Mind Your Health Review the Overarching Model of Care

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Mind Your Health Review - the Overarching Model
of Care
Mind your Health Working Together to Develop our
Services21 November 2007

• Kirsten Major
• Director of Strategic Planning and Performance
• Executive Lead for Mind Your Health Review

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Ah but...

• Its all draft
• Is an NHS model for mental health - need to
  develop a social model of health around the
  outputs so far.
• Identifying and costing the gaps.
• Todays test is the principles we established
  before - does it measure up?
• A game of 2 halves - how to organise services
  versus ways of working - we need to do both.

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Overarching model of service
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Tier 1 - Universal Services

• These services are not targeted at the treatment
  of mental illness.
• Significant socio-economic inequalities in mental
  health.
• Specific, targeted and organised support needs to
  be put in place for vulnerable groups by all
  partners e.g. looked after / accommodated
  children, carers, prisoners etc.
• Workplaces, schools, colleges, universities,
  communities, leisure facilities, the media,
  libraries and more can all do something to
  promote well-being.
• Need to build capacity and skills of all staff to
  promote well-being in our communities.
• Volunteering as a mental health promoting
  activity.

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Overarching model of service
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Tier 1 - Generic Primary Care Services

• Assessment and intervention by GPs, Health
  Visitors and District Nurses of people who self
  present.
• Case finding amongst vulnerable groups e.g those
  with chronic conditions and older people within
  care home settings.
• Sign-posting to other relevant services e.g. debt
  counselling, welfare rights, relationship support
  etc.

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Overarching model of service
TIER 2
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Tier 2 - Primary Care Mental Health Team

• A new service to be developed in each CHP - more
  of a consolidation in some areas more than
  others.
• Responsive assessment and treatment of mild to
  moderate mental health conditions.
• Multi-disciplinary team (nursing, OT, community
  resource workers, counsellors, psychologists,
  mental health school advisors, specialist health
  visitors etc.). Access to specialist support
  for advice and support as may be necessary e.g
  psychiatry.
• Professional support to primary care.
• Increase provision and availability of
  psychological and self-help interventions.
• Referral to specialist services.

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Overarching model of service
TIER 2
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Tier 2 - Liaison Services

• Support from specialist mental health team
  encompassing nursing, psychiatry, nursing and
  psychology approaches to physical health and
  chronic conditions.

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Overarching model of service
TIER 2
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Tier 2 - Child Adolescent Services

• A CAMHs worker to support children and
  adolescents with moderate mental health problems.
• Key links to Tier 3 CAMHs services and Primary
  Care Mental Health Teams.

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Overarching model of service
TIER 2
TIER 3
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Tier 3 - Specialist Teams

• Providing care in partnership
• Providing care in peoples homes
• Genuine alternatives to admission
• Moderate to severe and enduring mental illness
• Multi-disciplinary team to provide more complex
  interventions
• Reviewing and managing prescribing
• Support, advice and training to other
  professionals and tiers
• Links across specialist teams
• Undertake admissions to in-patient services

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Overarching model of service
TIER 2
TIER 3
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Tier 3 - In-Hours Crisis Response

• In hours crisis response provided by relevant
  specialist teams.

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Overarching model of service
TIER 2
TIER 3
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Tier 3 - Out of Hours Crisis Response

• New Ayrshire wide multi-disciplinary service to
  respond across all client groups.
• Rapid response and assessment
• Provision of intensive home treatment as
  alternative to admission where appropriate
• Follow up by relevant specialist team.
• Provide clear pathway to admission where
  necessary.

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Overarching model of service
TIER 2
TIER 3
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Tier 3 - Liaison Services

• Service for those presenting to general health
  service who also have mental health problem.
• Monday to Friday 9 am to 7 pm
• Provide support to general service with advice
  and training.
• Appropriate onward referral.

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Overarching model of service
ALL UNIVERSAL SERVICES
TIER 1
TIER 2
TIER 4
TIER 3
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Tier 4 - In-Patient Services

• Fit for purpose and therapeutic
• Adult acute care
• Older people
• Dual diagnosis (mental health addiction or
  learning disability)
• Inpatient detox - drugs and alcohol
• Intensive Psychiatric Care Unit
• Low secure forensic services
• Child and adolescent services through the West of
  Scotland
• Care and treatment
• Crisis management
• Rehabilitation
• Recovery focus
• Integration with wider service
• Reduced lengths of stay

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What about the patient pathway?
TIER 2
TIER 4
TIER 3
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What about the patient pathway?
TIER 2
TIER 4
TIER 3
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Ways of Working

• Patients needs at the centre of planning
• Avoiding admission wherever possible
• Focussing on recovery and the promotion of good
  mental health and well-being
• Working as a network
• Supporting, advising and learning from each other
• Working in partnership across agencies

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Stakeholder Groups

• How does this model measure up to the principles
  we agreed?
• Are there any key gaps in the overarching model?
• Is there anything you disagree with within the
  model?

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