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Rehabilitation in Psychosis: Rebuilding & Transforming Lives
Dr Sridevi Kalidindi PhD, FRCPsych
• Chair, Faculty of Rehabilitation & Social Psychiatry;
• Co-Chair, Joint Commissioning Panel –Mental Health;
• Consultant Psychiatrist in Rehabilitation & Recovery; Visiting Lecturer IOPPN
• Trust Clinical Liaison Lead for Contracts
• http://www.rcpsych.ac.uk/workinpsychiatry/faculties/rehabilitationandsocial.aspx
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Rehabilitation in Psychosis – Co-producing Transformed Lives. “Thank you for giving
me my life back”• Real life stories: Clinical and service user innovation
– the long(er) view• Severe personality disorder and psychosis• Autistic spectrum disorder and psychosis• Substance misuse and psychosis• BME, substance misuse and psychosis
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People with complex psychosis and complex needs
PsychosisTreatment resistanceNegative symptomsComorbidities – mental and physical healthFunctional impairmentsChallenging behaviourDifficult to engageRisk10-14% of EIP require rehabilitation10-20% of secondary care; Account for 25%-50% of the
annual UK mental health budget (MH Strategies 2012)
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Specialist skills of rehabilitation services
http://www.rcpsych.ac.uk/workinpsychiatry/faculties/rehabilitationandsocial.aspx
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Skills of a Community Rehabilitation Team
(see guidance)• Leadership; the long(er) view• ‘Pull through’ to less
restrictive, more independent, socially inclusive and meaningful lives
• Public Relations• Internal to the team • Patients & carers• Working with other teams• Provider facing• Managing transition
• Commissioner facing
• Census, performance management; systemic blocks, challenge discrimination - educate
• placements/care packages/ funding panel
• OATs
• local service development
• cost of unmet need (Campion 2012)
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Whole system approach to mental health rehabilitation services
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A National Strategy
National commissioning Guidance
(Waxing and waning rehabilitation
services nationally)
www.jcpmh.info
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Out-of-Area TreatmentIn Sight, In Mind – Toolkit for OATs
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Setting National Standards
• AIMS – Rehab; CQC • Community Rehab standards
underway
• NICE guidance eg.• i) Transition from Hospital • to Care Home
• ii) New – NICE guidance service specification (2016!)
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A Pathway Approach
Many local examples of good innovative pathways, both in-patient and community
National pathway:High level within the commissioning guidanceDetailed - under construction. Careful not to stifle local innovation, based on local needsEarlier intervention is key. Criteria – 2 acute admissions in one year, > 30 day admission
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Faculty of Rehabilitation & Social Psychiatry
• National review of Rehabilitation (all types)
• National review for Mental Health Supported Housing
• National Survey of Rehabilitation Services
• Employment– DWP, Expert Review;
Training for assessing Doctors
• Recruitment, Education and Training
• International Rehabilitation
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International Rehabilitation Psychiatry
#FundaMentalSDG
United Nations Sustainable Development Goals2015 Development Agenda
www.fundamentalsdg.org
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Rehabilitation in Psychosis – Co-producing Transformed Lives