Advancing the Shared Care Approach between Primary Care & Specialist Mental Health Services A guidAnCe PAPeR Prepared for the HSE National Vision for Change Working Group Uses: This is our master full colour logo which should appear on a white backround. A Vision for Change ADVANCING MENTAL HEALTH IN IRELAND Advancing the Shared Care Approach between Primary Care & Specialist Mental Health Services A guidAnCe PAPeR Prepared for the HSE National Vision for Change Working Group FOREWORD A Vision for Change recognises the essential role high quality, community based mental health played by our colleagues in Primary Care in the care. In a busy practice and complex fast provision of mental health care in Ireland. 90% of moving environments, simple protocols and mental health presentations remain in a primary straightforward engagement are the most care context and account for over 5 million powerful tools. occasions of care each year. This document endorses the use of electronic Chapter 7 of Vision introduces a number of communication and while this is still in models for collaboration with a preference for development in the health context in Ireland, the Shared Care model. This can improve service we felt it was important to anticipate the access, efficient use of specialist mental health widespread use of ICT tools which can greatly care services and facilitate early discharge enhance the delivery of services in a timely and and return to primary care. The importance of comprehensive way. maintaining the physical health of long term A survey conducted in the preparation of this mental health service users is also supported document greatly informed the work and took through this shared care approach. place as many primary care teams were being As Primary Care Teams continue to expand established. Thanks to those who contributed throughout the country it is now necessary to and gave feedback as part of this Guidance provide additional guidance. This document document development. recognises the various phases of development Practical recommended actions have been within the Teams and acknowledges that there placed to the fore of the document to highlight can be variation in the preparedness of some the importance of the immediate actions that can Primary Care and Community Mental Health best effect change in collaborative working at Teams for this shared role. local PCT/CMHT level. With the additional investment in Community Mental Health Teams this document provides timely guidance on how the essential links with primary care colleagues can be maintained. This document is one of a suite of resource materials prepared by the National Vision for Change Implementation Group. This group includes and values the expertise of multidisciplinary mental health professionals and the lived experience of Service Users. It is easy to overlook the benefits of peer to Martin Rogan Brian Murphy peer communication, the spoken word and Assistant National National Primary Care relationships between mental health and Director for and Social Inclusion primary care. These are still pivotal to providing Mental Health Services Manager 3 Acknowledgements I would like to acknowledge the work of the Primary Care subgroup Vision for Change in realising this Guidance Document in particular Louise Owens for her contribution on supporting the group and pulling together the graphics for the document. I would also like to thank all the people from both Mental Health and Primary Care services who took the time to complete the survey questionnaire and to those who contributed through their submissions. 4 CONTENTS Introduction 4 Recommended Actions 5 The Policy Context 8 The Shared Care Model 11 Mental Health & Primary Care Group Survey Results 15 Addressing the Challenges of Collaborative Working: Requirements for a Shared Care Model in Practice 17 References 20 Appendices 22 5 INTRODUCTION This Primary Care and Mental Health Group possible clinical outcomes for the patient/client, was established as a subgroup of the Vision for in practice this poses many challenges. Findings Change National Working Group (2010) (See from a survey of current collaborative working Appendix I for list of membership). The working amongst primary care and mental health service group engaged in a process of consultation practitioners conducted by the working group with key stakeholders including Service Users. showed that the level of integration between The group was tasked with examining the the mental health services and primary care recommendations laid out in Chapter 7 of a is inadequate in relation to what is necessary Vision for Change (2006) (see Appendix II) and to best facilitate the patient’s journey and to to develop a guidance document to promote support the professionals providing care collaborative working between specialist mental for patients. health and primary care services. This document will act as a ‘road map’ to support collaborative This document was developed to support staff working between Primary Care and Specialist working in Primary Care and Specialist Mental Mental Health Services in the delivery of a Health Services to achieve a more integrated comprehensive programme of care with the approach to patient care utilising a shared care Service User. approach. The Working Group is hopeful that this document will help to advance the shared care A key objective of the HSE is to integrate health approach to mental Health in Primary Care. care between the community and hospital services (DoHC, 2001(a)) so as to enable the The lay out of the document is designed to best possible patient care. Whilst there is highlight the recommended actions that support an acceptance that it is best for health care the collaborative working between Mental Health personnel to work together to ensure the best & Primary Care through a shared care model. 6 RECOMMENDED ACTIONS Introduction vi. All patients should have access to a comprehensive range of interventions Shared care is at the core of what health in Primary Care for disorders that do service delivery is about. A key challenge for not require Specialist Mental Health the health services is to achieve a standardised Services. collaborative working service delivery approach between mental health and primary care. This vii. The Service User and their family/carer requires a clear focus on shared care and a as appropriate should be involved at commitment to its development at national, every stage of the delivery of the shared regional and local levels. Working effectively care model. together, primary and specialist services can viii. Service Users need to be involved in the ensure that patients can access the most development and review of their plan appropriate, effective and timely service of care and must sign off on all plans that they need. relating to their care and treatment. A. Delivering Shared Care B. Communication and Information Sharing i. National policies and protocols that i. A senior member of the Specialist support shared care need to be Mental Health Team, ideally the Team developed and implemented between Co-ordinator, should be given the key Primary Care and Community Mental role of organising and liaising with GPs Health teams. and Primary Care Teams in relation to ii. Further development of clinical gover- referral and discharge processes. nance structures and strong leadership ii. Regular meetings between Primary is required to drive shared care. Care Teams’s, GPs and Mental Health iii. A consistent and standardisation of Services is an essential component of service delivery approach across the shared care approach and should the 4 HSE regions in terms of the be actively developed and supported by collaborative working approach to senior management at both Primary primary care and mental health is Care and Mental Health service level required. where absent or not developed. iv. Ensuring the boundaries for mental iii. National referral and discharge forms health and primary care services are such as that developed by the Primary co-terminus is an important measure Care Working Group (2006) should be that would help to achieve this goal. implemented. v. Primary Care and Mental Health Services iv. There is a need to develop effective should be co-located where possible. communication systems between 7 Primary Care and Specialist Mental and assist patients with mental health Health Services. It should include difficulties. the development of effective working iii. All staff including GP’s and Practice staff relationships between both services, are particularly well placed to have a key including exchange of information and role in mental health service delivery in regular meetings of senior staff to review and monitor communication practices. primary care. The role of the Practice (Goodwin et al 2011). Nurse in mental health promotion should be further explored and developed. v. Standardised electronic referral and discharge processes should be iv. Consideration should be given to the developed and implemented. training needs of the primary care practitioners in relation to the work of vi. Procedures and practices that support a the specialist mental health services consistent and safe approach to referral e.g. Team Based approaches to Mental management need to be prioritised. Health in Primary Care and National vii. All mental health service users, Guidance documents (Advancing including those in long stay wards, Community Mental Health Services in should be registered with a GP. Ireland, Guidance Papers, May 2012). viii. All service users should have an v. Greater awareness and co-ordination identified care co-ordinator (keyworker), between Mental Health Services, Primary be this staff member from Primary Care Care and Community Mental Health or specialist mental health services. resources and supports. ix. Patients who are identified as requiring vi. Community Mental Health Teams have the intervention of the Specialist Mental a key role in supporting clinicians who Health Team should be facilitated to work in primary care to meet the needs access these services in as seamless a of patients presenting with mental health manner as possible with clear processes problems.