SETTING U G UP A TELE-PSYCHIATRY S Y SERVICE CE F FOR R RU RURAL E EMERGENCY D NCY DEPART RTMENT NTS DR. R RAH AHUL G GUPTA FRANZCP CLINICAL LEAD – NMHEC-RAP HUNTER NEW ENGLAND MENTAL HEALTH SERVICE 1
NMHE MHEC-RAP RAP NORT RTHERN ME MENTAL H HEALTH E EMERGENCY CA CARE - RURAL A L ACCESS P SS PROGR GRAM 2
NMHEC EC-RAP T AP TEAM PETER K KEMP MP (SERVICE DIRECTOR) PAM D DAVIS/ S/SO SOPH PHIE P PHILLI LLIPS PS (TEAM MANAGERS) KATE S SIMPSO PSON (CLINICAL COORDINATOR) ANN NNE UNICOMB (PROGRAM MANAGER-MOH) JAY JO Y JONES (PROJECT COORDINATOR) & NMHEC-RAP C P CLINICIANS
OUTL TLINE Introduction Proj ojec ect Background nd Imp mpleme mentation Opera rati ting P Procedures Fa Facts & & Figur ures Challe llenges Summa mary Ref efer erenc nces 4
PRE-NMHEC-RAP: A RURAL HOSPITAL PERSPECTIVE Mental Health (MH) patients often present to rural EDs Extended wait in ED MH assessment. Stretched and under resourced Community Mental Health Services - limited response to EDs. If no local MH service - patient need to be transported. Limited transport options; none after-hours Vast geographical distance – ED to MH Facility e.g. Grafton ED to Lismore is 131km or 1hr 34mins. If transported & not admitted, patients are required to find their own way home. 5
MH COMMISSION OF NSW - REPORT 6
NMHE MHEC-RAP RAP NSW SW Governm nment ent fund unded ed p projec ect In response to “Living Well – A Strategic Plan” (Mental Health C Commis issio ion n of NSW SW, 2014) Esta tabli blish n new ment ntal h hea ealth r resour urce hub staffe fed - men ental h heal ealth p profes essio ionals, operati ting g 24 x 7 x 7 support r rura ral l and remot ote c communit ities o of northern NSW. W. NMHE HEC-RAP AP is joint initi tiati tive Hunter r New E Englan and d LHD, , Mid id North Co Coas ast LHD HD, Northern rn NSW SW LHD. . 7
MH ACT 200 MH A 2007 C 7 CHA HANGES -AU AUG 20 2015 15 Medical l officers (in a n absenc nce o of AM AMOs) c can an do S Schedule 1 1 (s (s19A) an and F Form 1(s 1(s27A) via videoconfere via rence. If can an be be done w e with “ “sufficie ient s skil ill & & car are” e” AMOs can u undertake e Form 1 1 asses essment ents at at a a decla lared M MH f facili lity ty of w which t they y are no not a an em n employee Accre redited Persons (AP (APs) can an d do Schedule le 1 ( (s19A) via a videoconfere rence 8
ORANGE GE GOULBUR URN WAGGA GA WAGGA GA 9
NE NEWC WCASTLE 10
NMHEC-RAP PRINCIPLES Menta tal H l Healt lth P Professionals ls p provide MH e expertise to regional al, r rural a and rem emote e EDs Ds where access ss to MH services s is n not r t readily ly availa lable le use video eo c conf nferenc ence to li link with E h EDs Utili lize ze a a consultat atio ion-li liaison mod odel i.e. ED ED reta tains t the c clinical r l responsibili lity ty o of t the patie ient. . 11
NMHEC-RAP PRINCIPLES Builds on existing m models ls of mental health response to EDs NMHEC-RAP is an enhanc ncement of emergency mental health responses; It does not replace existing face-to-face MH input toEDs Hence, it com omplement nts face-to-face services and extends afte ter-hours rs c cover 12
PROJECT IMPLEMENTATION LHD Partnerships Hub & Spoke model Project manager – NSW MOH Project officers at LHDs How this was evolved Consultation Data gathering Site Visits Development of MOC and Operational Guidelines 13
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PROJECT IMPLEMENTATION Co-located with the Mental Health Line Recruitment & training of additional staff MH Assessment training – Role play Accreditation training - Mental Health Act Roll out – 4 sites initially, then on a schedule 15
HOW DI W DID WE D WE SPREAD TH THE N NEWS? A Fact Sheet was disseminated LHD wide in late February 2016 to introduce the Northern MHEC-RAP service. This flyer was distributed LHD wide via email just prior to Go Live. 16
PROJECT ROLL-OUT Identified site sent information – Operational procedures etc Site visit by NMHEC-RAP Dr & clinician Site visit by project coordinator – Telehealth Cart Go live! Regular feedback meetings – weekly -> monthly 17
NHME HMEC-RAP RAP H HUB LOCATI TION Loc ocated a at the grounds o of James es F Fletcher Hos ospi pital, N , Newcast astle Staf aff Men ental H Heal ealth P Profes essio ionals – multi ti-discipl plina nary Med edical s staf aff – Psyc ychi hiatrist 0 0.6 FTE & & Psych h Re Reg 1.0 F 1. FTE Service Dire rector, T Team Manager & r & Clinical l Coor ordinator Project C Coordinato tor 18
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PHOTO JFH 20
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NHMEC-RAP ASSESSMENT ROOM 22
WORKSTATI TION ON O ON W WHEELS “ “WOW” W” 23
NMHEC-RAP Operational model 24
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PA T IENT INFO RMA T IO N SHEET What is a NMHEC_RAP assessment? Can a family member be with me during A NMHEC-RAP assessment is a mental the assessment? health assessment where you and the NMHEC-RAP encourages family and/or mental health professional are not in the carers to participate in the assessment, if this same room as each other and use is your wish. You can choose any support technology to complete the assessment. person to be with you during the assessment. How will I see the mental health Can I ask questions during the professional if we are not in the same consultation? room? You and your carer should feel free to ask The NMHEC-RAP assessment is conducted questions at any time before, during and using a portable videoconferencing machine after the assessment. with a camera, audio and a screen. Why use NMHEC-RAP? What if I don’t want to be part of a NMHEC-RAP assessment? A NMHEC-RAP assessment means that you will not need to travel to another hospital to You may choose not to participate in a be assessed. NMHEC-RAP assessment. Alternative arrangements will be discussed with you. You may, however, need to travel to another hospital if you need to be admitted. Consent for the assessment What if I am uncomfortable during the You will be asked for your verbal consent NMHEC-RAP assessment? before the assessment starts. You can ask to stop the assessment at any time. Who will be part of the consultation? Maintaining your privacy and confidentiality You will see the mental health professional on the screen. There may also be a staff All NMHEC-RAP assessments are secure member with you in the room if you do not a and subject to the same privacy have support person and it is felt that you requirements as face-to-face Health require one. services. The assessment will not be recorded. The mental health professional All staff involved in the assessment will will take notes during the assessment which introduce themselves at the beginning of the will be entered into your medical record, as session. would normally happen if you saw a Health professional face to face. How much will the consultation cost? 26 This service is free for people presenting to emergency departments.
EMR(S) 27
HNE - CHIME ACCESSIBLE VIA CAP 28
GL GLEN EN IN INNES ES 29
MH R MH ROOM 30
INVERE RELL 31
MH R MH ROOM 32
BENEF BEN EFITS R REC ECAP Patient nts access ss speciali list t assessment nt a and care c ca clo loser to home; e; Red educ uce n e need ed to transp sport to MH facili lity ty for r men mental heal alth asses essment ent. EDs - reduc uce waiting ng t times for m r menta tal l heal alth assessment nts Com ompreh ehens nsive, c contempo poraneous, standardised e electr tronic cli clinical documen entat atio ion in EMR MR 33
Some Facts & Figures 34
Com ommenc enced ed A Aug ugust 2016 Tota tal s l sites - 16 16 Total A Asses essmen ents – 1,325 FY 20 2017-18 - 956 35
EXISTING MH ACTIVITY OF ED 36
RECOMMENDATION FOR ADMISSION 26% Percentage of Inpatient Referrals/Compared to Average 40 37 35 32 30 31 30 28.5 27 25 25.7 25 22.7 20 21 20 20 15 10 5 0 0 0 37
TIME OF REFERRAL Times of NMHEC-RAP Requests 90 80 70 60 50 40 30 20 10 0 38
HOW IS NMHEC-RAP BEING RECEIVED? All EDs have embraced NMHEC-RAP service Staff are happy with the quality of picture and audio of the telehealth equipment. ED Staff have provided positive feedback re standard of assessment provided by the Hub, particularly the high Gra rafton B Base se H Hosp spital standard of documentation. Feedback from patients using the service has been positive. 39
Challenges 40
CHAL ALLENGES 41
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