Mental Health Forum For Cowal

The “Five” service Options which are to be concidered are listed below:-

Service options will be developed under the following headings:

1.Minimal change

2.Localised services, including in-patient beds in community hospitals

3.Flexible, central in-patient facility and enhanced community mental health service

4.Flexible, central in-patient facility (with day treatment and education centre) and enhanced community mental health service

5.No in-patient beds within Argyll and Bute with community focused treatment with access to beds out with the area on an as required basis.

Option One: Minimal Change

Basis of this option is to keep the current service configuration within the community services and in-patient areas broadly the same making small incremental changes as resources and internal redesign allow.

Primary Care:

•Work to develop guided self help within communities by recruitment of volunteers who are trained in Five Areas model of guided self-help and then supported by various mental health workers and other agencies such as healthy living centres, volunteer counselling services
•Expand training of primary care team in management of mild/moderate mental health issues including prescribing protocols and referral/assessment tools to facilitate prompt referral of more severe conditions into specialist services.

Rehabilitation/recovery/specialised community treatment:

•In-patient rehabilitation unit would be retained at Argyll & Bute hospital.

•The current individual residents within the continuing care ward (Arran) will continue to be assessed in a person centred process to identify individual care options for then. Until that is resolved the NHS has a duty of care to this client group. However the longer term strategic direction is for the NHS not to be the provider of continuing care. The NHS will work with the local authority to identify alternative care options.

•Current day support services such as the Link Clubs and local community support projects (Specific Mental Illness Grant funded) would be reviewed so as to focus on promoting independence and inclusion. Contracts with all independent providers funded by alternative means (such as Supporting People) would be reviewed to ensure consistent service model.

•Training of all staff in all agencies would be delivered to promote the understanding and usage of the recovery model.

Preventing Admission, dealing with crisis, supporting discharge:

•Examination will be made of a possible ward amalgamation between the current continuing care (mental Illness) and rehabilitation ward areas. Due to reduced bed occupancy numbers this might be achievable and therefore release a small level of resource to enable limited community mental health development.

•The current buildings usage could be examined leading to consolidation of services within West House. This would need to be renovated to meet statutory regulations and clinical needs.

•The Acute/IPCU bed configuration is likely to remain similar but examination would be made to reduce the length of stay and raise admission threshold. This would have the benefit of improving skill mix within these clinical areas.

•The community mental health team service and other out-patient services would be re-focused primarily on people at risk of admission and severe and enduring conditions with a reduced service for tier 1 and 2 type work. This would allow more focus on people with severe conditions and support the slight bed reduction and length of stay in hospital.

Option Two: Localised enhanced community service with local specialist units

Within this option, small, self contained mental health specific patient units would be developed within the community hospitals and Lorn and Isles District General Hospital. Access to specialist mental health services such as IPCU would be available.

Primary Care:

•Work to develop guided self help within communities by recruitment of volunteers who are trained in Five Areas model of guided self-help and then supported by various mental health workers and other agencies such as healthy living centres, volunteer counselling services
•Expand training of primary care team in management of mild/moderate mental health issues including prescribing protocols and referral/assessment tools
•Development of specialist Primary Mental Health Worker who is based within the primary care services (but supervised and strongly linked into the local CMHT) in each locality. Their role would be to:
oAssess people with a range of mental health problems and identify appropriate levels of intervention for them.
oTreat people with mild/moderate mental health conditions where intervention can be safely time limited (say to 4 sessions) using a range of self-help and short focused interventions.
oRefer onto both mental health specific services (CMHT) and generic services such as advice agencies and activity services.
oSupport the work of voluntary services related to mental health and well being
oEnsure high quality, up to date, accessible information about mental health and services is available within the local communities.

Rehabilitation/recovery/specialised community treatment:

•In-patient rehabilitation unit would not be retained at Argyll & Bute hospital

•The current individual residents within the continuing care ward (Arran) will continue to be assessed in a person centred process to identify individual care options for then. Until that is resolved the NHS has a duty of care to this client group. However the longer term strategic direction is for the NHS not to be the provider of continuing care. The NHS will work with the local authority to identify alternative care options.

•Current day support services such as the Link Clubs and local community support projects (Specific Mental Illness Grant funded) would be reviewed so as to focus on promoting independence and inclusion. Contracts with all independent providers funded by alternative means (such as Supporting People) would be reviewed to ensure consistent service model.

•Training of all staff in all agencies would be delivered to promote the understanding and usage of the recovery model

•The local CMHT would be resourced and designed to manage longer term rehabilitation within the local community working in partnership with local agencies and care providers.

•This role would include support/supervision of independent provider organisations

Preventing Admission, dealing with crisis, supporting discharge:

•Small, self contained mental health specific patient units would be developed within the community hospitals in Dunoon, Bute, Campbeltown, Mid-Argyll as well as the Lorn and Isles District General Hospital. The clinical areas would be designed with mental health usage in mind. They would have single, en-suite bedroom areas plus some living and therapeutic space.

•Islay (and possibly Mull) would have an area of their hospital available on an “as needed basis” for very short periods (48hrs) of care prior to transfer off the island. The remote islands would utilise the service most accessible to them in terms of transport.

•The aim of these units is to care for people for a relatively short period of time, perhaps three weeks, focusing on treatment and assessment. It would not be suitable for intensive psychiatric care treatment usage.

•The unit could be used for short term rehabilitation admission where community intervention has proved inadequate

•An intensive psychiatric care in-patient facility could be retained either within Argyll and Bute or commissioned from out with the area, i.e. NHS Glasgow and Clyde.

•Each local unit would have a dedicated consultant psychiatrist based locally working in partnership with local and general practitioners and hospital based staff

•This option would also include a level of enhanced community mental health team development. This team would operate out of the unit with shared team resources (staffing) to allow efficient usage of staff time and skills.

•The enhanced community team service would be provided 7 days per week (8am to 8pm) with a system of responding to crisis, providing a level of home based care to prevent admission or facilitate discharge.

•One key role of the team would be to act as gatekeeper to the use of the local unit.

•The team would include:

o Community Psychiatric Nurse
o Occupational Therapist
o Clinical Psychologist
o Medical staff
o Social Worker
o Support workers (as direct member of the team)
o Access to creative therapies and activities
o Administrative support

Option Three: Flexible, central in-patient facility and enhanced community mental health service

In this option a specialist rural mental health centre would be developed within Lochgilphead, catering for people within acute, intensive psychiatric care and rehabilitation areas of treatment. Local community mental health teams would be developed to offer a seven day a week service (possibly 8:00am to 8:00pm).

Primary Care:

•Work to develop guided self help within communities by recruitment of volunteers who are trained in Five Areas model of guided self-help and then supported by various mental health workers and other agencies such as healthy living centres, volunteer counselling services
•Expand training of primary care team in management of mild/moderate mental health issues including prescribing protocols and referral/assessment tools
•Development of specialist Primary Mental Health Worker who is based within the primary care services (but supervised and strongly linked into the local CMHT) in each locality. Their role would be to:
oAssess people with a range of mental health problems and identify appropriate levels of intervention for them.
oTreat people with mild/moderate mental health conditions where intervention can be safely time limited (say to 4 sessions) using a range of self-help and short focused interventions.
oRefer onto both mental health specific services (CMHT) and generic services such as advice agencies and activity services.
oSupport the work of voluntary services related to mental health and well being
oEnsure high quality, up to date, accessible information about mental health and services is available within the local communities.

Rehabilitation/recovery/specialised community treatment:

•A separate In-patient rehabilitation unit would not be retained at Argyll & Bute hospital but in-patient care would be available within the flexible in-patient centre.

•The current individual residents within the continuing care ward (Arran) will continue to be assessed in a person centred process to identify individual care options for then. Until that is resolved the NHS has a duty of care to this client group. However the longer term strategic direction is for the NHS not to be the provider of continuing care. The NHS will work with the local authority to identify alternative care options.

•Current day support services such as the Link Clubs and local community support projects (Specific Mental Illness Grant funded) would be reviewed so as to focus on promoting independence and inclusion. Contracts with all independent providers funded by alternative means (such as Supporting People) would be reviewed to ensure consistent service model.

•Training of all staff in all agencies would be delivered to promote the understanding and usage of the recovery model

•The local CMHT would be resourced and designed to manage most longer term rehabilitation within the local community working in partnership with local agencies and care providers.

•This role would include support/supervision of independent provider organisations

Preventing Admission, dealing with crisis, supporting discharge:

•There will be a range of patient accommodation on one site, designed in such a way as to have a high level of flexibility in its usage.

•The facility would cater for IPCU, Acute and specialist rehabilitation needs

•Clinical areas would be designed ranging from, IPCU levels of security to more domestic, independent living areas, enabling the person to be cared for within a level of security as near to their needs as possible.

•The overall aims of the facility would be to offer therapeutic interventions that address the persons needs and to minimise the length of stay for each person

•There would be single rooms (en-suite) with a wide range of living spaces and activity and therapeutic areas as well as adequate ground and garden space to promote a sense of safety and sanctuary.

•Community mental health teams would be developed to offer a seven day a week service (possibly 8:00am to 8:00pm). The community mental health teams would be joint with local authority with a single access point for referrals and comprise of social work, occupational therapists, support workers, CPN’s, clinical psychologists and consultant psychiatrists and other medical staff. Administrative support would be an essential component.

•It would be essential that the community mental health teams were able to deliver a broad range of services, including, talking and creative therapies.

•Each locality would be able to offer intensive 48 hour home based treatment, both at periods of crisis or to facilitate earlier discharge from hospital.

Option Four: Flexible, central in-patient facility (with day treatment and education centre) and enhanced community mental health service:-

This option is a variation of option three. Added is the addition of a day treatment and educational centre which has a number of functions including delivering formal individual and group therapies, assessment of people needing admission and supporting staff clinical development. It still includes the development of a rural mental health centre within Lochgilphead, catering for people within acute, intensive psychiatric care and rehabilitation areas of treatment. Local community mental health teams would be developed to offer a seven day a week service (possibly 8:00am to 8:00pm).

Primary Care:

•Work to develop guided self help within communities by recruitment of volunteers who are trained in Five Areas model of guided self-help and then supported by various mental health workers and other agencies such as healthy living centres, volunteer counselling services
•Expand training of primary care team in management of mild/moderate mental health issues including prescribing protocols and referral/assessment tools
•Development of specialist Primary Mental Health Worker who is based within the primary care services (but supervised and strongly linked into the local CMHT) in each locality. Their role would be to:
oAssess people with a range of mental health problems and identify appropriate levels of intervention for them.
oTreat people with mild/moderate mental health conditions where intervention can be safely time limited (say to 4 sessions) using a range of self-help and short focused interventions.
oRefer onto both mental health specific services (CMHT) and generic services such as advice agencies and activity services.
oSupport the work of voluntary services related to mental health and well being
oEnsure high quality, up to date, accessible information about mental health and services is available within the local communities.

Rehabilitation/recovery/specialised community treatment:

•A separate In-patient rehabilitation unit would not be retained at Argyll & Bute hospital but in-patient care would be available within the flexible in-patient centre.

•The current individual residents within the continuing care ward (Arran) will continue to be assessed in a person centred process to identify individual care options for then. Until that is resolved the NHS has a duty of care to this client group. However the longer term strategic direction is for the NHS not to be the provider of continuing care. The NHS will work with the local authority to identify alternative care options.

•Current day support services such as the Link Clubs and local community support projects (Specific Mental Illness Grant funded) would be reviewed so as to focus on promoting independence and inclusion. Contracts with all independent providers funded by alternative means (such as Supporting People) would be reviewed to ensure consistent service model.

•Training of all staff in all agencies would be delivered to promote the understanding and usage of the recovery model

•The local CMHT would be resourced and designed to manage most longer term rehabilitation within the local community working in partnership with local agencies and care providers.

•This role would include support/supervision of independent provider organisations.

Preventing Admission, dealing with crisis, supporting discharge:

•There will be a range of patient accommodation on one site, designed in such a way as to have a high level of flexibility in its usage.

•The facility would cater for IPCU, Acute and specialist rehabilitation needs

•Clinical areas would be designed ranging from, IPCU levels of security to more domestic, independent living areas, enabling the person to be cared for within a level of security as near to their needs as possible.

•The overall aims of the facility would be to offer therapeutic interventions that address the persons needs and to minimise the length of stay for each person

•There would be single rooms (en-suite) with a wide range of living spaces and activity and therapeutic areas as well as adequate ground and garden space to promote a sense of safety and sanctuary.

•Community mental health teams would be developed to offer a seven day a week service (possibly 8:00am to 8:00pm). The community mental health teams would be joint with local authority with a single access point for referrals and comprise of social work, occupational therapists, support workers, CPN’s, clinical psychologists and consultant psychiatrists and other medical staff. Administrative support would be an essential component.

•It would be essential that the community mental health teams were able to deliver a broad range of services, including, talking and creative therapies.

•Each locality would be able to offer intensive 48 hour home based treatment, both at periods of crisis or to facilitate earlier discharge from hospital.

A day treatment and education centre would be developed co-terminus to the above. It would provide:

•Formal group and individual therapies for both in-patients and community referrals such as CBT, EMDR, Creative Therapies, Anxiety Management, Occupational Therapy, Physiotherapy etc
•For example someone might attend a weekly group process with a mixture of in-patients and community referrals
•Assessment of people referred for admission including exploration of alternatives to in-patient care
•A level of phased discharge supported both by face to face care and the use of telephone and electronic forms of communication
•A focus for staff development and training for the whole service and all partners
•Assistance would be provided with travel and accommodation for people referred to the service from outwith Mid-Argyll.

Option Five: Intensive Community Treatment with no In-Patient Facility within Argyll and Bute.

Within this option, there would be an extended development of the community mental health team, within each major population centre. There would be no mental health in-patient beds within Argyll & Bute. When specialist mental health in-patient treatment is required this would be accessed within NHS Glasgow and Clyde mental health facilities.

Primary Care:

•Work to develop guided self help within communities by recruitment of volunteers who are trained in Five Areas model of guided self-help and then supported by various mental health workers and other agencies such as healthy living centres, volunteer counselling services
•Expand training of primary care team in management of mild/moderate mental health issues including prescribing protocols and referral/assessment tools
•Development of specialist Primary Mental Health Worker who is based within the primary care services (but supervised and strongly linked into the local CMHT) in each locality. Their role would be to:
oAssess people with a range of mental health problems and identify appropriate levels of intervention for them.
oTreat people with mild/moderate mental health conditions where intervention can be safely time limited (say to 4 sessions) using a range of self-help and short focused interventions.
oRefer onto both mental health specific services (CMHT) and generic services such as advice agencies and activity services.
oSupport the work of voluntary services related to mental health and well being
oEnsure high quality, up to date, accessible information about mental health and services is available within the local communities.

Rehabilitation/recovery/specialised community treatment:

•A separate In-patient rehabilitation unit would not be retained at Argyll & Bute hospital – the service would use home based care packages and individualised support.

•The current individual residents within the continuing care ward (Arran) will continue to be assessed in a person centred process to identify individual care options for then. Until that is resolved the NHS has a duty of care to this client group. However the longer term strategic direction is for the NHS not to be the provider of continuing care. The NHS will work with the local authority to identify alternative care options.

•Current day support services such as the Link Clubs and local community support projects (Specific Mental Illness Grant funded) would be reviewed so as to focus on promoting independence and inclusion. Contracts with all independent providers funded by alternative means (such as Supporting People) would be reviewed to ensure consistent service model.

•Training of all staff in all agencies would be delivered to promote the understanding and usage of the recovery model

•The local CMHT would be resourced and designed to manage longer term rehabilitation within the local community working in partnership with local agencies and care providers.

•This role would include support/supervision of independent provider organisations.

Preventing Admission, dealing with crisis, supporting discharge:

•Community Mental Health Team would operate primarily seven days a week, 8:00am-8:00pm, but with the ability to focus staff on people at periods of illness and crisis using home based treatment approach to keep people out of hospital.

•The emphasis would be on the use of local resources in a flexible and creative way in order to give care for people within either their own home or possibly within local community hospitals.

•The local team would include:

o Community Psychiatric Nurse
o Occupational Therapist
o Clinical Psychologist
o Consultant Psychiatrist and other medical staff
o Social Worker
o Support workers (as direct member of the team)
o Access to creative therapies and activities
o Administrative support

•When specialist mental health in-patient treatment is required this would be accessed by contract with NHS Glasgow and Clyde, but with a view that this would only be in extreme situations where the condition can not be managed locally.

•A key challenge with this model, would be providing this service across all localities of Argyll and Bute, specifically the smaller, rural areas and the island communities.