Award Winning Crisis Resolution Service Presentation for 18 th Jan 2008

BACKGROUND TO TEAM Intermediate services were developed within Glasgow following the modernising Mental Health Initiative to improve the quality of Psychiatric care in the UK (Dept of Health, 1998).Intermediate services were developed within Glasgow following the modernising Mental Health Initiative to improve the quality of Psychiatric care in the UK (Dept of Health, 1998). Intermediate teams were multi-disciplinary and multi agency in nature, with the main aims of providing an alternative to hospitalisation where possible, to promote early discharge from hospital, and to stabilise mental mental health within the home environment.Intermediate teams were multi-disciplinary and multi agency in nature, with the main aims of providing an alternative to hospitalisation where possible, to promote early discharge from hospital, and to stabilise mental mental health within the home environment.

Service Re-Design Service Re-design group established in 2005Service Re-design group established in 2005 Drivers for change are Mental health Care and Treatment Act 2003 and OMIG group.Drivers for change are Mental health Care and Treatment Act 2003 and OMIG group. Crisis Teams developed and CMHT teams reconfigured as a result.Crisis Teams developed and CMHT teams reconfigured as a result. Rights Relationship Recovery based nursing review (National Review Of Nursing)Rights Relationship Recovery based nursing review (National Review Of Nursing)

The Core Concepts of Crisis Work To facilitate and promote early discharge from psychiatric in-patient care where appropriate.To facilitate and promote early discharge from psychiatric in-patient care where appropriate. To provide short-term intensive community based care as a viable alternative to hospital admission, where appropriate.To provide short-term intensive community based care as a viable alternative to hospital admission, where appropriate. To engage service users and their families/ carers in tailored programmes of care and promote the stabilisation of an individual’s mental health within their home environment.To engage service users and their families/ carers in tailored programmes of care and promote the stabilisation of an individual’s mental health within their home environment.

Core Function Be available 24 hours a day and over 7 days a weekBe available 24 hours a day and over 7 days a week Provide alternative to hospital admission and provide an early discharge functionProvide alternative to hospital admission and provide an early discharge function Provide home assessment and treatment as an alternative to hospital admission for people experiencing an acute mental health crisisProvide home assessment and treatment as an alternative to hospital admission for people experiencing an acute mental health crisis Provide support to the gate keeping and care coordination function of Community Mental Health Teams to ensure appropriate referral and management of acute relapse in either inpatient settings or through the crisis serviceProvide support to the gate keeping and care coordination function of Community Mental Health Teams to ensure appropriate referral and management of acute relapse in either inpatient settings or through the crisis service

Core Function Provide short term interventions and management of an individuals care during the period of acute relapseProvide short term interventions and management of an individuals care during the period of acute relapse Remain involved until the crisis has been resolved whilst maintaining robust communication with the integrated care manager within the CMHT who will retain this function.Remain involved until the crisis has been resolved whilst maintaining robust communication with the integrated care manager within the CMHT who will retain this function. The service will also engage with service users who are discharged against medical advice or boarded out from their own Community Health and Care Partnership in- patient area.The service will also engage with service users who are discharged against medical advice or boarded out from their own Community Health and Care Partnership in- patient area. Where inpatient admission is necessary, be actively involved in admission, discharge planning and provide intensive care and support at home to enable early dischargeWhere inpatient admission is necessary, be actively involved in admission, discharge planning and provide intensive care and support at home to enable early discharge

ELIGABILITY CRITERIA Adults over the age of 18 including individuals under 18 who are receiving Adult MH services (e.g. ESTEEM) who are at risk of being admitted to Hospital and who are experiencing acute crisis and/or relapseAdults over the age of 18 including individuals under 18 who are receiving Adult MH services (e.g. ESTEEM) who are at risk of being admitted to Hospital and who are experiencing acute crisis and/or relapse 4.1 Eligibility Criteria – Facilitating Early Discharge4.1 Eligibility Criteria – Facilitating Early Discharge The Crisis Team will play a major role in ensuring an effective interface between in-patient and community services. The Crisis Team will have an active role, providing input to MDT review meetings within the in- patient serviceThe Crisis Team will play a major role in ensuring an effective interface between in-patient and community services. The Crisis Team will have an active role, providing input to MDT review meetings within the in- patient service Adults within acute in-patients services who require immediate intensive follow-up to facilitate early dischargeAdults within acute in-patients services who require immediate intensive follow-up to facilitate early discharge

ELIGABILITY CRITERIA In-patients who require home assessment whilst on pass from hospital as part of the discharge planning processIn-patients who require home assessment whilst on pass from hospital as part of the discharge planning process Patients who are discharged against medical advicePatients who are discharged against medical advice Patients boarding out of CHCP who can be discharged from the boarding hospital with intensive follow-upPatients boarding out of CHCP who can be discharged from the boarding hospital with intensive follow-up

EARLY DISCHARGE 4.1 Eligibility Criteria – Facilitating Early Discharge4.1 Eligibility Criteria – Facilitating Early Discharge The Crisis Team will play a major role in ensuring an effective interface between in-patient and community services. The Crisis Team will have an active role, providing input to MDT review meetings within the in-patient serviceThe Crisis Team will play a major role in ensuring an effective interface between in-patient and community services. The Crisis Team will have an active role, providing input to MDT review meetings within the in-patient service Adults within acute in-patients services who require immediate intensive follow-up to facilitate early dischargeAdults within acute in-patients services who require immediate intensive follow-up to facilitate early discharge

EXCLUSION CRITERIA Exclusion Criteria -Crisis The team will not engage with service users while their function is so impaired by drugs and alcohol that they cannot participate in therapeutic dialogueThe team will not engage with service users while their function is so impaired by drugs and alcohol that they cannot participate in therapeutic dialogue Service users with a primary diagnosis of Learning DisabilitiesService users with a primary diagnosis of Learning Disabilities Exclusion Criteria – Facilitating Early discharge Exclusion Criteria – Facilitating Early discharge Patient where another service has been identified as more appropriate to meet their individual needs i.e. D.A.R.T/AddictionsPatient where another service has been identified as more appropriate to meet their individual needs i.e. D.A.R.T/Addictions Delayed discharge patientsDelayed discharge patients

How Crisis team incorporates New MH act  Non- discrimination  Equality  Respect for diversity  Reciprocity  Informal care  Participation

How Crisis team incorporates new MH act  Respect for carers  Least restrictive alternative  Benefit  Child welfare

Team Composition 1 Team Leader (Band 7)1 Team Leader (Band 7) 2 Senior Crisis Practitioners (Band 6)2 Senior Crisis Practitioners (Band 6) 1 Senior 1 Occupational Therapist1 Senior 1 Occupational Therapist 4 Crisis Practitioners (Band 5)4 Crisis Practitioners (Band 5) 2 Associate Practitioners (Band 4)2 Associate Practitioners (Band 4) 0.5 Staff Grade Psychiatrist0.5 Staff Grade Psychiatrist 0.5 wte Clinical Psychologist ( A grade)0.5 wte Clinical Psychologist ( A grade) 1 wte Senior Social Work Practitioner1 wte Senior Social Work Practitioner 1 wte Social Work Practitioner1 wte Social Work Practitioner 2 Flexi Support workers2 Flexi Support workers

Innovation award for Specialist Team Mental Health Nursing Forum For ScotlandMental Health Nursing Forum For Scotland Judging panel is independent from the Nursing ForumJudging panel is independent from the Nursing Forum Care Commission for ScotlandCare Commission for Scotland NES (NHS Education Scotland)NES (NHS Education Scotland) SRN (Scottish Recovery Network)SRN (Scottish Recovery Network)

Comments on Submission The service demonstrated excellent understanding of the Milan Principles and how to translate them into practice The service demonstrated excellent understanding of the Milan Principles and how to translate them into practice The judges scored the submission 10 out of 10 with regard to its links with national standards The judges scored the submission 10 out of 10 with regard to its links with national standards The service demonstrated effective user and carer involvement at service delivery level The service demonstrated effective user and carer involvement at service delivery level The submission was clearly evidenced based and well referenced The submission was clearly evidenced based and well referenced The service clearly demonstrated effective use of Staying Well Plans The service clearly demonstrated effective use of Staying Well Plans

Client Comment  I found the service very inclusive. My thoughts and views regarding my treatment were taken seriously and incorporated into a programme of support. My views were sought at regular intervals, this I found very enabling  CTT very helpful and understanding without them I have no doubt I would have ended up in hospital

Performance Indicators Heat Targets Reduce the annual rate of increase of defined daily dose per capita of antidepressants to zero by 2009/10 Reduce Suicides in Scotland by 20% by 2013 (existing target) We will reduce the number of readmissions (within one year) for those who have had a hospital admission of over 7 days by 10% by the end of December 2009