Thread by @rcpsych

One of our parallel sessions at #RCPsychIC that is starting now is on 'Complex journeys from hospital to community', chaired by immediate past president, Professor @wendyburn.

The first speaker is Dr @KenCourtenay, Consultant Psychiatrist at @behmhtnhs and Chair of @rcpsych's Faculty of Psychiatry of Intellectual Disability. Their #RCPsychIC talk title is ‘Has Transforming Care transformed people’s lives?’

KC: The problem used to be around inpatient admissions. Over the last decade, there have been changes in providers and alternatives to hospital care are available, one of the 'big achievements' from the last 10 years.

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KC: Range of community support available for intellectual disability patients.

There are barriers to this journey from hospital to community care.

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KC: Sometimes there have been no alternatives to inpatient services. Questions exist over who is funding community services and the availability of housing stock is an issue.

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KC: Various facilitators in this process. Engaging with community services is really important. Need to ensure there is good support in the community.

Many agencies involved leading to 'many hoops to jump through'.

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KC: We have learned that people are often sent away to hospitals at great distances from their local area...and their families. Connection to families is important and it's not enough to just have telephone calls.

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KC: Enhancing community services is 'vitally important' as is integration between primary, secondary and social care. Not much can be achieved without social care being fully engaged.

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KC: Having the right mix of skills in Community Teams is important. Need to ensure regular meetings, facilitated more easily via virtual tools these days. We need to be more curious in our clinical approach to people and have more integration between services.

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KC: Funding is a big challenge. Going forwards we will be looking for Integrated Care Systems to provide funding to replace separate funding sources at present.

'People don't fit into neat boxes' and looking at bespoke packages of funding may be required.

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KC: We should be open to exploring all models that will help people move into the community. Need person-centred approach.

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KC: Knowledge of mental health legislation can be confusing to families. We need to help support them. Perhaps panels need to be less risk averse. Need to look at alternatives to detention.

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KC: Some transformation has occurred but more needs to happen.

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Next up is Bekki Davis from the Challenging Behaviour Foundation (@CBFdn). Their #RCPsychIC talk title is 'A family’s experience of hospital care and community aspiration’ who is talking about her brother Elliot's experience.

BD: Elliot has severe autism, a learning disability and challenging behaviour and has been labeled as 'complex' by professionals whereas to his family he is misunderstood by the systems in place. #RCPsychIC

BD: Several barriers to discharge, including many factors that @KenCourtenay mentioned earlier, e.g. housing not ready or available, struggles with funding etc.

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BD: Presenting ideas on working together to improve the situation.

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BD: "Mental health services and providers need to make sure staff are curious and compassionate first. Training is great but I think being curious and wanting to listen is the thing that seems to make the difference"

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BD: "Early intervention at a young age is key...There is a huge need for teaching assistants who are specially qualified to support challenging behaviours and learning difficulties in mainstream schools."

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BD: Thank you Bekki for sharing Elliot's story!

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The final speaker in this #RCPsychIC session on 'Complex journeys from hospital to community' is Dr Rajesh Mohan (@raj_psyc), Chair of @rcpsych's Faculty of Rehabilitation and Social Psychiatry. Talk title is ‘Safe and sustainable transitions to community for vulnerable adults’.

RM: There are 'major gaps' in the bridge between inpatient services and community support.

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While we try to re-establish the connection to @raj_psyc, Bekki Davis from (@CBFdn) is asked whether she thinks professionals are too risk-averse to which she answers 'Yes'.

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RM: People with long-term psychosis have complex needs. People are not always involved in their own care decisions.

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RM: Here are all the services and organisations that can be involved in the care of a single patient. Thi sis often surprising for patients and carers.
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RM: Three keys areas:

1. Physical health
2. Mental health
3. Social care

But all of this occurs in a single person. Has to be considered holistically.

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RM: @TheKingsFund has talked a lot about promoting physical and mental health. Have presented 10 priorities.

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RM: "Housing is a key ingredient for recovery". The Centre for Mental Health (@centreformh) have made some key recommendations, including acknowledging housing as a basic human right.
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RM: Fragmentation of professional relationships add to the challenge.

"More than 50% of rehabilitative care is currently delivered out of area."

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RM: Summarising recommendations from 'In sight and in mind' report by @rcpsych from last year.
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Read the report here: rcpsych.ac.uk/docs/default-s…

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RM: Recommending the reading of NICE guidelines on rehabilitation for adults with complex psychosis.

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RM: Interesting paper that looked at how continuity of care was happening (or not happening) over a long period (11 years).

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RM: That @TheBJPsych paper is available here:

'Continuity of care and clinical outcomes in the community for people with severe mental illness'
cambridge.org/core/journals/…
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Dr Rajesh Mohan (@raj_psyc) now presenting a summary concluding with the thought that it is always better to organise care around the individual.

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Thank you to all of the speakers (and the Chair) from this session! #RCPsychIC