Transcript imps_presentation_march_2014

Intermediate Mental & Physical
Health Care Team
and
Role of Physiotherapist in Mental
Health
Kashif Munir
(Physiotherapy Lead)
14th March 2014
 For Alzheimer’s, the estimated lifetime risk for men at 65 is 9.1
and 17.2
 Lifetime risk of first coronary heart disease event at age 40 is 48.6
for men and 31.7 for women. Confidence interval +- 3
 In the UK, one in four people will experience mental illness in their
lifetime
 46% of older people in hospital wards had a need for special care
in 2009
 The number of adults living in England who accessed specialist
mental health services between 1st April 2010 and 31st March
2011 was 1,259,650*, a 1.4 per cent rise on the number who
accessed services in the previous year (2009/10) when the
number of people who accessed services was 1,242,218
 NHS must treat mental and physical health equally
(Department of Health, 2 November 2013)
 Making mental health services more effective and accessible
(Department of Health , 25 March 2013)
 CQC calls for urgent improvements in mental health services in
England
(CQC, 30 January 2013)
 Using the mental health act people were made to have treatment
at home nearly 400 times more last year making a total of over
4,000
(Care Quality Commission January 2013)
Background to Service
 Review of Westminster Intermediate Care Services.
 Initial development across partner organisations: NHS
Westminster, CNWL, Local Authority and Acute Care.
 Influenced by:
– Local audit – adults & older adults with mental health problems
were staying longer in acute hospitals & difficulty in accessing
rehab pathways.
– NSF for Older Adults: Standards 3 & 7
Locality and Hours
 Currently: Vauxhall Bridge Road
 Older People’s and Healthy Ageing Westminster Services
CMHT, HTT, JHT, ABT, Recovery Team
 Mon – Fri 0830 – 1630
– Referrals are screened within 24 hours (Mon – Fri)
– Assessment 3 working days assess if urgent or 10 working
days for non-urgent
IMPS Structure
East Sector Manager
Administrator
Mental Health
Physiotherapy
Clinical Nurse Specialist
Physiotherapy Lead
RMN
Senior Physiotherapist
RMN
Senior Physiotherapist
Associate
Mental Health
Practitioner
Physiotherapist
Psychiatric Cover
Occupational
Therapist
Psychology
Rehab. Assistants
Rehab. Assistant
Clinical Psychologist
Acceptance Criteria
 Westminster residents only
 Medically stable with rehabilitation potential.
 Age: Adult 18 +
 Current mental health function condition is affecting their
physical rehabilitation.
 Physical condition is affecting their mental health resulting in
challenges/ in their rehabilitation.
 Clients to engage with Mental Health and Physical Care
Practitioners to enable holistic, goal specific, time limited
interventions to effectively optimise recovery.
 Clients cognitive impairment has deteriorated significantly or
is resulting in prevention of realistic rehabilitation due to
complex needs/condition.
Referrals
 Accepted from:
All health and social care professionals
 Paperwork: Accessible via the IMPS webpage
– SAP form
– Basic risk assessment
» For the those within CNWL a referral letter is
acceptable
Patient Referral Pathway
Patient Referral Received
Referral is screened by Duty
for acceptance criteria
Referral is discussed in
daily referral review meeting
Non- Acceptance for assessment
Accepted for assessment
Send referral back to referrer
with appropriate services identified
Initial Assessment
Not accepted onto caseload
Accepted onto caseload
Client is allocated
specific disciplines and
an individual case manager
according to main needs
Individual
Goal Orientated Care plan
is collaboratively
created with the client
Intervention Period
(Target of 8 weeks)
Discharge
-Client meets goal achieved
- No further rehabilitation potential
Assessment and Care Planning
 Case manager is identified according to the client’s key
issues.
 A single assessment framework is carried out with two
different disciplines in attendance
 After assessment and acceptance onto the caseload a
MDT Goal Orientated Treatment Plan is formulated
jointly with the client.
 Single professional records and shared protocols are
kept on JADE.
 Clients are frequently reviewed (either daily, weekly or
monthly according to needs and issues identified)
within the team.
Treatment/Interventions
 Providing Comprehensive Assessment, resulting in a structured
individual care plan that involves active therapy, treatment or
opportunity for recovery.
 A planned outcome of maximising independence and typically
enabling people to resume or continue living at home.
 Cross professional working, Intense, frequent input with flexible
durations to suit and meet the needs of each individual.
 Physiotherapy Assessment and Treatment.
 Psychological Therapies
 Psychosocial Interventions
 Environmental Assessment & Support
 Review & Rehab of ADL’s
 Medication Review
 Functional Assessment
 Financial Guidance and Referral
 Family and Carer Support
 Motivational Interviewing
 Diagnosis
 Facilitate access to community services
 Social Inclusion
The Role of the Team
 Short term rehabilitation (Target 8 weeks):
To clients whose physical health rehab is impeded by mental
health problems or their physical health is impeding their mental
health recovery.
 Prevent unnecessary admission:
To an acute setting and reduce avoidable use of long-term
care.
 Provide a multi-faceted service:
Encompassing; holistic assessment, community rehab,
discharge support and prevention of admission where
possible.
The role of physiotherapists working in Mental Health
 Meet the needs:
They are uniquely placed to meet the needs of service users
who have both physical and mental health needs. (Everett
et al. 2003).
 Clients goals:
Base the treatment plan on the older adult’s goals.
 Identify needs:
identifying the physical health needs of the patient
population, raising awareness of physical health issues, and
assisting patients to adopt ways of improving their
physical health (Warrell et al, 2005).
 Medications:
Prevent and/or manage medication side effects
 Education:
Incorporate older adult and family teaching
throughout assessment and treatment.
 Pain:
Address pain using an inter-disciplinary approach
 Recommendations for pain:
Recommended guidelines for Pain Management
Programmes for adults. This programme fulfils the
criteria for Combined Physical and Psychological
(CPP) treatment programmes as recommended by
the NICE 2009 guidelines on low back pain
 Behavioural modification:
Through education for those with high risk health
behaviour and promoting healthy eating and exercise such
as poor diet
People with schizophrenia living in the community have
been found to have a poor diet, with less than the
recommended intake of fruit and vegetables, and high
risks of cardiovascular disease (McCreadie, 2003), lack of
exercise, obesity, cigarette smoking, alcohol and
substance misuse, and poor sexual health (Office for
National Statistics, 2004; Department of Health &
Department for Education and Skills, 2004).
 Challenge symptoms:
Challenge symptoms associated with mental health by
physical tests.
 Weight management programmes:
Development and delivery of lifestyle and weight
management programmes
 Exercise prescription;
Experts in prescribing exercise. (The Chief Medical Officer
(Department of Health, 2004b) recommends for general
health that children should exercise for 60 min a day; the
recommended minimum for adults is a total of 30 min of
moderate-intensity physical activity a day on at least 5 days a
week). Graded activity, an operant treatment approach
based on principles of operant conditioning, was identified
as a CBT-based strategy with traceable theoretical
justification that can be applied by physiotherapists, Brunner
et al, 2013)
 Promoting independence:
Promoting and maintaining independence of people with
dementia.
 Effects of medication;
Provide information on physical effects of medication and
challenging physical presentation through physical tests.
 Touch:
Touch Based Skills (evidence has shown touch based
therapies produce reductions in cortisol levels and
blood pressure and gives relief from pain)
 Other:
Cognitive behaviour therapy, Counselling Skills, Minddistraction techniques, Basic Body Awareness Therapy
(BBAT), the Alexander Technique, Tai Chi, The Principles
of Recovery and Developing coping strategies.
Future developments
 Promotion of IMPS service: Presentations; Revamped Leaflet; GP
mailing
 Continued development of an evidence based service: recovery
model and social inclusion; CBT and counselling; improved
physical and mental health goal setting
 Enhanced working between health and social care teams:
Intermediate Care Project; maintain close links with CNWL
Teams.
 Community Independence Service – 1st April 2014
How To Contact
 Telephone: 0207 854 4151
 Fax: 020 79318087
 Email: [email protected]
 Webpage: http://www.cnwl.nhs.uk/imps.html
 Address:
3rd Floor
190 Vauxhall Bridge Rd
London
SW1V 1DX