Clinical Nurse Specialist Primary Care

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Clinical Nurse Specialist Primary Care

• Primary Care
• West Cork Mental Health Services
• Southern Health Board

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Giving People Time
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General Practitioner Referrals

• Location Clonakilty, Bantry, Castletownbere, Co
  Cork
• Purpose of the post
• To improve mental health
• To target less severe mental health problems
• To reduce stigma
• To improve communication/relationship between
  primary and secondary care

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Role of Clinical Nurse Specialist/Primary Care

• Offer a single, easy point of access
• Provide a rapid and appropriate response
• Undertake initial screening
• Promotion of well-being and positive life choices

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Treatments

• Giving advice, support, and short-term
  counselling
• Provide range of treatments in variety of
  settings, including home and surgery
• Access opinion from other health-care
  professionals

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Clinical Focus

• The aim of the Clinical Nurse Specialist/Primary
  Care is to work as an autonomous practitioner.
  The responsibilities are
• To determine appropriateness of referral
• To make an onward referral if necessary

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Supporting post primary school students

• Pilot location in two schools in Clonakilty Co
  Cork
• Referrals made via working professionals in post
  primary sector
• Support is provided to teaching staff and
  families
• Referrals for students and their families as
  appropriate within Primary Care

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Community Groups and Positive Mental Health

• Networking with community groups
• Post-natal depression
• Anxiety management
• Womens Travellers

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A REVIEW OF A PILOT PROJECT Mental Health Nurse
in a General Practice Setting DEPARTMENT OF
PUBLIC HEATH SOUTHERN HEALTH BOARD DECEMBER 2003
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MAIN FINDINGS

• A total of 102 patients were seen over a two year
  period.
• Age and Sex
• Mean age of attendees was 39 years of age
• More females (71) than males (29) attended the
  service
• Over 80 of patients were recorded as not having
  previously attended any type of mental health
  services I.e. new patients

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MAIN FINDINGS

• The majority (90) of new patients recorded less
  than 10 visits to the service while 32 of
  patients who were attending mental health
  services recorded more visits than 10 clinic
  visits

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OUTCOME OF ATTENDANCE

• Forty one percent of all those who attended the
  Mental Health Nurse service over the 2 year
  period were discharged.
• A quarter defaulted
• Nine patients were referred onto the psychiatric
  OPD services.
• Females were more likely to be discharged, and
  males to be referred to the psychiatric services

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PRESENTING COMPLAINTS

• Depression 87.0
• Anxiety FemalegtMale 80.7
• Relationship difficulties 76.7
• Financial difficulties 40.3
• Alcohol abuse 29.4
• Bereavement 25.4
• Family Violence 14.1
• Obsessive-Compulsive-disorder 12.3
• Fear of exam failure 1.7

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RELEVANT PAST HISTORY

• Previous history
• Suicide ideation 35 79female
• Domestic violence 32 77female
• Assault 18.5 70female
• Attempted suicide 16 70female
• Sexual abuse 12 73female

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PERFERENC FOR FUTUREATTENDANCE

• Respondents were asked where they would prefer to
  attend if they had a problem in the future. The
  majority (80) preferred the Mental Health Nurse

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RECOMMENDATIONS

• Consideration should be given to the optimum
  number of GP practices involved.
• Review of terms of reference. Appropriate
  referral guidelines and pathways of
  referrals.Stakeholders must agree which patients
  are appropriate to the service,i.e. only new
  patients, or include those already attending the
  psychiatric services
• A database should be maintained which would
  provide information on outcome measures including
  mental health status, outcome of attendance.

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THE WAY FORWARD

• Clinical Nurse Specialist in Mental Health part
  of the Primary Care Team

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ADRIENNE ADAMS

• Clinical Nurse Specialist
• Primary Care
• West Cork Mental Health Services
• SOUTHERN HEALTH BOARD