Acute Mental HealthFitting The Buildings To The Service

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Acute Mental Health-Fitting The Buildings To The
Service

• Paul Rooney
• Joint National Acute Care Programme Lead
  CSIP/NIMHE

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National Service Framework for Mental Health
,Modern Standards and Service Models (1999)

• Standard 5
• Each service user who is assessed as requiring a
  period of care away from their home should have
• Timely access to an appropriate hospital bed or
  alternative bed or place, which is
• In the least restrictive environment consistent
  with the need to protect them and the public.
• As close to home as possible.

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Adult Acute Inpatient Policy Implementation Guide
(2002)

• Inpatient treatments specific purpose for each
  service user must be addressed as part of their
  individual care plan.
• Integrated community and hospital joint working
  must be in place.
• Inpatient reception and admission arrangements
  must ensure that service users and carers are
  made welcome and informed.
• Service user, carer and staff collaboration in
  developing services and informing delivery
• Acute Care a priority for multi-disciplinary
  inputs.
• Wards should be designed and organised to
  facilitate time spent directly engaged with
  service users and carers.
• Acute care provision should be designed to
  maximise service and local community connections.

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Components of NSF integrated acute mental health
care system

• 24 hour help line
• Crisis resolution/home treatment service
• Crisis house/Respite provision
• Acute Day Care
• Acute inpatient wards
• Access to Psychiatric Intensive Care (PICU)
• Place of safety provision

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A Momentum for Improved Acute Mental Health Care

• Over 300 Crisis Resolution (home treatment) Teams
  established
• Approx 100,000 people used these services last
  year.
• Expansion in numbers of key staff.
• 1.6 billion capital invested in new and
  refurbished facilities (2001-6)
• Reduction in in-patient suicides by 29

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Accommodating the acute service

• Current Acute Unit building and design guidance
  out of date(HBN35 / 1996)
• Need to enable delivery of NSF whole system
  service model and standards
• The relationship between services is as important
  as the properties of the individual services
• An integrated CRHT and Inpatient care pathway is
  critical

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Buildings are important

• The size ,layout and location of inpatient
  provision projects powerful messages
• The worst thing that happened in my life was
  having my son admitted to hospital against his
  will (A Carer)
• The environment, in terms of what the ward looks
  like, the furnishing, the paint colours, and the
  food is as important as the quality of the
  auto-steriliser in an operating theatre
  (Consultant Psychiatrist)
• Inpatient wards have an important role to play
  in enabling people to sustain their community
  tenure (Service User/Psychologist)

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Some Basic Design and accommodation Issues

• Service co-working practicalities
• Reducing anxiety on arrival and admission
• Keeping people informed
• Personal space/gender separation
• Food
• Boredom, activities and breathing space
• Community inreach
• Design for people not illnesses

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Laying The Foundations

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National Support For Implementation

• Acute inpatient core national programme when
  NIMHE established April 2002
• Acute Care Forums in each Trust.
• Healthcare Commission Improvement review 2007-8
• Increasing number of examples of good practice
  and better environments
• Toolkits and Networks eg Star Wards, AIMS,
  NAPICU, A Positive Outlook..
• The Virtual Ward Website

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Virtual Ward and its editorial board