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Provision of care for people with poor mental health
The CQC rates practices against particular population groups
The CQC now inspects and rates practices against six population groups – older people; long-term conditions; mothers, babies and children; working age; people living in vulnerable circumstances, including people with a learning disability and people experiencing poor mental health , including dementia. This article, the final in a series of six, will address the ‘people experiencing poor mental health, including people with dementia’ population group and how we could improve the service we give to them.
This particular patient group includes the spectrum of poor mental health, ranging from depression - including post-natal depression - to severe and enduring mental illnesses, such as schizophrenia. It also includes people who have dementia.
Use of the Mental Health Act has grown. At the end of 2013/14, there were 23,531 people subject to the Act, either detained in hospital or under a community treatment order. This represents an increase of 6 per cent from 2012/13. As the number of patients with poor mental health continues to increase, the CQC is continuing to make sure that health and social care services provide them with safe, effective, compassionate and high-quality care.
How will the CQC assess services provided?
When considering this group, CQC inspectors will check that providers ensure patients, and their families or carers, understand their legal rights and are involved in their treatment. QCS policies, plus training and audits, will help staff to understand the specific needs of people and their families or carers. Following the publication of the revised Code of Practice in January 2015 https://www.gov.uk/government/news/new-mental-health-act-code-of-practice the CQC also encourages all providers and commissioners to work together to develop a plan for implementing the new Code that will improve the experience and outcomes for people subject to the MHA.
How to achieve a Good or Outstanding rating
Patient register and documentation
The practice should hold a register of patients experiencing poor mental health, including those diagnosed with dementia. If possible, prompts within the patient record system could highlight if the patient has a carer, and also identify any potential risks so that GPs can focus on the support that those patients need. Provide data wherever possible to show that the practice engages well with people experiencing poor mental health, for example, health screening performance for blood pressure, cholesterol, blood glucose and alcohol consumption, and cervical smears for female patients with complex mental health needs. Completed care plans should include identification of potential risks, plus actions to reduce these and any arrangements for carer support.
Improve access and support
Practices should consider improved access to support for patients living with long term conditions and their carers. They should know how to appropriately support patients in and signpost them and their carers to the local memory clinics for assessment where appropriate. Practices should have systems in place to follow up patients who have attended accident and emergency (A&E), where they may have been experiencing poor mental health. They should ensure staff receive training on how to care for people with mental health needs, and consider offering longer appointments at quieter times of the day.
Working with other healthcare professionals
Practices should try to gain regular access and advice directly from a local community mental health nurse and/or a local psychiatric consultant. They should regularly meet and work with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Practices should have advance care planning in place for patients with dementia, and actively screen patients who are displaying signs or at risk of dementia, if possible using a professionally recognised tool. It is always beneficial to work closely with the community mental health team when patients are in crisis.
Inform patients experiencing poor mental health about how to access various support groups and voluntary organisations, such as MIND and SANE, and refer to counselling services where appropriate.
Recent CQC reports have highlighted one particular practice that rated as outstanding because they facilitated patients’ access to counselling from the Depression and Anxiety Service (DAS) closer to home. They made a room available in the practice every week for these appointments to take place. This meant that patients were able to avoid having to travel almost 30 miles away for their appointments.
Another outstanding example included a practice who hosted a Memory Matters programme, run by the Alzheimer's society, at their practice. This enabled carers and patients to attend who were unable to travel far and would otherwise be unable to participate.
Key areas for action
These are actions which practices should consider to evidence they are meeting the needs of people with poor mental health, including dementia, and what outstanding provisions may also be offered:
- Hold a register of patients with poor mental health, including those with dementia.
- Carry out audit and review of care for patients in this population group to identify patients with the condition and to validate your register.
- Regularly work with multi-disciplinary teams in the case management of people diagnosed with dementia and carry out advance care planning wherever possible.
- Have a dementia lead GP and ensure staff have received training in dementia care, the Mental Capacity Act and capacity assessments.
- Actively engage with patients to encourage attendance for reviews, maybe by telephone, for frequent non-attenders.
- For patients who experience difficulties attending appointments at busy periods consider offering appointments at quieter times, such as at the beginning or end of the day, to reduce anxiety.
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