Full ESTEEM ahead for those who experience psychosis – Jonathan O'Reilly

Posted on January 9, 2020

“I no longer see psychosis as a catastrophe…I’ve been able to accept my diagnosis and not let it define me or my trajectory.”

These words were spoken at the first meeting of our Early Intervention in Psychosis Improvement Network (EIPIN) by Michael who has personal experience of psychosis.

With vulnerability and openness, Michael – and Stephanie, who also had experience of psychosis – brought to life for those attending the meeting what the experience is like, the recovery journey, and the impact and importance of early intervention.

Michael’s words of acceptance and hope had particular resonance for those attending the network meeting, as this is the very outcome we are striving to achieve for everyone who experiences psychosis in Scotland.

What is psychosis?

“Treating psychosis in the early stages can reduce the amount of time a patient needs to spend in hospital, reduce relapses, and leads to more effective and long lasting outcomes.”

Psychosis is characterised by hallucinations, delusions and disturbed thinking. It can cause considerable distress and disability for people affected, and for their families or carers. It’s estimated that there are approximately 1,600 new cases of psychosis in Scotland each year. Psychotic disorders can be extremely debilitating and it’s vital that those experiencing psychosis are treated quickly and effectively. Treating psychosis in the early stages can reduce the amount of time a patient needs to spend in hospital, reduce relapses, and leads to more effective and long lasting outcomes. Research from previous work in Scotland has shown improved outcomes when using a specially-designed model (called ESTEEM), compared to a more generic model, as inpatient stays can be significantly reduced, sometimes by up to 55%.

How the network came about

In the summer of 2019, Scottish Government published the action plan, Our Vision to Improve Early Intervention in Psychosis in Scotland, affirming their commitment to action 26 of the Mental Health Strategy, to improve access to services for those experiencing psychosis.

The Early Intervention in Psychosis Improvement Network is part of Healthcare Improvement Scotland’s Mental Health Improvement Portfolio of work.

By establishing and launching the network with the first meeting, Scotland took its first step in achieving those actions and mobilising a network consisting of health and social care, education sector, third sector, individuals with lived experience and carers.

The first EIPIN meeting was hosted by Healthcare Improvement Scotland with over 100 people from across Scotland in attendance. The aim of the meeting was to raise awareness of the importance of Early Intervention in Psychosis, the current evidence base for treatment, and how that evidence is currently being applied in the ESTEEM service in Glasgow (a community mental health service for people between 16-35 years, who appear to be experiencing their first episode of psychosis). Most importantly, the network will look at the positive impact of early intervention services on people’s lives.

Partnership working to drive improvements in care

“This work will ensure people presenting for the first time with psychosis anywhere in Scotland get access to effective care and treatment, with a focus on early intervention and recovery.”

A crucial part of this programme of work has been to recruit NHS Forth Valley and NHS Highland and their associated Health and Social Care Partnerships (HSCPs) to better understand the current provision of EIP services, what’s required to improve services, consider how data can be best collected and optimised, and determine what a good service for people experiencing psychosis looks like for service providers and service users.

I’m delighted to be involved in this important work. The work will ensure people presenting for the first time with psychosis anywhere in Scotland get access to effective care and treatment, with a focus on early intervention and recovery.

The success of the network launch – and the enthusiasm of all those who have stepped forward to be involved – has put us all on a strong footing to deliver improvements and recommendations to change the future for so many people experiencing psychosis in our communities.

Jonathan O’Reilly is an Improvement Advisor within the Mental Health Portfolio of Healthcare Improvement Scotland

More information

To learn more about the EIPIN and how we are progressing the action plan visit ihub.scot or on Twitter @spsp_mh. Get involved in the conversation on social media by following the hashtag #EIPScot.

Categories: ihub, Mental Health

Collaboration the key to consistent hospital care for those with dementia – Matilda McCrimmon

Posted on December 17, 2019

“My Mum was admitted to the medical assessment unit. The next day she was moved to a ward…this was after I told the staff she was very distressed by being moved about. She became so distressed she pulled her cannula out…. I spoke to the nurses in ward about not moving her again, but they said it would likely happen because of policy. Luckily she was discharged suddenly and this did not happen.”

“I would like to say how kind, caring and efficient all the staff were to my Dad when he was admitted before Christmas. He has dementia and as a result really struggles to be an inpatient and get very distressed easily. My mother and siblings were able to stay overnight to keep him calm and secure, and all the staff we encountered, from medical to domestic, showed immense understanding and compassion.”

These two stories from the Care Opinion website show the different experiences people with dementia are having in our hospitals, and the clear need for a consistent approach across Scotland, to ensure both they and their carers can be confident that no matter where they are treated, their care is of good quality. The Dementia in Hospital Collaborative, led by Healthcare Improvement Scotland’s Focus on Dementia team and the Alzheimer Scotland Dementia Nurse Consultants, aims to provide that approach.

A national priority

Dementia was made a national priority by the Scottish Government in 2007. We have made huge strides in improving hospital care for people living with dementia and their carers in the past 12 years. Unfortunately, these are not universal. Excellent work has taken place in some areas to ensure patients living with dementia experience minimal moves during hospital stays and where moves are necessary they are planned and at appropriate times. Yet in other areas, patients continue to be moved or “boarded”, creating distress and potentially prolonging hospital stays. I’ve visited patients requiring one to one nursing due to distressed behaviour to find that they have a nurse who sits and observes them, only intervening to stop “unsafe” behaviour. In other areas I have witnessed this being transformed into a therapeutic experience for the patient, with the one to one being used to provide social interaction and meaningful activity.

“We have made huge strides in improving hospital care for people living with dementia and their carers in the past 12 years.”

Improving on leadership

With a focus on preventing, identifying and managing the symptoms of stress and distress, the Dementia in Hospital Collaborative will support improved care for people with dementia in hospital settings. Key to this is ensuring there is clear leadership in each board to drive and monitor improvement. This leadership and improvement role is provided by our group of 16 Alzheimer Scotland Dementia Nurse Consultants, of which I am one. Our roles are four fold: to provide professional leadership, develop expert practice, training and education and develop and support practice improvement. These roles are partially funded by Alzheimer Scotland and provide the opportunity to develop these aims in a nationally coordinated way.

“With a focus on preventing, identifying and managing the symptoms of stress and distress, the Dementia in Hospital Collaborative will support improved care for people with dementia in hospital settings.”

As individuals, not only do we come from diverse geographical locations, we also have quite diverse professional backgrounds. Some of us have worked in mental health and general nursing, some have come directly from clinical practice and others have had roles in practice development or education. Our day to day roles also vary depending on our board, with a combination of direct patient care and community care. Some have input in mental health settings and others only in acute settings. The bringing together of our varied settings, roles and experience allows us to have a view of the wider landscape but also to identify common themes and challenges. Dementia is a complex condition, often accompanied by frailty and chronic disease. We’re just at the start of our journey to improve things, but believe that by combining our expertise with that of the Focus on Dementia team, we can to make a real difference for people living with dementia and their carers when it comes to hospital care.

Matilda McCrimmon is Alzheimer Scotland Lead Nurse for Dementia at Golden Jubilee Hospital.

More information

Visit the ihub website for information on the work of the Dementia in Hospital Collaborative.

Categories: ihub

Tagged: focus on dementia

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