Summary of Proposals For Those With Severe and Enduring Mental
Health Problems
(March 2005)
Aims and Objectives
There have been some significant developments in our local adult
mental health services in Neath Port Talbot over the last 3 – 5
years. Not least the commissioning of the new mental health unit in
Neath Port Talbot Hospital that now provides a purpose built unit
for those Neath and Port Talbot residents who require acute adult
mental health inpatient and day hospital care. However it has also
been recognised that there is a need to continue to develop our
local services to meet local needs effectively and comprehensively
in line with best practice and evidence.
The document seeks to provide a summary of the proposed
framework for supporting the further development of mental health
services for residents of Neath Port Talbot who have a recognised
severe and enduring mental health problem. The overarching aim is
to achieve a ‘whole system’ approach to the delivery of care for
this service user group within Neath Port Talbot as illustrated at
the end of this summary. A key challenge will be to broaden
partnership working outside the traditional health and social care
settings and promote a ‘mixed economy’ of providers in the
development of services.
The summary provides an overview of the key areas of work
undertaken to enable the framework to be developed, and sets out
the key conclusions and recommendations.
The key areas of work have included:
- A mapping of the present adult mental health service provision
across two distinct service pathways – Acute and Rehabilitation /
Continuing Care.
- A review of the current pathways and service model and
consideration of opportunities to develop further the philosophy of
integration within the service.
In undertaking this work, account has been taken of the All
Wales Mental Health Strategy (2001) and the Standards and Key
action within the National Service Framework for Adult Mental
Health Services (2002). In addition, the opportunity to harness the
recent implementation of the Care Programme Approach (CPA) within
Neath Port Talbot has been identified as a key driver to support
service development and improvement.
Service Criteria
With the links between the Care Programme Approach (CPA) and
Unified Assessment being developed over the next 12 months the
opportunity has been taken to provide eligibility criteria based on
need and risk for those individuals entering mental health
services. These joint criteria were agreed as part of last year’s
development of the Access Mental Health Teams in Neath Port
Talbot:
| Eligibility Criteria |
Substantial |
Critical |
| Mental Health |
Significant mental health problems have occurred or reoccurred.
Problems are such that there is:
- Loss of ability to make informed consistent decisions
- Substantial confusion
- Intervention required under the MHA
|
Has mental health problem to the degree that there is:
- Major risk to life· Immediate intervention is required under
MHA
- Immediate risk to self or others
- Severe confusion or depression
- Suicide attempt / self harm
- Severe difficulty in coping independently
|
| Risk |
Significant risk of self-neglect/injury or harm to others due to
mental health needs
|
Immediate very high risk of self neglect, or injury to self or
others due to mental illness
|
A brief overview of the key proposals can be illustrated as
follows:
Acute Pathway
- Develop and establish within the In Patient environment a
progressive model of care from admission through to discharge with
minimal stay as recently outlined within the Service and Financial
Framework (SaFF target date March 2006)
- Development of a Crisis Resolution and Home Treatment service
within the Neath Port Talbot Borough;(SaFF target date March
2006)
- Access to emergency respite care to offset the potential need
for admission to Ward F at Neath Port Talbot Hospital
- Develop an early intervention model of approach within the
Community Mental Health Teams
- Define and establish the appropriate psychology input into the
Community Mental Health Teams and in the multi disciplinary
approach of the early intervention model.
- Appraise and develop the skills and competencies of the multi
disciplinary workforce to meet the challenge of new approaches in
acute therapeutic practice
- Clarify and define a pathway to access Psychiatric Intensive
Care facilities.
Rehabilitation / Continuing Care Pathway
- Development of a comprehensive range of Supported Accommodation
within the Neath Port Talbot Borough, with integral access to
respite care, through planned disinvestment from Cefn Coed based
rehabilitation and continuing care beds.
- Development of an Employment Strategy for those service users
who are recovering and need to progress into formal training /
employment.
- Development of an Assertive Outreach / Community Intensive
Support Service for sustained engagement for those service users
with complexity of needs within the community.
- Health and Well Being – to ensure effective access to physical
health care within Primary Care Services.
- Community Advocacy Service development.
- Appraise and develop the skills and competencies of the multi
disciplinary workforce to meet the challenge of new approaches in
rehabilitative / recovery practice.
- Link into the recommendations that will emerge from the
regional led initiative on Low Secure Services due to report in
April 2005.
Supported Accommodation
An initial accommodation needs profile of those individuals
within the Community Mental Health Teams with severe and enduring
mental health problems highlight the service users who
prospectively need appropriate community based accommodation to
meet their needs in the future.
There will always be a proportion of the service user population
who will require continuous care and supervision not only as a
reflection of their vulnerability but also based on the very nature
and effects of their enduring mental health problems and
consequently the inappropriateness to a rehabilitative
approach.
The escalating costs of continuing care placements are a key
driver in ensuring that appropriate provision is provided for this
service user group within adequate supported and supervised
accommodation outside of the traditional hospital based
environment. This work is imperative in reducing Delayed Transfers
of Care that are recurring on the Adult Mental Health Ward at Neath
Port Talbot Hospital.
It is envisaged that the greater part of this development work
would be progressed within the Supported Accommodation proposal as
outlined in the above section.
Next Steps
The Local Implementation Team has had the opportunity to
consider and agree the content of the proposal document. Therefore
this summary is submitted to the Joint Executive Group for
consideration prior to a consultation period with key stakeholders
on these proposals. The consultation is a further stage along the
process of developing effective services for the residents of Neath
Port Talbot.
Statutory and Non- Statutory Organisations, Professional groups,
Service Users and Carers are being requested to respond with their
written comments by a provisional date of 29th April 2005
On completion of the consultation period the Local
Implementation Team, at the next meeting in mid May 2005, will then
consider the responses. The development of an action plan will then
be formulated and agreed by the Local Implementation Team and the
tasks will be progressed through prioritised project based work on
a multi disciplinary / agency basis and on a set timetable.
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