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
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12
10
8
16
95%CI
Assessment Discharge
Improvem
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