lecture - organisation of mental health services Flashcards
(25 cards)
what is the role of Primary care plus?
who is on the team?
Bridge the gap between primary and secondary care. Support patients discharged from CMHT and who need support. Prevent referrals to secondary care.
Based in primary care and team includes Psychiatrists and RMNs - registered mental health nurse.
what does IAPT stand for?
improving access to psychological therapies
what can be referred to IAPT?
Mild-moderate forms of mental illness (anxiety disorders including mild PTSD/OCD, depression, health anxiety, social phobia)
• Would not accept referrals for those with severe mental illness e.g. schizophrenia or patients using substances or a risk of Self harm/suicide
how many sessions would IAPT typically be? who delivers them?
• Delivered by IAPT practitioners (trained in basic CBT models).
Rx CBT based and typically 6-12 sessions.
it is primary care
list the 5 mental health secondary services
- Home treatment team/Crisis resolution team
- Liaison psychiatry team
- Inpatient services- Acute/Rehab/PICU
- Community mental health team (General/Old age) • Specialist teams/clinics
what is the role of the home treatment team?
Community based mental health team to support patients with an acute mental health crisis
Aim to treat crisis in the community when deemed safe to avoid hospital admission, also facilitate earlier discharge.
can assess and treat at home/variety of settings;
GP surgery, community mental health teams, A&E, S136 suit, hospital wards
what can home treatment teeam assessment include?
prescribing medication and monitoring adherence,
brief psychological support, emotional support and crisis planning
monitoring mental health/risks
what is the htt team composed of?
Psychiatrists, Nurses, Support workers and Psychologists.
what is liason psychiatry.
who are the team members?
MDT team that are based in acute trusts; includes mainly Psychiatrists and RMNs and possible specialist staff e.g. substance misuse nurse
what kind of patients do liason psychiatry see and where?
Accept referrals from A&E and all inpatient wards
• Support acute mental health crisis, patients with severe and enduring mental illness
DSH/suicidality, psychosis, affective disorder, delirium, dementia, medically unexplained symptoms, physical conditions with psychological presentations; i.e. patient on chemo experiencing low mood to assess suiicidality etc
what kind of support can liason psychiatry give?
advised treatment plans, acute support, advice psychopharmacology, risk assessment/management, advice on legal frameworks (MCA/MHA), discharge planning.
what are inpatient psychiatry services?
Admission wards - eg Ferneley - NWP.
- can have seclusion rooms
PICU - Psychiatric intensive care unit. Patient’s are acutely
disturbed and require a higher level of
nursing/pharmacological treatment and monitoring. 18+
Rehabilitations wards - eg Eastlake - NWP. higher proportion of informal patients who require rehabilitation and more support prior to discharge. so eg people who took drugs and had drug induced psychosis and called police to bring them in. or some1 with prior mental health issue who has not been taking meds/ been taking drugs and for reasons was sectioned, then later agreed to stay for rehab.
what is an informal patient?
someone who has agreed to come into hospital for assessment and treatment of a mental health condition
what is different about PICUs - Psychiatric intensive care units?
Higher nurse to patient ratio.
Secure environment- airlock doors, de-escalation areas and more seclusion rooms.
Patients are compulsorily detained under MHA
- Commonest reason for admission is to manage physical aggression
what is the CMHT - community mental health team?
where do referrals come from?
CMHT assess, support and treat patients in the community who experience complex or significant mental illness
Referrals accepted from GPs/IAPT/HTT/Liaison services
the cmht comprises of whom?
Psychiatrists, Nurses, Social workers, Psychologists,
Psychotherapists, AMHP, Support workers.
what are the 2 ways patients can be looked after in cmht?
Standard care’ patients are seen in clinic
Enhanced patents have a ‘Care coordinator’ who is responsible for regular reviews/risk assessments and supporting the patient with complex needs longitudinally.
what does cmht work involve?
regular patient reviews, administration of medication (esp Depot), Clozapine clinics, coordinating community MHA, Psychological/psychotherapy delivery
not for mild conditions eg mild depression (iapt can handle those ones)
what is the role of the EIS - early intervention service?
specific service that will work more intensely with patients suffering a ‘first episode’ of psychosis.
Also those with ‘prodrome’ or ‘at risk’ mental state.
Work with those aged 18-35yrs old for max 3 years.
Comprehensive MDT and much lower patient ‘caseload’ so higher frequency of review/support.
which psych services may only have REGIONAL inpatient services?
eating disorder services
perinatal psychiatry services
CAMHS
Forensic psychiatric services
Where would you refer a drug addict who wants rehab?
Addiction services- Separate to mental health services and provided as outpatient (use private services for detox and rehab)
what are the different levels of referral/ referral status and who can you send these to?
- Emergency (4hr) to the Home treatment team HTT
- Urgent (24hr) to HTT/CMHT
- Routine + (7 days) to CMHT/Specialist teams
- Routine (28 days) to CMHT/Specialist teams
If a patient is presenting with immediate risk what options are available?
• Call 999
- Ambulance to take the patient to A&E
- Police who may consider use of S136
• On ward: call the Psychiatry liaison team
where can people be referred to PICU from?
S136
Police cells
Open wards
Court order - hospital order section 37
