Intensive Psychiatric Care Units

Transcription

1 NHS Greater Glasgow and Clyde Stobhill Hospital, Glasgow Intensive Psychiatric Care Units Service Profile Exercise ~ November 009

2 NHS Quality Improvement Scotland (NHS QIS) is committed to equality and diversity. We have assessed the performance assessment function for likely impact on the six equality groups defined by age, disability, gender, race, religion/belief and sexual orientation. For this equality and diversity impact assessment, please see our website ( The full report in electronic or paper form is available on request from the NHS QIS Equality and Diversity Officer. NHS Quality Improvement Scotland 009 First published November 009 You can copy or reproduce the information in this document for use within NHSScotland and for educational purposes. You must not make a profit using information in this document. Commercial organisations must get our written permission before reproducing this document. Information contained in this report has been supplied by the NHS board concerned, unless otherwise stated, and is believed to be reliable on publication. =

3 Contents Background 1 1 Overview of local mental health services 3 Intensive psychiatric care unit provision 4.1 Admission to IPCU 4. Model of care provision 4.3 Discharge from IPCU 5 3 Demographics Numbers of IPCU admissions 6 3. Nature of admissions Management of other population groups 7 4 Links with other secure mental health provision 7 5 Governance arrangements 7 6 Plans for service development 7 7 Other points to note 8 Appendix 1 Glossary of abbreviations 9 = =

4 Background The Scottish Government s national mental health benchmarking project (January 008) defined intensive psychiatric care units (IPCUs) as: a multi-disciplinary team with specialised training; the ratio of nursing staff will be higher than a general psychiatric ward. The service is recovery focused; it provides intensive treatment and interventions to patients who present an increased level of clinical risk and require an increased level of observation. (Technical Appendix, January 008). The National Mental Health Services Assessment: Towards implementation of the Mental Health (Care and Treatment) (Scotland) Act 003 (March 004) Report highlighted specific challenges faced by IPCUs in light of changes in mental health legislation. In particular, the report outlines the dual function often ascribed to IPCUs where they function as both a low level secure forensic unit and as an extension of general adult inpatient psychiatric services. This is further complicated by the need for appropriate care environments for females, adolescents, older adults and those with learning disabilities. The report concludes that IPCU provision is a small but important part of services and should remain central to planning decisions when implementing the [Mental Health (Care and Treatment) (Scotland)] Act. Introduction to the IPCU project There is very little published UK data about IPCUs. The NHS Quality Improvement Scotland (NHS QIS) 3-year strategic work programme, Improving the Quality of Mental Health Services, recognised this and included a commitment to undertake an audit of IPCUs in Scotland. Before undertaking any work to assess how services are delivered within IPCUs, it is important that we have a clear picture of: how many IPCUs there are across Scotland the arrangements in place in NHS board areas that do not have local IPCU provision how the IPCUs are structured and staffed the relationships between IPCUs and other mental health services, and the referral pathways both in and out of IPCUs. In order to gather this background information it was agreed that the IPCU project would be delivered in two distinct stages. Stage 1 is a national service profiling exercise covering all of the territorial NHS boards in Scotland. In a parallel piece of work during Stage 1, the views and experiences of people who have received IPCU care and their informal carers will be sought. This work is being supported by Better Together, Scotland s national patient experience programme and is being delivered in collaboration with the Mental Welfare Commission for Scotland. 1

5 This report contains the service profiling information. The user and carer experience information will be included in a national overview report alongside the service profile information. The national overview will be published in spring 010 and will give a full representation of the national picture from both the perspective of those who provide services, and those who use them. The service profiling findings along with the views and ideas of service providers and service users and carers that have been sought and captured during Stage 1 of the project will inform the detail of Stage. The service profiling process has two key parts: local information gathering and follow-up meetings. Using a service profiling questionnaire produced by NHS QIS, each NHS board gathered information on the IPCUs in its local area. These data were submitted, together with supporting evidence if applicable, to NHS QIS prior to the follow-up meetings. Follow-up meetings were held with local staff between May July 009 to discuss the responses provided by the NHS board and seek clarification on any issues. This report presents the information supplied in the service profile form and the discussions at the follow-up meeting with NHS Greater Glasgow and Clyde on 1 May 009.

6 1 Overview of local mental health services Greater Glasgow and Clyde is a relatively compact region with a densely populated urban core and is situated in west central Scotland with a population of around 1,19, 419. As part of the redesign of its adult mental health services, NHS Greater Glasgow and Clyde has established a mental health partnership to oversee and co-ordinate services across the NHS board area. The partnership is a coalition of six community health and care partnerships (CHCPs) which involve joint management arrangements with Glasgow City Council (five CHCPs) and East Renfrewshire Council to provide integrated healthcare and social services to local communities. There are also four community health partnerships (CHPs) where services are managed with local authority partners in East Dunbartonshire, West Dunbartonshire, Inverclyde and Renfrewshire. The NHS board is also a minor partner in both the North Lanarkshire CHP and the South Lanarkshire CHP. NHS Greater Glasgow and Clyde is also responsible for partnerships for addictions, learning disability and homelessness. As with adult mental health, these specialist partnerships oversee services for their respective client groups which ensure a uniform approach to planning and delivery. Adult mental health acute, rehabilitation and secure inpatient services are provided as follows. NHS Greater Glasgow and Clyde Dykebar Hospital, Paisley Number of beds Acute mental health admissions 45 IPCU Arran Ward 8 Low secure forensic learning disability 8 Mental health elderly care inpatient beds 6 Mental health rehabilitation inpatient beds 0 Gartnavel Royal Hospital, Glasgow Number of beds Acute mental health admissions (adults) 60 IPCU 1 Acute mental health admissions (older adults) 5 Mental health rehabilitation inpatient beds 30 Leverndale Hospital, Glasgow Number of beds Acute mental health admissions beds (adult including beds at southern general) 88 mental health elderly care inpatient beds 58 mental health rehabilitation - inpatient beds 14 IPCU 1 Low secure forensic learning disability 8 Low secure forensic rehabilitation 41 Parkhead Hospital, Glasgow Number of beds Acute mental health admissions 7 Acute mental health admissions (older adults functional illness) 16 Acute mental health admissions (older adults organic illness) 1 Mental health rehabilitation 8 3

7 NHS Greater Glasgow and Clyde (continued) Rowanbank Clinic, Glasgow Number of beds Medium secure mental health care 74 Stobhill Hospital, Glasgow Number of beds Acute mental health admissions 60 IPCU 1 Intensive psychiatric care unit provision NHS Greater Glasgow and Clyde has four IPCUs. They are located within Dykebar Hospital, Gartnavel Royal Hospital, Leverndale Hospital and Stobhill Hospital. This report will cover IPCU provision at Portree Ward, Stobhill Hospital only. Separate reports will be prepared for each of the remaining IPCUs. Stobhill Hospital covers the north Glasgow and east Glasgow CHCPs, east Dumbartonshire CHP and also part of the north Lanarkshire CHP. The IPCU at Stobhill Hospital has a total of 1 inpatient beds. There are also three 0-bedded acute mental health wards on the Stobhill Hospital site. A new child and adolescent mental health service (CAMHS) inpatient unit, Skye Ward, comprising of three eight-bedded wards is due to open by the end of 009. The IPCU works closely with local community mental health teams (CMHTs) across the region in order to effectively manage and monitor a large number of patients with severe and enduring mental illness and many with complex needs and co-morbidities..1 Admission to IPCU The IPCU accepts both male and female patients over the age of 18. Admission must be agreed by the consultant psychiatrist and the nurse in charge. A set of admission criteria is in place to regulate these admissions. Among these criteria is the premise that there must be mutual agreement between the referrer and the IPCU on the positive therapeutic benefits to be gained from the time-limited admission including a clear rationale for assessment and treatment. Referrals will not be accepted without prior discussion and agreement. A clinical operational standards document is currently being developed by NHS Greater Glasgow and Clyde that will assist decision-making regarding admission into the IPCU. Local guidance is currently available which has been developed using the Department of Health (England) National Minimum Standards for Psychiatric Intensive Care Units (PICUs) and low secure units.. Model of care provision The IPCU employs a consultant-led model with multidisciplinary team input encompassing both inpatient and community-based services. There is dedicated consultant psychiatrist input to the IPCU supplemented by a 4

8 dedicated staff grade doctor. The consultant has responsible medical officer and approved medical practitioner responsibility for the majority of patients. There is dedicated occupational therapy (OT) input to the IPCU. The occupation therapists co-ordinate the group activities timetable and one-to-one sessions with patients. There are additional life-skills programmes available to patients including creative and recovery-focused groups. Mental health officer and social work input is provided on a locality basis through community psychiatric nurses based at a local resource centre. There is pharmacy input into case reviews and the pharmacist would also attend the kardex meetings which take place once per week. There is no dedicated psychology input in the IPCU, although some of the nursing staff have undertaken psychological therapy training in cognitive behavioural therapy (CBT). Access to a physiotherapist, based on the Stobhill Hospital site, is available by referral. The involvement of carers and relatives is encouraged and is arranged on a case-by-case basis. Representatives from a range of staff groups including the discharge and resettlement team (DART), crisis team and family are all invited to be present at multidisciplinary team meetings prior to discharge. Access to advocacy services is available through locality services and is accessed by referral only. IPCU staffing profile in Stobhill Hospital Medical Nursing Allied health professionals Consultant psychiatrist Staff grade psychiatrist FY (junior doctor) 9 WTE registered and unregistered: Band 7 Band 6 Band 5 Band 3 (unregistered nursing assistant) Occupational therapist Occupational therapy technical instructor Whole time equivalent (WTE) The usual nursing complement on the ward for any shift is seven staff at any one time, consisting of a minimum of four trained staff and including at least one female staff member. The gender mix of staff may be altered depending on the number of female patients in the IPCU. The IPCU accepts second-year students, one at a time, and occasionally bank staff, but does not use agency staff..3 Discharge from IPCU Patients are often discharged from the IPCU into a community setting. The DART acts as a liaison service, in conjunction with the local resource centres to return patients to their home after treatment. 5

9 3 Demographics The total adult population aged covered by the Stobhill IPCU is 34, Numbers of IPCU admissions The electronic Patient Information Management System (PiMS) records information on all inpatient mental health admissions including admissions to IPCUs. Data from PiMS indicate that there were 9 admissions to Portree Ward during 008. This equates to an occupancy rate of 85%. 3. Nature of admissions The 9 admissions can be broken down further as below. IPCU admissions to Stobhill Hospital in 008 Age Under Over 65 Gender Male Female Ethnicity White Scottish White British White other Black Other ethnic Not specified Caribbean Pakistani Indian Detention status Out-of-area referrals Civil law Criminal law Informal (elective) Formal agreement No formal agreement The IPCU in Stobhill Hospital covers a significant population size and has considerable social issues in the more deprived areas such as Parkhead, Springburn, Maryhill and Possilpark. Approximately 90% of all admissions are known to the CMHTs and/or police before they are admitted to the IPCU. There is a high incidence of co-morbidity and complex needs among these patients and many of these patients are based in supported accommodation. A typical admission to the IPCU may have co-morbidities and drug and/or alcohol problems. Stobhill IPCU would have the capacity to admit a maximum of four female patients who have access to a dedicated female-only corridor including bathroom and sitting room. No visitors are allowed on the female section of the ward. Alternative accommodation would be sought in the case of a fifth female admission. 6

10 3.3 Management of other population groups Stobhill IPCU would admit a maximum of four patients under the Criminal Procedures (Scotland) Act 1995 (CPA) due to the additional requirements and additional challenges they face. As a result of the high-incidence of patients with co-morbidities, there have been occasions where a patient with learning disabilities has been admitted to the IPCU. There have also been four cases of an under 16 years old being admitted to the IPCU, however it is hoped the completion of the CAMHS unit in the Skye Ward will reduce any further admissions of this kind. There was only one admission in 008 of a patient over the age of 65, who was admitted from the dementia ward at Leverndale Hospital. 4 Links with other secure mental health provision Rowanbank Clinic, a medium secure forensic unit based on the Stobhill site, houses 74 beds and is closely linked to the IPCU. There has been a reduction in general forensic admissions to the IPCU since the opening of Rowanbank and also a reduction in stepped-down admissions to the IPCU from The State Hospital. Patients discharged from Rowanbank may be admitted to IPCU but would ideally be admitted to a locality hospital. There has been only one admission from Rowanbank within the last two years. 5 Governance arrangements NHS Greater Glasgow and Clyde has an IPCU forum which every two months and is chaired by the head of mental health. The forum has been in existence for 18 months and has multidisciplinary representation from each of the four IPCUs. It provides the opportunity for discussion about organisational-wide operational issues. There is no specific mental health user and carer group. There is, however, user and carer representation at the monthly north east clinical governance group. Carers are also met on an individual basis by ward staff and invited to multidisciplinary meetings. The clinical governance team is leading an ongoing service redesign process. A local patient focus public involvement group and local ward community meetings filter information to patients and carers. 6 Plans for service development Following a training needs analysis recently undertaken, additional input to the addictions service and borderline personality disorder service is now available. There are also plans locally to increase training on CBT which would be a useful tool within the IPCU team. IPCU staff are also involved in the 10 Essential Shared Capabilities initiative. 7

11 7 Other points to note NHS Greater Glasgow and Clyde discussed the Time Out facility within the Stobhill Hospital IPCU, which could be used to manage acutely behaviourally disturbed people. It is also used to manage disturbed behaviour of people from admission wards and can serve to contain their immediate behavioural disturbance and, at times, allow for them to return without the need for IPCU admission. The room has padded walls and includes an en-suite bathroom. This room can also be accessed directly adjacent to the back door of the unit which is helpful during emergency admissions of patients deemed inappropriate through the main entrance. This helps to minimise disruption within the unit and with other patients. The use of this room is fully documented which can be effective for audit purposes. Stobhill Hospital IPCU staff raised concerns surrounding the definition of the term least restrictive and also commented on a number of issues relating to the detainment of CPA patients. The review team were also informed that there is an agreement from both parties to strengthen links with the forensic and CAMHS within the Stobhill Hospital site. 8

12 Appendix 1 Glossary of abbreviations Abbreviation CAMH CBT CHCP CHP CMHT CPA DART IPCU NHS NHS QIS OT PICU PiMS WTE child and adolescent mental health cognitive behavioural therapy community health and care partnership community health partnership community mental health team Criminal Procedures Act discharge and resettlement team intensive psychiatric care unit National Health Service NHS Quality Improvement Scotland occupational therapy psychiatric intensive care unit Patient Information Management System whole time equivalent 9