2 results
North West London New Model of Care Project (NMOC) – improving inpatient mental health care for children and young people
- Jovanka Tolmac, Alun Lewis, Azer Mohammed, Elizabeth Fellow-Smith, Johan Redelinghuys, Braulio Girelas
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S199
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- Article
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Aims
Specialised inpatient mental health services for children and young people are commissioned and managed by NHS England (NHSE) and provided by NHS as well as independent sector. The access to beds has been managed nationally with young people admitted far from home. There were capacity issues identified in London. To address these concerns, NHSE invited organisations to work in partnership to co-design and establish new models of care. This is one of the first of such projects, set up to manage the budget for children and young people's beds on behalf of NHSE and change the way of managing and monitoring admissions.
Our aims:
To reduce length of inpatient stay
To enable admission of young people as close to home as possible
To improve resource efficiency, capacity and capability of managing young people in crisis in the community.
MethodA number of changes were introduced, including engagement of community and inpatient clinical staff, repatriation to units closer to home and introduction of CRAFT meetings (early review meetings in inpatient units to enable timely and effective discharge planning and support back to local services). The implementation has been closely monitored by the project manager and clinical group, which included representatives from all organisations involved.
ResultAfter four years, young people are admitted to hospitals closer to home and the length of inpatient stay has decreased by 18%. The number of admissions has decreased by 28%. Out of area occupied beds days have been decreased by 66%.
Significant recurrent budget savings have been achieved. Over the past three years, these savings have been reinvested in developing crisis community support and more specialist community services within CNWL and West London Trust.
ConclusionThere have been considerable benefits of multiple organisations working in partnership to improve patients care. The success of the project has created further opportunities for the development of services which provide safe and effective alternatives to admission (such as crisis services, home treatment teams and specialized community services). In summary, this collaborative model has improved the quality of care and experience for young people and reduced the need for psychiatric admission.
CAMHS Emergency Assessment Service (EAS): development & implementation during the COVID-19 crisis
- Tania Saour, Jovanka Tolmac, Braulio Girelas, William Turton, Lauren Branney
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S55
-
- Article
-
- You have access Access
- Open access
- Export citation
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Aims
• To provide emergency psychiatric assessment throughout the COVID-19 pandemic.
• To maintain patient and staff safety by minimising exposure to infection risk by reducing A&E contact.
• To alleviate pressures on the A&E department by enabling CAMHS patients be seen in an alternative setting.
• To provide a more appropriate environment for the assessment of young people in acute distress.
Method• Service live 8th April 2020 to 8th June 2020.
• Exclusion criteria: 1) confirmed/suspected overdose; 2) self-harm with injuries requiring medical attention; 3) acute psychotic episode; 4) drug/alcohol intoxication; 5) high risk of absconding (ASD/LD/LAC), 6) severe agitation/aggression; 7) eating disorders requiring medical intervention; 8) section 136 of the MHA; 9) break down of a social care placement; 10)medically unexplained symptoms.
Data reviewed of all young people who were referred to A&E during March–April 2020. Each case was assessed as to whether they were then seen within the EAS Service.
These cases were reviewed demographically looking at ethnicity, gender, while also reviewing the reason for referral.
Result• A total of 90 cases referred to Urgent Care Team
• Nineteen (21%) met criteria for assessment at EAS
• 80% of presentations between 12am and 9am.
• Commonest reasons for referral : low mood with suicidal ideation (42%), anxiety (26%)
→ 50% service users not previously known to CAMHS
• Majority of service users were female
• Mean age 15 years
• All but one of the young people assessed at the EAS, were discharged home with community follow-up
Conclusion• Average total no. monthly referrals to CAMHS Urgent Care Team (UCT) fell from approx. 90 to 45.
• Only a small proportion of referrals (21%) could be safely seen by the EAS, suggesting that the majority of young people required a joint assessment by A&E and CAMHS Urgent Care Team.
• When need arises, very rapid reconfiguration and implementation of CAMHS emergency services is achievable.
• EAS diverted a small number of young people from exposure to COVID-19 in A & E.
• The service was set up speedily without evaluation of parent/carer/young people views or evaluation of cost-effectiveness.
• If similar services are to be set up permanently, the balance between safety and the risk of division between mental & physical health services and potential to increase stigmatisation of mental illness should be considered.
• Adaptation to future outbreaks should be informed by this initiative.