Home Based Crisis Team: initial steps towards recovery in the community

1. Home Based Crisis Team: initial steps towards recovery in the community Dr. Sinead O’Brien. Consultant Psychiatrist, Home Based Crisis Team. North Lee Mental Health Services.

2. Today..... • Vision for Change • City North Sector • Development of HBCT-City North. • Audit of case-load • Future Directions

3. A Vision for Change • Person centred • Recovery orientated • Holistic – all aspects of mental health: biological (e.g. medication), psychological (e.g. “talking therapies”) and social (e.g. housing, employment, education/training).

4. A Vision for Change • Community-based – provide services in communities where people live, reduce hospital admissions, more home-based treatments and outreach services. • Multi-disciplinary • Population Based

5. Mission Statement To provide a home-based crisis assessment and multi-disciplinary treatment and intervention service for individuals presenting with acute psychiatric illness in City North sector. We endeavour to respect each individual’s rights and values.

6. Cork City North Sector • Population: 53,000 • 2 Sector Multidisciplinary Teams. • CNW: Dr Ruth Collins • CNE: Dr Nataraj Gojanur

7. Cork City North Sector. • Sector includes: Knocknaheeny Gurranabraher Fairhill Blackpool Mayfield The Glen.

8. RAPID • “Revitalising Areas through Planning, Investment and Development”.

9. RAPID aims to...... • Increase the investment made by Government departments and state agencies in the 46 communities; • Improve the delivery of public services through integration and coordination • Enhance the opportunities for communities to participate in the strategic improvement of their areas.

10. Rapid Areas in Cork • Knocknaheeny/Hollyhill/Churchfield • Blackpool /The Glen/Mayfield • Fairhill/Gurranabraher/Farranree • Togher/Mahon

11. Priorities of RAPID.... • family support, • physical environment, • health, • community safety, • education, • employment • training and youth support.  

12. The Haase and Pratschke Index • uses 3 dimensions of affluence/disadvantage to comprise their index.  • ‘Demographic Profile’, • ‘Social Class Composition’ • ‘Labour Market Situation’

13. “Extremely disadvantaged” • Farranferris, • Knocknaheeny, • Fair Hill B • 9% of National ED rating

14. HBCT • Set up in 2007 • Funding for 1 additional Consultant • CD and Heads of Discipline examined need within North Lee MHS

15. North Lee MHS • Majority (>50%) of ALL admissions to Acute Unit were from City North Sectors

16. HBCT • 1 Consultant Psychiatrist • 1 Registrar • 2 CMHN • 1 social worker • 0.6 Occupational Therapist • 1 Psychologist • Clerical Support

17. Evolution of HBCT...April 2009 • 1 Consultant Psychiatrist • 1 Registrar • 2 CMHN • 0.6 social worker • 0.6 Occupational Therapist • Clerical Support

18. My Vision... Optimising Physical &Psychological Health Intensive Case Management Evidence Based Practice Health Economics SB Audit Ethics Autonomy Beneficence Non-Maleficence Justice Research

19. Inclusion Criteria The crisis team (HBCT) aim to treat individuals in the community, where appropriate, for approximately 4 weeks. We are targeting adults with severe mental illness, who require urgent assessment. This includes: Those in acute psychosocial crisis Those with acute psychiatric conditions in need of urgent psychiatric attention And those with long term, severe psychiatric problems who experience either of the first two problems.

20. Exclusion Criteria risk of violence in home &/ or to staff primary diagnosis of organic brain damage and dementia medical illness which may require medical assessment primary diagnosis of active substance misuse. severe personality disorder

21. HBCT Working Hours Mon-Fri. Mon-Thurs 9am-5pm. Fri 9am-4pm.

22. Referrals Referrals must be made by healthcare professionals using the referral form. An urgent referral must be followed up by a phone call to the team in order to discuss the case. The client must be aware of the referral and agreeable to assessment in their home.

23. Assessments • Initial assessment by 2 team members. • HBCT Proforma • HONOS • MADRAS • Risk Assessement.

24. Acceptance/Non Acceptance Procedure • Referrer notified immediately via fax. • Full detailed assessment to referrer within 2 working days.

25. Clients working with HBCT • Keyworker • Initial daily reviews • Weekly review of Collaborative Care Plan.

26. Audit of Home Based Crisis Team (HBCT)-Cork City North, Activity over a 6 month period

27. Aims of Audit... • To review Practices within HBCT • Accountibility • Service Development

28. Methods • conducted over a six month period • from 1/10/2009 to 31/03/2010. • Data was analyse using SPSS version 14 and graphs compiled using Minitab Graphics.

29. Results.......

30. Referrals • 158 referrals.

42. GP Perspectives on the Home Based Crisis Team.City North Sectors, Cork.

43. GP Satisfaction with HBCT • 92% of GPs were satisfied with the team re • management of patients • as suitable alternative to admission, • time from referral to assessment, • satisfaction with feedback and correspondence from the team

44. GP’s..... • 100% of GPs identified they would refer again

45. Future Plans

46. Future Plans • Further strategy Meeting with CNE • Further Meeting Primary Care Teams • Meeting with Liaison Psychiatry

47. Future Plans • Study ongoing re MDT input to HBCT case-load. • Continued CSQ-8 Collection • Assessment of family/carer views • Collection of emergency presentations/admissions to acute unit.

48. “Successful implementation of the CRHT teams as alternatives to hospital admission requires resources for home treatment out of hours, effective systems working among local services, stronger local understanding and advocacy of the teams’ role” Onyett 2008

49. The Team! • Mairead Murphy (CMHN) • Martina Cullinane (CMHN) • Aisling Hassett (CMHN) • Damien Fleming (SW) • Valerie Morrison (OT) • Freda Wynne (Psychologist in Clinical Training) • Geraldine Kenny, Martina Carroll (Clerical support) • Dr. Deirdre Muller-Neff (Registrar) • Dr. Sinead O’Brien