Using Quality Improvement Approaches to Improve Care Pathways in Mental Health
A Joint Healthcare Conferences UK and MINDSet Conference
Chaired by Geraldine Strathdee Clinical Director Mi4 and Former National Clinical Director for Mental Health NHS England, the conference offered the chance to network with others, find out how quality improvement is spreading in mental health settings and discuss improvement case studies with mental health clinicians who are using quality improvement approaches.
What is Quality Improvement?
Anna Burhouse Director of Quality Improvement Rubis QI, Northumbria Healthcare NHS Foundation Trust
- what is quality improvement?
- current trends and themes in quality improvement
- the improvement journey
- using quality improvement in mental health
Mental health services in the UK are beginning to adopt Quality Improvement methods and techniques at scale. Anna described the national context of this work and signposts to key papers to support your quality improvement journey. She commented; "Don Berwick hugely influential on quality improvement. The NHS needs to be an organisation that learns."
"Quality improvement needs a personal touch"
"Need to be a good clinician but also need to try and improve the system that we are working in"
"Quality improvement measures can help you as a trust systematically make change"
"Mustn’t forget ourselves, everyone of us us on an improvement project" Anna spoke about being very passionate about the mental health creative approach to coproduction.
Improving access to primary care mental health services
David Kingdon Professor of Mental Health Care Delivery University of Southampton and Consultant Adult Psychiatrist Southern Health NHS trust
- improving outcomes through better access to effective integrated care pathways
- implementing quality-focused workforce redesign
- using a Collaborative Care Model to engage stakeholders, identify issues and plan
- using clinical and system measures to track improvement in quality and outcomes
In his presentation David spoke about the issues with primary care in terms of mental health and commented; "there are real issues about managing Care in our services let alone stretching the workforce further."
"collaborative Care is particularly interesting and is a term we aspire to" David referred to collaborative care work in the USA.
"IAPT is still a very important player in primary mental health care"
"how are we going to learn from the STAR Project and take it further"
Pre conference abstract
Mental health presentations in primary care are common (estimated at up to 30% of consultations) and can be complex and time-consuming to manage. This demand has increased as traditional sources of support e.g. the extended family and religious organisations, have generally reduced. This a key issue increasing the current unsustainable demand for health services generally and particularly for primary care. Community Mental Health Services (CMHT) have focused on providing care for those with severe mental health problems and set criteria to reflect this. Improving Access to Psychological Therapy (IAPT) have been developed to provide support for lower levels of depression and anxiety but currently only meet 17.5% of need and the proposed expansion is only looking to increase this to 25%.
There have been many projects looking to develop mental health services in primary care over the past 30 years but few have been sustained. These have generally involved a displaced secondary care model of a psychiatric nurse and/or psychiatrist doing clinics in primary care premises. These have usually become over-whelmed with referrals leading to high waiting times and the services eventual demise. Even if this were a route to meet demand in primary care, there is a major shortage nationally and locally of psychiatrists and psychiatric nurses, similar to that of general practitioners, which means that these trained would not be available to meet the potential demand.
The project described, aimed to develop a cost-effective sustainable service to meet needs of those presenting with mental health issues and, as appropriate, provide self-help guidance, link to appropriate agencies, liaise with mental health services and minimise ineffective use of primary care and emergency department time. Band 4 workers with a Community Mental Health Team member (Band 6) accepted 160 referrals of people with ‘emotional needs’. Exclusions were those in current contact with specialist mental health, learning disability or substance misuse services. Levels of anxiety and depression were high in the group but brief problem solving and linkage to support was generally acceptable.
Quality improvement tools and resources
Dr Kathy Chapman Project Director MINDSetQI
- creating a plan to develop your personal effectiveness
- delivering improvements in quality to early and continuously
- accessible guidance, tools and templates
- other sources of support and development
Pre conference abstract
MINDSet www.mindsetqi.net is an online quality improvement for mental health. Initially developed in 2016, it has grown organically to include a range of partners from the NHS and the third sector. The purpose of MINDSet is to make continuous improvement in mental health easier, by sharing improvement information and case studies in a highly accessible form. By improvement information we mean information about the context and case for change in mental health, a simple description of quality improvement, case studies of improvement illustrating the use of quality improvement tools and techniques and other resources. This session provides an introduction to MINDSet and explores how MINDSet can support individuals and teams to develop their improvement capability.
Kathy is the Programme Manager for the Mental Health System Leadership Programme (Mi4). Mi4 works with a range of organisations and sectors using information and intelligence to improve the quality of services for people with mental health problems. Kathy coordinates a range of improvement projects including NHS England’s Clinical Service Quality Service Measures for psychosis, dementia and children and young people’s mental health and MINDSet, a quality improvement toolkit which aims to make continuous improvement in mental health easier. She is a qualified Agile Programme Manager and she is particularly interested in the ‘How?’ of quality improvement and delivering measurable patient benefit early and continuously. Kathy has more than 25 years experience in mental health, as Clinical Psychologist specialising in neuropsychology and forensic clinical psychology and in management roles including at Board level.
Future conferences of interest:
Violence and aggression: short-term management of violent and physically threatening behaviour among adults, children and young people with a mental health problem
Improving Mental Health Crisis Care
Eating Disorders Summit: Implementing the new NICE guidelines
IAPT: Improving Psychological Therapies for Older People
Dual Diagnosis: Implementing the NICE Guidance
30 October 2017