Psychosis Care Pathways for patients with diagnoses of mental illness in a Forensic Mental Health service.

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1 Psychosis Care Pathways for patients with diagnoses of mental illness in a Forensic Mental Health service. Delivered by Samantha Tait and Michelle Dutton (BSc, MSc, C.Psychol, AFBPsS) A REAL AND LASTING DIFFERENCE FOR EVERYONE WE SUPPORT

2 A bit of background Kemple View is a Low Secure and Locked Rehabilitation service for adult males sectioned under the Mental Health Act The hospital is located in Lancashire, in the heart of the Ribble Valley. There are 90 beds across the service. 24 of these are occupied by patients in the Locked rehabilitation service. The psychosis care pathway is currently being piloted on both wards that specialize in treating patients with a primary diagnosis of mental illness. Patients care is managed by a multidisciplinary team which includes: Psychiatrists, Psychologists, Nursing staff, Occupational Therapists, and Social Workers. Family involvement is encouraged and supported at every stage of patient care. Individual advocacy is also available for all patients. Samantha and Michelle are both Registered and Chartered Forensic Psychologists working across the two mental health wards. The Psychosis Care Pathway has been designed and developed by ourselves and other colleagues within the Psychology and Occupational Therapy Department* which is managed by Kate Jennings, The Director of Therapy Services at Kemple View. *with special thanks to Pen Hutchinson who was unable to attend today.

3 Aims of the workshop.. To introduce the Psychosis Care Pathway model. To discuss the development and aims of the model. To provide an opportunity for delegates to become familiar with the content of the stages of the model. To facilitate an exercise from the second stage of the model. To discuss ongoing development and future stages. To provide opportunity for discussion and questions.

4 Development and Aims of the model. The goals of the PCP are: To improve the structure of treatment that patients receive during their stay. To develop an understanding of patients mental illness and improve therapeutic relationships using 1-1 time constructively. To provide evidenced based treatment to develop patients understanding of and insight into their mental illness (consistent with NICE guidelines - schizophrenia-in-adults-prevention-and-management-pdf ). For patients to learn skills in identifying and managing symptoms and develop responsibility for managing their own illness. To encourage patients to collaboratively work with their team in order to manage their illness. To encourage patients to develop a structured and meaningful life which will support positive mental health in their future. To compliment other treatments that patients may be engaging with including medication. To create something that would be accessible to all patients.

5 The model. Module 1 Psycho-Education Workbooks: Individual work Module 2 Developing Insight and Self /Joint Management Mental Health Awareness: Group Module 3 Advanced Insight and Self Management CBT for psychosis: Individual work Module 4 Community based support Support Network Groups (e.g. hearing voices) Sequenced so that each level builds upon the previous intervention.

6 Cycle of Change. The Cycle of Change The new me Module 3 CBT Module 4 Keeping it up Making changes Module 2 MHA Group Network/peer support A one off mistake Thinking about change Module 1 Workbooks January 2017 The old me Not thinking about change

7 Module 1 - Workbooks. Four short modular workbooks: 1 Practical facts about Mental Illness. 2 Symptoms (positive and negative). 3 Treatment (medical and psychological). 4 Management (things that can exacerbate or trigger illness and protective factors). This is a low level intervention aimed at encouraging patients to begin to explore their illness. It is delivered in a motivational and non-challenging approach with use of reflective listening, non judgmental attitudes and empathy to maintain engagement. The workbooks are flexible in nature so material can be covered according to need and response of individual. Pre and post knowledge measures are used to assess progress. Patient and staff evaluation. Guidance booklet to assist staff in facilitation. Report detailing progress.

8 Module 2 MHA Group. The programme consists of approximately 24 sessions, each lasting between minutes. The sessions are designed to introduce the skills in a lighthearted and non-challenging way. Some of the aims of the group are to: Help patients increase their knowledge and understanding of mental illness. Help them understand the various types of mental illness including how diagnosis occurs and associated symptoms of mental illness. Help patients understand the stress-vulnerability model and be able to relate this to themselves. Explore ways of managing stress and increasing protective factors/resilience. Help patients understand how mental illness can be treated and managed; including ways to avoid a relapse. Highlight and tackle issues around stigma. Practice skills that will be useful in helping patients to manage difficult situations through using a problem solving approach, being assertive and focusing on their goals. Give patients a practical toolkit to help them manage their illness in the future.

9 Module 2 MHA Group. Let s practice!!! (Stress vulnerability exercise)

10 Module 3 - CBT. Individually tailored sessions as required. Formulation of the development of beliefs. Encourage patients to record and monitor any anxious/paranoid thinking. Opportunity to discuss. Assist patients in considering and evaluating evidence to support and dispute their thoughts. Opportunities to develop balanced/alternative thinking. Length of treatment is dependent upon the needs of the patient and is reviewed regularly with the MDT.

11 Module 4. Network/peer support Tailored towards finding support in the community. Opportunity for ongoing monitoring of symptoms. Availability of support. Consistent with the Good Lives Model* a strengths based approach premised on the idea that we need to build capabilities and strengths in people, in order for them to lead successful and fulfilling lives. * (Ward & Gannon, 2006; Ward & Stewart, 2003)

12 Questions.?