Otago dhb

 

Bernadette Forde, Nurse Practitioner (prescribing), Mental Health, Otago DHB 

 

Population

Adult mental health services (major mental illness) combined with intellectual disability.

 

Process to establish NP role within the Provider-arm Mental Health Service

 

Identified Need
Gaps in service provision for adult mental health clients with intellectual disability (ID). This dual diagnosis work is a specialised branch of mental health service provision.
Lack of psychiatrists with dual diagnosis (DD) skills – both locally and nationally, resulting in:

• Long waiting lists for psychiatrist
• Crisis admissions due to non-responsive service
• No established dual diagnosis service in Southland or clinicians with DD experience
• Southland wanting to contract service from ODHB

 

Service delivered

• Clinical responsibility and case management for people who meet the adult mental health services entry criteria (i.e. major mental illness) and who also have an intellectual disability
• Consultancy role with NGOs, PHOs and other Health Professionals regarding dual diagnosis issues, including mental health education focused on restoration of health, maintenance and preventative approaches aimed at enhancing their capacity and capabilities to support this population of people.

 

Implementation/ funding of NP Position

• Previous Clinical Nurse Specialist role prior to NP registration.
• Proposal for 6-month pilot of NP position (using basic business plan)
• Wider clinical team supportive of the role – NP role understood within the team due to previous (informal) trainee NP position.
• Funding for position from the existing community mental health nursing budget and money ring-fenced for “special project work”.

 

Outcomes

Establishment of the role following pilot based on outcomes which included:

• Low relapse rate, low admission rate and low use of the Mental Health Act. 
• Evidence of decrease in waiting times for assessment and follow-up appointments from 8-10 weeks to 2 weeks
• Evidence of significantly decreased requirement for psychiatrist consultations – allocation of psychiatrist time diminished to 1 – 1.5 hours per week.
• Establishment of nurse-led out-patient clinic across mental health community teams.
• Number of consultations / education sessions with the client, family/ NGOs, GPs and other health professionals with positive survey feedback.

 

Evaluation
The Mental Health Service has a specific contract, which is part of service specifications to provide a mental health service to people with an intellectual disability.  There has been little evaluation of the NP position at this stage as it is seen as meeting an integral component of service provision.

 

Feedback on NP contribution

• Now a clear referral and service delivery pathway for this population
• NP a valuable resource to the wider hospital on DD and ID issues, also positive feedback on consultancy and education role to NGOs
• More responsive service to NGOs for crisis response, first assessment appointments and follow-up appointments
• Low admission rate seen as very positive
• In-patient staff have found it really valuable having shared care arrangement - very different to how things normally work where pts then come under the in-patient team resulting in less continuity of care.