cardiff and vale nhs trust ymddiriedolaeth gig caerdydd a’r fro the south cardiff and vale crisis...

Cardiff and Vale NHS TrustYmddiriedolaeth GIG Caerdydd a’r Fro

The South Cardiff and Vale

Crisis Resolution

AndHome

Treatment Team Jayne BellTeam Leader029 20 906222


Pendine

Hafan Dawel

Amy EvansAmy Evans

Gabalfa

Pentwyn

Links

Barry

Splott

Cardiff Bay

Ely

Penarth

CRHT South

HAMADRYAD

CRHT North

LavernockPoint


Where we are

• Based in the Hamadryad Centre, co-located with the South West CMHT

• Approximately geographically central to our sector (traffic allowing!)

• Cover from Llantwit Major to the west, to Llanrumney to the east


Who we are

We are a multi-disciplinary team of• 2 psychiatrists• One part time psychologist• One senior social worker• Ten community psychiatric nurses• Five community support workers• One team leader


What we do• Offer a genuine alternative to

hospital admission through the provision of home treatment.

• Including the core functions of: Providing a rapid response Acting as the gatekeeper to

hospital beds Providing a prominent role in

facilitating early discharge


GP/HV/OTHERAGENCY

CMHT initiatesThe referral

POLICEClient assessed by

Police Surgeon Prior to referral to

CRHTT

POISONS UNITClient assessed by

Liaison Nurse

CARER REFERRALONLY if identifiedAs part of current

Care plan and agreedWith CRHTT A&E

Client assessed byMH Triage NurseAnd CRHTT Staff

Grade Psychiatrist

GENERAL IN-PATIENTWARD

Client must be assessedBy Psychiatrist prior

To referral to CRHTT

DAY HOSPITALMust be seen by Care CoordinatorRMO or other day Hospital staff the

Same day

SELF REFERRALONLY if identifiedAs part of current

Care plan and Previously agreed

With CRHTT

LIAISON PSYCHIATRYClient must be

Assessed by careCo-ordinator/RMO/Liaison

Psychiatry Staff

CMHT (Known Client)Must be seen by care

Coordinator/RMOOther CMHT staff

the same day

MH IN-PATIENT UNITCRHTT will assess for leave/early discharge

CRHTTASSESSMENT

In Hours Referrals


SELF REFERRALONLY if previously identified

As part of current carePlan with CRHTT

EMERGENCY DUTY TEAMJoint assessment with

CRHTT

POLICEMust be assessed by the

POLICE SURGEONPrior to referral to

CRHTT MH IN-PATIENT UNITCRHTT will assess prior

To leave or earlydischarge

A&E/POISONS UNITMust have a medicalAssessment prior to

Referral to CRHTT

CARER REFERRALONLY if previouslyidentified as part Of current care

Plan with CRHTT

WEEKEND CPNAssessed by

Weekend CPN orJoint assessment

With CRHTT

GPMust have assessed

a client prior to referral

to CRHTT

CRHTTASSESSMENT

Out of HoursReferrals


South CRHT Assessments for Admission Avoidance Oct 06 – Sept 07

CRHTIN PTSMHARTN

CRHT SUPPORT

IN PATIENT ADMISSION

MHA ADMISSION

RETURN TO REFERRER

284 165 78 324

Total No. of assessments 851


Why we do it

• Evidence and support for the impact that CRHT services are having

• Beneficial for service users and carers, and the service as a whole

• Service users and carers generally prefer home-based treatment

• CRHT services are as effective both clinically and socially as inpatient care.


How we do it• Open 24 hours a day, 7 days a week• Minimum of 4 staff on a day shift,

one at night. 3 shifts within 24 hours• Provide intensive contact for up to 6

weeks• Support people in the least

restrictive environment as close to home as possible

• Offer early discharge support for those who need a stay in hospital


CRISIS HOUSE

Philosophy:- • Short-term accommodation for adult

clients with severe and enduring mental illness who are experiencing acute mental health crisis

• Avoid stigmatisation of hospital admission

• Safe, comfortable and supportive environment

• Staffed 24 hours by support workers, supported by the CRHTs


Crisis House cont’dService aims:- • least restrictive environment with

the minimum of disruption to their lives.

• The Crisis House will only be accessed via the CRHTT who will act as “Gatekeeper” to the service.

• Provide intensive support to clients in the Crisis House as an alternative to inpatient care.


Crisis House cont’d

• To provide practical and emotional support to individuals who are experiencing an acute psychiatric crisis.

• Be actively involved in “care planning” to facilitate a return to the individuals home.


CRISIS RECOVERY UNIT

Philosophy:- • assessment, therapeutic intervention and

support, in a safe environment• provide a flexible and responsive

assessment and treatment service. • The service supports clients of both South

and North Cardiff Crisis Resolution Teams, providing a more intensive and consistent therapy that may not be available in a community based setting.


CRU cont’d

• The service provides respite for both Service Users and Carers, reducing tension and de-escalating difficult social situations.

• In some circumstances it will enable carers to return to work, if necessary.

• 7 day service.


CRU cont’dService Aims:-

• A range of treatments and activities provided

• Service Users will collaborate in the development of individually designed treatment programmes. These programmes will provide balance of therapeutic interventions, recreational activities and “time out” in a non-pressurised setting.


Sector alignment for Admission Avoidance

Assessments

0

50

100

150

200

250 NEW TOSERVICELINKS

HAMADRYAD

AMY EVANS

HAFAN DAWEL

CAU

212

243

174

103 60

7


Client Feedback

“ I liked that someone cared enough to listen to my feelings and problems. The staff appeared to show their concerns at my situation, and I felt their advice was specific to me and not necessarily the stock answer.”

“ I would have preferred to have seen the same person on each occasion rather than many different people.”

“ I have learned to monitor my state of mental health by looking out for ‘relapse indicators’, monitoring sleep patterns and social interaction patterns with my family and friends.”


Carer Feedback

“It enabled us to support our son at home as we felt assured we could phone if his condition worsened.”


References• The Department of Health The NSF

for Mental Health – five years on. London: DOH; 2004

• Northern Centre for Mental Health More than the sum of all parts. Improving the whole system with crisis resolution and home treatment Durham: The Northern Centre for Mental Health; 2003


References• Department of Health The Mental

Health Policy Implementation Guide London: DOH; 2001

• Sainsbury Centre for Mental Health Crisis Resolution London: The Sainsbury Centre for Mental Health 2001

• Welsh Assembly Government Policy Implementation Guidance on the Implementation of CRHT in Wales 2005


Websites

• All Wales Crisis Resolution Home Treatment Network www.wales.nhs.uk/crisis

• GOFAL Cymru for information on The Crisis House www.gofalcymru.org.uk

cardiff and vale nhs trust ymddiriedolaeth gig caerdydd a’r fro the south cardiff and vale crisis...

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