Equality Impact Assessment of A person-centred approach to improving the quality of intensive psychiatric (IPCU) care in Scotland.

Transcription

1 Equality Impact Assessment of A person-centred approach to improving the quality of intensive psychiatric (IPCU) care in Scotland. Section 1: Ownership and background 1.1 Title A person-centred approach to improving the quality of intensive psychiatric care unit (IPCU) care in Scotland 1.2 Start date 19 February Publication date: June Owner Jane Byrne, Programme Manager 1.5 Directorate/unit/committee/group: Performance Assessment 1.6 Related Programme of work: Mental Health 1.7 Type of work being assessed: Output Section 2: Involvement and impact 2.1 Aims of the output: This project set out to discover what it is like to experience care in an intensive psychiatric care unit (IPCU) in Scotland from the perspective of service users and their carers. This developed as an additional work stream within the main national audit of intensive psychiatric care provision. The project sought to explore service provision from a holistic perspective, mapping the demographics of national service user provision alongside experiences from service user and carers in one project. It delivered a range of key messages to support the development of a range of national and local improvement plans. It adopted a robust and comprehensive method of involving people with current or lived experience of IPCU care and their carers throughout the process, tailored to the diverse needs of this broad group of individuals. This project set out to add valuable data and key evidence to the sparse existing knowledge of what it is like to experience IPCU services in Scotland from service users and their carers. This work will provide a benchmark from which improvement Produced by: Public Involvement Page 1 of 9 Review date: None

2 in quality of services can be driven by local NHS boards and will add to the equality data available for this population of NHS service users. This project explored issues of equality and inclusion for people who use/have used IPCU services and placed the service user at the very heart of what it delivered. 2.2 Stakeholders: A range of key stakeholders have been identified. These include: 1 any individual who is admitted to an IPCU, their carer(s) and family. 2 any individual with lived experience of mental health difficulties and associated IPCU admission, their carer(s) and family. 3 The Scottish Government Health Directorates 4 All territorial NHS boards 5 Mental Welfare Commission for Scotland 6 VOX Scotland 7 Voluntary/advocacy organisations supporting individuals and families living with mental health difficulties. Produced by: Public Involvement Page 2 of 9 Review date: None

3 2.3 Evidence of potential impact (from existing NHS QIS documentation, research, consultation or literature search): From a review of the available literature and consultation with mental health teams across Scotland, we found that IPCUS provide care almost exclusively for compulsorily detained patients in secure conditions. Varying degrees of restrictions are applied as deemed necessary and proportionate to ensure the safe and therapeutic treatment of patients, and the management of clinical risk to self and others. Admission to an IPCU is usually a time-limited, short episode of care focusing on the management of acute mental health and behavioural disturbance. In reality, some people remain in IPCUs for longer than the time necessitated by clinical need. IPCUs in Scotland accommodate a diverse client group between the ages of By virtue of the stage that people are at in terms of their mental illness, IPCUs often have to provide care for people who present with a range of very complex and challenging needs. Most IPCUs stipulate that people should be detained under an appropriate section of the Mental Health Act to be considered for admission. In order to provide best care and treatment, exclusion criteria include: young people, under the age of 16; people with learning disabilities; people with dementia; people with substance misuse problems in the absence of serious mental disorder; and people whose physical condition is too frail to allow their safe management in an IPCU. A service profiling exercise was completed prior to this project to enhance the available data regarding service provision. There are 14 territorial NHS boards across Scotland, eight of which have local IPCU provision. Some NHS board areas have more than one unit; the total number of IPCUs across Scotland is 14. Of the six NHS boards that do not have local IPCU provision, three have a formal service level agreement with another NHS board for provision of IPCU care. For other NHS boards where no service level agreement exists, IPCU beds are sought in other NHS board areas on a case-by-case basis as the need arises. A total of 147 IPCU beds were available in Scotland at the time of this exercise, equating to 43 beds per million of the adult (18-64) population. Limited up-to-date statistical data is available on the characteristics and demographics of the people with mental health difficulties who access IPCU care in Scotland or in the UK. Little is known about the true proportions of the various equality groups and their cross-cutting strands within this population. A retrospective study has highlighted the increased prevalence of younger, Caucasian men with criminal convictions in IPCU care in the UK (Brown et al 2004). A census exercise completed as part of the service profiling exercise which Produced by: Public Involvement Page 3 of 9 Review date: None

4 preceded this project produced a national snapshot of the IPCU patient population on a given day in November 2009 (NHS QIS, 2010). At this time, 116 (79%) IPCU beds in Scotland were occupied. Of the 116 individuals, 76% were men and 24% were women. The most heavily populated age group was 31-50, followed closely by and then % of the 116 patients were single. 95% were listed as unemployed and a further 21% were classified as homeless. 88% of the 116 individuals were listed as white Scottish. 5 were listed as white British, 3 African, and 1 listed as other ethnic group. 82% of patients for whom detention status was provided were recorded as being in an IPCU on a civil detention at the time of the census exercise; 17% on a criminal detention. This information provided important equality data and indicators of potential impact to plan an inclusive, accessible and robust involvement strategy. No existing data is available on patient s experiences of IPCU service provision in Scotland. Scotland s national patient experience programme, Better Together, provided an excellent benchmark of patient experience of NHS inpatient and GP care using a range of tried and tested methods to collect, interpret and evaluate this. People with mental health difficulties receiving current IPCU care were not included in the inpatient survey. No information exists on the impact of the various equality strands on the patient experience of IPCU care. References Brown, S. Bass, N. The psychiatric intensive care unit (PICU): patient characteristics, treatment and outcome. Journal of Mental Health, December 2004; 13 (6): p NHS Quality Improvement Scotland Intensive Psychiatric Care s: Overview Report June Produced by: Public Involvement Page 4 of 9 Review date: None

5 2.4 Areas where evidence is unavailable or unclear: There is very little published Scottish or UK data about IPCUs. Our work sought to build on the available data set regarding service provision and identify what it is like to experience an IPCU first-hand from current and past service users, their carer(s) and families. Our work has enhanced the information available and provides useful baseline data on the national picture with regard to patient experience of IPCU service provision. We have produced a range of key national and local improvement messages based on this. This data should be used as the focus of future service improvement work Produced by: Public Involvement Page 5 of 9 Review date: None

6 Section 3: Checklist 3.1 We have checked the following protected characteristics, as a legal obligation: Positive Impact identified Negative impact identified Age YES NONE Additional information Disability YES NONE Gender YES NONE Gender Reassignment NO NONE Pregnancy or Maternity NO NONE Race YES NONE Religion or Belief YES NONE Sexual Orientation YES NONE In accordance with NHS QIS policy we have also checked the following characteristics: Criminal Justice YES NONE Homelessness YES NONE Language or social origin NO NONE Marriage or Civil Partnership YES NONE Mental Health YES NONE Poverty YES NONE 3.2 This output promotes or improves equality by: This output promoted and improved equality in a number of identifiable ways. The project offered a unique opportunity for people with current and lived experience of IPCU care to have their experiences of care heard to inform local and national improvement priorities. A robust methodology was adopted to identify, involve and support people to take part from across the various equality groups. This work promoted equal rights for people with mental health difficulties, ensured full support for everyone who wanted to take part and added valuable evidence to the existing knowledge base of patient experiences of IPC services in Scotland. NHS QIS worked in close partnership with the Mental Welfare Commission (MWC) and Voices of Experience Scotland (VOX) to deliver this project. The MWC is an independent organisation working to safeguard the rights and welfare of Produced by: Public Involvement Page 6 of 9 Review date: None

7 everyone with a mental illness, learning disability or other mental disorder. VOX Scotland is a mental health, service user lead charitable organisation. The project team wanted input from as wide a range of people with current lived experience of IPCU care as possible from across Scotland, regardless of whether there is local IPCU provision where they live. The support of these two organisations meant that the project could utilise their capacity to capture a range of service user and carer experiences from across the equality groups and offer the sensitivity, support and past experience to engage effectively with this previously hard to reach population. The MWC supported patient involvement for those individuals currently in IPCU care. VOX Scotland was tasked with gathering service user and carer experience from individuals with lived experience of IPCU care in the form of focus group sessions. A total of 80 people were involved in the project including people who were currently in an IPCU (n=50), service users (n=21) and carers (n=9). 11 IPCUs were visited across Scotland, including those that admit patients from a wider area than the hospital catchment and from other NHS boards. Only 144 IPCU beds exist in Scotland, meaning that at least 35% of the current IPCU inpatient population were involved in this project. 11 focus groups session were held in all mainland NHS board areas, including two areas where there is no local provision.. The project specifically ensured that the harder to reach groups within the IPCU population were identified and involved. These include women, those from minority ethnic backgrounds, people with an assigned legal status to their IPCU stay (for example criminal or civil detention) and people transferred in from other hospitals or NHS board areas. Representation was even across gender groups and the age range (16-65) for whom IPCU provision is available in Scotland. The project placed specific focus on ensuring than the various equality groups within the IPCU population were identified and involved, whilst respecting people s rights to take part on an opt-in basis. To achieve this, the project team ensured that a comprehensive communication strategy was developed and ensured that regular contact was sustained with its stakeholders from the health and voluntary sectors. The project team encouraged dissemination of this information within local networks to ensure that relevant staff, service users and carers were made aware of the forthcoming work in advance. The project offered alternative versions of the materials in hard copy format available on request and provided a link to the main NHS QIS website for those wishing to find out more information. Quick reference sheets, promotional posters and leaflets were made available to support staff to promote fair and equitable inclusion of as many IPCU service users and carers as possible from all equality groups. Staff were encouraged to inform service users of Produced by: Public Involvement Page 7 of 9 Review date: None

8 the forthcoming work and offer opportunity to read the accompanying material, why and the letter to service users and carers on the purpose of the project. NHS QIS collaboration with MWC and VOX Scotland allowed for two different approaches to capture first hand experiences of service users and carer. This allowed the project to fully address the support needs of the individuals in a number of ways and promote equality across all the identifiable groups. The MWC supported people to participate by: 1) giving participants information in advance of the visit to allow them time to think about taking part. 2) Making a free phone telephone number available in case of any questions. 3) Assuring individuals that any concerns about their care and/or treatment would be followed up appropriately by the MWC 4) Providing assurance that their feedback would be anonymous and nothing would be attributable to them in the final report. 5) Offering one to one semi-structured interview sessions to express views in a sensitive and private manner 6) Adopting a flexible and responsive interview style to promote participation and sharing of views. 7) Offering opportunity for an informal carer or advocate to join them for the interview session 8) Making the interview schedule available in advance to those who wanted it 9) Offering interpreting and communication support as required. VOX Scotland supported former IPCU patients and carers to participate by: 1) Holding the focus groups in all of the mainland NHS board areas and in nonhospital settings 2) Using a service user researcher with lived experience to facilitate to groups 3) Using creative methods e.g. inviting people to bring along written material or artwork, to help participants reflect on how they felt at the time 4) Assuring participants that their feedback would be anonymised and nothing would be attributable to them in the final report 5) Reimbursing all expenses incurred by the participants. 6) Offering interpreting and communication support as required. Produced by: Public Involvement Page 8 of 9 Review date: None

9 Limited equality data exists for the population of individuals who access IPCU care on a national and international level. This project will add to the literature available and support identification of differential impacts on the various equality groups in Scotland. From the literature available and consultation with colleagues working in the mental health field in NHS Scotland, all known equality gaps were identified and addressed in the project. The emergence of future equality data will support us to evaluate and develop our work, identify gaps in our involvement process and address them accordingly 3.3 A full Equality Impact Assessment is not required. This has been agreed because: The completed project successfully captured the experiences of service users and carers at different stages in their journeys. This has offered NHS QIS a wide perspective on what it is like to experience an IPCU for both service users and carers. This works complements the previous work of this project in profiling IPCU service provision and gathering census data on the services available from the perspective of NHS boards. The project adopted a person-centred approach to involving people with experience of IPCU care and gave people opportunity to have a voice regardless of the extent of their mental illness or stage of recovery. It adopted a robust and inclusive involvement strategy to ensure that the key equality groups were targeted in this previously hard to reach population. The work has added valuable data to the existing knowledge base of IPCUs and patient experience in Scotland. This project delivered measurable outcomes based on areas of differential healthcare experience of IPCU service in Scotland and identified recommended areas of improvement based on the involvement of service users and carers. 3.4 Assessors: Fiona Campbell, PFPI Officer, NHS QIS. Jane Byrne, Programme Manager, NHS QIS. Date of Assessment: 25 th February Quality Assurance (E&D Officer): Jeniffer Kibagendi Date of Quality Assurance: 10 th March 2011 Produced by: Public Involvement Page 9 of 9 Review date: None