1 CHATHAM KENT HEALTH ALLIANCE INPATIENT MENTAL HEALTH Becky Elgie RN CPMHN Clinical Manager Mental Health and Addictions Program Deb Watterworth BA, MRSC candidate Mental Health Rehabilitation Specialist
2 PRESENTATION OUTLINE Why did we change? What were the needs? Our goal Why a recovery approach? The program objectives What the program looks like Preliminary findings Next steps & Lessons learned
3 WHY CHANGE? Although the importance of general hospital psychiatric units has been recognized as an integral component of service delivery to the mentally ill, there is growing awareness of the need to rethink key functions and mechanisms, or reconsider models to better link facility and community based care (Standing Senate Committee on Social Affairs, Science and Technology, 2004; Glick, Sharfstein & Schwartz, 2011)
4 WHY CHANGE? The shift to a recovery framework as recommended by the first Canadian Strategy on Mental Health, Changing Directions, Changing Lives (2012) requires an expansion of services to include recovery based plans and a focus on community inclusion.
5 A2 NEEDS Lack of co-ordination and no consistency with offering inpatient programs Patient satisfaction is low. Complaints of boredom No formal means of family support or education Length of stay is long for complex cases
6 NEEDS ASSESSMENT SURVEY Inpatient Staff and Community Providers Identified the following barriers for patients : Lack of knowledge about community services The transition from hospital to community Patients not retaining information from hospital Lack of communication and respect between community providers and hospital staff
7 NEEDS ASSESSMENT SURVEY Barriers Housing Poverty Lack of community and family support/acceptance Lack of patients belief in their own ability to recover Skill deficits Discharge process is problematic
8 COMMUNITY TRANSITION- RESEARCH Community providers and inpatient staff both indicate the discharge and transition period to be problematic Period following discharge is stressful Characterized by loneliness, fear of relapse and lack of support (Nolan, Bradley & Brimblecomb, 2011;Durbin, Line, Layne & Teed, 2007). 30 day period immediately after discharge is period of high risk (Durbin et al., 2007)
9 COMMUNITY TRANSITION- THE RESEARCH 2 Risk of Suicide 43% of suicides occur within 3 months of discharge, with a heightened risk period in the first 5 days following discharge (Harkavy-Friedman et al. 1999). The risk of suicide peaks immediately after discharge and is particularly high with those having a short admission (Qin & Nordentoft, 2005)
10 I went from a controlled environment and then it felt like I was thrown to the wolves. There is just not enough follow up. Former patient
11 OUR GOAL Implement a rehabilitation program based on the principles of recovery that facilitates improved transitions for patients and promotes community integration. And Provide the tools to foster patient self management
12 WHY A RECOVERY APPROACH? Opportunity to introduce patients to recovery at time of crisis Not discipline specific Consistent with patient-centred care Empowering to our patients Holistic approach to care Evidence based practice Transitions well to community approach Promotes community inclusion
13 THE BENEFITS OF INPATIENT REHABILITATION Offering inpatient rehabilitation services in conjunction with treatment a more holistic approach increases the supports that patients receive at a critical time maximizing their opportunities for recovery. Rehabilitation programs focused on community re-entry have demonstrated positive results including improvement in symptoms, social recovery and follow through with after care (Kopelowicz, Wallace & Zarate, 1998; Mann,. et al., 1993; Kopelowiz & Liberman,2002)
14 PROGRAM OBJECTIVES Providing holistic individualized assessment and comprehensive inpatient groups that are recovery focused and facilitate community re-entry. Partnering with service providers to achieve continuity of care through post discharge goal planning, conferencing, and transitional discharge services that provide enhanced supports at discharge.
15 PROGRAM OBJECTIVES 2 Providing patients with tools such as recovery binders, and wellness kits to assist in the patient s ability to self manage their illness. To connect rather then simply refer patients to community resources during their stay in hospital to increase the likelihood of follow though after discharge. To provide a climate of hope and recovery for inpatients to foster their belief in their own abilities.
16 PROGRAM OBJECTIVES 3 To provide support to families by providing educational manuals and support with social work To provide community follow up 3 months after discharge to encourage patient accountability of discharge goals and to provide an evaluation of program needs
17 THE INPATIENT REHAB PROGRAM Psycho-educational Groups Recovery and Hope Self Management Relapse Prevention & Crisis Planning Coping, Relaxation Problem Solving Wellness education Mind & Mood connection Medication and its role in recovery Substance use
18 Psycho educational groups Leisure planning Social Skills Spirituality, Self Esteem, Self Identity
19 Psycho-educational Groups Health & Self Care Smoking cessation (+ individual coaching) Diet & Nutrition Exercise Sleep Hygiene Lifeskills Budgeting Cooking Decision making
20 INPATIENT REHAB PROGRAM ADDITIONAL INTERVENTIONS Family Support & Education Individualized Strengths based assessments Transitional Support Program Connections to Community Resources 3 month follow up
21 INPATIENT REHAB PROGRAM OTHER INTERVENTIONS CONT D Individual skills teaching and counselling Referrals to & Discharge conferences with community service providers Recovery binders and Wellness tools Peer recovery Stories
22 PRELIMINARY FINDINGS Improvement in Recovery Star Assessment by patient at 3 month follow up Completed both N= % mean increase mean # domains improved = 6.25
23 For me this was very good to see it on paper- it connects with my brain. All the things seem abstract but Recovery Star makes it more tangible and visual and easier to measure This showed my progress. Without doing this I would not have sat down and thought about this.
25 TRANSITIONAL SUPPORT Started in May patients referred in All followed thru with service & attended outpatient appts No readmits during transition period
26 OTHER FINDINGS NRC PICKER Improvement in patient satisfaction Mean 95% = 6% increase Were You Given Reassurance and Support About Your Ability to Recover? 16% increase SMOKING CESSATION 5 referrals to smoker s helpline referral program 2 followed through and 1 quit smoking 1 referral at 3 month follow up Informal feedback from FHT s
27 Patient letter The classes (as I like to call them) taught me more during my stay than I have received in the past 20 years...also, the Recovery Binder was a very welcome tool. I appreciated being able to constructively organize all the handouts for future reference when I was home. It helped greatly to organize my thoughts. I had never done anything like this before.
28 NEXT STEPS Nursing staff training in Recovery Formation of a Recovery leadership committee to guide Recovery process on the unit Increased peer role- volunteer, recovery story Explore ways to further meet needs of concurrent patients & other hard to serve Research- quantitative pre-post with 3 recovery measures
29 Lessons Learned Biomedical model can be moved to a recovery model- it is work Acute care is the perfect place to start an introduction to recovery Need a physician to champion it as well Staff attitude can be affected by seeing the positive results of the program.
30 ANY QUESTIONS?
31 References Dickens, G., Weleminsky, J., Onifade, Y., Sugarman, P. (2012) Recovery Star: validating user recovery, The Psychiatrist, 36, Corrigan, P; Salzer, M., Ralph, R., Sangster, Y. & Keck, L. (2004). Examining the factor structure of the recovery assessment scale. Schizophrenia Bulletin, 30 (4), Durbin, J., Lin, E., Layne, C., & Teed, M. (2007). Is readmission a valid indicator of the quality of inpatient psychiatric care? Journal of Behavioral Services and Research, 34 (2), Harkavay- Friedman, J., Restifo, K., Malispina, D., Kaufmann, C., Amador, X., Yale, S., & Gorman, J.( 1999). Suicidal behaviour in Schizophrenia: characteristics of individuals who had and had not attempted suicide. American Journal of Psychiatry, 156, Le Boutillier, C., Leamy, M., Bird, V. J., Davidson, L., Williams, J., & Slade, M. (2011). What does recovery mean in practice? A qualitative analysis of international recovery-oriented practice guidance. Psychiatric Services (Washington, D.C.), 62(12), Links, P., Nisenbaum, R., Ambreen, M., Balderson, K., Bergmans, Y., Eynan, R.,... Cutcliffe, J. (2012). Prospective study of risk factors for increased suicide ideation and behavior following recent discharge. General Hospital Psychiatry, 34(1), doi: /j.genhosppsych McNaut, M., Caputi, P., Oades, L., & Deane, F. (2007). Testing the validity of the recovery assessment scale using an Australian sample. Australian and New Zealand Journal of Psychiatry, 41 (5), Minister s Advisory Group. (December 2010) Respect, Recovery, Resilience: Recommendations for Ontario s Mental Health and Addictions Strategy-Report to the Minister of Health and Long-Term Care on the 10-Year Mental Health and Addictions Strategy. Toronto Ontario. Retrieved from :(http://www.health.gov.on.ca/en/public/publications/ministry_reports/mental_health/mentalhealth_rep.pdf) Mental Health Commission of Canada. (2012). Changing directions, changing lives: The mental mealth strategy for Canada. Calgary, AB Author Nolan, P., Bradley, E., & Brimblecomb, E. (2011). Disengaging from acute inpatient psychiatric care: a description of service users experiences and views. Journal of Psychiatric and Mental Health Nursing, 18,
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