Developing Integrated Mental Health Services
Professor Mervyn MorrisCCMHBCU
31st MAY 2013
Where are we?UK West Midlands Region
SCOTLAND
WHERE PRINCE WILLIAM AND KATE LIVE
LONDON
Birmingham* mental health services Key Facts (2008-9)
Population
Number of staff
Number of beds
Community Teams
Service users seen
1.2 m (including Solihull)
3,924
722
79
48,459
*Birmingham and Solihull NHS Mental Health Foundation Trust
Location of City’s 3 Premiership Football teams
West Bromwich Albion(Lukaku)
Birmingham City
ASTON VILLA(Benteke)
CONTINUING NEED
Rehab / Recovery
(SUB) ACUTE Primary Care Liason
CONTINUING NEED
ASSERTIVE OUTREACH
ACUTE
HOME TREATMENT
Residential based care:Hospital Beds, Day services, Crisis Houses,
PRIMARY CAREBirmingham Model
Functional Map
Belgium Functional Map of Adult Services
CONTINUING NEEDF3
Rehab / Recovery
(SUB) ACUTE F1/2aPrimary Care Liason
CONTINUING NEEDF2bASSERTIVE OUTREACH
ACUTEF2a
HOME TREATMENT
Residential based care: F4Hospital Beds, Day services, Crisis Houses,
PRIMARY CARE F1Birmingham Model
Functional Map
Total mental health beds per 100 000 population(WHO Mental Health data From Atlas, 2011)
1:700
1:5000
What was Birmingham’s message?
• It is possible to develop a full range of mental health services in the community that replaces the need for current levels of hospital provision.
• Community services can develop different functions in the same way as hospitals and, like hospitals, can develop an integrated approach.
• The community creates new opportunities because people and problems are ‘in vivo’.
• The community creates different challenges because the system has less control than hospital.
Three levels of an integrated system
• Practitioners work in teams, not as individuals
= Collaboration = Integrated Care
• Teams work as part of an organisation of healthcare
= Co-operation = Integrated Pathways
• Health organisations work with other non-healthcare organisations
= Co-ordination = Integrated Agencies
Integrated Care – Integrated Pathways – integrated Agencies
• Each team member, both as a person and by professional training, has a different view of the person, their problems and their situation.
• Diverse thinking is important in making sense and finding solutions, but it is also important that the team works together (collaborate) to identify a common strategy and goal.
Integrated Care – Integrated Pathways – integrated Agencies
• It is important for the person, their family, and people they look to for help to know what service is available and how to access it.
• Once connected to the service, everyone involved knows what help will be offered, and what continuing mental health service is available next.
• Teams co-operate to agree who is responsible in what situation to prevent gaps in service, ensuring continuity of care.
• An integrated pathway has similarities to a stepped care model.
Integrated Care – Integrated Pathways – Integrated Agencies
• Not all support for people with mental health problems is available from mental health services. Access to social care, social support, social housing, welfare payments, all require involvement of other agencies.
• Co-ordination with other agencies ensures common agreement about longer term support and planning, ensures maximum use of resources, and prevents delay.
Integrated Home Treatment• Specifically targeted to people who would otherwise go to
hospital• 24 hours, 7 days a week, frequent, flexible visiting• Multi-professional team; doctors and nurses, social worker,
occupational therapist, psychologist, community support workers
• Rapid response, within 2 hours• Pathway from and back to community care• Gatekeeper to hospital• Crisis houses developed as alternative to hospital• In-reach to hospital for early discharge
COMMUNITY MENTAL HEALTH TEAMPrimary Care Continuing Need:Liaison Rehab and Recovery
CONTINUING NEED
ASSERTIVE OUTREACH TEAM
HOME TREATMENT
TEAM
Residential based care: Hospital Beds, Day services, Crisis Homes
‘Acute’ Care core pathway
PRIMARY CARE
COMMUNITY MENTAL HEALTH TEAMPrimary Care Continuing Need:Liaison Rehab and Recovery
CONTINUING NEED
ASSERTIVE OUTREACH TEAM
HOME TREATMENT
TEAM
Residential based care: Hospital Beds, Day services, Crisis Homes
‘Acute’ Care core pathway
PRIMARY CARE
26%50 37Three
48%96 50Two
53%94 44One
AdmissionReduction %
1 Year PreHome Treatment
1 Year PostHome Treatment
District
Admissions
Overall reduction in n. Admissions = 43%
Impact on Bed Usage
Data on 3 new teams, Birmingham 1995
Impact on Bed Usage
30%1,823 1,290Three
55%3,667 1,662Two
36%3,036 1,953One
OBD*Reduction %
1 Year PreHome Treatment
1 Year PostHome Treatment
District
Occupied Bed Days
Average reduction in n. bed days = 40%
*OBD = OVERALL BED DAYS
Data on 3 new teams, Birmingham 1995
What have we learnt from supporting development in other countries?
• There is existing community innovation and expertise that needs to be recognised and valued, but ultimately to be of value, becomes integrated.
• Community and hospital psychiatry can have theoretical and ideological and differences, and this can impact on developing integration at all levels.
• The way funding of services works is a big challenge; usually different services are paid for from different sources. It also means involving different government and local agencies.
Developing Community Mental Health
You can:• Develop a more differentiated community service, that
reflects the traditional differentiation found in psychiatric hospitals.
• Develop evidence to prove the care traditionally provided in hospitals can in many cases be provided in the community, more cost effectively, and with better patient outcomes.
• Can make community care work for all types of ‘disorder’ and a higher level of ‘severity’.
Some possible questions for Brussels..
• What is your overall vision for your services?
• Can you describe your services using functional mapping? What stage are you at?
• What does a functional map identify that you need to do in a short and long-term plan? Where are the gaps?
• What is the priority at each level for developing services; teams, pathways, agencies?
• What is practically possible.. next?