“no wrong door” - ireland's health services - hse.ie · “no wrong door” a project...

“No Wrong Door” A project working towards integration of Mental Health

and Substance Misuse Services Dr Marie Oppeboen, SR to Dr P. Doyle, Consultant Psychiatrist, Tevere Day Hospital (Community Mental Health Service), Limerick

Mr Colin O’Driscoll, Clinical Lead HSE Midwest Drug and Alcohol Service

Mr Donal Ryan, Addiction Counsellor, Nenagh Community Mental Health Service, North Tipperary

• Co-Occurring Disorders (COD) = Substance Misuse + Mental Health Problems

• COD - now more the norm than the exception

- presents many challenges to health care professionals and services

- is difficult to treat

- has poorer outcomes

• Clear consensus that Integration between mental health and addiction services is sorely

needed and long overdue.

• It is clear from National Protocols and Policy Informing Documents governing both services that

- Working in accordance with the concept of Recovery, Empathy and engaging in Evidence Based Practice with the Service User at the centre, is critical to effective treatment.

- There is great emphasis on working together across sectors of care and Integrating Services to better meet the needs of the individuals with Complex

Clinical Presentations.

For people with COD and Complex Needs in the Mid-West

• A collaborative partnership was established and a proposed service model was agreed on between above stakeholders from mental health and addiction services, by means of improved communication and identification of “common grounds” through the Recovery Concept

• PAR provided an excellent organisational framework

• We believe the “No Wrong Door” project has moved us closer towards integrating care for people with COD and complex needs in the Mid-West

• We hope to further develop integrated care pathways towards full service-level integration

• For this we would need Re-Direction or Shared Distribution of Funding and an Agreed Clinical Governance structure likely to require commitment from HSE on a National Level

• We call for The Integration of Mental Health and Addiction Services for people with

• Multi-disciplinary • Mental Health

• Evidence Based • Integrated • Motivational • Recovery Oriented

• Therapeutic Alliance • Continuity of Care • Harm Minimisation

Team

Treatment

Priorities

Service Priorities in Mental Health Division Operational Plan 2015

- To design Integrated Evidence Based, Recovery Focused services - To design and establish two additional Clinical Programmes informed by emerging models - To develop and agree processes for integrated working within the mental health service sub-specialties, and with the other Divisions.

• A Recovery Approach within the Irish Mental Health Services – A Framework for Development (MHC 2008) • A Vision for Change. Report of the Expert Group on Mental Health Policy. Government Publications Office (2006). 146 – 148.

• COCE (2006). Overarching principles to address the needs of persons with co-occurring disorders, Overview Paper 3, Cooccurring Center for Excellence, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services.

• Connecting for Life Ireland’s National Strategy to reduce Suicide 2015-2020.(June 2015) National Office for Suicide Prevention, HSE, Department of Health. 41-47.

• Davidson, L & White, W. (2007). The concept of recovery as an organizing principle for integrating mental health and addiction services. Journal of Behavioral Health Services and Research, Journal of Behavioral Health Services and Research, 34(2), 1094-3412.

• HSE Mental Health Division – Operational Plan (2015) p.16-26 • HSE Primary Care Division – Operational Plan (2015) p. 41

• John Connolly , Liam MacGabhann , Olive McKeown , (2015) "Developing a dual diagnosis service in Cork, Ireland by way of participatory action research (PAR)", Advances in Dual Diagnosis, Vol. 8 Iss: 1, pp.29 – 41

• Keane, Mc Aleenan and Barry, 2014. Addiction Recovery: A contagious paradigm! A case for the re-orientation of drug treatment services and rehabilitation services in Ireland. Published by Soilse, Dublin 2014.

• MacGabhann L., Scheele A., Dunne T., Gallagher P., MacNeela P., Moore G., Philbin M.. National Advisory Committee on Drugs. (2004) Mental health and addiction services and the management of dual diagnosis in Ireland. Stationery Office, Dublin .

• National Substance Misuse Strategy - Steering Group Report (Feb 2012

• White, W., Boyle, M. And Loveland, D. (2002). Addiction as chronic disease: From rhetoric to clinical application. Alcoholism Treatment Quarterly. 3/4:107-130.

References

• The “No Wrong Door” project aims to improve:

1) Access to Treatment 2) Quality of Care 3) Outcomes

• To improve communication and establish Collaborative Partnerships between Mental Health and Addiction Services

• To develop a model for an Integrated Co-Occurring Treatment Resource

- Sitting in between Mental Health and Addiction: Bridging the Gap - Location for Integrated Treatment - Specialist Consultant Agency to

1) Support both Mental Health and Addiction services in the region 2) Enhance Competencies of issues related to COD among staff

3) Develop a No Wrong Door approach/policy in the Mid-West

Prior to Integrated Treatment Programmes

Substance Abuse Psychiatric Illness

Diagnosed with

Psychiatric Illness Substance Abuse

Addiction Programme

Mental Health Programme

Sorry, Go There First to Get Treated for Your Other

Issue

Denied Admission Denied Admission

• Establish common interests and shared values between stakeholders through reflection:

1) Providing and advancing Recovery-Oriented Services and Person-Centred Care 2) Engaging in evidence based practice 3) Developing formal links and joint protocols between services 4) Formalise service user involvement

• Decide on Appropriate Actions 1) Develop, pilot and evaluate an integrated, motivational and recovery focused

group programme 2) Hold Focus Groups with service users/families 3) Enhance competency and knowledge of issues related to COD among staff and

service users in MH and addiction services 4) Collaboratively develop a proposed service model for an integrated, recovery

oriented co-occurring treatment resource

• Plan and Engage in a Participatory Action Research Project (PAR)

• Why use PAR? 1) To Engage in Recovery-Oriented Research 2) To Facilitate Real Change 3) To Achieve Empowerment of those involved

• Identify and engage stakeholders in conversation: 1) Addiction Counsellor/Psychotherapist in Mental Health 2) General Adult Psychiatrist 3) MWRDAF Co-ordinator 4) Clinical Lead Mid-West Drug and Alcohol Services 5) Service Users 6) Family Members

Background Objectives / Aims

Method

Results

• A Collaborative Partnership was established between Mental Health and Addiction through regular meetings of key stakeholders

• Pilot Programme - For patients with COD in a CMHS in North Tipperary - Developed, Completed and Evaluated with active Service User Involvement and

good results - Further groups were established as a result to meet varying needs and offer choice

• Presentations - on Mental Health, Substance Misuse and related issues held within

mental health and addiction services, and for the general public

• A proposed Integrated Service Model

“No Wrong Door”

Conclusion