Psychiatric Services Flashcards
Why we need to review the history of psychiatric services?
- More than disciplines such as cardiology or nephrology, psychiatric treatment and diagnosis are affected by the surrounding culture and society (and therefore more dynamic)
- Important to understand:
- The problems inherited (and improved) over time
- The longstanding pendulum of restriction vs freedom, based on prevailing social pressures (patient rights vs societal interests)
What is the aim of community care?
- Aim to treat acute illness as soon and as close to home as possible.
- No longer long admissions to hospital (fewer and closure of hospitals)
- Minimising inpatient stay
- Rehabilitation and discharge
- Multidisciplinary teams
- Legal reform
- Care coordination
- Patient involvement
- Collaboration with Primary Care
- Looking at a patient in a holistic view
What are the components of psychiatric services?
- Primary Care
- Improving Access to Psychological Therapy (IAPT)
- Voluntary Sector
- Private/Independent Sector
- Community Mental Health Teams
- Addictions Services
- Crisis Resolution and Home Treatment Teams
- Liaison Teams (Medical and Criminal Justice)
- Inpatient Wards
Explain primary care in MH?
- The most common mental disorders are managed within the blanket of Primary Care
- Usually the first point of contact
- Some practices will have a dedicated counsellor or MH practitioner attached
- Referred on if there is complexity, treatment resistance, or risk
What is IAPT?
Improving Access to Psychological Therapies
- Set up in 2008 to do exactly as it says
- Designed to treat more common mental disorders like anxiety and depression
- Variety of names and configurations of service provider (often a combo of NHS and third sector)
- Waiting lists can also vary depending on locality
- Self-referral or referral by a healthcare professional
- Sunderland Psychological Wellbeing Service locally
Explain the voluntary sector of psychiatric services
- AKA ‘The Third Sector’
- Charities, social enterprises and voluntary groups
- Local to national, specific to general
- Plug gaps in the system
- Numerous examples
Explain secondary care in MH
- Acute access points (Green)
- Subacute access points (Pale Blue)
- Referral for hospital admission is usually coordinated by either CMHT, CRHT, PLT or CJLD
- Most CMHTs and hospital wards are further divided by sub-speciality
Crisis resolution and home treatment team - first on call to the patient, see patient every day, go to homes and maintain safety in the community
Psychiatry liaison team - liaison between hospital and psychiatric services, live everywhere in the hospital
Criminal Justice Liaison & Diversion - if someone gets arrested and possibly they hallucinate or suicidal ideation (mental health problems), will be in the police station and co-ordinate to possibly go back home or to hospital or detained under mental health act
What are the sub-specialities of psychiatry?
- Child and Adolescent
- Learning Disabilities
- General Adult Psychiatry
- Liaison
- Early Intervention in Psychosis
- Perinatal
- Addictions
- Eating Disorders
- Neuropsychiatry
- Rehabilitation and Social
- Older Adult Psychiatry
- Forensic Psychiatry
- Medical Psychotherapy
What are the sub-specialities of psychiatry?
- Child and Adolescent
- Learning Disabilities
- General Adult Psychiatry
- Liaison
- Early Intervention in Psychosis
- Perinatal
- Addictions
- Eating Disorders
- Neuropsychiatry
- Rehabilitation and Social
- Older Adult Psychiatry
- Forensic Psychiatry
- Medical Psychotherapy
Explain child and adolescent psychiatry (&types of patients)
- Assessment and management of children and young people presenting with complex, severe and high-risk problems
- Combine a variety of approaches (eg combining psychotherapy with pharmacotherapy or individual with family approaches)
- Skilled in working with children and families with complex disorders, where an understanding of the biopsychosocial interplay is important and where multimodal interventions are indicated
Types of patients
A lot of trauma, eating disorders, ADHD, substance misuse, social issues, sometimes psychiatric disorders, anxiety disorders, children with emotionally unstable personality disorder
Explain learning disability psychiatry
- Partnership with GPs, other specialties, social care, and private agencies.
- Assessment and treatment of mental disorder in people with LD.
- Sub-specialist teams/pathways focusing on challenging behaviour, offenders with LD, autism spectrum disorders, dementia assessment and management, particularly in the Down population, complex physical health needs or epilepsy.
- Communication skills key.
Down syndrome patients higher risk of Alzheimer’s because extra gene due to extra chromosome puts them at higher risk
Explain general adult psychiatry
- Majority of mental health services
- Subspecialties
- Liaison Psychiatry
- Perinatal Psychiatry
- Addictions
- Rehabilitation/Social Psychiatry - work in integration back into the community
- Neuropsychiatry - organic psychiatry, usually a structural or neurological diagnosis (space occupying lesions e.g. tumours, head injuries, dementias, epilepsy)
- Eating Disorders
Explain old age psychiatry
- People of any age with a primary dementia.
- People with a mental disorder and physical illness or frailty that contributes to, or complicates, the management of their mental illness. (may include people <65yo)
- People with psychological or social difficulties related to the ageing process, or end-of-life issues, or who feel their needs may be best met by a service for older people. Would normally include people >70yo
Explain forensic psychiatry
- Assessment and treatment of mentally disordered offenders, investigation of complex relationships between mental disorder and criminal behaviour, and collaboration with criminal justice agencies to support patients and protection of the public.
- Leadership in the care and treatment of mentally disordered offenders and others needing similar services, including risk assessment and management and the prevention of further harm.
- Work side by side the Police, Probation Service, courts, Crown Prosecution Service, and prisons
Explain medical psychotherapy
- Work with complex and severe mental disorders, and especially those with a combination of medical and psychological issues.
- Expertise in leadership, supervision and clinical management in teams; essential for team cohesion and clinical effectiveness when working therapeutically with highly complex cases.
- Promote a culture of enquiry and reflective practice in community and in-patient mental health settings.
