H o m e T r e a t m e n t E x p e r i e n c e C h o i c e & A l t e r n a t i v e

Kevin Heffernan

Nurse11 years leading HT developments in BirminghamConsultant for the World Health OrganisationNational Institute Mental Health England (RegionalImplementation5.5 M pop.39 HTT, 27 AOT)Research fellow Birmingham City UniversityWest Midlands Strategic Health Authority (Service Development)

Kevin.Heffernan@wmrdc.org.uk

Danger/risk and AdversityOpportunity forPersonal Growth

Fidelity principles

Gatekeeper to all potential admissions Operating a corporate caseload (utilising MDT skill mix) Rapid Response (1-4 hour variable) 24 hour/7 day availability Flexible visiting (duration/frequency/Intensity) Clearly targeted Caseloads (acute) Time limited (average length of stay) Fully Integrated (not operating in isolation, whole system responsibility)

Comprehensive Assessment Address social issues (in vivo) Medical staff involved/available Mobile Practical problem solving approach Supervision and administration of medication Advice, support for Carers Early Discharge (not becoming discharge team) Effective communication and planning

Fidelity principles

Advantages

Intensive monitoring of complex cases Can be more flexible/sensitive ethnic minority groups Extended Support for Carers Explanation and advice and post crisis planning Confront social problems directly Work closely with Dual Diagnosis issues Reduce stigma of hospitalisation Higher satisfaction users and carers Development of an acute team

Advantages

Avoidance of admission (1st presentations.Zacch)Interrupt cycle of admission (change expectationsDavid)Facilitate early dischargeReduced bed use - admissions and length of stayDifferent framework for sustaining recovery focused engagementSupport can be perceived as;

More Personal/Individualised Increased Negotiation leading to a sense of increased autonomy Potential to develop more true Partnership working (Trialogue can emerge) Narrative scrutiny (exploration of the why now and true context becomes more possible)

I hope this conference is inspiring and gives you hope for the future development of local community based mental health servicesThis is your opportunity! And not a danger or risk

Home Treatment HopeOptimismMotivationExploration

TemperanceRecoveryEmpowermentAutonomyTruthMeaningEmpathyNegotiationTrust

Values of Home Treatment workingSupport Clients to acknowledge and value theuniqueness of their experience, personal narrative exploration allows intervention to beless stigmatising and medicalised

Become a catalyst for inspiration

Encourage personal responsibility

Clients can begin the journey of recovery andnot become passive victims of illness

Community teams in BirminghamCaseload size and distribution in a locality of 150,000 population

Distribution of CasesCMHTs20 staffRehab & recovery15 staffAssertive Outreach12 staff*************************************************************************************************600 CasesDaysYearsIntensity of support & Length of stay in the service************** ************** ************** ****************************370 Cases123 cases********************************** ************ ***********************Serious Mental Illness

Distribution of CasesCMHTs20 staffRehab & recovery15 staffAssertive Outreach12 staff*************************************************************************************************600 CasesDaysYearsIntensity of support & Length of stay in the service************** ************** ************** ****************************370 Cases123 cases********************************** ************ ***********************Serious Mental IllnessHome Treatment14 staff20 cases************************ ************************************************ ********************** ********************* ******************* ***********************************