ENGLISH CASE STUDY Birmingham. Prof. Mervyn Morris Birmingham City University EH MApresentation 10 th December 2010
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1 ENGLISH CASE STUDY Birmingham Prof. Mervyn Morris Birmingham City University EH MApresentation 10 th December 2010
2 Part of West Midlands region services
3 Birmingham and Solihull
4 Mental Health Service reform NHS National Service Framework for Mental Health(1999) A template for redesign of failing community mental health services. The document specifically recommended (and the National Plan, 2002 then funded) Home Treatment and Assertive Outreach teams, both pioneered as system-wide services in Birmingham.
5 Equity Mental Health Service reform Evidence (NICE) Empowerment (Recovery)
6 De-institutionalisation : Birmingham Beds: 722 (pop.1.2 million) BED TYPE n Comments Acute sites across City and Solihull 17 units, 6-16 beds per unit Includes 2 Intensive Care Units Separate Male and Female Longer Stay 112 Hospital type facilities Forensic 152 REGIONAL medium secure Speciality 30 REGIONAL Deaf (12), Eating Disorder (10) Mother and Baby (8) Older Adults years
7 PRIMARY CARE Birmingham Adult Core Services COMMUNITY MENTAL HEALTH Primary Care Continuing Need: Liaison Rehab and Recovery HOME TREATMENT CONTINUING NEED ASSERTIVE OUTREACH Residential based care: Hospital Beds, Day services, Crisis Homes
8 CORE ADULT SERVICE S CASELOAD/ Size/ Time VISITING Availability/ Frequency INTENSITY How long/where CMHT: Primary Care Liaison & 1:30 Up to 6 months working week Weekly Monthly Clinic or Home Therapeutic Session Up to 1 hour Rehabilitation/ Recovery 1:25 Years (ALAN) Working week Weekly - Fortnightly Activity based Home or community Assertive Outreach 1:12 Years (ALAN) days Daily-Weekly Minutes to Hours Home or Community Crisis/ Home Treatment 1:2 Up to 3 months 24 hours, 7days Multiple Daily 3 times per week Minutes to hours, as required Home or Community
9 PRIMARY CARE Health System Interfaces Primary Care interface COMMUNITY MENTAL HEALTH Primary Care Continuing Need: Liaison Rehab and Recovery HOME TREATMENT CONTINUING NEED ASSERTIVE OUTREACH Residential based care: Hospital Beds, Day services, Crisis Homes, Hospital interface
10 PRIMARY CARE IAPT Services COMMUNITY MENTAL HEALTH Primary Care Continuing Need: Liaison Rehab and Recovery HOME TREATMENT CONTINUING NEED ASSERTIVE OUTREACH Residential based care: Hospital Beds, Day services, Crisis Homes Acute Care pathway
11 PRIMARY CARE Locally Enhanced Service COMMUNITY MENTAL HEALTH Primary Care Continuing Need: Liaison Rehab and Recovery HOME TREATMENT CONTINUING NEED ASSERTIVE OUTREACH Residential based care: Hospital Beds, Day services, Crisis Homes Continuing Care Pathway
12 PRIMARY CARE Birmingham Adult Services 2010 COMMUNITY MENTAL HEALTH Primary Care Continuing Need: Liaison Rehab and Recovery EARLY INTERVENTION SERVICE HOME TREATMENT CONTINUING NEED ASSERTIVE OUTREACH Residential based care: Hospital Beds, Day services, Crisis Houses,
13 LIAISON SERVICES SOCIAL CARE DRUG & ALCOHOL SERVICES OTHER ADULT SERVICES PRIMARY CARE COMMUNITY MENTAL HEALTH Primary Care Continuing Need: Liaison Rehab and Recovery HOME TREATMENT CONTINUING NEED ASSERTIVE OUTREACH Residential based care: Hospital Beds, Day services, Crisis Homes
14 What made community services work? An integrated service pathway Effective boundary management between teams system of gateways and filters Integration with social care housing, employment, benefits and 3 rd Sector Teams with competent team managers Preparation and learning as we go Data targets and monitoring Continue to innovate and adapt
15 Gaps/ issues/areas for development Transition from child to adult services Biological v Social models: i.e. EVIDENCE!! (families, work) Fidelity (e.g. CRHT) CMHT s function Shifting/ diversifying provision Effective commissioning/ contracting
16 Thank you
17 Pre-conditions for transformation A vision.. Being ready.. Evidence of effective community models Service user and carer support Existing competence amongst staff in independent community practice An opportunity e.g. psychiatric hospital that needs to close Courage
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