Health Perspective 1 in 4 people will experience a Mental health problem at some time in their life We have introduced open access psychological therapy services In primary care In a year about 29OOO ID: 245034
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Slide1
The Pointless Separation of CareSlide2
Health Perspective
1 in 4
people will experience a Mental health problem at some time in their life
We have introduced open access psychological therapy services
In primary care.
In
a year about 29,OOO
Derbyshire people
will be open to NHS MH adult teams
.
Integrated services is a fundamental driver for the future
Derbyshire CCG have invested more in MH services but…
Non Service Solutions, community asset building and resilience is needed .Slide3
Crisis Concordat A Health Perspective
Casualty 1500 people a year coming to casualty following self harm (approx.)
Used to be seen 9-5 7 days week.
Now 24 hours 365 days per week through RAID investment-Liaison team in DRH and CRHSlide4
Liaison team Slide5
The view for AMP
Increasing use of MH Act powers
5 % increase year on year in compulsory admissions
Before the street triage pilot of those that come to hospital on a section 136 only 30% are admitted.
Disjointed connections between agencies and expectations of roles and of what a person wishes and what is offered –
see the vignettes
Reforming 136 Group and multi professional forum to link into the Crisis concordatSlide6
136 to HospitalSlide7
Out of hours
High priority and area of concern for People who use services
How to extend hours so a problem doesn't become a crisis
Help
line Rethink Focus Line and Samaritans
Trialling a nurse in 111 over weekend Slide8
Children and Young People
Note: Patients may be included more than once if multiple categories have been identified. Slide9
Young People referrals
General Medical Practitioner
905
After A&E Attendance
459
Other
420
Other specialist clinical department
105
CMHT
75
Education Service
24
A&E Ref
38
Self Referral
63
Allied Health Professional
15Same Consultant6Self16Social Services12Ref by Other Consultant8Child & Adolescent Services4Attendance After Inpatient Episode4Criminal Justice System - prison etc.2Police1
For Southern Derbyshire and Erewash CCG s only
data for DHcFTSlide10
Adult Crisis Team
43,617 contacts
1090 people
Total
MH contacts by
Crisis team and
by CCG
Average length of treatment spell is 39 daysSlide11
Crisis Team By cluster
cluster
Percentage %Slide12
Clusters
Care Cluster 4: Non-Psychotic (Severe) - This group of PATIENTS is
characterised
by severe depression and/or anxiety and/or other disorders, and increasing complexity of needs. They may experience disruption to function in everyday life and there is an increasing likelihood of significant risks.
Care Cluster 5: Non-Psychotic Disorders (Very Severe) - This group of PATIENTS will be severely depressed and/or anxious and/or other. They will not present with hallucinations or delusions but may have some unreasonable beliefs. They may often be at high risk for suicide and they may present safeguarding issues and have severe disruption to everyday living.
Care Cluster 6: Non-Psychotic Disorder of Over-Valued Ideas - This group of PATIENTS suffer from moderate to very severe disorders that are difficult to treat. This may include treatment resistant eating disorders, Obsessive Compulsive Disorder
etc
, where extreme beliefs are strongly held, some personality disorders, and enduring depression.
Care Cluster 7: Enduring Non-Psychotic Disorders (High Disability) - This group of PATIENTS suffer from moderate to severe disorders that are very disabling. They will have received treatment for a number of years and although they may have an improvement in positive symptoms, considerable disability remains that is likely to affect role functioning in many ways.
Care Cluster 8: Non-Psychotic Chaotic and Challenging Disorders - This group of PATIENTS will have a wide range of symptoms and chaotic and challenging lifestyles. They are
characterised
by moderate to very severe repeat deliberate self-harm and/or other impulsive
behaviour
and chaotic, over-
dependant
engagement, and are often hostile with services
.
http://
www.datadictionary.nhs.uk/data_dictionary/nhs_business_definitions/m/mental_health_care_cluster_de.asp?shownav=1Slide13
Clusters
Care Cluster 10: First Episode Psychosis - This group of PATIENTS will be presenting to the Mental Health service for the first time with mild to severe psychotic phenomena. They may also have depressed mood and/or anxiety and/or other
behaviours
. Drinking or drug taking may be present but will not be the only problem.
Care Cluster 11: Ongoing Recurrent Psychosis (Low Symptoms) - This group of PATIENTS have a history of psychotic symptoms that are currently controlled and causing minor problems if any at all. They are currently experiencing a period of recovery where they are capable of full or near functioning. However, there may be impairment in self-esteem and efficacy and vulnerability to life.
Care Cluster 12: Ongoing or Recurrent Psychosis (High Disability) - This group of PATIENTS have a history of psychotic symptoms with a significant disability with major impact on role functioning. They are likely to be vulnerable to abuse or exploitation.
Care Cluster 13: Ongoing or Recurrent Psychosis (High Symptoms and Disability) - This group of PATIENTS will have a history of psychotic symptoms which are not controlled. They will present with moderate to severe psychotic symptoms and some anxiety or depression. They have a significant disability with major impact on role functioning.
Care Cluster 14: Psychotic Crisis - This group of PATIENTS will be experiencing an acute psychotic episode with severe symptoms that cause severe disruption to role functioning. They may present as vulnerable and a risk to others or themselves.Slide14
Crisis TeamSlide15
Is a bed available ?
Last 3 years build up of demand leading to in 1April 2013-14 March31 125 People sent outside Derbyshire for an Acute
ie
urgent MH bed
Invested in crisis house -5 beds
Invested in new ward in Derby and home treatment staff
Now no one sent outside Derbyshire (but its very tight)Slide16
East Midlands Ambulance service
April 2014 we attended 172 calls for psychiatric/suicide in Derbyshire alone; this does not include many other call categories for this patient type
We do our best!!!
But is it good enough for these patients?
We want to work with you to help these people but we can’t do it without youSlide17
Workforce at EMAS
Clinicians
Emergency care assistants and Technicians
Paramedics and ECPs
Registered Nurses
Recruiting GPs
Emergency Control room
Call takers and dispatchers
Clinical assessment teamSlide18
Issues we face
Limited care pathways for patients with mental health problems/ in crisis
Limited referral routes especially out of hours
Frontline staff with limited MH training expected to treat this patient group
No access to patients notes so unaware of the patients background (especially when violent)
No where to take the patient except ED ????Slide19
The question from EMAS
“Where
do we refer these patients to?? There are very few pathways open to them and we do not have the skills to adequately assess them correctly
.”Slide20
The NHS Questions
What can we do differently to divert before a crisis?
Once a crisis has occurred what could we do differently?
Should we all aim to reduce compulsory admissions by 2017 is that a sensible target for us all?