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Service Description and Operating Procedures Function To provide a comprehensive rehabilitation service for people experiencing severe and enduring mental illness with the aim of restoring of an individual to optimal physical, cognitive, psychological and social functioning following a breakdown of functioning cause by a mental disorder. Philosophy and Guiding Principles of the service Broadly the rehabilitation service offers three main approaches: Restoration of damaged function Compensation for lost function Helping the patient to take back control over their own lives, maximising activity and participation both on a functional and psychosocial level in a socially inclusive manner The service will work in partnership with commissioners, independent and charitable care providers to ensure the identified people receive the highest quality of care to meet their needs. The Royal College of Psychiatry s 2009 publication Enabling recovery for people with complex mental health needs: A template for rehabilitation services offers the following objective for a rehabilitation service: The purpose of specialist rehabilitation services is to deliver effective rehabilitation and recovery to people whose needs cannot be met by less intensive mainstream adult mental health services. The focus is on the treatment and care of people with severe and complex mental health problems who are disabled and often distressed, and who are or would otherwise be high users of in-patient and community services. The aim is to promote personal recovery, whilst accepting and accounting for continuing difficulty and disability The service supports and works to this description as is an active participant in the Accreditation of Inpatient Mental Health Services (AIMS) programme, which is a standards-based accreditation programme designed to improve the quality of care in inpatient mental health wards. Through a comprehensive process of review, AIMS identify and acknowledge high standards of organisation and patient care, and support other services to achieve these. The service primarily works within the NICE guidance on Schizophrenia and uses a recovery focussed approach. 2 of 7
The service consists of two inpatient units (St. Andrew s Place and Hawthorne Court) with complementary functions. It also offers a limited outreach services to enable people to move on into or be maintained in suitable accommodation, while continuing to receiving the support of staff they have developed relationships with. Client group The client group are characterised by the following: History of poor compliance with drug and care regimes Severely damaging and serious mental illness Lack of independent living skills Significant degree of cognitive impairment Sporadic presentation of challenging behaviour Difficult to place A history of offending behaviour Socially excluded Seen as unsupportable by main stream services, including assertive outreach. Referrals Referrals are accepted from other adult inpatient units and NHS community mental health services or commissioners of mental health services. All referrals will under go a comprehensive multi-disciplinary assessment against the criteria set out above. All patients remaining on acute mental health units for over 3 months should be considered for referral to the service. Referrers should contact St. Andrew s Place on 01482 336501 if they wish to make a referral. The target from receiving a referral to offering a bed (if appropriate) is 28 days. Inclusion Criteria St. Andrew s Place In addition to the client group characteristics listed above, to be considered for admission to St. Andrew s Place, people should: Have an agreed diagnosis of severe and enduring mental illness which may co-exist with another condition 3 of 7
Have been an inpatient in an acute inpatient service and or PICU for 3 months OR discharge is highly unlikely before that time OR have had repeated admissions over the preceding 2 years. Be able to normally be cared for under the Trust s standard observations Be free from a history of serious assaults for 6 months Be able to keep themselves safe without controlled egress from the building Have been able to leave the referring unit unescorted and without incident for at least 6 weeks (12 weeks if in low secure or above) Be willing to accept the terms of the model tenancy agreement Hawthorne Court In addition to the client group characteristics listed above, to be considered for admission to Hawthorne Court, people should: Have an agreed diagnosis of severe and enduring mental illness which may co-exist with another condition Be considered as being on the optimum medication regime stable, but continue to have significant symptoms of serious mental illness. Have been an inpatient in an active rehabilitation service for more than 1 year OR have been under the care of Assertive Outreach Teams for over two years. Be normally cared for under the Trust s standard observations Have been free from serious assaults for at least 1 year Have been free from sexual offending while in an open environment for at least 5 years Exclusion Criteria St. Andrew s Place Those not consider suitable for admission include: People who require a secure environment People experiencing acute psychiatric symptoms People who would need to be transferred directly from a high secure setting People who have a primary diagnosis of personality disorder People who require detoxification from drugs or alcohol People who require detaining under an assessment section of the mental health act People under 20 years of age People who require a single sex environment People whose only need is for housing 4 of 7
Hawthorne Court Those not consider suitable from admission include: People considered to be a danger to children People with a history of offending against children People who require a secure environment People experiencing acute psychiatric symptoms People who need to be transferred directly from high secure settings People who need to be transferred directly from prison People with a primary diagnosis of personality disorder People requiring detoxification from drugs or alcohol People under an assessment section of the mental health act People who are under 25 years of age People who require a single sex environment Interventions While the exact nature of the interventions people in the service will receive are determined by a person centred plan they are likely to include: Help with setting individual goals to improve quality of life Management of physical health deficits or potential deficits Mental health symptom management Maintenance of daily living skills Maintenance and enhancement of social skills Access to education Physical exercise programmes Development of recreational interests Health promotion Access to work Integration into mainstream opportunities These interventions will be delivered by a multi-professional and where possible multi-agency team working together to help the person to have an optimal quality of life. Discharge Some people will not be expected to be discharged from the service for over 2 years, as they have been recognised as having complex long term care needs. However, others may be discharged from the inpatient services into appropriate supported accommodation within a few months where they may be followed-up by members of the rehabilitation service, or discharged into generic services. 5 of 7
User/ Carer Involvement As people stay for extended periods in the rehabilitation service we have the opportunity to develop good and close relationships with them and their families or carers. The patients meet weekly with the unit nurse manager to raise any problems or suggestions they may have. In addition the service enjoys support from the Patient Experience Team who meet with the patients and we have the services of an independent advocate. Links with other services The service has close links with the local acute units, Psychiatric Intensive Care Unit and Assertive Outreach Teams. It also has established links with residential and nursing homes, supported accommodation providers and local authority housing teams to ensure we can identify a suitable move on placement for our patients. Location and facilities St. Andrew s Place (St. Georges Road, Hull) is a 13 bed unit offering single rooms in gender segregated sleeping accommodation. It has a range of shared and single sex sitting rooms, activity rooms and a fully equipped rehabilitation kitchen. In addition it has a purpose build ground floor disabled bedroom and bathroom and a self-contained flat for patients nearing the end of their stay. Hawthorne Court (Manor Road, Beverley) is an 18 bed unit offering single rooms in gender segregated sleeping accommodation. It has a range of shared and single sex sitting rooms, activity rooms and a fully equipped rehabilitation kitchen and a self-contained flat. Hours of work Service is open 24 hours a day 365 days a year. Staffing The individual units are primarily staff by qualified nurses supported by support staff to provide 24 hour care and treatment in a safe and supportive environment. The service also offers a high level of Occupational Therapy assessment and intervention provided by qualified Occupational Therapists. 6 of 7
Medical support is offered by a Consultant Psychiatrist with a special interest in rehabilitation and severe and enduring mental illness and her team of junior doctors. The service also has the support of a Clinical Psychologist and Clinical Pharmacist. Contacting the service Hawthorne Court can be contacted on 01483 336830 St. Andrew s Place can be contacted on 01482 336501 Author This Service Description & Operational Procedures document was written by: Name Title Date Gary Darley Matron 8 th Ratification This Service Description & Operational Procedures document was ratified by: Group Name Date Rehabilitation Senior Management Group Sue Lake Dr. Gulati Loraine Emery Gillian Lowe Sue King Gary Darley 18 th Review Date This Service Description & Operational Procedures document will be reviewed before the end of September 2013. 7 of 7