1. Mental Health Integration Diagram *Interactive version (DRAFT 007/31.09.10:DT/QIS) For further information please contact: David Thomson NHS Quality Improvement Scotland. Mental Health Projects Manager, Directorate of Implementation, Improvement and Support & National ICP Coordinator, Patient Safety and Performance Assessment Unit dthomson2@nhs.net

2. The following presentation is a PowerPoint based version of an interactive diagram which helps focus on where key drivers and work streams in mental health align, crossover and run parallel. The diagrams are generated from the developments and successful role out to mental health of ‘Releasing Time to Care’. These diagrams will evolve as services develop and progress towards excellence. This capacity for change reflects and promotes the principles of quality improvement and the necessity for on-going cycles of improvement as key. If you would like additional information to be added to the diagrams, please contact David Thomson - dthomson2@nhs.net Mental Health Integration Diagram *Interactive version

3. Quality Infrastructure A key requirement to realise our Quality Ambitions is for our systems and actions to be integrated and aligned across the whole NHS system. We need to identify and remove any hurdles and barriers presented by the current approaches to policy development and delivery across Scottish Government and NHSScotland. (The Healthcare Quality Strategy for NHSScotland, The Scottish Government, May 2010 ) By developing diagrammatic representations of key initiatives in mental health, it is intended that promoting better comprehension of integration contributes to removing obstacles to progress and further more, encourage increased confidence from individuals and organisations from all aspects of health care to participate and contribute to service improvement.

4. Best Practice Statement Admissions to adult mental health inpatient services (BPS) HEAT Targets Mental Health Collaborative Tissue Viability Scottish Patient Safety Programme (SPSP) Clinical Quality Indicators (CQIs) Mental Health Act (MHA) Joanna Briggs Institute (JBI) Better Together/ Patient experience Healthcare Associated Infections (HAI) Falls Nutritional Care Scottish Recovery Indicator (SRI) Standards for integrated care pathways for mental health (ICP) Considerations to integration in mental health Consider the 10 Essential Shared Capabilities for Mental Health Practice Click for further information on ESC Key areas of consideration. *It should be noted that this list is not exhaustive and may alter through time Consider Leadership Click for information on leadership Releasing Time to Care (RTC) Rights, Relationships & Recovery

5. Releasing Time to Care: Modular Content The Productive Mental Health Ward Modules: Patient Wellbeing Therapeutic Interventions Ward Round Safe and Supportive Observations Admissions and Discharges Shift Handover Meals Medicines Knowing How We’re Doing Well Organised Ward Patient Status at a Glance The Productive Mental Health: Community Hospital Admissions and Discharges Forward Planning MDT Working Handover Patient Flow Managing Drug Administration Good Stock Management Patient Involvement Clinical Leadership Knowing How We are Doing *All modular houses are underpinned with Project Leader’s and Executive Leader’s Guides Click for examples of practice

6. Productive Community Services Strategic Positioning Technology Team Leaders Guide Well Organised Working Environment Patient Perspective Knowing How We are Doing Patient Status at a Glance Toolkit Managing Caseload and Staffing Planning our Workload Working Better with Our Key Care Partners Agreeing the Care Plan with the Patient Standard Care Procedures Perfect Intervention *All modular houses are underpinned with Project Leader’s and Executive Leader’s Guides

7. Pre admission considerations Advanced statements and existing care plan MH(C&T)(S)A – Section 275 p216 Advance statements Click for MH(C&T)(S)ACT 2003 BPS Section 1(a,b,c,d) p8-12 Pre admission statement Click for BPS ICP P9 Referral and Triage Click for ICP Toolkit ICP P1-8 (Process Standards ) Click for ICP toolkit Knowing How We’re Doing (RTC) Click for RTC information l Patient Status At a Glance (RTC) Click for RTC information ICP 21 (Measures of need & outcome) Click for ICP toolkit ICP 11 (Risk assessment and management) Click for ICP toolkit Well Organised Ward (RTC ) Click for RTC information Key Points: Clear benefit from admission identified Consider all potential options to aid recovery RTC Community Services Click for RTC information Click to view improvement methodologies associated with Process Mapping Click for examples of practice

8. Considerations following admission to inpatient services ICP Standard 20 (Admission and Discharge Pathway) Click for ICP toolkit ICP Standards 10-17 (Generic Standards applicable to all e.g. Risk assessment, diagnosis. etc) Click her for ICP toolkit Best Practice Statement Admissions to adult mental health inpatient services (Risk assessment key points) (Section 2 – p13) Risk assessment and management plans (Subsections 2a-f) Exchange of information (Section 3 p20) Click for BPS RTC Process Modules Admissions and Discharge Click for RTC information HEAT Reduction of re-admissions Click here for information on HEAT Targets

9. RTC Safe &Supportive Observations Click for RTC information BPS Section 2(f) (p19) (Risk assessment and management plans in relation to observation levels) & Section 4 (p27) (Assessment and planning for recovery) Click for BPS ICP Standards 10 (Holistic assessment) Click here for ICP toolkit 11 (Risk assessment) Click here for ICP toolkit & 17 (Single care plan) Click her for ICP toolkit HEAT Reduction of suicide Click here for information on HEAT Targets Scottish Patient Safety Programme Click here for information on the Scottish Patient Safety Programme

10. RTC Patient Wellbeing Click for RTC information ICP Standard 13(Physical health assessment & management) Click here for ICP toolkit & 16 (Person centred care ) Click here for ICP toolkit BPS Section 5 (Holistic assessment: psychological /occupational /physical needs & strengths) Click for BPS Tissue viability click for tissue viability online Nutritional Care Click for information on nutritional care Pressure Area Care CQI Click for information on the CQI Food, fluid & nutrition CQI Click for information on the CQI Falls Click here for information on falls Falls CQI Click for information on the CQI

11. RTC Medicines Click for RTC information BPS Assessment and Planning Recovery Section 3(e)p27 Click for BPS ICP Standard 18 (Recording Medications) Condition Specific Standards 15,16 &32 (considers medication monitoring) Click for ICP toolkit Scottish Patient Safety Programme Click here for information on the Scottish Patient Safety Programme Click for information on improvement methodologies - LEAN

12. RTC Shift Handovers Click for RTC information ICP Standards 7&38 (applying use of variance reporting and how information is conveyed) Click for ICP toolkit BPS Section 2a (p15) (conveyance of risk information) Section 2f (ensuring robust systems of communication) Click for BPS Consider principles of SBAR (Situation-Background- Assessment- Recommendation) Click here for information on SBAR

13. RTC Therapeutic Interventions Click for RTC information ICP Standard 15 (Psychological/Psychosocial interventions) Click here for ICP toolkit BPS Section 5 (p31) (Holistic assessment of psychosocial, occupational and physical needs and strengths) Click for BPS Consider the 10 Essential Shared Capabilities for Mental Health Practice Click for further information on ESC Click for examples of practice

14. RTC Meals Module Click for RTC information ICP Standard 13(Physical health assessment & management) Click here for ICP toolkit & 16 (Person centred care) Click here for ICP toolkit BPS Section 5b (p33) (Guidance on physical needs assessment) Click for BPS Tissue Viability click for tissue viability online Nutritional Care Click for information on nutritional care Pressure Area Care CQI Click for information on the CQI Food, fluid & nutrition CQI Click for information on the CQI Also consider guidance within Health Facilities Scotland Click here for information on HFS Click here for information on improvement methodologies - PDSA

15. RTC Ward Round Click for RTC information ICP Standard 7 (Recording & sharing information) Click here for ICP toolkit & 17 (Single care plan) Click here for ICP toolkit BPS Section 3 (p20) (Admission to hospital/exchange of information) Click for BPS Consider principles of SBAR (Situation-Background- Assessment-Recommendation) Click here for information on SBAR

16. Pre and Post Discharge Considerations MHA Chapter 5 Section 227 (p82) Assessment of need for community care Chapter 7 (p122) Assessment of Need Click for MH(C&T)(S)ACT 2003 BPS Section 6 (p35) Pre/post discharge arrangements Section 4 (Measures of quality & experience) Click for BPS Scottish Recovery Indicators (Informing service improvements) Click for information on SRI/ ICP Standards 38 & 39 (Use of variance reporting to inform service improvements Click for ICP toolkit Consider quality measures and monitoring patient experience via for example ‘my view’ & SPSP SPSP Click here for information on the Scottish Patient Safety Programme Better Together Click here for information on patient experience RTC Community Services Click for RTC information RTC Admissions and Discharge Click for RTC information Click to hear about patient experiences Click for improvement tools re stories