SETTING UP A TELE-PSYCHIATRY SERVICE FOR RURAL EMERGENCY DEPARTMENTS

DR. RAHUL GUPTA F RAN Z CP

CLINICAL LEAD – NMHEC-RAP

HUNTER NEW ENGLAND MENTAL HEALTH SERVICE

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NMHEC-RAPNORTHERN MENTAL HEALTH EMERGENCY

CARE -RURAL ACCESS PROGRAM

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PETER KEMP (SERVICE DIRECTOR)

PAM DAVIS/SOPHIE PHILLIPS (TEAM MANAGERS)

KATE SIMPSON (CLINICAL COORDINATOR)

ANNE UNICOMB (PROGRAM MANAGER-MOH)

JAY JONES (PROJECT COORDINATOR)

&NMHEC-RAP CLINICIANS

NMHEC-RAP TEAM

IntroductionProject Background ImplementationOperating ProceduresFacts & FiguresChallengesSummaryReferences

OUTLINE

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Mental Health (MH) patients often present to rural EDs

Extended wait in ED MH assessment. Stretched and under resourced Community Mental

Health Services - limited response to EDs. If no local MH service - patient need to be

transported. Limited transport options; none after-hours Vast geographical distance – ED to MH Facility e.g.

Grafton ED to Lismore is 131km or 1hr 34mins. If transported & not admitted, patients are required

to find their own way home.

PRE-NMHEC-RAP: A RURAL HOSPITAL PERSPECTIVE

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MH COMMISSION OF NSW - REPORT

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NSW Government funded project In response to “Living Well – A Strategic Plan” (Mental

Health Commission of NSW, 2014)

Establish new mental health resource hub staffed - mental health professionals, operating 24 x 7 support rural and remote communities of northern

NSW.NMHEC-RAP is joint initiative Hunter New England LHD, Mid North Coast LHD, Northern NSW LHD.

NMHEC-RAP

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Medical officers (in absence of AMOs) can do Schedule 1 (s19A) and Form 1(s27A) via videoconference. If can be done with “sufficient skill & care”

AMOs can undertake Form 1 assessments at a declared MH facility of which they are not an employeeAccredited Persons (APs) can do Schedule

1 (s19A) via videoconference

MH ACT 2007 CHANGES -AUG 2015

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ORANGE

WAGGA WAGGA

GOULBURN

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NEWCASTLE

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Mental Health Professionals provide

MH expertise to regional, rural and remote EDs

where access to MH services is not readily available

use video conference to link with EDs

Utilize a consultation-liaison model i.e. ED retains the clinical responsibility of the patient.

NMHEC-RAP PRINCIPLES

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Builds on existing models of mental health response to EDsNMHEC-RAP is an enhancement of emergency

mental health responses; It does not replace existing face-to-face MH

input toEDsHence, it complements face-to-face services

and extends after-hours cover

NMHEC-RAP PRINCIPLES

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LHD PartnershipsHub & Spoke modelProject manager – NSW MOHProject officers at LHDsHow this was evolvedConsultationData gatheringSite VisitsDevelopment of MOC and Operational Guidelines

PROJECT IMPLEMENTATION

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Co-located with the Mental Health LineRecruitment & training of additional staffMH Assessment training – Role playAccreditation training - Mental Health ActRoll out – 4 sites initially, then on a

schedule

PROJECT IMPLEMENTATION

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HOW DID WE SPREAD THE NEWS?

A Fact Sheet was disseminated LHD wide in late February 2016 to introduce the Northern MHEC-RAP service.

This flyer was distributed LHD wide via email just prior to Go Live.

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Identified site sent information –Operational procedures etcSite visit by NMHEC-RAP Dr & clinicianSite visit by project coordinator –

Telehealth CartGo live!Regular feedback meetings – weekly ->

monthly

PROJECT ROLL-OUT

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Located at the grounds of James Fletcher Hospital, NewcastleStaffMental Health Professionals – multi-disciplinaryMedical staff – Psychiatrist 0.6 FTE & Psych Reg

1.0 FTE

Service Director, Team Manager & Clinical CoordinatorProject Coordinator

NHMEC-RAP HUB LOCATION

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PHOTO JFH

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NHMEC-RAP ASSESSMENT ROOM

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WORKSTATION ON WHEELS “WOW”

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NMHEC-RAP Operational model

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What is a NMHEC_RAP assessment? A NMHEC-RAP assessment is a mental health assessment where you and the mental health professional are not in the same room as each other and use technology to complete the assessment.

Can a family member be with me during the assessment? NMHEC-RAP encourages family and/or carers to participate in the assessment, if this is your wish. You can choose any support person to be with you during the assessment.

How will I see the mental health professional if we are not in the same room? The NMHEC-RAP assessment is conducted using a portable videoconferencing machine with a camera, audio and a screen.

Can I ask questions during the consultation? You and your carer should feel free to ask questions at any time before, during and after the assessment.

Why use NMHEC-RAP? A NMHEC-RAP assessment means that you will not need to travel to another hospital to be assessed. You may, however, need to travel to another hospital if you need to be admitted.

What if I don’t want to be part of a NMHEC-RAP assessment? You may choose not to participate in a NMHEC-RAP assessment. Alternative arrangements will be discussed with you.

Consent for the assessment You will be asked for your verbal consent before the assessment starts.

What if I am uncomfortable during the NMHEC-RAP assessment? You can ask to stop the assessment at any time.

Who will be part of the consultation? You will see the mental health professional on the screen. There may also be a staff member with you in the room if you do not a have support person and it is felt that you require one. All staff involved in the assessment will introduce themselves at the beginning of the session.

Maintaining your privacy and confidentiality All NMHEC-RAP assessments are secure and subject to the same privacy requirements as face-to-face Health services. The assessment will not be recorded. The mental health professional will take notes during the assessment which will be entered into your medical record, as would normally happen if you saw a Health professional face to face.

How much will the consultation cost? This service is free for people presenting to emergency departments.

PATIENT INFORMATION SHEET

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EMR(S)

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HNE - CHIME ACCESSIBLE VIA CAP

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GLEN INNES

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MH ROOM

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INVERELL

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MH ROOM

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Patients access specialist assessment and care closer to home; Reduce need to transport to MH facility for

mental health assessment.EDs - reduce waiting times for mental health

assessments Comprehensive, contemporaneous,

standardised electronic clinical documentation in EMR

BENEFITS RECAP

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Some Facts & Figures

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Commenced August 2016Total sites - 16Total Assessments – 1,325FY 2017-18 - 956

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EXISTING MH ACTIVITY OF ED

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RECOMMENDATION FOR ADMISSION 26%

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25

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22.7

20

31

0

2120

25.7

30

27

0

28.5

0

5

10

15

20

25

30

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40Percentage of Inpatient Referrals/Compared to Average

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TIME OF REFERRAL

0

10

20

30

40

50

60

70

80

90

Times of NMHEC-RAP Requests

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All EDs have embraced NMHEC-RAP service

Staff are happy with the quality of picture and audio of the telehealth equipment.

ED Staff have provided positive feedback re standard of assessment provided by the Hub, particularly the high standard of documentation.

Feedback from patients using the service has been positive.

HOW IS NMHEC-RAP BEING RECEIVED?

Grafton Base Hospital

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Challenges

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CHALLENGES

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Change managementGetting used to technology!Credibility of clinical advice given by

NMHEC-RAP staff across sites/LHDsDifferent databases and eMR systems

across the LHDs. Different pathways for internal (HNE) and

external (MNC & NNSW) LHDsMedical credentialing & jurisdiction across

3 LHDs

CHALLENGES

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Workflow – Unpredictability of NMHEC-RAPs referrals Diversion from non-NMHEC-RAP EDsVariations in processes across sites. Contact with Staff specialists – various

processes for LHDs, intra-LHD. Transport & bed finding

CHALLENGES

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IN THE END IT ALL COMES TOGETHER *

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Continuing Roll-outHunter New England (Total ~26)Merriwa, Murrurundi, Scone, Singleton,

Gloucester, Cessnock, Tomaree

Mid-North Coast TBA

Northern NSWTBA

NEXT SITES

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References

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https://www.ranzcp.org/Publications/Telehealth-in-psychiatry.aspx

Saurman, E., Kirby, S. & Lyle, D. (2015). No longerflying blind: how access has changed emergencymental health care in rural and remoteemergency departments, a qualitative study. BMCHealth Services Research. Vol 15:156.

Guidelines for the use of Telehealth for Clinical and Non Clinical Settings in NSW. https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0010/258706/ACI-telehealth-guidelines.pdf

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•END

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