What makes a good Crisis Plan? Miles Rinaldi Head of Recovery & Social inclusion
On an important note, the team that supports me believes fully that I have the right to decide the treatment I need and this extends to crisis. This allows me to work collaboratively with them and I trust them.
CQC Community mental health survey 2013 Q: Does your NHS care plan cover what you should do if you have a crisis? 8 7.5 7 6.5 6 5.5 5 BEH Camden & Islington CNWL East London FT North East London FT Oxleas SLAM South West London Surrey & Borders West London
Policy and guidance NICE (2011) Quality Standard for adult mental health People who may be at risk of crisis are offered a crisis plan (QS 9). People are actively involved in shared decision-making and supported in self-management (QS 3). People in hospital for mental health care, including service users formally detained under the Mental Health Act, are routinely involved in shared decision-making (QS 10). Mental Health Act code of practice chapter 17.
NICE (2011): A crisis plan should contain: Possible early warning signs of a crisis and coping strategies Support available to help prevent hospitalisation Where the person would like to be admitted in the event of hospitalisation The practical needs of the person if they are admitted to hospital (e.g. childcare, care of other dependants, including pets) Details of advance statements and advance decisions Whether and the degree to which families or carers are involved Information about 24-hour access to services Named contacts.
Crisis Plan What the person wants to happen if they are in crisis and need others to take care of them and keep them safe Different from other plans: Care plan = a person s assessed health and social care needs that promotes recovery by focusing on improving outcomes that mattered to the person Personal recovery plan = what the person will do for themselves Crisis plan = what they want others to do for them in a crisis
Trust audit (2012): Recovery focused care planning
What is a Joint Crisis Plan? The Joint Crisis Plan is an advance agreement between service users and their care team regarding service user preferences for treatment and practical arrangements in the event of future mental health crises. A joint crisis plan aims to empower service users while facilitating early detection and treatment of a relapse. A joint crisis plan has to be negotiated and agreed (for it to be a joint crisis plan).
What is clear from the research evidence? Service users like having crisis plans. The completion process, content of the document and quality of experience much is known. In a time of crisis, crisis plans are all too often not followed by mental health services. Little is known about access and honouring crisis plans The quality of crisis plans mirrors the quality of the process whereby which they were developed.
What makes a good crisis plan? Delphi: services users, family, friends, carers and mental health professionals. 78/94 statements reached positive consensus An interesting finding... 10% of service users 25% of carers, families and friends 49% of mental health professionals Disagreed or strongly disagreed with the statement: crisis plans will not work because services will not honour them.
Outcome of the coproduction exercise New collaborative crisis plan Good practice standards for the Trust
Developing collaborative crisis plans Collaborative crisis plans have to be negotiated, agreed and shared with others... and the negotiation is a critical part of the process. Hence the need for a collaborative process.
Collaboratively developing crisis plans
Collaborative crisis plans uploaded on RiO
Comments We often only meet the unwell individual and do not have any baseline. If we have a collaborative crisis plan where we have information on what they like to do and eat, their family and friends etc., this helps us to engage the person who is unwell. Deputy Ward Manager the nurses can quickly see what does and doesn t work for you the plan immediately cuts out the things that aren t helpful and makes it possible to articulate things that you cannot articulate when in crisis. Service User
Systems: Crisis plans Community team and GP Crisis plans inform initial HTT / ward care plans Updated crisis plans informed by recent crisis Home Treatment Team Inpatient Ward
Thank you Miles.Rinaldi@swlstg-tr.nhs.uk