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BEING A GOOD PSYCHIATRIST – What I Was Taught

MOVING FROM “WHAT’S THE MATTER WITH YOU” MEDICINE TO “WHAT MATTERS TO YOU”: A PARADIGM SHIFT IN PHILOSOPHY OF CARE. BEING A GOOD PSYCHIATRIST – What I Was Taught. As clinicians we are the ones responsible for whether people “get better” or not

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BEING A GOOD PSYCHIATRIST – What I Was Taught

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  1. MOVING FROM “WHAT’S THE MATTER WITH YOU” MEDICINE TO “WHAT MATTERS TO YOU”:A PARADIGM SHIFT IN PHILOSOPHY OF CARE.

  2. BEING A GOOD PSYCHIATRIST –What I Was Taught • As clinicians we are the ones responsible for whether people “get better” or not • Relieving people of their voices, unusual beliefs, anxiety, and depression is the core of good clinical care and • Good clinical care is the core of what it takes to foster recovery from severe mental illness

  3. The Patient The “Zone of Delusion” Over Outcome

  4. FROM DEFINED ROLES FOR DOCTOR AND PATIENT • Power imbalance • Clinician responsibility • “What’s the matter with you” • Compliance • Constraint

  5. TO A FOCUS ON BUILDING TRUST AND PARTNERSHIP • Partnership • Shared responsibility • Health Behaviour • “What matters to you” • Liberation

  6. Kia Kaha: Manage Better Feel Stronger A Mental Well-Being & Self-Management Support Programme Offered by a Professional/Peer Team in a Primary Healthcare Locality ISPS - MSOPConference Oct 2014

  7. Background • 12-18% of those with Long-Term Conditions (LTCs) are likely to have severe Mental Health & Addiction (MH&A) conditions which significantly contributes to poor health outcomes and increased service utilisation. • On the other hand, people with severe MH&A conditions will die on average 15-20 years younger, mostly as a result of poorly managed LTCs – CVD, Diabetes, Cancer etc. • The presence of a comorbid MH&A condition in people with LTCs increases risk of admission by up to 3x, increases LOS up to 2x, and increases use of Outpatient Services by up to 2x. • The presence of unmet psychosocial and cultural needs further adds to poor outcomes and increased service utilization.

  8. Aims Background (contd) • Research has clearly demonstrated that identifying and meeting this MH&A need, and any associated psychosocial or cultural need, results in much improved outcomes and significantly reduced health service (secondary/tertiary) utilization. • To achieve a 25% reduction in overall hospital and GP utilisation for 125-150 individuals with LTCs, and co-existing severe MH&A issues engaged by 1 July 2014. • This will be achieved by identifying and meeting mental health, addiction, and psychosocial needs; and building self-management skills of these individuals and their whanau.  • We intend to do this by expanding our current Primary Mental Health service and introducing evidence-based interventions in an innovative way

  9. Kia Kaha – Initial Concept Patients with poorly managed LTCs Screen for severe MH need Engage using Flinders Care Planning Stanford SME Health Psychology

  10. Initial Findings Not all of the high users seen identified themselves as having a “mental health issue” What we identifed was high psychological distress and psychosocial complexity Many were current CMHC pts but not well engaged, no focus on physical healthcare needs Engagement was the biggest challenge (>50% fail rate) We trialed the use of peer support workers to engage with the most hard to reach patients Along the way, we recognisedmore and more the value of peer support as an “intervention” in itself

  11. Initial Findings • Some interesting themes emerged in the “stories” that sat behind these patients: • Patient perspective – “no-one listens… sick of everyone telling me what to do… they don’t understand…” • Clinic perspective – “no matter what we do they don’t change, they miss appointments – they don’t want to be well…” • Most of these people are disempowered and feeling hopeless BUT want their lives to be better, want to be well, and have been so grateful to be heard, and provided help in a way that works for them.

  12. Dis-Engagement De-Activation Dis-Connection

  13. Effect of Peer Outreach on Engagement % making first appointment Peer specialist pilot starts

  14. Engagement Activation Connection

  15. Kia Kaha – Change Package 2+ LTCs and 2+ EC admit past year Flexible Peer and Professional Outreach Patient Choice, Patient Voice Peer Support Self- Management Health Psychology Case Co-ordination OUTCOME: Activated patient - Activated Services

  16. Gender 54% 46% Total cohort to date n=69

  17. Age Age grouping Number of participants Total cohort to date n=69

  18. Ethnicity Ethnic group Number of participants Total cohort to date n=69

  19. Significant Reduction in Generalised Anxiety Symptoms Number of patients Changes in GAD-7 score between initial assessment & exit from programme

  20. Significant Reduction in Depression Symptoms Number of patients Changes in PHQ-9 score between initial assessment & exit from programme

  21. Feedback from Patients & Whaanau 95% positive “The programme is fricken awesome…it feels like I got my life back!” “I’m much happier, much healthier, and not only that, I’m much freer – and that’s what Kia Kaha is all about – better yourself, and get stronger!”

  22. Acknowledgements Clinical Lead:Dr David Codyre Project Manager: Jacqueline Schmidt-Busby Improvement Advisor:Ian Hutchby Project Team: Health Psychologists – Pam Low, Leona Didsbury Peer Specialists – Merle Samuels, Gary Sutcliffe

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