Improving mental health pathways

Objectives

In September 2017, a hospital Trust that delivers an acute Mental Health (MH) service across multiple sites, both in hospitals and in community, commissioned TN to:

• Deliver a diagnostic to establish ‘one version of the truth’ to identify current challenges facing the Trust
• Co-create transformation initiatives targeting service delivery to expedite MH patient flow
• Establish delivery mechanism for a sustainable and effective transformation programme

1. Diagnostic to understand root causes and create “one version of the truth”

• Quantitative analysis of MH admissions, referrals, and assessment data
• Qualitative observations from immersion with operational and clinical teams to (1) map out assessment process and (2) identify bottlenecks  (see Figure 1)
• Utilising quantitative and qualitative data, developed insights on bottlenecks and their root causes. Established common narrative, ‘busted myths', and built a case for change. For example, long wait times (12+ months) to be seen by one Community Mental Health Team (CMHT) created the false perception that all CMHTs had similarly long wait times. Therefore, the Mental Health Liaison Team (MHLT) avoided referrals to any CMHT, despite other teams having no wait time at all

2. Co-created transformation initiatives across three themes: systems and processes, resources, people and mindsets

Systems and processes

• Improve the MHLT rota, by creating overlap to avoid service gaps during handover
• Streamline MHLT paperwork process, including adopting ‘triage and referral’ form for ‘simple’ cases
• Enhance the interface with other MH Trusts to expedite ‘out-of-area’ admissions/discharges
• Improve referral system efficiency, including adopting ‘Early MH triage’: faster assessment for patient-cohorts likely discharged home, to the GP, or already under CMHT team
• Agree KPIs and reporting mechanism to track performance, e.g., average time from MHLT referral to MH assessment, % of patients assessed by MHLT within 1 hour of referral

Resources

• Recruit Approved Mental Health Professionals (AMHP) in response to increasing MH assessment referrals
• Train ED consultants to complete mental health assessment alongside certified mental health consultant

People and mindsets

• Introduce new ways of working, including weekly touch points to create a culture of effective communication and information sharing between teams (MHLT, Rapid Response, Child and Adolescent Mental Health Services (CAMHS) and older-people crisis teams, acute Trust ED, and inpatient teams, etc.)

3. Establish delivery mechanism

• Governance: Agreed and set up forums to manage programme delivery
• Reporting: Defined KPIs, including when and how they will be tracked
• Accountability: Established incentives for delivery and consequences for not delivering