Service user and carer feedback

Specialist home treatment for older adults with mental health problemsDr Alice Mills, Clinical Psychologist, NHS Clinical Leadership Fellow 2011-12 on behalf of the home treatment team

“They treated me as a very important person”

“Put in a nice manner ‘helping us both” - carer support

“Helped me to get my life back to normal and sort out what is important in my life”

“Decided I wasn’t going to run for the rest of my life and decided to stay. Decided I would open the door to them”

“I could go out on my own, I was better. They were there when I needed them, in a depressed state”

“As the care is given in the home it is comforting and takes away the fear of being taken to a strange place with strangers which in the elderly can have the opposite effect of getting them to a happy and healthy place…therefore we only have positive feedback to give”

4. Activity and outcomes to date• Highrateofreferralsandeffective‘gatekeeping’ieteaminvolvementinreferralsfor

inpatientadmission• Mostreferrals(40%)fornon-psychoticreferralse.g.,severedepression28%psychotic,

22%dementia• ClinicianratingoutcomesmeasuredusingHoNOS65+(12scalesrangeofhealth

andsocialdomains). Significantimprovementindifficultiesfromstarttofinishofhometreatmentepisodeofcare (t=5.44(93),p=.000).

3. How the team works

Not suitable for home treatment

No further Input (Back to referrer)

Admission topsychiatric ward

Resolution of Crisis & discharge to community

mental health team

Implementation of care plan

Development of care plan

Suitable for hometreatment

Referral to home treatment: (Mental health trust services, A&E)Crisis or facilitated early discharge

Referral to community mentalHealth team (new presentations)

Promotion of recovery - social/occupational activities

Medication monitoring, review & administration

Practical support

Emotional support

Carer support

Psycho-education

Advocacy

Physical health care

Liaison with other services

Social care monitoring

Onward referral / co-working

Assessment (within 4 hours

and where possiblewith referrer)

1. Why a new home treatment service?

• Hometreatmentprovidescrisisinterventiontopreventunnecessaryadmissionstopsychiatrichospitalortofacilitateearlydischargefromhospital

• Provisionforolderpeopleisvariablenationallyandespeciallyforpeoplewithdementia(Cooperet al.2007)

• Service-usersandcarershavehighlightedthisinequalitynationallyandlocally(CommissionforSocialCareInspection(2006)

• Inpatientcarecanbeassociatedwithdeclineineverydayskillsandinturn,riskofadmissiontocarehomesforolderpeople

• DementiaStrategy(2009)assertsneedforleastrestrictiveoptionfortreatmentalongsidecarersupport

• HometreatmentforolderpeoplerepresentsanopportunitytomeettheproductivitychallengefacedbytheNHS(Naylor&Bell,2010)

2. Planning for success

• Astrongandsupportivecoalitionofmulti-disciplinarycliniciansandmanagersabletopresentarobustcaseforaoneyearpilot

• EmployedanengagingleadershipmodeleffectiveinhometreatmentservicesAlimo-Metcalfe(2008)

–Engagementofstakeholders

–Sensitivefacilitationofchange

–Focusonteamwell-beinganddevelopment

• Datacollection,analysisandsharingtoenableservicedevelopment

• Processmappingapproachtocollectserviceuserandcarerexperience

Moving forward• Finalevaluationofpilotyearunderway.Reportwillbesharedwithstakeholders

andfindingsusedtoimproveefficiencyoftheacutecarepathway• Teamperformanceandoutcomestodatepositivelyreviewedbycommissioners• Strengthofoutcomeshaveresultedincommissionforhometreatmentservice

inneighbouringborough

Thehometreatmentteam,serviceusersandcarerspastandpresentcelebrateWorldMentalHealthDay&BlackHistoryMonth,November2012

Mean HoNOS65+ ratings at assessment and discharge

References:Alimo-Metcalfe,B.andAlban-Metcalfe,R.J.(2008)Engagingleadership:creatingorganisationsthatmaximisetheirpeople.CommissionforHealthcareAuditandInspection(2006)Livingwellinlaterlife:AreviewofprogressagainsttheNationalServiceFrameworkforOlderPeople.Cooperet al.(2007)AcutementalhealthcareforolderpeopleincrisisbycrisisresolutionteamsinEngland.InternationalJournalofGeriatricPsychiatry,22(3):263-265.DepartmentofHealth(2009)Livingwellwithdementia:aNationalDementiaStrategy.Naylor,CandBell,A.(2010)Mentalhealthandtheproductivitychallenge:improvingqualityandvalueformoney.King’sFund

14

12

10

8

16

95%CI

Assessment Discharge

Improvem

ent