Care Homes Mental Health Liaison Team

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Care Homes Mental Health Liaison Team

• Toni Smith
• Specialist Mental Health Liaison Nurse

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Background

• Introduction of Free Nursing Care and development
  of Continuing Care Criteria
• Number of people living within care homes with
  mental health needs attending Out Patient
  appointments/ receiving Domiciliary visits from
  the Consultant Psychiatrist.

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The Team

• Specialist Mental Health Liaison Nurse
• 3.6 WTE Band 6 Mental Health Liaison Nurses 2
  posts funded by local P.C.T.s
• 0.5 WTE Band 3 Healthcare Support Worker
• 1WTE Admin Assistant
• Sessional support from Consultant Psychiatrists
• Monthly support from Clinical Psychologist for
  case review

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Referrals

• The team accepts liaison referrals for people
  over the age of 65 with a functional diagnosis
  and over the age of 18 with an organic diagnosis
  if living permanently within a care home.
• Last 12 months
• C.C/ RNCC
• Referrals direct from PCTs or through ongoing
  liaison work
• Liaison
• Referrals via SPA
• Residential Homes via GP or DN
• Nursing Homes via GP or Registered Nurse within
  the home
• Total Contacts - 2360

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Service Provided to P.C.Ts

• Initial, 3 month and 12 month Continuing Care and
  RNCC review for all residents within mental
  health nursing homes
• Care Management for people placed outside of area
  within specialist placement
• Ombudsman case review
• Participation in Continuing Care Panels
• 2nd Opinion assessment
• Joint review of people living in General
  settings.

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Service Provided to Care Homes

• Team accepts referrals from all care homes in the
  WMDC
• Ongoing formal educational package provided to
  all care homes
• Informal education and training
• Full comprehensive mental health assessment
• Review following out-patient appointments

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Cont.

• Medication review
• Identification of causes for changes in
  presentation and formulation of care plans to
  assist management
• Problem solving
• Reflective Practice
• Adult Protection
• Easier access to services rather than Out
  Patients appointment or D.V.

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Challenges

• Maintaining standards
• Developing and maintaining relationships
• Low staffing levels
• Limited meaningful activity within care homes
• Addressing physical health issues/lack of
  community services i.e Dietetics.

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Opportunities

• Reduced reliance on other teams within mental
  health services including admission into mental
  health beds
• Improved physical health of care home residents
  through screening process
• Improvement in standards of care
• Increased awareness of mental health issues for
  older people

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Cont.

• Care Home staff have an increased awareness of
  the impact of their approach.
• Better monitoring of care standards links with
  CSCI and Adult Protection Co-ordinator
• Improved follow-up post discharge from mental
  health or acute hospital
• Improved joint working with other agencies

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Future Plans

• Current pilot evaluation in progress
• Future 6 month evaluation
• Further developments with training
• Possible expansion of link nurse system