What do specialist teams contribute to community psychiatry? Discuss with reference to at least two teams, invoking relevant evidence.

 

Community psychiatry describes the multiplicity of community-based programs and support teams which largely supplanted psychiatric hospitals in the post asylum era to support those with or who may be vulnerable to mental health problems. The methods employed often differ to traditional methods utilized in asylums, with community mental health teams being setup to provide services within easy reach or even in the outpatient’s own home, thus circumventing the requirement in many cases to remove service users from their homes and communities to place into hospitals. A key benefit of community psychiatry programs is that are integrated as much as possible into the everyday life of the service user than the inpatient service model. Allowing the service user to maintain closer to a normal standard of living than would be possible with hospital admission.

Specialist teams were introduced to provide a more targeted approach to support provision for those requiring mental health care than CMHTs.

 

The various specialist teams although different in skillset and services offered, have transparent support criteria and a collective focus on social inclusion to improve the service users’ opportunities for integration into society (Kalidindi et al. 2012). The specialized teams also have a degree of flexibility to work with individuals whose diagnoses may span multiple categories. The teams are generally deployed within a well defined catchment area which contains all the community mental health services that might be required within a relatively short distance including some inpatient facilities.

 

Assertive outreach teams (AOTs) provide services to people who have trouble cooperating with mental health services or have long term complex mental health problems and require intensive care and support. Individuals with severe ongoing mental disorders which affects them on a daily basis are those who fall into the inclusion criteria for assertive outreach team support (Ryan et al 2004). Other complex needs which qualify a service user for assertive outreach include violent behaviour, self harm, dual diagnosis, non-responsive to treatment or no fixed abode. Such high-risk individuals require intensive support which is provided by an AOT, which comprises several highly skilled individuals to meet their needs and help them to acquire help from additional services if needed. AOTs provide the care to promote the recovery of service users and reduce likelihood of hospital admission.

 

Early intervention in psychosis services (EIPS) are targeted at people with or vulnerable to developing psychosis, especially young people who have a predisposition to psychotic illness. They apply intensive, individually customized support to help prevent the emergence of psychosis in at risk individuals. The support usually lasts for three years and utilizes evidence based treatments whilst supporting the families and carers of the service users. The introduction of EIPS has significantly altered the requirement for hospital admission and shortened the wait times from first psychotic break to receiving treatment (Singh, S. 2017). Extensive evidence shows that EIPS is more effective than conventional care at managing the early phase of psychotic illness and receive widespread approval from service users and carers alike (Lester et al. 2009). Although it is questionable whether the long-term benefits are maintained once EIPS treatment ceases.

 

Crisis resolution teams provide emergency support for people experiencing a mental health crisis. They are especially accommodating for the specific needs of the individual such as willingness to meet at a location of their choice. This team provides a fast assessment for outpatients identified for acute hospital admission. By providing intensive 24 hour care often in the service users own home, the team can often circumvent the requirement for hospitalization or diminish the severity of illness and thus reduce the required length of subsequent hospitalization (Johnson, S. 2013).

 

Specialist teams have been instrumental in transforming community psychiatry as evidenced by service users improved mental health response over standard care platforms and the general preference for the community or home based care where family involvement is more readily sourced. The flexibility of these teams in meeting service user requirements is also highly valued. Additionally, socio-economic gains are attained relative to conventional mental health care as services are cheaper and there is a reduction in patient admissions. The community integrated nature of specialist teams promotes the capacity of the individual to work and earn money, which indirectly offsets potential losses from hospital admissions (Davies et al. 2005).

 

Kalidindi, S., Killaspy, H. & Edwards, T. (2012) Community psychosis services: the role of community mental health rehabilitation teams. Royal College of Psychiatrists’ Faculty of Rehabilitation and Social Psychiatry. November 2012

Ryan, T., Pearsall, A., Hatfield, B., et al (2004) Long-term care for serious mental illness outside the NHS: a study of out of area placements. Journal of Mental Health, vol.13, 425–429

Davies, S., Mitchell, S., Mountain, D., et al (2005) Out of Area Treatments for Working Age Adults with Complex and Severe Psychiatric Disorders: Review of Current Situation and Recommendations for Good Practice. Royal College of Psychiatrists.

Singh, S. (2017) Early intervention in psychosis: much done, much more to do. World Psychiatry. 2017 Oct; 16(3): 276–277. World Psychiatry. 2017 Oct; 16(3): 276–277.

Lester H, Birchwood M, Bryan S, England E, Rogers H, Sirvastava N. (2009) Development and implementation of early intervention services for young people with psychosis: case study. Br J Psychiatry 2009; 194: 446–50

Johnson, S. (2013) Crisis resolution and home treatment teams: an evolving model. Advances in psychiatric treatment (2013), vol. 19, 115–123.