Standards for Community-Based Mental Health Services

Standards for Community-Based Mental Health Services Editors: Jen Perry, Lucy Palmer, Peter Thompson, Adrian Worrall, Jane Chittenden, Matt Bonnamy Pu...
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Standards for Community-Based Mental Health Services Editors: Jen Perry, Lucy Palmer, Peter Thompson, Adrian Worrall, Jane Chittenden, Matt Bonnamy Publication Code: CCQI201

Contents

Contents Foreword Introduction Standards: 1. Access and referral 2. Waiting times 3. Preparing for the assessment 4. Initial assessment 5. Completing the initial assessment 6. Following up service users who don’t attend appointments 7. Reviews and care planning 8. Care and Treatment 8.1 Therapies and activities 8.2 Medication 9. Physical healthcare 9.1 Physical healthcare and substance misuse 9.2 Managing the physical health of service users on mood stabilisers or antipsychotics 10. Risk and safeguarding 11. Discharge planning and transfer of care 12. Interface with other services 13. Capacity and consent 14. Service user involvement 15. Carer engagement and support 16. Treating service users with compassion, dignity and respect 17. Provision of information to service users and carers 18. Service user confidentiality 19. Service environment 20. Leadership and culture 21. Teamworking 22. Staffing levels and skill mix 23. Staff recruitment and induction 24. Appraisal, supervision and support 25. Staff wellbeing 26. Staff training and development 27. General management 28. Clinical outcome measurement 29. Audit and service evaluation 30. The service learns from incidents 31. Commissioning and financial management References Glossary Acknowledgements

Standards for community-based mental health services

02 03 04 04 05 05 06 06 06 07 08 09 09 10 10 11 12 12 12 13 13 14 14 15 15 16 16 17 17 17 18 18 19 19 19 20 21 23

1

Foreword

Introduction

Foreword

Introduction

I am pleased to introduce the Royal College of Psychiatrists’ first set of core standards for mental health services. For many years, the College Centre for Quality Improvement (CCQI) has been producing sets of standards for its individual networks, each covering their own speciality areas. These individual sets of standards are respected, however there are core principles of high quality care which run through all services, no matter what the setting or service user group. Offering service users timely, evidence-based treatment which is provided by competent and well supported staff is fundamental to all good mental health services. Providing support to service users and carers and treating them with dignity is essential, whatever the specialty. So is evaluating services using outcomes measures, feedback and audit. We have therefore brought together these core elements of good quality care into two simple documents – one for inpatient mental health settings and one for community-based services.

Description and scope of the standards

We can all benefit from these core standards. Healthcare professionals across mental health settings will have clear consistent standards to work towards and they will have a shared understanding of good quality care. Service users will be clearer about what they can expect from mental health services, regardless of the setting. The standards should lead to less unwanted variation between services and overall better care for service users.

How the standards were developed

And what might this mean for the College in the future? This project has aligned CCQI work with the work of the British Standards Institution (BSI) which is the UK’s largest standards developer. It has also helped to prepare the CCQI to potentially publish standards through the International Organisation for Standardisation (ISO) network. I would like to thank the many service users, carers, healthcare professionals, CCQI staff and the BSI who have worked to develop the first set of core standards and I look forward to seeing them being put into action. Professor Sir Simon Wessely President of the Royal College of Psychiatrists

The core standards for community-based mental health services have been developed by the Royal College of Psychiatrists’ College Centre for Quality Improvement (CCQI) and the British Standards Institution (BSI). The community-based standards cover access to services and what a good assessment looks like as well as care, treatment and discharge planning. They also cover the service environment, staffing and governance. Within the core standards we have included some minimum standards. The reason for doing this is that we need to be certain that services which are accredited by the CCQI are safe, comply with the law, respect service users’ rights and provide the fundamentals of care. The statutory regulator will not have inspected the safety of all of the services which apply to go through the accreditation process at a detailed level.

The CCQI and BSI undertook a review of 17 sets of its existing standards to identify which standards were ‘core’ to all mental health services. These core standards then underwent an extensive review process. A steering group and a reference group made up of clinical, service user and carer experts enabled representation from each of the different specialties whose standards were used in this project. Feedback was also sought from other sources including CCQI staff, the chair persons of the CCQI advisory groups and representatives from the college’s faculties and divisions. The following principles were used to guide the development of these standards: • Access: Service users have access to the care and treatment that they need, when and where they need it. • Compassion: All services are committed to the compassionate care of service users, carers and staff. • Valuing relationships: The value of relationships between people is of primary importance. • Service user and carer involvement: Service users and carers are involved in all aspects of care. • Learning environment: The environment fosters a continuous learning culture. • Leadership, management, effective and efficient care: Services are well led and effectively managed and resourced. • Safety: Services are safe for service users, carers and staff.

How the core standards will be used The core standards will be used by the clinical audits, quality networks and accreditation programmes within the CCQI. Each project will take on the relevant core standards which will be used alongside their own specialist standards.

Use of terminology

All criteria are rated as Type 1, 2 or 3 Type 1: Essential standards. Failure to meet these would result in a significant threat to patient safety, rights or dignity and/or would breach the law. These standards also include the fundamentals of care, including the provision of evidence based care and treatment. Type 2: Expected standards that all services should meet.

The core community-based standards use the terms ‘service user’ and ‘carer’. The decision was made to use these terms after consulting reviewers, the reference group and the steering group. When projects come to take on these standards, they will be able to change these terms to best suit their specialty. For example, child and adolescent mental health services may wish to replace the term ‘service user’ with ‘young person’.

Linking with the Care Quality Commission’s regulations The standards have been linked to the CQC’s ‘Regulations for service providers and managers, 2014’.

Type 3: Desirable standards that high performing services should meet. The development of the core standards was funded by the Royal College of Psychiatrists. Disclaimer. These standards are, to the best of our knowledge, in line with current legislation.

2

Standards for community-based mental health services

Standards for community-based mental health services

3

Standards

Standards

Number

Type

CQC Regulations Ref 2014

Access and referral

1 1.1

Standard

2

Number

Type

17.2b

1,2

3.1

1

• Information on who can accompany them;

3

Everyone is able to access the service using public transport or transport provided by the service.

15.1f

2,3

1.3

1

Clear information is made available, in paper and/or electronic format, to service users, carers and healthcare practitioners on:

9.3g

2,4

• How to contact the team if they have any queries, require support (e.g. an interpreter), need to change the appointment or have difficulty in getting there. 3.2

1

Service users are given verbal and written information on their rights under the Mental Health Act if under a Community Treatment Order (or equivalent) and this is documented in their notes.

3.3

2

Service users are given verbal and written information on:

• A simple description of the service and its purpose; • Clear referral criteria; • How to make a referral, including self-referral if the service allows;

• Their rights regarding consent to care and treatment;

2

Where referrals are made through a single point of access, e.g. triage, these are passed on to the community team within one working day.

1

• How to raise concerns, complaints and compliments; • How to access their own health records. 18.1

4

2

There are systems in place to monitor waiting times and ensure adherence to local and national waiting times standards.

2

The team provides service users with information about expected waiting times for assessment and treatment.

9.3g

The assessing professional can easily access notes (past and current) about the service user from primary and secondary care.

2,8

Initial assessment

4

17.2a

4.1

1

Staff members are easily identifiable (for example, by wearing appropriate identification).

4.2

1

Staff members address service users using the name and title they prefer.

10.1

6

4.3

1

Service users have a comprehensive assessment which includes their:

9.3a, 12.2a

2,9

6

12.2a

2,10

• Mental health and medication;

1,2,5

• Psychosocial needs; • Strengths and weaknesses. 4.4 9.3g

1,2

Guidance: Service users on a waiting list are provided with updates of any changes to their appointment, as well as details of how they can access further support while waiting.

4

3

4

Guidance: There is accurate and accessible information for everyone on waiting times from referral to assessment and from assessment to treatment. 2.2

3.4

4

Waiting times

2 2.1

Outcomes of referrals are fed back to the referrer, service user and carer (with the service user’s consent). If a referral is not accepted, the team advises the referrer, service user and carer on alternative options.

2,7

16.2

• How to access interpreting services;

• Contact details for the service, including emergency and out of hours details.

1.5

9.3g,

• How to access a second opinion;

• Main interventions and treatments available;

A clinical member of staff is available to discuss emergency referrals during working hours.

7

• How to access advocacy services;

• Clear clinical pathways describing access and discharge;

1

6

• The name and role of the professional they will see;

1.2

1.6

For planned assessments the team sends letters in advance to service users that include: • An explanation of the assessment process;

Guidance: The data are used to understand who is accessing the service, identify under-represented groups, promote the service to these groups and improve the accessibility of the service.

1.4

CQC Regulations Ref 2014

Preparing for the assessment

3

The service reviews data at least annually about the service users who use it. Data are compared with local population statistics and action is taken to address any inequalities of access where identified.

Standard

Standards for community-based mental health services

1

A physical health review takes place as part of the initial assessment. The review includes but is not limited to: • Details of past medical history; • Current physical health medication, including side effects and compliance with medication regime; • Lifestyle factors e.g. sleeping patterns, diet, smoking, exercise, sexual activity, drug and alcohol use.

Standards for community-based mental health services

5

Standards

Standards

Number

Type

Standard

CQC Regulations Ref 2014

Number

Type

Standard

4.5

1

Service users have a risk assessment that is shared with relevant agencies (with consideration of confidentiality) and includes a comprehensive assessment of:

12.2a

7.2

1

Risk assessments and management plans are updated according 12.2a,b to clinical need or at a minimum frequency that complies with national standards, e.g. College Centre for Quality Improvement specialist standards or those of other professional bodies.

2,4

7.3

1

The team has a timetabled meeting at least once a week to discuss allocation of referrals, current assessments and reviews.

2,9

5,8

• Risk to self; • Risk to others; • Risk from others. 4.6

1

9.3b, 12.2b

Guidance: Referrals that are urgent or that do not require discussion can be allocated before the meeting.

11 7.4

1

1

5.3

2

1

All service users have a documented diagnosis and a clinical formulation.

6.1

1

• Strategies for self-management; • Any advance directives or stated wishes that the service user has made; • Crisis and contingency plans;

The team sends a letter detailing the outcomes of the assessment to the referrer, the GP and other relevant services within a week of the assessment.

12.2i

All assessments are documented, signed/validated (electronic records) and dated by the assessing practitioner.

17.2c

If a service user does not attend for assessment, the team contacts the referrer.

12.2i

6.3

1

2

The team follows up service users who have not attended an appointment/assessment or who are difficult to engage.

12.2b

Data on missed appointments are reviewed at least annually. This is done at a service level to identify where engagement difficulties may exist.

17.2a

8

7.1

6

Managers and practitioners have agreed minimum frequencies of clinical review meetings that comply with national standards, e.g. College Centre for Quality Improvement specialist standards or those of other professional bodies.

1

The practitioner develops the care plan collaboratively with the service user and their carer (with service user consent).

9.3d

4

7.6

1

The team reviews and updates care plans according to clinical need or at a minimum frequency that complies with College Centre for Quality Improvement specialist standards.

9.3b

2,5

7.7

1

The service user and their carer (with service user consent) are 9.3b,d,g offered a copy of the care plan and the opportunity to review this.

13

8

Care and treatment:

8.1

Therapies and activities

14 8.1.1

1

2,5

Service users are offered evidence-based pharmacological and psychological interventions and any exceptions are documented in the case notes.

9.1.a

1,7

Guidance: The number, type and frequency of psychological interventions offered are informed by the evidence base.

Reviews and care planning 1

7.5

2,13

Guidance: This should include monitoring a service user’s failure to attend the initial appointment after referral and early disengagement from the service.

7

• Review dates and discharge framework.

9

Guidance: If the service user is likely to be considered a risk to themself or others, the team should contact the referrer immediately to discuss a risk action plan. 6.2

2,4,5

• Measurable goals and outcomes;

2,12

Following up service users who don’t attend appointments

6

9.3b,e

• Agreed intervention strategies for physical and mental health;

Guidance: The formulation includes the presenting problem and predisposing, precipitating, perpetuating and protective factors as appropriate. 5.2

Every service user has a written care plan, reflecting their individual needs. Guidance: This clearly outlines:

Completing the initial assessment

5 5.1

The team discusses the purpose and outcome of the risk assessment with the service user and a management plan is formulated jointly.

CQC Regulations Ref 2014

12.2b

2,8

Standards for community-based mental health services

8.1.2

1

Service users’ preferences are taken into account during the selection of medication, therapies and activities, and are acted upon as far as possible.

9.3b

7

8.1.3

2

Service users have access to occupational therapy.

9.1a

7

8.1.4

3

Service users have access to art/creative therapies.

9.1a

7

8.1.5

1

The team signposts service users to structured activities such as work, education and volunteering.

10.2b

2,6

Standards for community-based mental health services

7

Standards

Standards

Number

Type

Standard

CQC Regulations Ref 2014

Number

8.1.6

1

Service users and carers are offered written and verbal information about the service user’s mental illness.

9.3g

9

Physical healthcare

9.1

Physical healthcare and substance misuse

2,8

Guidance: Verbal information could be provided in a 1:1 meeting with a staff member or in a psycho-education group. 8.1.7

2

The team provides information, signposting and encouragement 10.2b to service users to access local organisations for peer support and social engagement such as:

2,8,15

Type

• Community centres;

8.1.8

8.1.9

1

1

Where concerns about a service user’s physical health are identified, the team arranges or signposts the service user to further assessment, investigations and management from primary or secondary healthcare services.

12.2b,i

9

9.1.2

1

The team gives targeted lifestyle advice to service users. This includes:

12.2b

16

12.2b

2

1

12.2b,i

8

12.2b

17

• Peer support networks;

• Smoking cessation advice;

• Recovery Colleges.

• Healthy eating advice;

All staff members who deliver therapies and activities are appropriately trained and supervised.

12.2c

• Physical exercise advice.

1,2 9.1.3

1

Medication When medication is prescribed, specific treatment targets are set 12.2b for the service user, the risks and benefits are reviewed, a timescale for response is set and service user consent is recorded.

2

8.2.2

1

Service users and their carers (with service user consent) are helped to understand the functions, expected outcomes, limitations and side effects of their medications and to self-manage as far as possible.

9.3c,e

13

Service users have their medications reviewed at a frequency according to the evidence base and clinical need. Medication reviews include an assessment of therapeutic response, safety, side effects and adherence to medication regime.

12.2a

• Drug/alcohol screening to support decisions about care/treatment options; • Liaison between mental health, statutory and voluntary agencies; • Staff training; • Access to evidence based treatments. 9.1.5

1

2,13

8.2.5

1

1

The service/organisation has a care pathway for the care of women in the perinatal period (pregnancy and 12 months post-partum) that includes: • Assessment; • Care and treatment (particularly relating to prescribing psychotropic medication);

Guidance: Side effect monitoring tools can be used to support reviews. Long-term medication is reviewed by the prescribing clinician at least once a year as a minimum. 8.2.4

The service has a policy for the care of service users with dual diagnosis that includes: • Liaison and shared protocols between mental health and substance misuse services to enable joint working;

1

1

The team understands and follows an agreed protocol for the management of an acute physical health emergency. Guidance: This includes guidance about when to call 999 and when to contact the duty doctor.

8.2.1

8.2.3

1

The service user and the team can obtain a second opinion if there is doubt, uncertainty or disagreement about the diagnosis or treatment. 9.1.4

8.2

CQC Regulations Ref 2014

9.1.1

• Voluntary organisations; • Local religious/cultural groups;

Standard

• Referral to a specialist perinatal team/unit unless there is a specific reason not to do so.

When service users experience side effects from their medication, this is engaged with and there is a clear plan in place for managing this.

9.3b, 12.2b

The safe use of high risk medication is audited at a service level, at least annually.

17.2a

2

Managing the physical health of service users on mood stabilisers or antipsychotics

9.2 2

Guidance: This includes medications such as lithium, high dose antipsychotic drugs, antipsychotics in combination and benzodiazepines.

9.2.1

1

Service users who are prescribed mood stabilisers or antipsychotics 12.2a are reviewed at the start of treatment (baseline), at 3 months and then annually unless a physical health abnormality arises. The clinician monitors the following information about the service user:

18

• A personal/family history (at baseline and annual review); • Lifestyle review (at every review); • Weight (at every review); • Waist circumference (at baseline and annual review);

8

Standards for community-based mental health services

Standards for community-based mental health services

9

Standards

Standards

Number

Type

Standard

CQC Regulations Ref 2014

• Blood pressure (at every review);

Number

Type

Standard

CQC Regulations Ref 2014

11.4

1

The team follows a protocol to manage service users who discharge themselves against medical advice. This includes:

12.2i

2,3

• Fasting plasma glucose/HbA1c (glycated haemoglobin) (at every review);

• Recording the service user’s capacity to understand the risks of self-discharge;

• Lipid profile (at every review).

• Putting a crisis plan in place;

Guidance: Service users are advised to monitor their own weight every week for the first 6 weeks and to contact the service if they have concerns about weight gain. 9.2.2

1

• Contacting the relevant agencies to notify them of the discharge.

For service users who have not successfully reached their physical 9.3c, health targets after 3 months of following lifestyle advice, the 12.2b team discusses and recommends a pharmacological intervention to them. This is documented in the service user’s notes.

11.5

2

When a service user is admitted to hospital, a community team representative attends and contributes to ward rounds and discharge planning.

12.2i

2,3

11.6

1

Service users who are discharged from hospital to the care of the community team are followed up within one week of discharge, or within 48 hours of discharge if they are at risk.

12.2b,i

9

18

Guidance: This is done in collaboration with the GP and according to NICE guidelines. For example, a service user with hyperlipidaemia could be prescribed a statin.

Risk and safeguarding

10 10.1

Guidance: This may be in coordination with the Home Treatment/Crisis Resolution Team.

1

The team receives training, consistent with their roles, on risk 13.2, assessment and risk management. This is refreshed in accordance 13.4b, with local guidelines. This includes, but is not limited to, training on: 18.2a

8

11.7

1

When service users are transferred between community services 12.2i there is a handover which ensures that the new team have an up-to-date care plan and risk assessment.

19

11.8

3

When service users are transferred between community services 12.2i there is a meeting in which members of the two teams meet with the service user and carer to discuss transfer of care.

9

11.9

1

There is active collaboration between Child and Adolescent Mental Health Services and Working Age Adult Services for service users who are approaching the age for transfer between services. This starts at least 6 months before the date of transfer.

12.2i

20

12.2i

9

12.2i

21

12.2i

2

• Safeguarding vulnerable adults and children; • Assessing and managing suicide risk and self-harm; • Prevention and management of aggression and violence. 10.2

1

Staff members follow inter-agency protocols for the safeguarding of vulnerable adults, and children. This includes escalating concerns if an inadequate response is received to a safeguarding referral.

12.2b, 12.3, 13.2

5,8

12.1

Discharge planning and transfer of care

11 11.1

2

Discharge or onward care planning is discussed at the first and every subsequent care plan review.

11.2

1

Service users and their carers (with service user consent) are involved in decisions about discharge plans.

Interface with other services

12 1

Guidance: This includes the team informing the service user’s GP of any significant changes to the service user’s mental health or medication, or of their referral to other teams. It also includes teams following shared prescribing protocols with the GP.

2,13

9.3d

7 12.2

1

Guidance: This could be through a formal discharge meeting. 11.3

1

A letter setting out a clear discharge plan is sent to the service user and all relevant parties within 10 days of discharge. The plan includes details of:

9.3g

The team follows a joint working protocol/care pathway with primary health care teams.

Guidance: This includes joint care reviews and jointly organising admissions to hospital for service users in crisis.

2,3,8

• On-going care in the community/aftercare arrangements;

The team follows a joint working protocol/care pathway with the Home Treatment/Crisis Resolution Team in services that have access to one.

12.3

1

The team supports service users to access organisations which offer:

• Crisis and contingency arrangements including details of who to contact;

• Housing support;

• Medication;

• Social services.

• Details of when, where and who will follow up with the service user as appropriate.

• Support with finances, benefits and debt management;

12.4

1

There are arrangements in place to ensure that service users can 12.2i access help, from mental health services, 24 hours a day, 7 days a week.

2,5

Guidance: Joint protocols are agreed, for example, with commissioners, primary healthcare services, emergency medical departments and social services.

10

Standards for community-based mental health services

Standards for community-based mental health services

11

Standards

Standards

Number

Type

Standard

CQC Regulations Ref 2014

Number

Type

Standard

12.5

1

The team follows an agreed protocol with local police, which ensures effective liaison on incidents of criminal activity/ harassment/violence.

12.2i

15.4

2

The team provides each carer with a carer’s information pack.

12.6

3

The service has a meeting, at least annually, with all stakeholders 17.2e to consider topics such as referrals, service developments, issues of concern and to re-affirm good practice.

8

22 15.5

2

Capacity and consent 1

Capacity assessments are performed in accordance with current legislation.

13.2

1

When service users lack capacity to consent to interventions, decisions are made in their best interests.

9.2,11.1, 12.2a,13.4a

2,10

There are systems in place to ensure that the service takes account of any advance directives that the service user has made.

11.1, 13.4d

15

1

2,8

1

The team follows a protocol for responding to carers when the service user does not consent to their involvement.

2

15.7

2

The service has a designated staff member dedicated to carer support (carer lead).

13

16.1

1

1

2

Service users and their carers are given the opportunity to feed back about their experiences of using the service, and their feedback is used to improve the service.

9.3f, 17.2e,f

Service user representatives attend and contribute to local and service level meetings and committees.

2

9

17.2e

22

15.1

1

Carers are involved in discussions about the service user’s care, treatment and discharge planning.

3,21

15.2

1

Carers are advised on how to access a statutory carers’ assessment, provided by an appropriate agency.

2,9

1

Service users are asked if they and their carers wish to have copies of letters about their health and treatment.

17.2

1

Information, which is accessible and easy to understand, is provided to service users and carers.

1

10.1

23

Carers are offered individual time with staff members to discuss concerns, family history and their own needs.

5

9.3g, 10.1

15,7

The service has access to interpreters and the service user’s relatives 10.1 are not used in this role unless there are exceptional circumstances.

2,7

Guidance: Exceptional circumstances might include crisis situations where it is not possible to get an interpreter at short notice.

Guidance: This advice is offered at the time of the service user’s initial assessment, or at the first opportunity.

12

15,21

Guidance: Information can be provided in languages other than English and in formats that are easy to use for people with sight/ hearing/cognitive difficulties or learning disabilities. For example; audio and video materials, using symbols and pictures and using plain English, communication passports and signers. Information is culturally relevant. 17.3

2

Service users feel listened to and understood in consultations with staff members.

17.1

Note: Carer involvement in the service user’s care and treatment is subject to the service user giving consent and/or carer involvement being in the best interests of the service user.

15.3

10.1

Provision of information to service users and carers

17

Carer engagement and support

15

Service users are treated with compassion, dignity and respect. Guidance: This includes respect of a service user's race, age, sex, gender reassignment, marital status, sexual orientation, pregnancy and maternity status, disability and religion/beliefs.

Guidance: This might include service user and carer surveys or focus groups. 14.2

Treating service users with compassion, dignity and respect

16

16.2 14.1

2,22

15.6

Service user involvement

14

Carers have access to a carer support network or group. This could be provided by the service, or the team could signpost carers to an existing network. Guidance: This could be a group/network which meets face-to-face or communicates electronically.

13.1

13.3

2,3

Guidance: This includes the names and contact details of key staff members in the service. It also includes other local sources of advice and support such as local carers’ groups, carers’ workshops and relevant charities.

Guidance: Stakeholders could include staff member representatives from inpatient, community and primary care teams as well as service user and carer representatives.

13

CQC Regulations Ref 2014

17.4

2

The service uses interpreters who are sufficiently knowledgeable to provide a full and accurate translation.

10.1

2,5

17.5

1

When talking to service users and carers, health professionals communicate clearly, avoiding the use of jargon so that people understand them.

10.1

13

9

Standards for community-based mental health services

Standards for community-based mental health services

13

Standards

Standards

Number

Type

CQC Regulations Ref 2014

Service user confidentiality

18 18.1

Standard

1

Confidentiality and its limits are explained to the service user and carer at the first assessment, both verbally and in writing.

1

All service user information is kept in accordance with current legislation.

17.2c

7

Guidance: Staff members ensure that no confidential data is visible beyond the team by locking cabinets and offices, using swipe cards and having password protected computer access. 18.3

1

Type

Standard

19.11

2

There are sufficient IT resources (e.g. computer terminals) to 15.1c provide all practitioners with easy access to key information, e.g. information about services/conditions/treatment, service user records, clinical outcome and service performance measurements.

2,7

19.12

3

The team is able to access IT resources to enable them to make contemporaneous records at meetings.

15.1c

2

19.13

1

Emergency medical resuscitation equipment (crash bag), as required by Trust/organisation guidelines, is available at the team’s base within 3 minutes.

15.1f

8

19.14

1

The crash bag is maintained and checked weekly, and after each use. 15.1e

8

19.15

2

Staff members have access to a dedicated staff room.

8

2,7

Guidance: For carers this includes confidentiality in relation to third party information. 18.2

Number

The service user’s consent to the sharing of clinical information 17.2c outside the team is recorded. If this is not obtained, the reasons for this are recorded.

7

Service environment

19.1

2

The service entrance and key clinical areas are clearly signposted. 15.1c

19.2

1

If teams see service users at their team base, the entrances and exits are visibly monitored and/or access is restricted.

15.1b

5

19.3

1

Clinical rooms are private and conversations cannot be easily over-heard.

10.2a, 15.1c

13

19.4

1

The environment complies with current legislation on disabled access.

10.2a 15.1c

3,8

1

Staff members follow a lone working policy and feel safe when conducting home visits.

18.1

20.1

1

There are written documents that specify professional, organisational and line management responsibilities.

16

20.2

2

Staff members can access leadership and management training appropriate to their role and specialty.

2,8

20.3

2

Staff members have an understanding of group dynamics and of what makes a therapeutic environment.

2

20.4

3

The organisation’s leaders provide opportunities for positive relationships to develop between everyone.

2,23

3

Guidance: This could include service users and staff members using shared facilities at the team base.

Guidance: Relevant assistive technology equipment, such as hoists and handrails, are provided to meet individual needs and to maximise independence. 19.5

20.5

2

Team managers and senior managers promote positive risk-taking to encourage service user recovery and personal development.

20.6

1

Staff members and service users feel confident to contribute to and safely challenge decisions.

1

An audit of environmental risk is conducted annually and a risk management strategy is agreed.

12.2d, 17.2a

8

19.7

1

Furniture is arranged so that doors, in rooms where consultations take place, are not obstructed.

12.2d

8

19.8

1

There is an alarm system in place (e.g. panic buttons) and this is 12.2d, easily accessible. 15.1b

7

19.9

1

A collective response to alarm calls and fire drills is agreed before incidents occur. This is rehearsed at least 6 monthly.

15.1b

2,7

All rooms are kept clean.

15.1a

20.7

1

14

Standards for community-based mental health services

2,23

Staff members feel able to raise any concerns they may have about standards of care.

12.2b, 13.2,20.1

2,9

12.2i

2,8

Teamworking

21.1

1

The team meets for handover, as required, which includes a discussion of service users’ needs, risks and management plans.

21.2

2

Staff members work well together, acknowledging and appreciating each other’s efforts, contributions and compromises.

21.3

2

The team has protected time for team-building and discussing service development at least once a year.

2,3

Guidance: All staff members are encouraged to help with this.

9.3d, 20.1

Guidance: This includes decisions about care, treatment and how the service operates.

21

1

2,22

2,5

19.6

19.10

15.1c

Leadership and culture

20 19

CQC Regulations Ref 2014

Standards for community-based mental health services

2,24

17.2a

7

15

Standards

Standards

Number

Type

22.2

CQC Regulations Ref 2014

Staffing levels and skill mix

22 22.1

Standard

1

1

Number

Type

2,8

The service has a mechanism for responding to low staffing levels, including:

2,14

18.1

24.1

1

24.2

1

• An agreed contingency plan, such as the minor and temporary reduction of non-essential services. 22.3

1

There is an identified duty doctor available at all times. They are able to attend the team base within 1 hour.

22.4

2

There has been a review of the staff members and skill mix of the 17.2a, team within the past 12 months. This is to identify any gaps in the team 18.1 and to develop a balanced workforce which meets the needs of the service.

23.2

18.1

1

8

All clinical staff members receive clinical supervision at least monthly, or as otherwise specified by their professional body.

18.2a

2,8

2,7

24.3

2

Staff members in training and newly qualified staff members are offered weekly supervision.

18.2a

2

14

24.4

2

The quality and frequency of clinical supervision is monitored quarterly by the clinical director (or equivalent).

17.2a

2,8

24.5

2

All supervisors have received specific training to provide supervision. This training is refreshed in line with local guidance.

18.2a

1

24.6

2

All staff members receive monthly line management supervision. 18.2a

Staff recruitment and induction 2

18.2a

Guidance: Supervision should be profession-specific as per professional guidelines and be provided by someone with appropriate clinical experience and qualifications.

• Access to additional staff members;

23.1

All staff members receive an annual appraisal and personal development planning (or equivalent). Guidance: This contains clear objectives and identifies development needs.

• A method for the team to report concerns about staffing levels;

23

CQC Regulations Ref 2014

Appraisal, supervision and support

24

The service adheres to agreed minimum staffing levels that comply 18.1 with national standards, e.g. College Centre for Quality Improvement specialist standards or those of other professional bodies.

Standard

Service user or carer representatives are involved in interviewing potential staff members during the recruitment process. Staff members receive an induction programme specific to the service, which covers:

8

Staff wellbeing

25 18.2a

2,21

25.1

2,8

1

The service actively supports staff health and well-being.

17.2a

1,14

Guidance: For example; providing access to support services, monitoring staff sickness and burnout, assessing and improving morale, monitoring turnover, reviewing feedback from exit reports and taking action where needed.

• The purpose of the service; • The team’s clinical approach; • The roles and responsibilities of staff members; • The importance of family and carers; • Care pathways with other services. Guidance: This induction should be over and above the mandatory Trust or organisation-wide induction programme. 23.3

1

New staff members, including agency staff, receive an induction 18.2a based on an agreed list of core competencies.

25.2

1

Staff members are able to take breaks during their shift that comply with the European Working Time Directive.

25.3

2

Staff members have access to reflective practice groups.

2,8

18.2a

8

7,14

Guidance: This should include arrangements for;

Staff training and development

26

• Shadowing colleagues on the team; • Jointly working with a more experienced colleague;

26.1

2

Staff members have access to study facilities (including books and 18.2a.b journals on site or online) and time to support relevant research and academic activity.

7

26.2

1

Clinical staff members have received formal training to perform 18.2a as a competent practitioner, or, if still in training, are practising 19.1b under the supervision of a senior qualified clinician.

1

• Being observed and receiving enhanced supervision until core competencies have been assessed as met. 23.4

1

All newly qualified staff members are allocated a preceptor to oversee their transition into the service.

18.2a,c

8

Guidance: This should be offered to recently graduated students, those returning to practice, those entering a new specialism and overseas-prepared practitioners who have satisfied the requirements of, and are registered with, their regulatory body. See http://www.rcn.org.uk/__data/assets/pdf_ file/0010/307756/ Preceptorship_framework.pdf for more practical advice. 23.5

16

2

All new staff members are allocated a mentor to oversee their transition into the service.

26.3

26.3.a 18.2a

2,8

Standards for community-based mental health services

Staff members receive training consistent with their role, which 18.2a,b is recorded in their personal development plan and is refreshed in accordance with local guidelines. This training includes: 1

The use of legal frameworks, such as the Mental Health Act (or equivalent) and the Mental Capacity Act (or equivalent);

Standards for community-based mental health services

3

17

Standards

Standards

Number

Type

Standard

26.3.b

1

Physical health assessment;

CQC Regulations Ref 2014 9

Guidance: This could include training in understanding physical health problems, physical observations and when to refer the service user for specialist input. 26.3.c

26.3.d

1

1

Recognising and communicating with service users with special needs, e.g. cognitive impairment or learning disabilities.

2,5

Statutory and mandatory training;

8

Number

Type

Standard

CQC Regulations Ref 2014

Audit and service evaluation

29 29.1

2

A range of local and multi-centre clinical audits is conducted which include the use of evidence based treatments, as a minimum.

17.2a

7

29.2

3

The team, service users and carers are involved in identifying priority audit topics in line with national and local priorities and service user feedback.

17.2a

7

29.3

2

When staff members undertake audits they;

17.2a

2,7

17.2a

2

Guidance: Includes equality and diversity, information governance. 26.3.e

2

Clinical outcome measures;

8

26.3.f

2

Carer awareness, family inclusive practice and social systems, including carers’ rights in relation to confidentiality.

9

26.4

2

Service users, carers and staff members are involved in devising and delivering training face-to-face.

9

• Agree and implement action plans in response to audit reports; • Disseminate information (audit findings, action plans); • Complete the audit cycle.

26.5

3

Shared in-house multi-disciplinary team training, education and practice development activities occur in the service at least every 3 months.

29.4 18.2a

2

22

The service learns from incidents

30

General management

27 27.1

2

The team attends business meetings that are held at least monthly.

27.2

3

The team reviews its progress against its own plan/strategy, which includes objectives and deadlines in line with the organisation’s strategy.

27.3

2

Front-line staff members are involved in key decisions about the service provided.

27.4

2

Managers ensure that policies, procedures and guidelines are formatted, disseminated and stored in ways that the team find accessible and easy to use.

30.1

1

Systems are in place to enable staff members to quickly and effectively report incidents. Managers encourage staff members to do this.

12.2b, 13.2

2,16

2

30.2

1

Staff members share information about any serious untoward incidents involving a service user with the service user themself and their carer, in line with the Statutory Duty of Candour.

12.2b, 20.2a

9

2,23

30.3

1

Staff members, service users and carers who are affected by a 20.2b serious incident are offered a debrief and post-incident support.

9,25

8

30.4

1

Lessons learned from incidents are shared with the team and disseminated to the wider organisation.

12.2b

11

30.5

2

Key clinical/service measures and reports are shared between 17.2a the team and the organisation’s board, e.g. findings from serious incident investigations and examples of innovative practice.

11

15 17.2a

17.2a

Clinical outcome measurement

28 28.1

1

Clinical outcome measurement data is collected at two time points (initial assessment and discharge) as a minimum, and at clinical reviews where possible.

28.2

2

Clinical outcome monitoring includes reviewing service user progress against service user-defined goals in collaboration with the service user.

9.3d

3

Outcome data is used as part of service management and development, staff supervision and caseload feedback.

17.2a

2

Commissioning and financial management

31 31.1

28.3

Key information generated from service evaluations and key measure summary reports (e.g. reports on waiting times) are disseminated in a form that is accessible to all.

2

1,3

The service is explicitly commissioned or contracted against agreed standards.

14

Guidance: This is detailed in the Service Level Agreement, operational policy, or similar and has been agreed by funders. 3

31.2

3

Commissioners and service managers meet at least 6 monthly.

2,5

Guidance: This should be undertaken every 6 months as a minimum.

18

Standards for community-based mental health services

Standards for community-based mental health services

19

References

Glossary

References 1)

ROYAL COLLEGE OF PSYCHIATRISTS. Accreditation Programme for Psychological Therapies Services (APPTS): Quality Standards for Psychological Therapies Services. First Edition. London, 2014

2)

ROYAL COLLEGE OF PSYCHIATRISTS. Standards working group. 2015

3)

ROYAL COLLEGE OF PSYCHIATRISTS. Quality Network for Inpatient CAMHS (QNIC): Service Standards. Seventh Edition. London, 2013

4)

ROYAL COLLEGE OF PSYCHIATRISTS. Quality Network for Perinatal Mental Health Services: Perinatal Community Mental Health Services: Service Standards. Second Edition. 2014

5)

ROYAL COLLEGE OF PSYCHIATRISTS. Quality Network for Community CAMHS (QNCC): Service Standards. Fourth Edition. London, 2014

6)

THE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Service user experience in adult mental health: improving the experience of care for people using adult NHS mental health services/ CG136. 2011. Available from http://www.nice.org.uk/guidance/CG136

7)

ROYAL COLLEGE OF PSYCHIATRISTS. Quality Network for Perinatal Mental Health Services: Service Standards for Mother and Baby Units. Fourth Edition. London, 2014

8)

ROYAL COLLEGE OF PSYCHIATRISTS. Accreditation for Inpatient Mental Health Services (AIMS): Standards for Acute Inpatient Services for Working-Age Adults. Fifth Edition. London, 2014

9)

ROYAL COLLEGE OF PSYCHIATRISTS. Accreditation for Community Mental Health Services (ACOMHS) Standards. First Edition. London, 2015

10) ROYAL COLLEGE OF PSYCHIATRISTS. Accreditation for Inpatient Mental Health Services (AIMS): Standards for Adult Inpatient Learning Disability Units – Assessment and Treatment Units. Second Edition. London, 2010 11) ROYAL COLLEGE OF PSYCHIATRISTS. Quality Network for Forensic Mental Health Services: Standards for Medium Secure Services. London, 2014

21) ROYAL COLLEGE OF PSYCHIATRISTS. Home Treatment Accreditation Scheme (HTAS): Standards for Home Treatment Teams. Second Edition. London, 2013 22) ROYAL COLLEGE OF PSYCHIATRISTS. Accreditation for Inpatient Mental Health Services (AIMS): Standards for Psychiatric Intensive Care Units (PICUs). Third Edition. London, 2014 23) ROYAL COLLEGE OF PSYCHIATRISTS. Enabling Environments Standards. London, 2013 24) ACADEMY OF MEDICAL ROYAL COLLEGES and NHS INSTITUTE FOR INNOVATION AND IMPROVEMENT. Medical Competency Leadership Framework: Enhancing Engagement in Medical Leadership. Third Edition. 2010. Available from: http://www.leadershipacademy.nhs.uk/wp-content/uploads/2012/11/NHSLeadershipLeadership-Framework-Medical-Leadership-Competency-Framework-3rd-ed.pdf 25) MILLS, S. NHS Wales Collaborative National Framework Agreement for CAMHS Hospital Services. Cardiff: NHS Wales, 2015

Glossary Term

Definition

Advanced directives

A document drawn up by a person when they are well, saying how they want to be cared for if they become unwell.

Advocacy services

A service which seeks to ensure that service users are able to speak out, to express their views and defend their rights.

Antipsychotics

Medication used to treat psychotic illness.

12) MACNEIL, C.A., HASTY, M.K., CONUS, P., BERK, M. “Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice.” In: BMC Medicine 2012, 10:111

Capacity

The ability to understand and weigh up information, make a decision and communicate that decision.

13) ROYAL COLLEGE OF PSYCHIATRISTS. Accreditation for Inpatient Mental Health Services (AIMS): Standards for Adult Inpatient Eating Disorder Services. First Edition. London, 2013

Care Plan

14) ROYAL COLLEGE OF PSYCHIATRISTS. Psychiatric Liaison Accreditation Network (PLAN): Quality Standards for Liaison Psychiatry Services. Fourth Edition. London, 2014 15) ROYAL COLLEGE OF PSYCHIATRISTS. Memory Services National Accreditation Programme (MSNAP): Standards for Memory Services. Fourth Edition. London, 2014 16) ROYAL COLLEGE OF PSYCHIATRISTS. Quality Network for Forensic Mental Health Services: Standards for Low Secure Services. London, 2012 17) THE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Antenatal and postnatal health: Clinical management and service guidance. 2015. Available from: http://www.nice.org.uk/guidance/cg192/resources/guidance-antenatal-and-postnatal-mental-health-clinicalmanagement-and-service-guidance-pdf 18) NHS ENGLAND, NHS IMPROVING QUALITY, PUBLIC HEALTH ENGLAND and THE NATIONAL AUDIT OF SCHIZOPHRENIA TEAM. Positive Cardiometabolic Health Resource. Lester UK adaptation. 2014. Available from: http://www.rcpsych.ac.uk/quality/nationalclinicalaudits/schizophrenia/nationalschizophreniaaudit/nasresources.aspx#LesterResource 19) ROYAL COLLEGE OF PSYCHIATRISTS. Accreditation for Inpatient Mental Health Services (AIMS): Standards for Assessment/Triage Services. Fourth Edition. London, 2014

20

20) SINGH, S.P. The Great Divide: Transition of Care from Child to Adult Mental Health Services. University of Warwick: Coventry, 2009. Available from: http://wrap.warwick.ac.uk/3758/1/WRAP_Singh_current_opinions5.pdf

Standards for community-based mental health services

An agreement between an individual and their health professional (and/or social services) to help them manage their health day-to-day. It can be a written document or something recorded in the service user's notes.

Carer

In this document a carer refers to anyone who has a close relationship with the service user or who cares for them.

Clinical formulation

A theoretically based explanation of a service user's presentation. It covers the presenting problem and predisposing, precipitating, perpetuating and protective factors.

Clinical supervision

A regular meeting between a staff member and their clinical supervisor. A clinical supervisor's key duties are to monitor employees' work with service users and to maintain ethical and professional standards in clinical practice.

Commissioners

Individuals (or groups of individuals) whose role it is to buy services for their local population.

Consent

A service user gives their permission for something to happen.

Crisis and contingency A document drawn up by a person when they are well, with their key worker. plans It includes relapse warning signs, what they can do to manage the situation themselves, who to contact and when, and what has been helpful and unhelpful in the past. Dual diagnosis

Experiencing both severe mental illness and problematic drug and/or alcohol use.

Standards for community-based mental health services

21

Glossary

Glossary

Duty of Candour

The Duty of Candour places a requirement on providers of health and adult social care to be open and transparent with service users when things go wrong.

Statutory carers assessment

An assessment of a carer’s needs by an appropriate statutory organisation (Carer in this context refers to anyone in a caring role).

Fasting plasma glucose

Blood tests which measure glucose levels.

Therapeutic environment

A place which attends to psychological, emotional and social factors in creating a space that maximises the potential for healing, development and growth.

European Working Time Directive

Initiative designed to prevent employers requiring their workforce to work excessively long hours, with implications for health and safety.

GP

General practitioner or ‘family doctor’.

Group dynamics

The way in which people in a group interact with one another.

Home Treatment Some teams call themselves ‘crisis resolution’, others call themselves ‘home treatment’, Team/Crisis Resolution and some are both. These teams all treat people with severe mental health problems Team outside hospital – in their own homes or in suitable residential facilities. Hyperlipideamia

High levels of cholesterol or trigylcerides.

Line management supervision

Supervision involving issues relating to the job description or the workplace. A managerial supervisor’s key duties are; prioritising workloads, monitoring work and work performance, sharing information relevant to work, clarifying task boundaries and identifying training and development needs.

Lipid profile

A blood test used to measure cholesterol and trigylceride levels.

Mental Capacity Act

A law which is designed to protect and empower individuals who may lack the mental capacity to make their own decisions about their care and treatment.

Mental Health Act

A law under which people can be admitted or kept in hospital, or treated against their wishes, if this is in their best interests or for the safety of themselves or others.

Mood stabilisers

Medication used to treat mood disorders.

Multi-disciplinary team

A team made up of different types of health professionals.

NICE

National Institute for Health and Clinical Excellence. Publishes guidance for health services.

Organisation’s board A board of directors is a body of appointed members who jointly oversee the activities of an organisation. Peer support

The help and support that people with lived experience of a mental illness can give to one another.

Perinatal team

A team which supports women experiencing mental health problems in pregnancy, childbirth and early motherhood.

Positive risk taking

Allowing people to take responsibility for their actions, to empower them and to improve understanding of decision making and consequences.

Preceptor

A registered practitioner who has been given a formal responsibility to support a newly registered practitioner through preceptorship.

Psycho-education group

A group in which service users come together to learn about mental illness and how to live with it.

Recovery college

A service that gives people with mental health problems the opportunity to access education and training programmes designed to help them in their recovery.

Reflective practice

The ability for people to be able to reflect on their own actions and the actions of others.

Service

The team(s) which provide care and treatment for service users.

Single point of access This is a one point of contact for referrals and communication which provides access to a number of health services.

22

Standards for community-based mental health services

Acknowledgements We would like to thank all of the people listed below who contributed to the lengthy consultation process. The core standards would not have been what they are without their hard work and support, for which we are very grateful.

Steering Group Clare Bingham – Consultant Clinical Psychologist, Head of MSU Psychology Polly Blaydes – Clinical Specialist Occupational Therapist Chris Freeman – Consultant Psychiatrist, Clinical Lead for Accreditation Nicky Guy – Senior Policy Advisor Daniel Harwood – Consultant Psychiatrist, Clinical Director Sophie Hodge – Programme Manager Dermot Hurley – Carer Representative Jonathan Hurley – Service User Representative Tim McDougall – Nurse Consultant, Clinical Director, Chair of the Quality Network for Inpatient CAMHS Advisory Group Sarah Paget – Programme Manager Chris Wright – Service User Representative

Reference Group Loraine Emery – Specialist Occupational Therapist Lorna Farquharson – Consultant Clinical Psychologist Marc Jeanneret – Clinical Fellow to the Chief Inspector of Hospitals, Care Quality Commission. Psychiatry Core Trainee Eliza Johnson – Chartered Consultant Clinical Psychologist Veronica Kamerling – Carer Representative Juliette Korner – Service User Representative Shane Mills – Clinical Lead for Collaborative Commissioning, Head of NHS Wales Quality Assurance Team Margaret Oates – Consultant Perinatal Psychiatrist; Clinical Director of the East Midlands Strategic Clinical Network for Mental Health, Dementia & Neurological Conditions, NHS England; Chair, Perinatal CRG Alexander Onyenaobiya – Modern Matron Susan Williams – Organisational Consultant

Advisory Group Chairs Jim Bolton – Consultant Liaison Psychiatrist, Chair of the PLAN Accreditation Committee Stephan Curran – Consultant Old Age Psychiatrist, Chair of the MSNAP Advisory Group Julie Curtis – Senior Clinical Nurse, Chair of the Quality Network for Community CAMHS Advisory Group Quazi Haque – Executive Medical Director, Chair of the Quality Network for Forensic Mental Health Services Advisory Group

CCQI Staff Natalie Austin-Parsons – Project Worker Thomas Barnes – Professor of Clinical Psychiatry, Imperial College London, and Joint-Head of POMH-UK Mark Beavon – Deputy Programme Manager Francesca Brightey-Gibbons – Central Administrator Sonya Chee – Project Worker

Standards for community-based mental health services

23

Harriet Clarke – Programme Manager Francesca Coll – Project Worker Mike Crawford – Director of CCQI Megan Georgiou – Project Worker Samantha Holder – Deputy Programme Manager Amy Lawson – Project Worker Carol Paton – Chief Pharmacist Joint-Head of POMH-UK Alan Quirk – Senior Programme Manager Tiffany Rafferty – Project Worker Kanza Raza – Project Worker Colleen Roach – Project Worker Holly Robinson – Deputy Programme Manager Hannah Rodell – Deputy Programme Manager Renata Souza – Programme Manager

Faculties, Divisions and Governmental Departments Diana Cody – Consultant Psychiatrist, Chair of Northern Ireland Division Reiner Heun – Professor of Psychiatry, Member of the Faculty of General Adult Psychiatry Executive Committee Sridevi Kalidindi – Consultant Psychiatrist, Chair of the Faculty of Rehabilitation and Social Psychiatry Ian McMaster – DHSSPS Medical Policy Advisor Stephen Orleans-Foli – Consultant Psychiatrist, Member of the Faculty of Old Age Psychiatry Ashok Roy – Consultant Psychiatrist, Chair of the Faculty of Psychiatry of Intellectual Disability James Warner – Consultant Psychiatrist, Chair of the Faculty of Old Age Psychiatry

Royal College of Psychiatrists’ Officers Laurence Mynors-Wallis – Ex-College Registrar Simon Wessely – College President

These standards were published in September 2015. They will be due for revision in September 2016.

24

Standards for community-based mental health services

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