Overview
Acute Forum Award Winners 2008
Working collaboratively with the Community Mental Health Team and other agencies within the field of community care the Crisis Resolution Team is a multi-disciplinary, multi-agency and nurse led service.
Local Area
Greater Glasgow and Clyde
Care Setting
Community care, In-Patient Setting
Care Group
All Care Groups
Evidence Base for Practice
ECRT was developed as part of a city wide strategy born out of the Modernising Mental Health Initiative. Aimed at improving the quality of care provided to individuals suffering from mental health difficulties. At a local level audit, research and evaluation where utilised to determine the needs of the local populations which individual teams would serve. In the Larkfield Resource Centre catchment area the following needs were identified as being pertinent to the population;
• To facilitate and promote early discharge from psychiatric in-patient care where appropriate.
• To provide short-term intensive community based care as a viable alternative to hospital admission, where appropriate.
• To engage service users and their families/ carers in tailored programmes of care and promote the stabilisation of an individual’s mental health within their home environment.
By incorporating and implementing many of the evidence based values which are approved and recommended by the Sainsbury Centre for Mental Health, the main focus of ECRT’s inclusion criteria is to provide a service for clients and their support networks. By maintaining the service in the same locality as the Community Mental Health Team (CMHT), CRT has ensured that the most vulnerable of service users within mental health services are not disadvantaged by being referred to a service out with there locality. This maintains continuity in the management of service users’ needs as key worker status will remain with CMHT were they are involved, ECRT being a complimentary service designed to provide increased support. This collaborative working is evidenced by the sharing of clinical notes and records with the CMHT, significantly reducing the number of possible sites of confidential information whilst maintaining as seamless a service as possible...Text edited. For full text please contact the contributor - recommended.
Quality assurance/impact of practice
In terms of qualitative data, both service users and their carers are given the opportunity to feed back to the team their opinions and perceptions of the service which they received during the period of time that they where involved with the LCRT. Care and treatment plans are regularly audited to ensure that consistency is maintained in the keeping of records and documentation. Through annual reviews of statistics over this past five years LCRT has been empirically been able to evidence data pertaining to client groups, their diagnosis, length of contact with the services and the use of in-patient beds.
On-going audit of the origins of all referrals is continuous within the ECRT service. Matters relating to patients medications are also monitored. This allows both in-patient and community based staff to identify those individuals and their families/carers who may benefit from education and information about matters pertaining to medication. On going audit and research are routinely undertaken within in-patient services and good practice shared across the wider health network. It is important to note that regular contact is maintained with the Practice Development Nurse to ensure quality in the work being undertaken.
Through the process of audit, it was identified that those individuals referred to our service from General Practitioners, via The Community Mental Health Team (CMHT) where at times being assessed three times in one 24hour period. In an attempt to improve the individuals’ experience of mental health services and maintain the dignity of the service user, a process of joint assessment with the CMHT was devised. This process also allowed crisis staff to promote an inclusive approach to assessment, reinforcing our commitment to be inclusive in the service we provide in an attempt to challenge the stigma of mental illness.
Practice Summary
The purpose of the service is to provide a short-term, community based programme of care for service users with severe and enduring illness in times of mental health crisis and in doing so offer a realistic and viable alternative to hospital admission. Despite being a community based service, CRT is fully engaged with in-patient services, offering assessment of service users on pass from hospital, discharge planning and post discharge follow-up. CRT will engage the service user in a tailored package of care, designed to assist them and their family/ carers to cope with mental health crisis.
Practice Detail
The Millan Principles have in many ways guided the development and implementation of the ECRT. One of the primary aims of the ECRT is to remain honest to the principles devised in the Millan report and the significant role which they played in the development of the New Mental Health Care and Treatment Act.
Reciprocity - where society imposes an obligation on an individual to comply with a programme of treatment and care, it should impose a parallel obligation on the health and social care authorities to provide safe and appropriate services, including ongoing care following discharge from compulsion.
Larkfield CRT strives to ensure that it meets the obligation of ensuring that as a nurse led service it takes seriously its commitment to not only work with those clients in community settings, but with those who may be within an in-patient environment. This is to say that whilst an individual may be in hospital whist they are un-well or their mental health is deteriorating, ECRT will continue to develop and maintain a therapeutic and tangible relationship with the service user and their families. This is primarily focused upon maintaining a cohesive approach to discharge planning. In doing so carer involvement is sought and becomes directly linked to the process of discharge and the planning of treatment plans pertaining to discharge.
Participation - service users should be fully involved, to the extent permitted by their individual capacity, in all aspects of their assessment, care, treatment and support. Account should be taken of both past and present wishes, so far as they can be ascertained. Service users should be provided with all the information and support necessary to enable them to participate fully. All such information should be provided in a way which renders it most likely to be understood.
In planning the care for an individual engaged with...Text edited. For full text please contact the contributor - recommended.
Challenges
Over this next 12months, ECRT will continue to integrate with In-patient based services to help deliver an increased and improved package of care. This will bring with it numerous on-going challenges in terms of staff involvement and the development of the user experience. Government Heat Targets specific to bed usage will prove to be a vital driver in this.
Additional Comments
East-Dunbartonshire CRT as a service over this past twelve months have been increasingly involved in the planning of various events, including Clinical Governance (Feb 08) and at this Years Rights Relationships and Recovery event at which the Team Leader will be presenting.
Supportong documents:
Barker P(2000) The Tidal Model: Theory and Practice University of Newcastle.
Barker P, Jackson S and Stevenson C (1999) The need for psychiatric nursing: Towards a
multidimensional theory of nursing. Nursing Inquiry 6, 104-12
Garcia. I : Leading the way in times of crisis, Mental Health Practice, RCN Publishing, October 2006, Volume 10, Number 2, Page 22-23.
Joy CB, Adams CE, Rice K; Crisis intervention for people with severe mental illnesses. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD001087. [abstract]
Michael S (1994) Invisible skills. J Psychiatric and Mental Health Nursing 1 (1) 56-7