Mental Health Measure Clinician survey Dr Raman Sakhuja Consultant Psychiatrist Cwm Taf Health Board Chair of Faculties of General Adult & Addiction Psychiatry- RCPsych in Wales
Background Legislation of Mental Health Implementation- stages By June 6 th 2013- Relevant patient- CTP Major reconfiguration of Mental Health in Wales Dr Raman Sakhuja, RCPsych in Wales
Aims Clinicians perspective of the Measure Influence and aid the Welsh Governments review of the measure Aiding future position of the Faculty Dr Raman Sakhuja, RCPsych in Wales
Method Questionnaire developed covering key aspects of the 4 parts of the measure Invited full membership of the College- all specialities to respond Survey monkey to ensure anonymity Analysed using descriptive statistics Themes from qualitative responses identified Dr Raman Sakhuja, RCPsych in Wales
Findings Dr Raman Sakhuja, RCPsych in Wales
550 members 121 responded 20% response rate Acknowledgements Manel Tippett Dr Alka Ahuja Dr Gemma Williams ST6 Dr Omer Minhas ST6 Dr Kavitha Pasunuru Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Email Meetings Self reading Lectures Minority- Insufficient, contradicting, poor Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales SpR Training Day Trainer Colleague
Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
56 explanations offered- Positives Patients feel more comfortable upon discharge knowing that they can refer directly back to secondary care services. People now have plans which they might not have had before the implementation of the Measure. Better staffing and process in Memory Clinics Negatives The level of patient care is compromised due to a significant increase in bureaucracy More problems with referrals Fewer patients are being treated in secondary care- inappropriate emphasis on CTP Care co- ordination- negatively affected- specially in sub- specialties Dr Raman Sakhuja, RCPsych in Wales
102 respondents- 83 comments Dr Raman Sakhuja, RCPsych in Wales
1. The Measure has had a negative Impact upon patients 2. Increased workload but reduced patient care 3. Increased admissions 4. Increased barriers to care 5. Early discharge of patients 6. Potential Risks of patients slipping through the net 7. Concerns regarding legal implications of increased bureaucracy Dr Raman Sakhuja, RCPsych in Wales
8. Loss of resources in secondary care 9. Increased (inappropriate) referrals to secondary care 10.Issues with the division between primary and secondary care 11. Re-branding of Secondary Care 12.Interdisciplinary Tensions 13.Changes in service provision Dr Raman Sakhuja, RCPsych in Wales
Specific examples The Care and Treatment Plan restricts the natural flow of communication.. Documenting care has resulted in more jargon Staff appear to be more concerned about whether the patient is primary or secondary and fail to consider adequately the patients needs. It becomes a form of rationing There is a risk that CPA assessment actually discriminates against people with mental health problems compared to when they see other medical specialities in primary care or hospitals who do not use similar paperwork..now a higher threshold to accept patients into secondary care services. Dr Raman Sakhuja, RCPsych in Wales
Specific examples Psychiatrists feel less able to provide liaison and advice for patients in primary care. Many patients are therefore being denied services rather than being offered more services. The waiting list for patients needing Psychological Therapy and Psychology has increased. Patients cannot access therapy because they are in the wrong part of the service. CDAT patients who have dual diagnosis often find they cannot access either primary or secondary care services. Primary care are unwilling to accept referral from (CDAT) and Secondary care will not recognise them as relevant patients so resources for treatment of mental health problems are frequently withheld from this patient group. Dr Raman Sakhuja, RCPsych in Wales
Specific examples More confusion in ID patients.social care led...part ½ distinction doesn t fit with CAMHS Confusion regarding pathways in OPMHS increased...little or no discourse to primary care physicians. major problems for psychiatric outpatients requiring CTP's yet minimal involvement with the service and no clear guidance from the assembly on how to deal with this bureaucratic nightmare Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Comments People unduly categorized under Mental Health- open to legal challenge Lack of additional resources to deliver the measure Lack of clarity of medical accountability when patients seen in primary care Lack of clarity of relevant patient and definitions of the new branded secondary care Care- Co- ordination confusion Confusion over discharge from Sec 117 aftercare- when, whether possible under the Measure, ID patients with older definition- can remain on CTP for life. Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Themes Wide variation in LA practices Social Workers may be unwilling to take on Care Coordination- varied reasons Technological barriers- IT Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales 92 responses
Themes Uncertainty in meeting needs for ID, Addiction, Perinatal, CAMHS, OP clinics, memory clinics Areas of concern-?nice compliant, limited psychological interventions, limited access to psychological services Specialist community services access to PMHSS more confusing and increasingly hard Limited online info Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Themes/Comments In development and can lead to misunderstanding GPs still confused GPs still find mental health a mystery Access to PMHSS by Secondary care- unclear ID, CAMHS, Addictions pathways unclear North Wales- e referrals/ electronic pathways for access to psychology Dr Raman Sakhuja, RCPsych in Wales
Relevant Patient 74 responses, lack of agreed definitions/criteria- difficult for patients in sub- specialties to access services Level of complexity & Intensity and range of needs SMI Complex psychosocial needs Co- morbidities Risk Factors Needing polypharmacy What the most assertive person in the team says It is clear as mud water as to how to define this in the intellectually disabled. Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Professions excluded CAMHS practitioners Art Therapists, music therapists, and family therapists CAMHS nurses with paediatric background Nurses who do not have mental health or intellectual disability qualification by who may work in mental health teams. Paediatric nurses Counsellors Community Support Officers Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales 87 responses
Consultant Psychiatrists as Care- Increase in Workload Coordinators Increase in already existing bureaucratic practice Does not match with New Ways of Working and job plans Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales? Legislation- Healthcare quality
Dr Raman Sakhuja, RCPsych in Wales Carers Care Coordinators Do not complete CTPs Other agencies
Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Explanations MORE- Patients feel more comfortable- can access services again quickly ID- not affected GA- Vulnerable patients may not refer themselves back, some patients may come back quickly, some reluctant to be discharged for fear of abandonment LESS LIKELY- no explanations offered Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Dr Raman Sakhuja, RCPsych in Wales
Summary First Wales Survey of College members 20% response rate Important findings relating to Part 1 and Part 2 of the measure Dr Raman Sakhuja, RCPsych in Wales
Lack of clarity PMHSS Relevant patients Care Coordination Redefining secondary care Legal Implications Access and pathways Improvement in quality of care Out of Wales patients requirements Dr Raman Sakhuja, RCPsych in Wales
Actions Faculty Position paper Collaborative work with WG for development of clearer guidelines for implementation Developing standards of care in PMHSS Defining Relevant Patient Collaborative study of patients perspective on quality of Mental Health Services Dr Raman Sakhuja, RCPsych in Wales
Thanks Dr Raman Sakhuja, RCPsych in Wales