Principles of capacity management, applied in the mental health context

2018 ◽  
Vol 42 (4) ◽  
pp. 438
Author(s):  
Kathryn Zeitz ◽  
Darryl Watson
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Average Length ◽  
Patient Flow ◽  
Waiting Times ◽  
Capacity Management ◽  
Mental Health Setting ◽  
Mental Health Consumer ◽  
Mental Health Consumers ◽  
Flow Improvement

Objective The aim of the paper was to describe a suite of capacity management principles that have been applied in the mental health setting that resulted in a significant reduction in time spent in two emergency departments (ED) and improved throughput. Methods The project consisted of a multifocal change approach over three phases that included: (1) the implementation of a suite of fundamental capacity management activities led by the service and clinical director; (2) a targeted Winter Demand Plan supported by McKinsey and Co.; and (3) a sustainability of change phase. Descriptive statistics was used to analyse the performance data that was collected through-out the project. Results This capacity management project has resulted in sustained patient flow improvement. There was a reduction in the average length of stay (LOS) in the ED for consumers with mental health presentations to the ED. At the commencement of the project, in July 2014, the average LOS was 20.5 h compared with 8.5 h in December 2015 post the sustainability phase. In July 2014, the percentage of consumers staying longer than 24 h was 26% (n = 112); in November and December 2015, this had reduced to 6% and 7 5% respectively (less than one consumer per day). Conclusion Improving patient flow is multifactorial. Increased attendances in public EDs by people with mental health problems and the lengthening boarding in the ED affect the overall ED throughput. Key strategies to improve mental health consumer flow need to focus on engagement, leadership, embedding fundamentals, managing and target setting. What is known about the topic? Improving patient flow in the acute sector is an emerging topic in the health literature in response to increasing pressures of access block in EDs. What does this paper add? This paper describes the application of a suite of patient flow improvement principles that were applied in the mental health setting that significantly reduced the waiting time for consumers in two EDs. What are the implications for practitioners? No single improvement will reduce access block in the ED for mental health consumers. Reductions in waiting times require a concerted, multifocal approach across all components of the acute mental health journey.

Mental Health Triage in Emergency Medicine

1999 ◽  
Vol 33 (1) ◽  
pp. 57-66 ◽  
Author(s):  
David Smart ◽  
Cecily Pollard ◽  
Bryan Walpole
Keyword(s):  
Mental Health ◽  
Medical Information ◽  
Mental Health Problems ◽  
Waiting Times ◽  
Health Problems ◽  
Mental Health Disorder ◽  
Liaison Psychiatry ◽  
Structured Education ◽  
Transit Times ◽  
Mental Health Patients

Objective: The aim of this study was to: (i) develop a triage scale consistent with the National Triage Scale (NTS) for patients with mental health problems attending emergency departments; and (ii) to reduce emergency waiting times, transit times and improve skills assessing mental health problems. Method: We developed a Mental Health Triage Scale (MHTS) consistent with the NTS. The MHTS was then implemented using a structured education package, and evaluated from March to August 1994. Further evaluation occurred after 2 years. Results: Afour-tiered MHTS was produced: category 2, violent, aggressive or suicidal, danger to self or others or with police escort; category 3, very distressed or psychotic, likely to deteriorate, situational crisis, danger to self or others; category 4, long-standing semi-urgent mental health disorder, supporting agency present; and category 5, long-standing non-acute mental health disorder, no support agency present. Patients with illness, injury or self-harm were triaged using combined mental health and medical information. Mean emergency waiting times and transit times were reduced. More consistent triaging for mental health patients occurred, and more consistent admission rates by urgency. Reduced mental health ‘did not waits’ showed improved customer satisfaction. Mental Health Triage Scale was considered appropriate by liaison psychiatry and its use has continued at 2 years follow-up. Conclusions: Asystematic approach to mental health triaging produced a workable scale, reduced waiting times, transit times, and provided effective and consistent integration of mental health patients into a general emergency department.

Loneliness among Chinese Migrants in Portugal

2021 ◽  
Vol 17 (1) ◽  
pp. 196-213
Author(s):  
Félix Neto ◽  
Maria da Conceição Pinto
Keyword(s):  
Mental Health ◽  
Ethnic Identity ◽  
Mental Health Problems ◽  
Average Length ◽  
Perceived Discrimination ◽  
Health Problems ◽  
Sociocultural Adaptation ◽  
Chinese Migrants

Abstract The goal of this research is to explore the acculturation and adaptation factors that are likely to predict the level of loneliness among Chinese migrants residing in Portugal. The sample is constituted by one hundred and eighty-nine participants (25 percent women and 75 percent men) with an average age of 29 years. The average length of sojourn was 8 years. We used the ULS-6 scale to assess loneliness. Other instruments were utilized to evaluate ethnic identity, perceived discrimination, mental health, sociocultural adaptation, and tolerance. In agreement with expectations, ethnic identity negatively predicted loneliness, and perceived discrimination positively predicted loneliness. Lastly, sociocultural adaptation and tolerance negatively predicted loneliness, and mental health problems positively predicted loneliness. The adaptation factors predicted 60 percent of the variance in loneliness. Implications of these findings for reducing migrants’ loneliness are considered.

Die andere pandemie: inzichten in en suggesties voor een betere public mental health (care)

2021 ◽  
Author(s):  
K. VAN DEN BROECK
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Waiting Times ◽  
Public Mental Health ◽  
Well Being ◽  
Health Problems ◽  
Mental Wellbeing ◽  
Public Mental Health Care

That other pandemic: insights and suggestions for a better public mental health (care). Like Covid-19, mental health problems threaten to undermine our society and the personal well-being of many – perhaps more dormantly, but not less destructively. Many people suffer from mental health problems and high suicide rates, skyrocketing psychopharmaceutical use and endless waiting times suggest that the quality of care today – despite the efforts of dedicated professionals –is sub-optimal. These staggering figures make the rollout of a larger plan to prevent, early identify and promptly treat mental health problems an urgent matter. This article focuses on how we can intervene in the mental wellbeing of our population: what bottlenecks underlie the current situation, what societal changes need to be made, and what data can contribute in the matter.

Use of a capacity audit tool in a mental health setting

2016 ◽  
Vol 40 (1) ◽  
pp. 82 ◽  
Author(s):  
Kathryn Zeitz ◽  
Paul Hester
Keyword(s):  
Mental Health ◽  
Patient Flow ◽  
Local Health ◽  
Audit Tool ◽  
Mental Health Setting ◽  
Model Of Care ◽  
Patient Capacity ◽  
Bed Capacity ◽  
Improve Patient ◽  
Improve Access

Objective This paper reports on a pilot applying the capacity audit tool (CAT) in a mental health environment and what the tool reveals regarding mental health in-patient capacity issues. Methods The CAT was modified to create an electronic mental health-relevant tool to audit acute in-patient capacity. This tool was then piloted across nine bedded units, within a single Local Health Network, covering a total of 153 mental health beds. Results The application of the mental health CAT resulted in 100% compliance in completion. The findings revealed that 16% (25 beds) of the 153 beds surveyed were occupied by patients who did not need to occupy the bed or the bed was vacant. Of these 25 beds, 10 had patients awaiting transfer to another facility or service, nine were empty and six were occupied by patients ready for discharge but for whom there were delays. Conclusion The CAT was successfully applied to the mental health setting and identified a set of opportunities to improve processes and practices to reduce the identified delays or barriers in order to improve patient flow. What is known about the topic? Capacity management and, in particular, timely discharge are key components to optimise patient flow and improve access block for emergency departments. The CAT has been successfully applied in general health settings to identify key delays and barriers to discharge. What does this paper add? This article reports on the applicability of the CAT in a mental health setting and the ability of the tool to improve our understanding of bed capacity by identifying key reasons for the use of mental health in-patient beds across a stepped model of care and quantifying the most frequent causes of discharge delay. What are the implications for practitioners? This paper describes the modifications of the CAT to make it applicable to the mental health setting and the associated results obtained using the CAT in a mental health setting. The project demonstrated applicability of the tool to the mental health setting. It can be used in other jurisdictions to identify key discharge delays to underpin targeted improvement work within local mental health environments.

scholarly journals HappyMaps: a single hub of resources on children and young people's mental health for parents and professionals

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S26-S26
Author(s):  
Georgina Griffiths ◽  
Jasmin Krischer ◽  
Cara Roberts-Collins ◽  
Elaine Lunts
Keyword(s):  
Mental Health ◽  
Young People ◽  
Mental Health Problems ◽  
Service Providers ◽  
Waiting Times ◽  
Health Issues ◽  
Children And Young People ◽  
Self Help ◽  
The Uk ◽  
Future Work

AimsMental health issues in children and young people are a growing concern and the benefits of intervening early are well established for many mental health problems, but existing Child and Adolescent Mental Health Services (CAMHS) are often over-stretched with variable waiting times for assessment. Many children also have problems which do not reach the referral thresholds and parents are left to find advice elsewhere. Existing resources for parents are scattered across many different websites and therefore difficult to access both for parents and professionals working with young people. With this in mind, and in consultation with CAMHS Bristol and many other stake-holders (including parents themselves) we designed an easily navigable website intended as a single comprehensive portal of resources for parents of children with mental illness and difficulties.MethodQualitative research methods were used to gather information about how the website should be designed and also to gather feedback once the website was live. Focus groups were performed with parents/carers and stakeholder discussions took place to inform the design of the website. Once the website was live, surveys via a Survey Monkey link on the website and Google Analytics were used to evaluate the website.Result60,000 users have utilised the website since the launch in March 2019. Two thirds of users are women and one third are men. Most popular webpages that are visited are primary, secondary, help-in -a-crisis and self-help for young people. Positive feedback has been collected from both parents/carers and service providers. The website has continued to develop and is now a registered charity and has received community lottery funding, which will allow for further evaluation and developments.ConclusionHappyMaps has been successful in providing a single hub of information for parents/carers, GPs, CAMHS workers and teachers. Future work involves evaluating the website and attracting interest from other CAMHS teams and professionals in other areas of the UK so that they can create HappyMaps sections for their populations.

scholarly journals Mental health consequences of long-term stays in refugee camps: Preliminary evidence from Moria

2020 ◽  
Author(s):  
willemine van de Wiel ◽  
Carla Castillo-Laborde ◽  
Francisco Urzúa I. ◽  
Michelle Fish ◽  
Willem F. Scholte
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Mental Health Problems ◽  
Average Length ◽  
Case Definition ◽  
Living Conditions ◽  
Refugee Camps ◽  
Mental Health Crisis ◽  
Cross Sectional ◽  
Health Crisis

Abstract Background Over the last decade, millions of refugees have arrived in Europe. Upon arrival refugees reside in designated refugee camps which, even though originally designed to home refugees on a short stay basis only, developed into long-stay facilities. Some of these camps have detention-like characteristics and dire living conditions. One such example is Moria camp on the island of Lesvos, Greece, which has been repeatedly reported for being overcrowded, unhygienic, and unsafe. This study explores the incidence of acute mental health crises and their relationship with the length of stay in the camp. Methods A cross-sectional study was conducted using routinely collected data on 857 consultations during 90 nights at an emergency night clinic in Moria camp. Logistic regression analysis was used to explore whether the length of stay in the camp was predictive of the occurrence of acute mental health crises. Results Of all consultations (n=857), 25⋅5% (n=219) were related to mental health problems; 17⋅4% (n=38) of these met the study’s case definition of acute mental health crisis. Such crises were positively associated with the length of stay in the camp (p=0⋅044); the odds ratio increases with 1·03 for every 10% increase in days of residence. This is notable when considering the average length of stay in the camp (71 days). Conclusion Acknowledging that this study does not provide causal effects on the relation between length of stay and mental health crises, the established link can hardly be related to anything else but the inhumane living conditions in the camp, its inhabitants’ lack of future expectations, and the scarce provision of mental health services. This form of neglect urgently calls for attention of the medical world and Europe’s policy makers.

scholarly journals Mental health consequences of long-term stays in refugee camps: preliminary evidence from Moria

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Willemine van de Wiel ◽  
Carla Castillo-Laborde ◽  
I. Francisco Urzúa ◽  
Michelle Fish ◽  
Willem F. Scholte
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Mental Health Problems ◽  
Average Length ◽  
Case Definition ◽  
Living Conditions ◽  
Mental Health Crisis ◽  
Contributing Factors ◽  
Cross Sectional ◽  
Health Crisis

Abstract Background Ever since the implementation of the EU-Turkey deal, most refugees that enter Greece via sea are confined to the island on which they arrive until their asylum claims are adjudicated, where they generally reside in camps. Some of these camps have detention-like characteristics and dire living conditions, such as Moria camp on the island of Lesbos, Greece. Aid-organizations have stated that the situation in camp Moria deteriorates the mental health of its inhabitants and there is qualitative evidence to support this. This study explores the quantitative relationship between the incidence of acute mental health crises and the length of stay in the camp. Methods A cross-sectional study was conducted using routinely collected data on 856 consultations of 634 different patients during 90 nights at an emergency clinic in Moria camp. Logistic regression analysis was used to explore whether the length of stay in the camp was predictive of the occurrence of an acute mental health crisis. Results Of the 634 patients, the majority were men (59·3%), the average age was 23·2 years [0–71], and 24·3% was < 18 years. 25·5% (n = 218) of consultations were related to mental health problems; 17·0% (n = 37) of these met the study’s case definition of an acute mental health crisis. Such crises were positively associated with the length of stay in the camp (p = 0·011); the odds ratio of a mental health crisis increases with 1·03 for every 10% increase in days of residence in the camp. This is notable when considering the average length of stay in the camp is 71 days. Conclusion This study offers quantitative support for the notion that the adverse conditions in Moria camp deteriorate the mental health of its inhabitants as suggested in qualitative research. Although this study does not provide evidence of causality, it is likely that the poor and unsafe living conditions, challenging refugee determination procedures, and a lack of mental health services in the camp are significant contributing factors. We urgently call for Europe’s policymakers to honour the ‘51 Geneva refugee convention and terminate the neglectful situation on the Greek archipelago.

scholarly journals Appropriateness of referrals to Whiston hospital Mental Health Liaison Services

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S352-S352
Author(s):  
Nick Strouther ◽  
Divya Jain
Keyword(s):  
Mental Health ◽  
Data Collection ◽  
Mental Health Problems ◽  
Waiting Times ◽  
Timely Manner ◽  
Patient Demographics ◽  
Drugs And Alcohol ◽  
Referral Form ◽  
Medical Wards ◽  
Different Levels

Aims1. The aim of this study was to assess the appropriateness of referrals to Whiston Mental Health Liaison Services (WMHLS) according to Royal College of Psychiatrists and local trust guidelines.2. To assess whether the referrals were being reviewed in timely manner as per the trust's guidelines.MethodData collection was completed using a proforma to ensure uniform data collection. The proforma included information on patient demographics, previous mental health service involvement, other details like reasons and time of referral and their outcomes. Data sample comprised of 46 patients who had been referred to the WMHLS in the month of August 2019 were randomly selected.Result44 of the 46 referrals analyzed were found to be appropriate. 40 patients were deemed to have appropriate documentation. The ratio of males to females was 20:26. 21 referrals were from the observation ward, 14 from A&E, and 11 from medical wards. 40 patients were previously known to mental health services. The reasons for referral ranged from suicidal ideation/attempt (48%), Drug related (12%), Assessment (7%) and more. There were various outcomes recorded. One of them was that 18 (28%) referrals were assessed for Depression and for other mental health problems.78.6% of patients referred from A&E, and 95.2% of patients in the observation ward, were not seen in the 1 hour window set out by the Trust's guidelines. 91.1% of patients referred from the wards were seen within the 24 hour target.ConclusionThe vast majority of referrals were found to be appropriate (44/46). It was found that the referral form used across the Trust, contained different levels of details and information on the patient depending on the source of referral. Using a standard process to complete referral forms to be used across the whole trust may ensure that all patients receive a standardized and appropriate referral based on the guidelines. Making the form electronic may reduce problems deciphering handwriting, and could allow WMHLS have a better understanding of the patient, and allow them to identify a patient that may be more appropriate for another service, e.g. drugs and alcohol team. This may and make the overall referral process quicker and reduce waiting times in A&E, as well as faster referrals to the appropriate services.

scholarly journals Service innovation: the first year of a brief psychiatric screening clinic in primary care

2002 ◽  
Vol 26 (6) ◽  
pp. 218-221 ◽  
Author(s):  
Ross Hamilton ◽  
Peter Gordon ◽  
Simon Naji
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Waiting Times ◽  
Psychiatric Morbidity ◽  
Health Problems ◽  
First Year ◽  
Attendance Rate ◽  
Screening Clinic ◽  
Brief Screening

AIMS AND METHODTo introduce a monthly screening clinic for new patients referred to the community mental health team with less severe mental health problems.RESULTSSixty patients were selected for screening in the first year. Their non-attendance rate of 48% was more than double the rate for all new patients. We did not diagnose severe mental illness in any patients on first assessment or during the 6 months of follow-up.CLINICAL IMPLICATIONSPatients referred from general practice with minor psychiatric morbidity may have particularly high rates of non-attendance. The brief screening clinic model offered us considerable savings in consulting time. The outcome for our service is shorter waiting times for patients with more severe mental health problems.

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