centre staff attend Recovery Team meetings Regular joint reviews Regular review and design of DC programmes Occupational Therapy input to assess occupational needs Use of MOHOST Embedded service user consultation Close liaison following client crisis

3. Care plans with client centred goals Recovery Star WRAP DC care plan is an extension of the MDT plan Occupational needs/aspirations

4. Recovery based DC programmes Traditional building based activities Different days for different needs Specific skills based programmes Community based programmes Explore options beyond the DC Recovery Through Activity Reaching out to younger people

5. Strong focus on Community Integration Ongoing Community Mapping Programmes delivered in community locations Traffic Lights Model Cross sector working OT co-facilitated programmes Supporting clients to do ordinary things in ordinary places ‘Moving on’ sessions

6. Service User co-production & co-facilitation Chairing meetings Leading activities- walking, gardening, music Organising social events Involvement with Recovery college- co-production & facilitation

7. Comprehensive Training Recovery principles Groupwork skills Mental Health promotion Recovery Star / WRAP Psychological approaches

8. Skills Mix New 8a Manager post (Occupational Therapist) Band 5 Occupational Therapist pilot Band 6 Occupational Therapist input from team Peer Consultant Peer support workers

Finally… Increased flow in system DCs as extensions of CMHT Significant OT input Tiered system- tailored for individual Younger people involved Increased satisfaction- users & staff