Service user experience in adult mental health

Implementing NICE guidance

December 2011

NICE clinical guidance 136

What this presentation covers

Background

Epidemiology of mental health problems

Scope

Recommendations

Costs and savings

Discussion

NICE pathway & NHS Evidence

Find out more

Quality standard

Background

• Several documents and initiatives have highlighted the importance of the service user's experience and the need to focus on improving these experiences where possible

• Despite these initiatives further work is needed to deliver the best possible experience for users of NHS services

• High-quality care should be clinically effective, safe and be provided in a way that ensures the service user has the best possible experience of care.

Epidemiology of mental health problems

Mental ill health represents around 23% of the total burden of ill health in the UK and is the single largest cause of disability.

One in six adults in England will have a mental health problem at any one time.

Demand for mental health services is increasing. In 2009/10 more than 1.25 million people (2700 per 100,000 population) used NHS specialist mental health services.

Scope

This guidance makes recommendations on the appropriate treatment and care of people within the NHS. The accompanying quality standard is based on the guidance recommendations.

The guidance and quality standard cover people who use adult NHS mental health services in community and inpatient mental health settings.

The guidance does not cover those using mental health services for physical health problems or carers’ experiences of services.

Recommendations

The key recommendations are those from which the quality statements were developed. These cover :

•Relationships and communication •Avoiding stigma and promoting social inclusion•Decisions, capacity and safeguarding•Engaging service users in improving care•Access to care•Assessment•Community care•Assessment and referral in crisis•Hospital care•Assessment under the Mental Health Act (1983; amended 1995 and 2007)•Control and restraint, and compulsory treatment.

When working with people using mental health services and their families and  carers:

•work in partnership•offer care in an atmosphere of hope and optimism•take time to build trusting, supportive, empathic   and non-judgemental relationships 

•promote active participation in treatment decisions and self-management•maintain continuity of therapeutic relationships •offer access to a trained advocate.

 

Relationships and communication

When working with people using mental health services ensure that you:

•take into account stigma and discrimination

•are respectful of and sensitive to service users’ gender, sexual orientation, socioeconomic status, age, background and any disability

•work with local authorities and health/social care providers.

Avoiding stigma and promoting social inclusion

Develop advance statements and advance decisions with the service user if they wish to do so. Document these in their care plans and ensure copies are held by the service user and in primary and secondary care records.

When a service user has impaired capacity, check their care record for advance statements and advance decisions before offering or starting treatment.

Advance statements and advance decisions

Service providers should consider employing service users to be involved in the training and support of health and social care professionals.

Such training should be tailored to the needs of people who attend mental health services and should be evaluated using experience of care as an outcome.

 

Engaging service users in improving care

Consider employing service users to monitor the experience of using mental health services. Offer service users training to do this.

Engaging service users in monitoring experience

Service managers should commission reports on the experience of care. These reports should:

• include data that allow direct comparisons of the experience of care according to gender, sexual orientation, socioeconomic status, age, background (including cultural, ethnic and religious background) and disability  

• include analyses of data from multiple sources• be routinely communicated to the health and

social care providers’ board.

Reports on experience of care

When people are referred to mental health services, ensure that:

•they are given/sent a copy of the referral letter•they are offered a face-to-face appointment within 3 weeks of referral•they are informed that they can change the date/time of the appointment •any change in appointment does not result in a delay of more than 2 weeks.

Access to care: referral

Mental health services should establish close working relationships with primary care services and third sector organisations to ensure:

•agreed processes for referral are in place•primary care can provide information about mental health and social care services •that all people have equal access to services based on clinical need•services are culturally appropriate.

Access to care: working relationships

When carrying out an assessment:

•ensure there is enough time for the description and discussion of problems and for summarising conclusions•explain the use/meaning of any clinical terms •explain and give information in an accessible format about any diagnosis given •give information about different treatment options•offer support after the assessment, particularly if sensitive issues have been discussed•ensure the wait before an assessment is no longer than 20 minutes after the agreed appointment time.

Assessment

Develop care plans jointly with the service user and:

•include activities that promote social inclusion•provide support to help the service user realise the plan•give the service user an up-to-date written copy of the care plan, and agree a suitable time to review it.

Community care: care plans

For people who may be at risk, a crisis plan should be developed and should include:

•early warning signs and coping strategies

•support to help prevent hospitalisation and where the person would like to be admitted

•the practical needs of the service user if admitted to hospital

•details of advance statements and advanced decisions

•whether families or carers are involved

•information about 24-hour access to services

•named contacts.

Community care: crisis plans

Health and social care providers should ensure that service users:

•can routinely receive care and treatment from a single multidisciplinary community team•are not passed from one team to another unnecessarily •do not undergo multiple assessments unnecessarily.

Community care: continuity of care

• Assessment should be undertaken by experienced professionals competent in crisis working

• Assessment should include relationships, social and living circumstances and level of functioning

• A service user should be seen within 4 hours of referral

• Health and social care providers should provide local 24-hour helplines

• Crisis resolution and home treatment teams should be accessible 24 hours a day.

Assessment and referral in crisis

Undertake shared decision-making, including, whenever possible, with service users who are subject to the Mental Health Act.

Offer service users in hospital:•daily one-to-one sessions lasting at least an hour•regular one-to-one sessions lasting at least 20 minutes with their consultant • an opportunity to meet with a specialist mental health

pharmacist• access to a wide range of meaningful and culturally

appropriate occupations and activities.

Hospital care

When a service user is admitted to a ‘place of safety’ ensure:•they are assessed for the Mental Health Act within 4 hours and that this assessment is carried out in a calm and considered way•that the reasons for the compulsory detention or treatment are explained and understood•that the receiving mental health service is informed so they are expecting and are ready to welcome the service user•the service user is informed of their right to appeal.

Assessment and treatment under the Mental Health Act

Control, restraint and compulsory treatment including

rapid tranquillisation, should be used:•as a last resort •when all means of  negotiation and persuasion have been tried•by trained healthcare professionals.

Document the reasons for such actions.  

Control, restraint and compulsory treatment

Costs and savings

There is unlikely to be significant resource impact associated with implementing the guidance and achieving the quality standard, although commissioners and providers may need to invest time in activities that support improved service user experience, such as:

•implementing systems and undertaking audit to proactively measure service user experience

•promoting a positive culture of communication and integration

•involving service users in service redesign to improve service user experience.

In some instances this may involve an initial investment of resources, however this may lead to a reduction in future negative service user experiences and an associated saving in resources.

Discussion

• What steps do we need to take to make sure that we engage service users within service improvement?

• Do professionals within our service need training or update training about providing person-centred care?

• Do we routinely develop advance statements within our service? If not how can we do this?

• Do mental health services in our area have a good working relationship with primary care services?

• How can we change practice to meet recommendations?

NICE Pathway

The NICE service user experience pathway will be available soon and covers recommendations on:

• care and support across all points on the care pathway• access to care• assessment• community care• hospital care• discharge and transfer• assessment and referral in crisis• assessment and treatment under the Mental Health Act

Click here to go to NICE Pathways

website

NHS Evidence

Visit NHS Evidence for the best available evidence on all aspects of mental healthcare

Click here to go to the NHS Evidence

website

To be added- the latest NHS evidence image

Find out more

Visit www.nice.org.uk/guidance/CGG136 for:

•the guidance •‘Understanding NICE guidance’•support for commissioners and others•baseline assessment tool•audit support

Quality standard

• The quality standard outlines the level of service that people using NHS mental health services in England should receive.

• It describes markers of high-quality, cost-effective care that should contribute to improving the effectiveness, safety and experience of care for service users in the following ways:

•enhancing quality of life for people with long-term conditions •ensuring that people have a positive experience of care•treating and caring for people in a safe environment and

protecting them from avoidable harm.

• The quality standard consists of 15 quality statements and was developed from the guidance.

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