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TAKING CONTROL IN THE HOME Intensive Home Treatment Team

TAKING CONTROL IN THE HOME Intensive Home Treatment Team. Rhona Blues Lucia Bogucki Ann Cybulska Lorna Wotherspoon. Forth Valley. 1026 square miles 285,000 inhabitants 1h 30 mins from Bo’ness to Crianlarich. Access to Acute Mental Health Services.

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TAKING CONTROL IN THE HOME Intensive Home Treatment Team

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  1. TAKING CONTROL IN THE HOMEIntensive Home Treatment Team Rhona Blues Lucia Bogucki Ann Cybulska Lorna Wotherspoon

  2. Forth Valley 1026 square miles 285,000 inhabitants 1h 30 mins from Bo’ness to Crianlarich

  3. Access to Acute Mental Health Services • Acute Mental Health Services within Forth Valley • Ward 18, FDRI • Ward 19, FDRI • Ward 1, FDRI • IHTT • Access to any of the above is now gained through the IHTT. The IHTT is the Gatekeeper to all acute mental health services during operating hours. • Duty SHO is the gatekeeper to in-patient wards outwith IHTT operating hours. • Why is the IHTT the gatekeeper? In-patient services must be available for those most in need of very high levels of care and treatment.

  4. Operating Hours Monday - Friday 9.00am - 9.00pm Weekends 10.00am - 6.00pm Gate-keep Admissions Facilitate Early Discharge Nursing & Occupational Therapy Staff participate in shifts. Consultants available during office hours Mon-Fri (9-5pm).

  5. Team Composition 1.7 Admin Support 1.5 Consultants 1 Occupational Therapist 0.2 WTE Pharmacy Technician 0.2 WTE Psychology 10 RMN 2 Social Care Workers 1 Team Manager (part-time to the team with many other responsibilities)

  6. What Is Home Treatment? “Home Treatment is a service whereby seriously ill patients (that is those who are suicide risks, aggressive, non-compliant or severely psychotic) who would normally be treated in hospital for their acute relapse are treated at home” Dean and Gadd 1990

  7. When Should a Referral be Made to the IHTT? Anyone who appears to require acute in-patient care Who is Home Treatment for? • Acute psychosis • Relapsing long-term mental health problems • Acute stress reactions • Severe depression • Self harm/suicidal ideation

  8. Patients not Suitable for IHTT • Intoxicated • Alcohol or drug withdrawal • Social difficulties • Chronic Psychiatric symptoms

  9. Referrals May 2005-December 2006 Not Assessed 19% n=389 Assessed 81% n=1212

  10. Assessments Patient admitted at assessment 11% n=134 Individual assessed, neither taken onto caseload nor admitted 47% n=592 Patient assessed and taken onto caseload 43% n=542

  11. Diagnosis of Caseload Alcohol & Drugs 6% Other 7% Personality Disorder 10% Psychosis 25% Depression 36% Bipolar 16%

  12. Duration of Patient Contact with IHTT (Days) (Average = 15.6 days)

  13. Why IHTT? Forth Valley Healthcare Strategy Implementation of New Mental Health Act Service Redesign Care Group - Models of Care

  14. Mental Health (Care and Treatment) (Scotland) Act (2003) • Least restrictive alternative • Reciprocity • Informal care

  15. Benefits of Delivering Treatment in the Community • Care in the least restrictive environment • Trauma of admission • Stigma • Maintains the social system • Users and carers prefer it • More negotiated care. Shift of power. • More family/carer involvement • Less cost

  16. Success Factors in Shifting Balance of Care • Targeted • Integrated • Gatekeeping • Multidisciplinary • Training • Accessible 24/7 • Mobile/Home Based Intervention • Risk Assessment and Management

  17. What Service Users Said About Us “It’s far superior to be treated at home. It’s better to be amongst your own things and not being amongststrangers”. “Staying in hospital was just not suitable, it was far too distressing for me and I believe it would have made things a lot worse”. “I felt very involved, they definitely listened to me”. “They always took my opinion, and they never, ever, put my opinion down”. “They couldn’t be kinder, sir. I know that kindness isnae a remedy, but my key worker was gentleman, but when he disagreed with me, he would do it in an acceptable, mannerable way, but definite, no, I’m sorry, I’m not accepting that”. “The way they act, they treat you like a person, not just a number … you are treated with respect at all times”.

  18. Questions

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