Week 4: Community Care in Practice Flashcards
A more straightforward term that simply means “outside the walls” or “outside the hospital.”
Extramural Psychiatry
Is a way of providing mental health care that focuses on treating people within their communities, rather than solely relying on hospitals.
Community Care
What are the concerns of the National Schizophrenia Fellowship (28 Feb 1984) regarding deinstitutionalization?
- Inadequate aftercare for patients
- Insufficient aid for patients and their families
- Underestimation of the severity of mental illness
- Need for ongoing support
- Criticism of highlighting political correctness without addressing real-world challenges of patients and caregivers
Him and his team in The Assessment of Psychiatric Services (TAPS) conducted a thorough investigation into the impact of closing mental hospitals in England.
Julian Leff
What were the highlights of Care in the Community (Julia Leff)?
1) Evolution of policy was influenced by ideology
2) Residential care in the community works well
3) Cost of community care was not cheaper than hospitals
4) Large hospital closure led to challenges in acute hospital service
5) Staff training needs remained a constant issue
6) Media and public attitudes can influence closure of programs
7) Reprovision needs to be “future-proofed”
8) Difficult patients still require specialized care
9) A false antithesis between the hospital and the community
10) Comprehensive community care is essential
4 Essential Elements in Promoting Mental Health Care (Thornicroft, 2011)
1) Address population-based needs in an accessible and acceptable way
2) Build on the goals and strengths of those who experienced mental illness
3) Promote a wide network of support, services, and resources
4) Emphasize services that are evidence-based and recovery-oriented
Evolution of Approach to understanding Need
Normalization: A popular approach in the 1980s and 90s, emphasizing integration into the community.
Recovery (2000s): A more recent approach, emphasizing empowerment, hope, and a fulfilling life.
A concept that aims to promote social inclusion and reduce stigma for individuals with disabilities or mental illness by emphasizing their similarities to people without disabilities.
Normalization
A term used to describe a supportive living arrangement for individuals with disabilities or mental illness, often involving a group of people who live together and share responsibilities.
Pseudo-Family
A type of community-based support service that provides assistance to individuals with disabilities or mental illness in their own homes or in the community, as needed.
Floating Support
2 Contrasting Models of Mental Health Care
1) Implicit Model
2) Psychiatric Model
Key features of the Implicit Model
Focus: Individual needs and strengths
Support: Largely provided by non-professional staff Goals: Social integration and an “ordinary life”
Perspective: Focuses on the individual and their needs within society
Approach: Holistic, optimistic, and empowers users
Key features of the Psychiatric Model
Focus: Specific treatment needs
Support: Professional interventions
Goals: Symptom management and social functioning
Perspective: Epidemiological
Approach: More traditional and symptom-focused.
The study of the distribution, patterns, and determinants of health and disease in a population.
Epidemiology
DOMAINS
Basic Needs: Accommodation, food, self-care, home maintenance.
Activities: Daytime activities, physical health.
Symptoms: Psychotic symptoms, psychological distress.
Safety: Safety to self and others.
Information: Understanding of the condition and treatment.
Substance Abuse: Drugs and alcohol.
Social Life: Company, intimate relationships, sexual expression.
Childcare: Assistance with childcare.
Education: Educational needs.
Technology: Access to telephone and mobile phone.
Transportation: Assistance with transportation.
Financial: Money and benefits.
RATINGS
No problem
Met need
Unmet need
Not known
Camberwell Assessment of Need Short Appraisal Scale (CANSAS)
Provides a comprehensive assessment of an individual’s needs, helping to identify areas where support and intervention are required.
This information can be used to tailor treatment plans and ensure that individuals receive the necessary assistance to improve their quality of life.
Camberwell Assessment of Need Short Appraisal Scale (CANSAS)
A highly effective model for providing intensive community-based mental health care to individuals with severe mental illness.
The requirements identified by Stein and Test highlight the importance of addressing a wide range of needs to ensure successful community living.
Assertive Community Treatment (ACT)
Key requirements of people at risk hospital admission per the Assertive Community Treatment (ACT) model
- Material Resources: food, shelter, clothing
- Coping Skills: budgeting, cooking, using public transport
- Motivation: systems to help cope with stress
- Community Support: education and support
- Assertive Support System: prevent individuals from dropping out of care
- Independence: freedom from dependent relationships
- Effective treatment of symptoms and distress
Provides a comprehensive assessment of an individual’s quality of life, highlighting areas where improvements are needed.
This information can be used to guide service planning and intervention, ensuring that services address the specific needs and priorities of individuals with mental illness.
Manchester Short Assessment of Quality of Life (MANSA)
Domains of Assessment of the Manchester Short Assessment of Quality of Life (MANSA)?
Employment: Job or training, sheltered employment opportunities.
Financial Situation: Satisfaction with finances.
Social Life: Friendships, leisure activities, accommodation.
Safety: Personal safety (considering victimization and vulnerability).
Relationships: Living arrangements, sexual relationships, family relationships.
Health: Physical and mental health.
Refers to the process of gathering information about an individual’s needs, circumstances, and challenges to comprehensively understand the individual’s situation.
Methods: interviews, questionnaires, observations, and psychological tests
Assessments
Why is assessment important?
- Identifies the problem/s and need/s
- Identifies entitlement or eligibility to services
- Identifies steps for action or treatment plans
- Identifies/measures outcomes
Is a personal, ongoing process of:
- Improving one’s well-being and mental health
- Living a meaningful and fulfilling life despite any ongoing challenges
- Learning to manage symptoms and cope with mental illness
- Regaining hope and self-determination
Recovery
Starts from the individual’s own experiences and perspectives.
Suggests that traditional approaches to understanding and addressing needs may be limited.
Recovery
Natural healing response and an approximation to cure.
Recovery
Recovery from symptoms and difficulties in response to effective care and treatment as described in most evidence-based guidelines.
Getting better.
Clinical Recovery
Recovery of a valued pattern of life and living, with or without ongoing symptoms and difficulties, linked to an active personal commitment to working on recovery.
Living well.
Personal Recovery
A values-led collaborative endeavor of people in recovery, practitioners and many others, working to develop and transform mental healthcare and treatment.
The Recovery Movement
The overall pattern of care, support, and professional practice based on learning ‘what works’ from people in recovery.
Recovery-Oriented Approaches and Services
The ability to overcome challenges and bounce back from setbacks.
Resilience
A belief in a positive future and the possibility of recovery.
Hope
What was Pat Deegan’s definition of Recovery?
The goal of recovery is not to become normal. The goal is to deeply embrace the vocation of becoming more deeply, more fully human.
What is the US New Freedom Commission on Mental Health’s (HOGAN 2003) definition of Recovery?
A process of positive adaptation to illness and disability, linked strongly to self-awareness and a sense of empowerment.
What is the South London and Maudsley NHS Foundation Trust’s (2007) definition of Recovery?
Recovery involves living as well as possible.
What is the Royal College of Psychiatrists’ (2012) definition of Recovery?
For many people, recovery is the process of developing a new sense of self, purpose in life, and hope. It is a journey for the individual and those close to them to rebuild a satisfying life. Central to the theme of recovery is resilience which allows for individual strengths and coping skills to surface, in spire of adversity.
Support provided by individuals who have shared experiences of mental illness.
These groups offer a safe and understanding environment for individuals to connect with others who have similar experiences.
Peer Support
What is Helen Killaspy’s Definition of Rehabilitation?
A whole systems approach to recovery from mental illness that maximizes an individual’s quality of life and social inclusion by encouraging their skills, promoting independence and autonomy in order to give them hope for the future and leads to successful community living through appropriate support.
Components of a Competent, Community-Oriented Mental Health Service
- Comprehensive Assessment
- Individualized Treatment Plans
- Skill Development
- Supported Housing
- Peer Support
- Vocational Rehabilitation
- Crisis Intervention
- Community Outreach
- Advocacy
It aims to provide appropriate care based on individual needs and available resources.
This model likely emphasizes a balanced approach that incorporates:
Community-based services
Hospital-based services
Primary care as the bedrock of mental health services
The Balanced Care Model (Thornicroft & Tansella, 2013)
Different Resource-Settings in the Community
High Resource Settings
Medium Resource Settings
Low Resource Settings
The below are included as mental health services in this setting:
- Primary care
- General adult
- Specialized adult
High Resource Settings
The below are included as mental health services in this setting:
- Primary care
- Limited specialist mental health staff
Low Resource Settings
The below are included as mental health services in this setting:
- Primary care
- General adult mental health (stripped down)
Medium Resource Settings
Service Components in Community Mental Health Care
- Crisis and emergency services
- Early interventions
- Case management and Assertive Community Treatment
- Outpatient clinics
- Day hospitals and partial hospitalization programs
- Work rehabilitation - individual placement and support
- Inpatient treatment
- Residential care
- Programs to support family members and caregivers
- Medication
- Managing co-occurring physical disorders
- Self-management programs
Increasing emphasis on the role of individuals with lived experience in providing support and guidance.
Peer-led and Peer support services
Community-based education and training programs for individuals with mental illness.
Recovery College Movement
A well-defined geographical area that the community mental health service serves.
Catchment Area
Essential Elements of a Successful Community Mental Health Service
- Staff who care about their work
- Good local management
- A focus on individual needs and their carers that goes beyond protocol-based treatment
- Awareness of functional impairments and how these may be overcome
- Optimistic, problem-solving approach
