An overview of Adult Mental Health Services in Portsmouth 1. Background
Portsmouth City Primary Care Trust both commissions and provides Adult Mental Health Services for the registered population of 200,000 people in Portsmouth, and also has delegated lead responsibility on behalf of Portsmouth City Council to deliver fully integrated services to meet local health and social care needs.
Portsmouth City Primary Care Trust provides inpatient and community based AMH services and employs 305 whole time equivalent staff in adult mental health services, (107 of which are employed in inpatient services), within a total budget of £11.3 million in 2006/07. In addition, the PCT spends on average approximately £2.7m to commission specialist placements, continuing care and extra contractual referrals per annum. Portsmouth City Council employs 58.5 wte staff, with a total budget of £4.2 million, which includes £2.17 million for community care commissioning.
Portsmouth City Primary Care Trust and Portsmouth City Council are committed to the provision of modern, responsive mental health services, which are fully integrated and offer more convenient access and greater plurality of choice. Significant work has been undertaken to modernise mental health services and this has resulted in the development of a comprehensive range of community based mental health teams, (including crisis resolution and home treatment, early intervention in psychosis, and assertive outreach services) which are evidence based and designed to pro-actively support people with mental health problems within the community, resulting in reduced admissions for acute psychiatric care.
This paper summarises Adult Mental Health Service provision in Portsmouth City. It should be noted that the Improvement Review being undertaken by the Healthcare Commission and Commission for Social Care Inspection will only focus on community mental health services.
2. Adult Mental Health Services 2.1 Community Based Services
A comprehensive range of services to provide high quality and accessible community based mental health assessments, treatment and interventions, including:
Primary Care Screening Assessment
Provision of mental health screening assessment for GP referrals, A&E or St Mary’s Treatment Centre attendees exhibiting mental health problems, homeless people and prisoners in HMP Kingston.
Short Term Interventions
Provision of short term interventions in a primary care setting for service users who have a common mental health problem and are sufficiently motivated to engage in a self help approach to overcoming their difficulties.
Secondary Care Assessment
Provision of full mental health assessment (including risk), encompassing both the health and social care needs of the service user within 12 weeks of referral. A triage assessment function at Community Mental Health Team (CMHT) bases (by phone and/or face to face), weekdays (5 hours per day) is also provided for all known service users and their carers, offering assessment and time limited support or onward referral.
Case Management via Care Programme Approach (CPA)
Provision of appropriate contact and support with service users in line with the CPA approach, including the development and review of care plans.
Provision of medication clinics in a variety of settings including home visits to undertake symptom & side effect monitoring, provide information to service users on injection, blood taking procedures and prescribed medication, and provide written & verbal progress reports to contribute to the CPA process.
Provision of consultant led outpatient clinics at a variety of community based settings including the assessment of service users with complex needs, the prescription and monitoring of medication and complex risk assessment.
24 hour Crisis Resolution
The Crisis Resolution and Home Treatment Team provide support 24 hours a day, 365 days of the year for adults 16 – 64 years who have a severe mental illness such as schizophrenia, manic depressive disorder, and / or severe depressive disorder. The service is provided to those experiencing a crisis of such severity that, without the involvement of the team, hospitalisation would be necessary. The team also provides intensive home treatment (up to 4 weeks) to facilitate early discharge from hospital.
Housing Related Support
Provision of assistance to service users in securing and sustaining accommodation.
Early Intervention in Psychosis Service
Early Intervention in Psychosis Teams work with people aged between 14 and 35 who present with psychotic symptoms for the first time or who are in the first three years of a psychotic illness.
The Assertive Outreach Team works with adults aged between 16 – 64 years who have a severe and persistent mental health disorder. The team works with people who have a history of frequent hospital admissions (usually more than two admissions or more than 6 months of inpatient care in the past two years), and have difficulty in maintaining contact with mental health services.
Provision of carers assessments in accordance with the Carers Recognition and Services Act 1995 and the Carers and Disabled Children Act 2000, together with ongoing support to carers.
Provision of assessments of Mentally Disordered Offenders (MDO) at the earliest opportunity following arrest, and ongoing support.
Nurse Specialist (HIV & Sexual Health)
The delivery of staff training on issues of HIV and Sexual Health and co-working with other professionals within the AMH service where there are concerns around HIV, sexual health and sexuality.
The provision of personal and spiritual support to service users, carers / family and staff.
2.2 Inpatient Services
A comprehensive range of inpatient and day treatment facilities for assessment, treatment and rehabilitation of people usually aged between 16 and 64 years of age who cannot be safely or optimally cared for in the community, including:
The provision of rehabilitative inpatient user care within a 12 bed unit for people with longer term and enduring mental health problems, particularly those who have severe and traumatic past life experiences resulting in a long protracted inpatient user admission and who have not responded to traditional treatment options.
Maples: A 12 bed unit which provides intensive psychiatric care to service users who are experiencing an acute episode of mental illness who require an increased level of security and care due to the potential risk posed by them or to them as a result of their illness. Hawthorns: A 24 bed unit providing a supportive and safe environment for service users experiencing an acute episode of mental illness whose level of risk does not require a locked environment. Provision includes multi disciplinary assessment and treatment, implementation of CPA and one to one and group input to service users.
Provision of inpatient care in a 13 bed low secure environment for people with severe mental health problems and/or personality disorders who as a result of their condition may exhibit challenging behaviours. The service provides:
Multi-disciplinary assessment and 24 hour treatment for adults that have experienced secure care and who require intensive and sustained help towards recovery, recognising that there may continue to be residual behavioural difficulty that requires skilled intervention.
Multi-disciplinary assessment and 24 hour treatment of adults with severe and enduring mental health problems who also have chronic behavioural difficulties e.g. significant risk of aggression, absconding, intentional self harm etc which seriously compromises well being and may pose a risk to others.
Liaison with AMH Psychiatric Intensive Care Unit, Regional Medium Secure Unit, Prison Service and multi-agency public protection forums where appropriate.
Provide a time limited service that may prevent inpatient admission or facilitate early discharge. The service includes:
Individual and Group treatment and support to patients in crisis to alleviate the acuity of symptoms or bridge a difficult transition from inpatient to community based care.
The initiation of Clozaril on an outpatient basis in conjunction with inpatient unit and CMHT.
The provision of therapeutic care and support as an alternative to admission
2.3 Specialist Services
The PCT also provides a range of clinical and support based professional services to promote the recovery and rehabilitation of service users. This includes a comprehensive psychological therapies service, occupational therapy, nurse consultant and community development workers. Recruitment is underway to employ 2 Community Development Workers. They will work with local black and minority ethnic communities and will have four key roles:
to identify community concerns and gaps in services
to advise on training and education of staff
to address language and other barriers to services
assist in the development of community organisations.
2.4 Community Support Services
Portsmouth City Council commissions a range of community support services to promote recovery through inclusion and supporting people to access mainstream services. Community support services include day services, vocational support and advocacy. In addition the Council also commissions registered and domiciliary care provision across the City and utilises supporting people funding to facilitate and support service users to move to
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