Best Practice When Engaging Hospitals & Community Mental Health Teams

1. Best Practice When Engaging Hospitals & Community Mental Health Teams Sophie Koehne and Steffan Desscan Advanced Mental Health Practitioners KHP Pathway Homeless Team - SLaM

2. Outline • Mental Health and Homelessness • Difficulties Accessing MH Services • 4 Levels of Mental Health Care • Points of Access to services • Onward Referrals • Working with Mental Health Services • KHP Pathway Homeless Team Model

3. Complex Health needs & Tri-morbidity Mental Health Substance Misuse > 60% history of substance misuse 70% reach criteria for personality disorder 4-5 times high rates of psychosis than housed population Physical Health >80% at least 1 health problem, 20% have more than 3 health problems

4. Homelessness Mental Health

5. Difficulties with accessing mental health services • Lack of holistic approaches • Lack of understanding of MH and Homelessness • Not knowing the full history • Busy/hurried clinicians • MH Gatekeeping • Knowing what to expect • Knowing where to start • Getting an assessment • Lack of early intervention before crisis point • Knowing when to access A&E • What are your rights and duties as carers

6. 4 Levels of Mental Health Care Hospital Admission Crisis Resolution Home Treatment Team (CRHTT) Community Mental Health Team (CMHT) General Practitioner (GP)

7. Points of access GP Non-urgent/Routine Main point of access to MH Services A&E In Crisis Out of hours emergency Police Causing a risk to themselves or others in a public place

8. Onward Referrals CMHT Needs specialist input GP IN CRISIS HTT/ CRT A&E Hospital Admission Police Place of Safety (s136)

9. Onward Referrals CMHT GP Low MH Risk Minimal MH risk HTT/ CRT Medium MH Risk A&E High MH Risk Hospital Admission Police Place of Safety (s136)

10. Onward Referrals CMHT GP Minimal MH Risk Low MH Risk HTT/ CRT A&E Medium MH Risk Physical Health risk Hospital Admission Police Place of Safety (s136) High MH Risk Chaotic/Violent

11. Onward Referrals CMHT GP HTT/ CRT A&E Hospital Admission Police Place of Safety (s136)

12. What you can do to aid access to services • Know your local services • Have a list of contacts – build a database • Support clients to attend appointments at GP / A&E • Write a letter outlining concerns to GP or CMHT • Knowing your client’s story…

13. What you can do to aid access to services • Knowing your client’s story: • What’s brought the client (and you) here (presenting issue)? • How has their behaviour changed (symptoms)? • How long have you noticed changes in behaviour (recent history)? • Has this happened before (history)? • What is normal behaviour for client (baseline)? • What’s caused this change (triggers/stresses)? • What’s worked well in the past (coping strategies)? • What are your concerns if left without specialist support (risks)? • Who is in their support network? • What do you think they need (care plan)?

14. Working with Services • Personalised Collaborative Care Plans • Risk – shared management • Holistic care - discuss strengths and goals • Know what can and can’t be communicated with and without consent (confidentiality) • Attend ward rounds/CPA (care planning meetings) with your clients to be involved in times of transfer of care • Regular communication with services involved with clients • Know your duties and limitations as carers • Manage your (and clients) expectations!

15. KHP Pathway Homeless Team Model • Prevent the revolving door • Improve hospital experience • Reduce unsafe discharges • Improve health and housing outcomes • Support to access scheduled care • Reduce bed days • Reduce readmission to hospital • Promote Inclusion Health approach

16. Multidisciplinary Approach Team focus on case formulation and action planning • GP- Holistic clinical review, advise support admitting team. • Housing Worker - specialist housing knowledge, rotations, advocacy at housing, knowledge of services • Advanced MHP – backgrounds of working with patients with complex mental health issues, knowledge of mental health services and formulation of plan for how the team will work with that patient and manage risk

17. Multidisciplinary Approach Flexible approach – Bridging the Gap • Interventions as an inpatient • Specialist knowledge and networks to support in patient wards • Support post discharge • Handover and support to community teams and services • What that means for the patients

18. Interventions Care Coordinator Advice Staff Training Advocacy Challenging practice Information gathering Frequent Attender Work Community Access Identifying ‘missing’ persons

19. Services we work with

20. What we achieved Spreadsheet data: 465 referrals and 237 seen and caseworked by team between Feb 2015-Dec 2017:

21. Summary • Mental Health is complicated. Mental Health services are even more complicated! • Being homeless or socially excluded adds further complexity! • Real role for homelessness professionals to advocate and educate for our client group • Multidisciplinary and multi-agency working is vital to support the needs of this client group

22. Multi-agency and Multidisciplinary KHPHomelessTeam@slam.nhs.uk

23. Any Questions??? Sophie Koehne – sophie.koehne@slam.nhs.uk Steffan Desscan – steffan.desscan@slam.nhs.uk Khphomelessteam@slam.nhs.uk