PRIMARY CARE MENTAL HEALTH by stU54o

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									SHOULD I STAY OR
 SHOULD I GO ?
        SUE ALTASS
 Sue.altass@hullpct.nhs.uk
    Tel; 01482 344082
    Primary Care Mental Health Workers
     Dept of Health chose this initiative to put more
      resources into PRIMARY care
     Three broad roles envisaged;
     1. Clinical

     2. Organisational work with primary care

     3. Wider liaison between primary care and
        other agencies including secondary care and
        voluntary agencies
      GRADUATE MENTAL HEALTH
            WORKERS
   Extended practitioner role, maintaining
    contact with patients newly prescribed
    anti-depressant medication.
   To increase compliance of medication
   Identify issues e.g side effects
   Explore and encourage use of facilitated
    self help information
   Increasing capacity in Primary Care
             Key priorities
Have a full range of effective
 interventions available:
   Available access to information including
    support groups
   Screening
   Watchful waiting
   Self help and Guided self help
   Short term psychological treatment
   CBT/CCBT
   Social prescribing
   Maintenance and Monitoring
                 FOR HULL ?
   Seven PCMHWs to cover Eastern & West
    Hull.
   Pilot study for twelve months.
   To work with Specific GP practices that
    have agreed to a shared protocol.
   The workers cover a population not
    attached to one practice.
   Evaluated after the initial twelve months
                FINANCE
   All employed as Band 4
   After completing training automatically
    went onto Band 5
   After at least 18months experience and
    extra training they would be eligible to
    apply for Band 6
   All received monthly clinical supervision
    and fortnightly peer group supervision
PRIMARY CARE                        GP               SPECIALIST CARE

                                  MATRIX +
                                   PHQ9


MENT AL HEALT H                                       MENTAL HEALT H
    M ild/Mo de rate                                    Se ve re & E n d uri ng
  S tep pe d Ca re 1 -3                                 S tep pe d Ca re 4 -5
          CB T                                                  A cu te
         CCB T                                              S ub A cute
           S TI




                                                       Psych olog ical
 COUNSEL LING
                                                         Services
                                                                P TS D
                                                          Asylu m S eeke rs
                           PRIMARY CARE MENT AL         P erso na lity Diso rde r
                              HEALT H SERVICE               Fam ily Issu es
     SOCIAL
    Mon ey/Fin an ce
    Ad vice/S up p ort       Primary Care Setting
        Dro p In                    Safety
       Vo lu ntar y
    No n-S tatu tory               Disp osal          CRISIS SERVICE
                                 Timeliness
                           Outcom e Managed (PHQ9)

  SELF-HELP                                               PSYPHER
   Ea ting Disor de rs
         Ph ob ias
         A n xie ty
      D ep ression
  "B etter with B oo ks"



                                                        ADDICT IONS
MENTAL HEALTH MATRIX
 Patient Presentation 1 :
Primary Care Mental Health
  Team
Patient Presentation 2 :
Primary Care Counselling Team
Patient Presentation 3 :
Specialist Mental Health Team
        2006-2007 moving
        on……………
To  develop career progression for
retention of staff
Offer a range of skills within a primary
care team
To influence job satisfaction by being
flexible and supportive
                                      PRIMARY CARE MENTAL HEALTH TEAM


                                             PRIMARY CARE MENTAL
                                                 HEALTH LEAD
                                                  SUE ALTASS

                                                                   TEAM LEADER
                                                                      (prisons)




         SENIOR PRIMARY CARE MENTAL HEALTH                                  WELL BEING NURSE
                      WORKER –                    ADMINISTRATOR.




     PCMH           PCMH      PCMH         PCMH          PCMH         PCMH         PCMH         PCMH
    WORKER         WORKER    WORKER       WORKER        WORKER       WORKER       WORKER       WORKER




ADVICE & SUPPORT
    WORKER
        SERVICE SPECIFICATION

   Primary care service offered in GPs
    surgeries
   Use of Primary Health Care Questionnaire
    (PHQ9) as a referral from GPs
   Staff and GPs determined the service
    offered
   Partnership working with other agencies
    What does it involve ?
   NOT ;                IT IS ;
     To replace            A sign posting

      counselling            service to involve
                             other agencies
     A screening
                            Brief psychological
      service                intervention
     A shortcut to         Tele-
      secondary              communication for
      services               support and pro-
                             active focus
     A stand alone
                            Guided self-help
      service
 Questions
………………
           NICE Stepped
               Care
Step   Who ?               What is the      What do they do
                           focus
Five   Inpatient team,     Risk to life,    Medication,
       Crisis team         severe self      combined
                           neglect          treatments
Four   Mental Health       Treatment        Meds. Complex
       Specialists         resistance &     interventions,
                           frequent         combined
                           recurrences      treatments
Thre Primary Care          Moderate or      Meds,
e    Primary Care Mental   severe           psychological
     Health Workers                         intervention,
                                            social support
Two    Primary Care        Mild Depression Guided self help,
                                           brief
                                           psychological
                   20
                        40
                             60
                                  80




               0
 Depress ion
     Mixed
   Anxiety /
    Anxiety
    Disorder
      Other

       Grief
Relationship
  Problem
       Work
      Stress
 Post Natal
 Depress ion
      PTSD
                                                                  Referrals




  Self Harm
                                       Main Reason for Referral




 Addictions

      Anger
    Eating
   Distress
   Physical
    Abuse
     (blank)
          Data Collected
                      Attendance Outcomes

80


60


40


20


0
     Seen Face Did Not Opt   Seen      Not Yet   DNA   Cancelled
      To Face       In     Telephone    Seen
      Looking to the
         Future
   Agreed PCT strategy for Primary care Mental
    Health Services.Implementation of stepped
    care models and nice guidelines.
   Working towards and agreeing enhanced
    services for depression contract.
   Kite marking of support services?
   Support and supervision strategy
   Access, choice and reduction in waiting
    times.
   Career Pathway.
   Training for staff.
   Nice Guidelines
 PrimaryCare organisations should
 consider establishing multifaceted
 care programmes that integrate-
 through clearly specified
 protocols-the delivery and
 monitoring of appropriate
 psychological and
 pharmacological interventions for

								
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