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Crisis response and resolution services to reduce hospital admissions and repeat admissions
The crisis function of any NHS, local authority ( LA), Voluntary Sector or joint service is to address prevention, intervention and recovery through the management of individuals during periods of acute illness, relapse or mental distress.
In all cases and for all arrangements crisis services should link with longer term mental health agencies who should retain lead responsibility for individual care from completion of acute episode or resolution of crisis and discharge to recovery.
Crisis response may be delivered in a number of ways, reflecting the needs of local areas and settings and will include, but not be restricted to, specialist crisis teams, community mental health teams, outreach teams and other services.
1. OBJECTIVES
1.1 To provide an alternative to unnecessary admission/alternative to unnecessary statutory referral for people experiencing an acute mental health crisis.
1.2 To provide assessment, intensive home treatment or other relevant crisis resolution input.
1.3 To ensure people experiencing severe mental health difficulties are treated and/or assisted in the least restrictive environment.
1.4 (Where the function is from a separate team); to provide short-term management of an individual's care during a period of acute relapse.
1.5 (Where crisis services are provided out with the community mental health team); to work in conjunction with (and transfer lead care at the appropriate point) to the community mental health team key worker.
2. ELIGIBILITY CRITERIA
2.1 People with first onset of severe mental illness.
2.2 People with severe mental illness and/or psychotic relapse undergoing a period of acute crisis or relapse.
2.3 People experiencing a crisis that without professional or crisis service intervention might require hospital stay.
2.4 People who may benefit from short term intervention to prevent longer term reliance on mental health services.
3. OUTLINE QUALITY OBJECTIVES
3.1 Response time from approach to intervention no more than 4 hours.
3.2 Overall contact (receiving crisis intervention or support from a specialist service or a CMHT or other linked service) should be no longer than 21 calendar days unless exceptional circumstances apply.
4. WORKFORCE INTERVENTIONS
4.1 NHS Boards will lead on the following core specialist functions. Consistent with the needs of individuals in crisis, (high risk/dynamic and intensive) this will include:
- Risk assessment;
- Medication management;
- Managing challenging behaviour;
- Managing process from crisis to resolution;
- Successful client engagement;
- Holistic approaches; and
- A focus on client strengths (as opposed to illness model).
4.2 Social Work Departments will have cross cutting interest in joint working and will lead on:
- Screening, assessment and care management;
- Social care, either directly provided by LA or commissioned/purchased from other providers;
- Mental Health Officer services; and
- Work with service users and informal carers to reduce the likelihood of a crisis occurring or recurring. This includes giving information, and/or arranging relevant services or supports.
4.3 Some functions will apply to specific professions and a multidisciplinary skill mix will be required to protect this capacity.
5. ROLES AND INTERFACE
5.1 The NHS has lead responsibility for overview, gatekeeping, care
co-ordination and referral to inpatient beds.
5.2 The long-term care and case management responsibilities will remain with the generic community function or team who will maintain standard levels of engagement.
5.3 There should be clear guidelines and agreed protocols for Consultant and Senior House Officer responsibilities across all community team interfaces (i.e. who, what, when and where) as part of the Psychiatric Emergency Plan for each NHS Board area.
5.4 Where age consideration applies protocols should be agreed for referrals and supported transitions to child, adolescent and old age psychiatry services.
5.5 Those areas without crisis services will require all specialist teams to include crisis response within their protocols.
5.6 Long-term management is the lead responsibility of the community team. Day to day care management lead will be held by the crisis service, where one exists.
5.7 All staff directly or indirectly involved in crisis prevention, response or resolution should have appropriate (and ongoing) training and skills development.
5.8 Crisis services should form part of a stepped care system in the Community Health Partnership ranging from community support to primary care interventions to specialist secondary care intervention in the community and acute in-patient care.
5.9 Levels of need should be matched to the level and duration of intervention. Interventions should be delivered in response to need by the most appropriate agency.
5.10 Where no dedicated out of hours service is provided support should be available through NHS Accident and Emergency and Social Work standby services.
6. OUTCOMES
- Reduce hospital admission rates by 10% (by end December 2009).
- Reduce the number of readmissions (within one year) for those that have had a hospital admission of over 7 days by 10% (by end December 2009).
There will also be qualitative measures which will incorporate the following:
- Acceptable locations for and quality of care to service users.
- Improvement of service user experience in management of episodes of crisis care; and
- Increase/improve social inclusion.
Work is being taken forward as part of the Mental Health Delivery Plan on the development of a Scotland wide tool to assess the values, ethos and principles of all mental health services. This will provide a basis for assessing qualitative measures in crisis services.
7. TIMETABLE
Delivering for Mental Health (December 2006) confirms the expectation that local agencies and partners work together to deliver crisis services and responses in line with the standards set out in this document by end December 2009.
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