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

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

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Outdated programmes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

5. 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)

6. “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)

8. 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.

9. 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.

11. 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

12. 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

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

14. 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

15. 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

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

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

18. 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

19. 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