H o m e T r e a t m e n t E x p e r i e n c e C h o i c e & A l t e r n a t i v e

Kevin Heffernan Nurse 11 years leading HT developments in Birmingham Consultant for the World Health Organisation National Institute Mental Health England (Regional Implementation…5.5 M pop….39 HTT, 27 AOT) Research fellow Birmingham City University West Midlands Strategic Health Authority (Service Development)

Characters represent CRISIS Danger/risk and Adversity Opportunity for Personal Growth

Fidelity principles Gatekeeper to all potential admissions Operating a corporate caseload (utilising MDT skill mix) Rapid Response (1-4 hour variable) 24 hour/7 day availability Flexible visiting (duration/frequency/Intensity) Clearly targeted Caseloads (acute) Time limited (average length of stay) Fully Integrated (not operating in isolation, whole system responsibility)

Comprehensive Assessment Address social issues (in vivo) Medical staff involved/available Mobile Practical problem solving approach Supervision and administration of medication Advice, support for Carers Early Discharge (not becoming discharge team) Effective communication and planning Fidelity principles

Advantages Intensive monitoring of complex cases Can be more flexible/sensitive ethnic minority groups Extended Support for Carers Explanation and advice and post crisis planning Confront social problems directly Work closely with Dual Diagnosis issues Reduce stigma of hospitalisation Higher satisfaction users and carers Development of an acute team

Advantages Avoidance of admission (1 st presentations….Zacch) Interrupt cycle of admission (change expectations…David) Facilitate early discharge Reduced bed use - admissions and length of stay Different framework for sustaining recovery focused engagement Support can be perceived as; More Personal/Individualised Increased Negotiation leading to a sense of increased autonomy Potential to develop more true Partnership working (Trialogue can emerge) Narrative scrutiny (exploration of the why now and true context becomes more possible)

I hope this conference is inspiring and gives you hope for the future development of local community based mental health services This is your opportunity! And not a danger or risk

Home Treatment H ope O ptimism M otivation E xploration T emperance R ecovery E mpowerment A utonomy T ruth M eaning E mpathy N egotiation T rust

Values of Home Treatment working Support Client’s to acknowledge and value the uniqueness of their experience, personal narrative exploration allows intervention to be less stigmatising and medicalised Become a catalyst for inspiration Encourage personal responsibility Clients can begin the journey of recovery and not become passive victims of illness

Community teams in Birmingham Caseload size and distribution in a locality of 150,000 population

Distribution of Cases CMHT’s 20 staff Rehab & recovery 15 staff Assertive Outreach 12 staff ***************** ***************** ***************** ***************** ************ ***************** 600 Cases Days Years Intensity of support & Length of stay in the service ************** ************** ************** 370 Cases 123 cases ************ *********** *********** ************ *********************** Serious Mental Illness

Distribution of Cases CMHT’s 20 staff Rehab & recovery 15 staff Assertive Outreach 12 staff ***************** ***************** ***************** ***************** ************ ***************** 600 Cases Days Years Intensity of support & Length of stay in the service ************** ************** ************** 370 Cases 123 cases ************ *********** *********** ************ *********************** Serious Mental Illness Home Treatment 14 staff 20 cases ************************ ************************ ********************** ********************* ******************* ****************** *****************