Rehabilitation in Psychosis: Rebuilding & Transforming Lives

Dr Sridevi Kalidindi PhD, FRCPsych

• Chair, Faculty of Rehabilitation & Social Psychiatry;

• Co-Chair, Joint Commissioning Panel –Mental Health;

• Consultant Psychiatrist in Rehabilitation & Recovery; Visiting Lecturer IOPPN

• Trust Clinical Liaison Lead for Contracts

• Sridevi.kalidindi@slam.nhs.uk

• http://www.rcpsych.ac.uk/workinpsychiatry/faculties/rehabilitationandsocial.aspx

Rehabilitation in Psychosis – Co-producing Transformed Lives. “Thank you for giving

me my life back”• Real life stories: Clinical and service user innovation

– the long(er) view• Severe personality disorder and psychosis• Autistic spectrum disorder and psychosis• Substance misuse and psychosis• BME, substance misuse and psychosis

People with complex psychosis and complex needs

PsychosisTreatment resistanceNegative symptomsComorbidities – mental and physical healthFunctional impairmentsChallenging behaviourDifficult to engageRisk10-14% of EIP require rehabilitation10-20% of secondary care; Account for 25%-50% of the

annual UK mental health budget (MH Strategies 2012)

Specialist skills of rehabilitation services

http://www.rcpsych.ac.uk/workinpsychiatry/faculties/rehabilitationandsocial.aspx

Skills of a Community Rehabilitation Team

(see guidance)• Leadership; the long(er) view• ‘Pull through’ to less

restrictive, more independent, socially inclusive and meaningful lives

• Public Relations• Internal to the team • Patients & carers• Working with other teams• Provider facing• Managing transition

• Commissioner facing

• Census, performance management; systemic blocks, challenge discrimination - educate

• placements/care packages/ funding panel

• OATs

• local service development

• cost of unmet need (Campion 2012)

Whole system approach to mental health rehabilitation services

A National Strategy

National commissioning Guidance

(Waxing and waning rehabilitation

services nationally)

www.jcpmh.info

Out-of-Area TreatmentIn Sight, In Mind – Toolkit for OATs

Setting National Standards

• AIMS – Rehab; CQC • Community Rehab standards

underway

• NICE guidance eg.• i) Transition from Hospital • to Care Home

• ii) New – NICE guidance service specification (2016!)

A Pathway Approach

Many local examples of good innovative pathways, both in-patient and community

National pathway:High level within the commissioning guidanceDetailed - under construction. Careful not to stifle local innovation, based on local needsEarlier intervention is key. Criteria – 2 acute admissions in one year, > 30 day admission

Faculty of Rehabilitation & Social Psychiatry

• National review of Rehabilitation (all types)

• National review for Mental Health Supported Housing

• National Survey of Rehabilitation Services

• Employment– DWP, Expert Review;

Training for assessing Doctors

• Recruitment, Education and Training

• International Rehabilitation

International Rehabilitation Psychiatry

#FundaMentalSDG

United Nations Sustainable Development Goals2015 Development Agenda

www.fundamentalsdg.org

Rehabilitation in Psychosis – Co-producing Transformed Lives