Workshops and concurrent sessions

Mental Health Nursing,  Jul 2004  

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Access, booking and choice (ABC) programme within mentai health

Susan White/lead and Jo Daw's

The acute sector has been practising full booking since 1998. Mental health services are just beginning to come on board. Considering that national booking targets stipulated that bv March this year, 67 per cent of GP to consultant referrals would be booked and that all NHS services are to be booked by 2005, mental health is behind.

Full booking was defined as: The patient being given the opportunity to agree a date at the time of or within one working day of the referral or the decision to treat. The patient may choose to agree the date when it is initially offered or defer their decision until later.'

Delegates were asked to point out problems they felt could arise from using full booking in their practice. Issues such as limited flexibility, getting people to turn up, double booking and consultant 'set in stone' ways of practising were raised. The main benefit that was flagged up was increased patient choice.

Susan Whitehead described the pilot ABC project she has led to introduce full booking in an integrated adult CMHT.

The process of referral was kickstarted by the GP, who decided whether or not to refer to the CMHT. The decision as to whether a patient could access services him or herself was also taken by the GP. The GP would complete a referral form, which would be faxed to a central number, received and logged and then given to the team manager who decides which member of the team will treat the patient, according to caseload and skills.

If the client is able to access the service themselves, they are given an information leaflet by the GP and they make contact with the booking clerk to negotiate an appointment. If the client is not able to access the service, the practice negotiates an appointment on their behalf.

The project was led by the CMHT, GPs and service users and teamwork was found to be essential to the effective working of the ABC process.

Process mapping was used to kickstart the ABC. The CMHT sat down and mapped the journey from GP to actual appointment, highlighting how every member of the team, is involved in the process. 'We thought we knew what we were doing, but we soon found out how complicated and difficult it is to map such a process properly,' said Ms Whitehead.

Process mapping helped the team to identify where the obstacles lay and to redesign the services accordingly.

Problems in implementing the ABC programme included IT systems, GPs forgetting to give leaflets to patients at the point of referral, patients not ringing for an appointment and administrative staff within the team feeling that booking appointments was not part of their job.

Such problems were overcome by working closely with GPs to encourage them to give patients the leaflets and inform them of the progress of the pilot, implementing a system for patients not contacting the service and involving administrative staff in the implementation process from the start.

The outcomes speak for themselves. As a result of the pilot, 23 per cent of referrals were found to be urgent, compared to 41 per cent before the pilot and 10 per cent of referrals were DNAs, compared to 18 per cent beforehand.

Promoting public health: the role of mental health nurses

Standard One of the National Service Framework for Mental Health focuses on the promotion of mental health and reducing the discrimination associated with mEntal hpalth.

Mental health nurses have a huge role in promoting mental health, not just treating it, and training for mental health practitioners in recognising the signs of physical ill health as part of a patient's general wellbeing is essential said Ms Gale. 'At the end of the day, health, whether it be mental or physical is health.'

Many nurses, however, are missing signs of physical ill health in their patients, said Ms Gale, maybe because they do not see it as their remit, but mainly because they lack training in spotting physical signs of ill health. They may well be able to carry out all sorts of tests/ said Ms Gale, 'but are they able to accurately interpret the results?'

To deliver the Standard, nurses must work with individuals and communities to promote mental health, giving the appropriate support and information to patients. 'As a discipline its (mental health promotion's) time has come,' said Ms Gale. 'Mental health nurses can and do make an important contribution to the agenda.'

Dangerous and severe personality disorder programme

Nick Joseph, project manager, Mental Health Unit, the Home Office. Claire Moore, psychologist at Rampton Hospital.

Nick Joseph began by briefly I describing the purpose and various strands of the DSPD programme. It formed part of the Labour Party's 2001 manifesto - 'to deal with the most dangerous offenders of all those with a severe personality disorder - we will... create over 300 more high security prison and hospital places.'

The purpose of the programme within high secure establishments is to

contribute to public protection from some of the most dangerous people in society, to better manage a small group of dangerous offenders and to provide effective services to tackle their needs and where possible, effect successful integration back into society.