Intermediate Mental & Physical Health Care Team and Role of Physiotherapist in Mental Health Kashif Munir (Physiotherapy Lead) 14th March 2014

For Alzheimer’s, the estimated lifetime risk for men at 65 is 9 For Alzheimer’s, the estimated lifetime risk for men at 65 is 9.1 and 17.2 Lifetime risk of first coronary heart disease event at age 40 is 48.6 for men and 31.7 for women. Confidence interval +- 3 In the UK, one in four people will experience mental illness in their lifetime 46% of older people in hospital wards had a need for special care in 2009 The number of adults living in England who accessed specialist mental health services between 1st April 2010 and 31st March 2011 was 1,259,650*, a 1.4 per cent rise on the number who accessed services in the previous year (2009/10) when the number of people who accessed services was 1,242,218

(Department of Health, 2 November 2013) NHS must treat mental and physical health equally (Department of Health, 2 November 2013) Making mental health services more effective and accessible (Department of Health , 25 March 2013) CQC calls for urgent improvements in mental health services in England (CQC, 30 January 2013) Using the mental health act people were made to have treatment at home nearly 400 times more last year making a total of over 4,000 (Care Quality Commission January 2013)

Background to Service Review of Westminster Intermediate Care Services. Initial development across partner organisations: NHS Westminster, CNWL, Local Authority and Acute Care. Influenced by: Local audit – adults & older adults with mental health problems were staying longer in acute hospitals & difficulty in accessing rehab pathways. NSF for Older Adults: Standards 3 & 7

Locality and Hours Currently: Vauxhall Bridge Road Older People’s and Healthy Ageing Westminster Services CMHT, HTT, JHT, ABT, Recovery Team Mon – Fri 0830 – 1630 Referrals are screened within 24 hours (Mon – Fri) Assessment 3 working days assess if urgent or 10 working days for non-urgent

Senior Physiotherapist IMPS Structure East Sector Manager Mental Health Clinical Nurse Specialist RMN Associate Practitioner Physiotherapy Physiotherapy Lead Senior Physiotherapist Physiotherapist Occupational Therapist Rehab. Assistants Rehab. Assistant Psychology Clinical Psychologist Administrator Psychiatric Cover

Acceptance Criteria Westminster residents only Medically stable with rehabilitation potential. Age: Adult 18 + Current mental health function condition is affecting their physical rehabilitation. Physical condition is affecting their mental health resulting in challenges/ in their rehabilitation. Clients to engage with Mental Health and Physical Care Practitioners to enable holistic, goal specific, time limited interventions to effectively optimise recovery. Clients cognitive impairment has deteriorated significantly or is resulting in prevention of realistic rehabilitation due to complex needs/condition.

Referrals Accepted from: All health and social care professionals Paperwork: Accessible via the IMPS webpage SAP form Basic risk assessment For the those within CNWL a referral letter is acceptable

Patient Referral Pathway

Assessment and Care Planning Case manager is identified according to the client’s key issues. A single assessment framework is carried out with two different disciplines in attendance After assessment and acceptance onto the caseload a MDT Goal Orientated Treatment Plan is formulated jointly with the client. Single professional records and shared protocols are kept on JADE. Clients are frequently reviewed (either daily, weekly or monthly according to needs and issues identified) within the team.

Treatment/Interventions Providing Comprehensive Assessment, resulting in a structured individual care plan that involves active therapy, treatment or opportunity for recovery. A planned outcome of maximising independence and typically enabling people to resume or continue living at home. Cross professional working, Intense, frequent input with flexible durations to suit and meet the needs of each individual. Physiotherapy Assessment and Treatment. Psychological Therapies Psychosocial Interventions

Environmental Assessment & Support Review & Rehab of ADL’s Medication Review Functional Assessment Financial Guidance and Referral Family and Carer Support Motivational Interviewing Diagnosis Facilitate access to community services Social Inclusion

The Role of the Team Short term rehabilitation (Target 8 weeks): To clients whose physical health rehab is impeded by mental health problems or their physical health is impeding their mental health recovery. Prevent unnecessary admission: To an acute setting and reduce avoidable use of long-term care. Provide a multi-faceted service: Encompassing; holistic assessment, community rehab, discharge support and prevention of admission where possible.

The role of physiotherapists working in Mental Health Meet the needs: They are uniquely placed to meet the needs of service users who have both physical and mental health needs. (Everett et al. 2003). Clients goals: Base the treatment plan on the older adult’s goals. Identify needs: identifying the physical health needs of the patient population, raising awareness of physical health issues, and assisting patients to adopt ways of improving their physical health (Warrell et al, 2005). Medications: Prevent and/or manage medication side effects

Education: Incorporate older adult and family teaching throughout assessment and treatment. Pain: Address pain using an inter-disciplinary approach Recommendations for pain: Recommended guidelines for Pain Management Programmes for adults. This programme fulfils the criteria for Combined Physical and Psychological (CPP) treatment programmes as recommended by the NICE 2009 guidelines on low back pain

Behavioural modification: Through education for those with high risk health behaviour and promoting healthy eating and exercise such as poor diet People with schizophrenia living in the community have been found to have a poor diet, with less than the recommended intake of fruit and vegetables, and high risks of cardiovascular disease (McCreadie, 2003), lack of exercise, obesity, cigarette smoking, alcohol and substance misuse, and poor sexual health (Office for National Statistics, 2004; Department of Health & Department for Education and Skills, 2004). Challenge symptoms: Challenge symptoms associated with mental health by physical tests.

Weight management programmes: Development and delivery of lifestyle and weight management programmes Exercise prescription; Experts in prescribing exercise. (The Chief Medical Officer (Department of Health, 2004b) recommends for general health that children should exercise for 60 min a day; the recommended minimum for adults is a total of 30 min of moderate-intensity physical activity a day on at least 5 days a week). Graded activity, an operant treatment approach based on principles of operant conditioning, was identified as a CBT-based strategy with traceable theoretical justification that can be applied by physiotherapists, Brunner et al, 2013) Promoting independence: Promoting and maintaining independence of people with dementia.

Effects of medication; Provide information on physical effects of medication and challenging physical presentation through physical tests. Touch: Touch Based Skills (evidence has shown touch based therapies produce reductions in cortisol levels and blood pressure and gives relief from pain) Other: Cognitive behaviour therapy, Counselling Skills, Mind- distraction techniques, Basic Body Awareness Therapy (BBAT), the Alexander Technique, Tai Chi, The Principles of Recovery and Developing coping strategies.

Future developments Promotion of IMPS service: Presentations; Revamped Leaflet; GP mailing Continued development of an evidence based service: recovery model and social inclusion; CBT and counselling; improved physical and mental health goal setting Enhanced working between health and social care teams: Intermediate Care Project; maintain close links with CNWL Teams. Community Independence Service – 1st April 2014

How To Contact Telephone: 0207 854 4151 Fax: 020 79318087 Email: imps@nhs.net Webpage: http://www.cnwl.nhs.uk/imps.html Address: 3rd Floor 190 Vauxhall Bridge Rd London SW1V 1DX