The following nominations are the winners and highly commended nominations for the Improving Care for People in a Mental Health Crisis Award:-
Initial Response Team (IRT) – Northumberland, Tyne and Wear NHS Foundation Trust. The need to improve access to mental health services where there was an urgent request for help became clear through extensive engagement with service users, families and referrers across Sunderland, South Tyneside & Gateshead through 2010/12. This whole system engagement about transforming mental health care, led by commissioners, provided the means to develop a wide range of improvements, one of which is the Initial Response Team (IRT). The primary aims of NTW’s Initial Response Team (IRT) were to offer an efficient and clinically effective 24/7 response, through a single point of access, to urgent telephone requests for help from people of all ages and conditions, and to offer triage & routing or signposting to appropriate services within and without NTW.
The implementation was to reduce clinician administration burden in the existing crisis response & home treatment teams, freeing time to care for service users with the greatest need, while also improving personal and clinical outcomes for people in crisis with mental ill health by reducing harm and premature mortality, improving safety and patient experience. Service users receive a timely response to urgent requests for help and are now being seen and routed to the most appropriate service. The IRT’s timely response (typically between 10 – 60 minutes) has reduced the number of occasions when a situation escalates to the point where a service user needs assistance from an emergency service i.e. ambulance or police.
All IRT staff were given training in the new model, including empathy and involvement training delivered by service users. Questionnaires (developed by service users) and collected through Points of You (a service user forum) have generated very positive responses clearly showing service users feel the IRT staff are polite, show kindness and empathy, and behave in a professional manner. Remarkably all service users were happy with the responsiveness and 100% would be happy to recommend the service to a friend.;
HIGHLY COMMENDED –
Recovery Clinics – Kent and Medway Partnership NHS Trust. This is about a project where Recovery clinics were introduced which has set out new ways of working in an acute admissions unit. The title of this project was “Recovery Clinics”- ‘A way forward to promote service user involvement in acute mental health inpatient units.’ This project has been a great success and became very popular among service users and in the organization with evolving results. The clinics has provided an opportunity for nurses to have therapeutic interactions with service users and thereby promoting their involvement. The clinics are user led for a duration of 45 minutes. Therefore the topic for each session is chosen by service users which are relevant to assist in their recovery. The nurse who facilitates the clinics takes a role as an active listener. However, the clinics also provide opportunity to apply Psycho social interventions such as anxiety management, relapse prevention plan, medication management, problem solving and other interventions. The time spent in the clinics are in addition to the time service users spend with their primary nurses. The clinics were also beneficial in facilitating meeting between service users, carers and nurses (Triangle of care).
* RECOVERY CLINICS PROVIDE SERVICE USERS WITH: More opportunity to have one to one time with nurses on the ward; A genuine opportunity to be involved in their care and to empower them; Opportunity to make informed choice, comments and suggestions about their treatment; Support and time for carers there by fulfilling all aspects of the “Triangle of care”.;
* THE RECOVERY CLINIC PROVIDES NURSES WITH: Protected time to engage with service users without being distracted; An opportunity to apply psychosocial interventions; The opportunity to modify current role of Inpatient Nurses to Nurse practitioners; The opportunity to empower staff to empower service users.;
* RECOVERY CLINICS HELP THE ORGANISATION; To evidence the implementation of Therapeutic intervention module for the Productive ward series.; To improve patient satisfaction survey results.
– Improve reputation of the ward
Example: A service user who was reluctant to engage with any form of work with nurses on the ward was invited to the clinic. The service user asked the facilitating nurse “what’s your agenda this time then?” When the nurse answered “Please feel free to choose a topic that you think will help you with your recovery”. This change in approach has helped to establish a rapport with this service user that had a positive impact on his recovery.
“Another Service user suggested that “This should happen in all hospitals”.
This time i felt there was someone there to listen to”- Service user
“This is a really good idea!”Service user.
“That was (Recovery Clinics) the best thing ever happened in this ward i would say, this should have done long time ago” – A carer’s response.;
HIGHLY COMMENDED –
Family Work Service – South London and Maudsley NHS Foundation Trust. We have developed a family work service within the acute inpatient care pathway which has been initially piloted in Croydon, London before being shared with our other boroughs. Carers are a well known resource and a valued asset. They are often the people who become first aware of their relative’s mental health difficulties, whether it be at initial onset or later relapse, and enable people to seek help (Carter, 2011). However, despite their important contributions, many carers report feeling isolated, unheard, and excluded. Research has also confirmed that caregivers experience high levels of distress especially in the context of recent inpatient admissions (Boye & Malt, 2002).
Our new service seeks to develop and promote further inclusion of families and improved access to psychological support and therapy. It aims to contribute to clients’ recovery and relapse prevention; offer therapeutic interventions in keeping with NICE guidelines and working in line with other national polices (Triangle of Care; Worthington, Rooney, & Hannan, 2013).
The family work service includes four different types of activity across three wards. A family and carer ‘awareness-raising’ teaching session has been provided to all wards and is facilitated by our psychologist and a Carer Consultant. A carers’ clinic has been made available which families and carers can self-refer to. Family meetings are carer led but usually consist of understanding the family/carer perspective of how and when their relative’s problems appeared; how they have made sense of what has happened; how the client’s need for mental health services has affected the family/carer and offering support. Structured family work has also been offered to clients and their families and carers. These are facilitated by our psychologist and supported by the ward staff nurses. They consist of family intervention using Behaviour Family Therapy (Falloon et al., 2006) derived from Cognitive Behavioural Therapy.
A significant number of ward staff have attended training (50); our carer complaints have reduced; carer and client distress has also improved following therapy and in the longer term we hope family work will reduce client relapse/readmission.
Feedback from our service users and carers (carers clinic and family work): 88% very satisfied/satisfied with carers clinic and 100% would recommend to others.;