Report of the Working Group Service Planning Forum Report of the Working Group Mental Health Service...

Report of the Working Group

Service Planning Forum


Mental Health Service Delivery Models and Inpatient Capacity for

Persons with Significant Intellectual Disability and Mental Health

Problems


Working Group Representation

Health Service Executive Representation

Irish Medical Organisation Representation

Irish College of Psychiatrists Representation

Irish Hospital Consultants Association Representation

National Federation of Voluntary Bodies Representation

Heads of Psychology Services Ireland

Chairman: Mr Hugh Kane


Terms of Reference of the Working Group

To explore options capable of creating immediate additional capacity for the provision on a regional basis of inpatient facilities for persons with a significant intellectual disability who require involuntarily admission under Part 2, Section 8 of the Mental Health Act, (2001).

To identify the most appropriate, integrated and cost efficient models which can provide HSE with readily accessible quality service settings for the client group and make proposals to the Mental Health Directorate of the HSE on options to be pursued to ensure interim arrangements at commencement of the remaining sections of the Mental Health Act, (2001).


Definition of the Target Populations

Population 2 (individuals with specific mental health problems requiring involuntary admission)

adults with significant intellectual disability and mental health problems who require involuntarily admission under Part 2 of the Mental Health Act, (2001).

Population 1 (individuals with general mental health problems)

Individuals with intellectual disability with significant mental health problems


Main Guiding Principles of the Working Group

Mental health services for people with intellectual disability must be reconcilable with the Mental Health Act, 2001 and the current framework for mental health policy (Vision for Change, 2006).

Mental health services for those with mild ID and less severe mental health problems will be provided by generic services in accordance with the principle of mainstreaming

Mental health services for people with intellectual disability (as defined in the target populations) should be provided by a specialist mental health of intellectual disability team.

Mental health services for individuals with intellectual disability must be coordinated and draw on existing mental health and intellectual disability expertise. Maintaining continuity of care and building on existing networks of support and expertise should be a priority concern of the service-delivery system.

Mental health services for individuals with intellectual disability must be underpinned by a recovery orientation.


The Working Group Recommends……….

that the framework for specialist service provision be underpinned by the Report of the Expert Group on Mental Health Policy “A Vision for Change, (2006)”

that existing clinical resources in ID services be reconfigured to form Community Intellectual Disability Teams on a catchment area basis

that a catchment area based specialist Mental Health Intellectual Disability Team (MHID team) will be a core resource. (provided on the basis of two teams per 300,000 population).

that the initial roll-out of the proposed model builds on the capacities and resources currently deployed within statutory and non statutory sectors.

that in areas of the country where there is a recognized lack of existing service an opportunity should be provided to the voluntary and private sector to tender for the provision of services in those areas.

Proposed Model of Service Delivery


The Referral Pathway

Intellectual Disability Services-Multidisciplinary Team, Intellectual Disability Services-Multidisciplinary Team, providing comprehensive Health & Social Care providing comprehensive Health & Social Care

Individual at home- no

Intellectual Disability Service

Individual at home- day Intellectual Disability Service

Individual residing in Intellectual Disability Service

GP & PHCTGP & PHCT

Acute, Assessment and Rehabilitation beds and Day Hospital places as appropriate

Mental Health Intellectual Disability Team (MHIDT) Multidisciplinary Team, providing Assessment, Treatment and Care

GP & PHCTGP & PHCTGP & PHCTGP & PHCT

Referral point to TeamReferral point to Team


Clinical and Service Governance


the implementation of a integrated framework of service delivery (part of the mental health services for a defined catchment area) with measures put in place to ensure that the same service and clinical governance principles as outlined in Report of the Expert Group on Mental Health policy apply to the MHID team. (Vision for Change, 2006, p 172).


Model of Service Governance

National Mental Health Service Directorate

National Care Group Manager Mental Health

Senior Management Staff

National Medical Director

National Director of Nursing

Representatives of other professions in Mental Health

Service User

Mental Health Catchment Area Management Team

(for population over 300,000)

Managers of 2-3 local health offices

Medical Director

Nursing Director

Heads of Discipline for Psychology, Social Work & Occupational Therapy

Service User

Mental Health Intellectual Disability Teams (MHIDT)

Team Leaders

Team Co-ordinators

Practice Managers


Inpatient capacity and beds numbers


that a national review of mental health of intellectual disability acute in-patient bed capacity be undertaken prior to the 1st of November 2006.

that initially 5 acute in-patient mental health intellectual disability beds, 10-day hospital places and 10 rehabilitation beds per 300,000-population catchment be made available. (Vision for Change, 2006, p 130).

that a spectrum of regionally based facilities be put in place to provide a flexible and effective continuum of care based on need.

the National Intellectual Disability Database Committee incorporate national statistics for individuals with intellectual disability & mental health problems in its annual report..


LHO Area Population Per Area**Acute Bed Requirement Current Capacity Additional Capacity Acute BedsDublin Mid Lenister 20.51Area 1 East Coast Dublin 181,670 3.03Area 2 S.E. Dublin 107,738 1.80Area 3 S.W. Inner City 142,012 2.37Area 4 & 5 S.W, Dublin 258,865 4.31Area 9 W Wicklow/ Kildare 190,476 3.17Area 10 Wicklow 106,812 1.78Longford / Westmeath 112,033 1.87Laois / Offaly 130640 2.18Dublin Nth East 15.34Area 6 N.W. Dublin 159,477 2.6Area 7 Nth Inner City 148,918 2.48Area 8 Nth County Dublin 234,536 3.91Louth / Meath 260,635 4.34Cavan / Monaghan 120,365 2.01HSE West 16.88Clare 110,919 1.85Donegal 138,555 2.31East Galway 106,213 1.77Limerick 188,277 3.14Tipperary (North) 65,525 1.09Roscommon 58,004 0.97Sligo / Leitrim 100,692 1.68West Galway 118,085 1.97Mayo 126,137 2.10HSE South 17.75North Cork 79,171 1.32North Lee 168,051 2.80South Lee 180,375 3.01Kerry 142,732 2.38Carlow / Kilkenny 119,883 2.00Tipperary (South) 85,213 1.42Waterford 109,365 1.82West Cork 54,715 0.91Wexford 125,574 2.09

Acute Beds


Rehab Beds

LHO Area Population Per Area**Rehab Bed Requirement Current Capacity Additional Capacity Rehab BedsDublin Mid Lenister 41.11Area 1 East Coast Dublin 181,670 6.06Area 2 S.E. Dublin 107,738 3.60Area 3 S.W. Inner City 142,012 4.74Area 4 & 5 S.W, Dublin 258,865 8.62Area 9 W Wicklow/ Kildare 190,476 6.43Area 10 Wicklow 106,812 3.56Longford / Westmeath 112,033 3.74Laois / Offaly 130640 4.36Dublin Nth East 30.68Area 6 N.W. Dublin 159,477 5.2Area 7 Nth Inner City 148,918 4.96Area 8 Nth County Dublin 234,536 7.82Louth / Meath 260,635 8.68Cavan / Monaghan 120,365 4.02HSE West 33.73Clare 110,919 3.7Donegal 138,555 4.62East Galway 106,213 3.54Limerick 188,277 6.25Tipperary (North) 65,525 2.18Roscommon 58,004 1.94Sligo / Leitrim 100,692 3.36West Galway 118,085 3.94Mayo 126,137 4.2HSE South 35.5North Cork 79,171 2.64North Lee 168,051 5.6South Lee 180,375 6.02Kerry 142,732 4.76Carlow / Kilkenny 119,883 4.00Tipperary (South) 85,213 2.84Waterford 109,365 3.64West Cork 54,715 1.82Wexford 125,574 4.18


Education


that staff educators examine educational and training opportunities and develop innovative strategies that address shared multi disciplinary learning and professional development.

the strengthening of linkages between service and the tertiary academic and research communities not alone for the pursuit of scholarship but more importantly to ensure that practice development is continually shaped by the growing evidence base about the mental health needs of adults with intellectual disability


New Partnerships


that access to specialist service would be through one point-of-entry, the MHID team.

the continued development of the national infrastructure of primary multidisciplinary supports i.e. Community Intellectual Disability Team (as there are many areas that lack such teams), which is a crucial element, to the success of the proposed model and must be in place.

that all individuals with intellectual disability be registered with their General Practitioners.

that a national mapping process be undertaken to align mental health intellectual disability services with Local Health Office catchment area designation.



the need for specific interface and management contracts, protocols & service-level agreements between all agencies involved with the provision of specialist mental health service to individuals with intellectual disability.

the development of fora and processes to facilitate integrated service planning and coordination in order to assure quality and to ensure that services and supports are coherent, linked and comprehensive.

New Partnerships cont’d


Critical Factors

Identification of current acute in-patient bed capacity

Audit of the national acute in-patient bed requirements

Identification of current resources Statutory & non Statutory

Establishment of the MHID teams

Continued development of the Community Intellectual Disability Teams that will work in parallel with the primary care teams

Mapping process be undertaken to align mental health intellectual disability services with Local Health Office catchment area designation.

Inclusion of all stakeholders, resolution of service & clinical governance issues

Development of explicit joint-care protocols and service level agreements

Utilisation of the Report of the Working Group to informs the “Vision for Change” implementation team


• Organisation/funding is based on population service needs– Agency needs to be associated with a geographic catchment area.

– Consultant Psychiatrists need to be associated with a geographic catchment area (as per Vision for Change).

• Recognise higher vulnerability and specialist nature of access – Same workload for consultant, same access for client (1 consultant

team per 150,000 population).

– Engage with psychiatrists to work through what service they currently provide and distinguish mental health needs.

• ID Clients access to same level of service as rest of population– Agencies to enhance existing services, supported by MHID team.

– Legislative impact on practice – currently detain/seclude without legal framework in an intellectual disability setting. Not addressed under disability act.

Options, choices and equivalence


Options, choices and equivalents

• The acute beds provided by HSE or designated provider.

• The rehab beds, in a step-up and step-down capacity, remain within the agencies.

• Day hospital provided by HSE or by designated provider, in actual or virtual capacity.

• Who is best placed to do this? The current providers, however MHID team is missing.

Options for inpatient capacity


• For the immediate future presentations will be addressed on a case by case basis.

• Children with an intellectual disability and mental health problem are a small cohort – a group within a group.

• In crafting a solution on an individual basis we can draw on multiple services, that is child and adolescent , id, childcare, etc.

What about children?


• Retain current status quo including provision within the existing adult mental health services

• Number of designated units, e.g. Stewarts Hospital & St. Josephs

• Look at developing and/or enhancing current services

• Address MHID team deficit

• Option to buy capacity in private sector

• Overseas treatment – preference to provide treatment here.

Inpatient capacity on 01.11.06


• We have overarching plan

• Local plan between HSE & agencies; need to enter into discussion and agree arrangements now

• Ongoing development funding through mental health and disability services.

• Sub-group of Implementation Team for Vision for Change to implement the recommendations made by the MHID Service Planning Forum.

• Reconfigure current resources - staff and infrastructure

• Option exists to become an approved centre operating under a consultant psychiatrist. The whole unit must be approved.

• HSE through its Local Health Managers obliged to provide service to all people in catchment area.

What do we need to do now?

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