Mental Health Division Healthcare Policy and …

1 HealthcarePolicyandStrategyDirectorateMe ntalHealthDivisionT: 0131-2442599F 01312442591 ( , , ~~~.DEREKFEELEY>~1~--TheScottishGovernme ntCEl13(2007)October2007 AddressesForactionChiefExecutives,NHSB oardsChiefExecutive,TheStateHospitalsBoa rdforScotlandMedicalDirectors[tocascadet oSeniorHealthRecordsManagers,CaldicottGu ardiansandDataProtectionOfficers]Regiona lPlanningDirectorsForinformationBritishP sychologicalSociety,ScottishDivisionChai rs,NHSB oardsChiefConstablesChiefExecutive,Menta lHealthTribunalforScotlandChiefExecutive ,NHSE ducationforScotlandChiefExecutive,NHSN ationalServicesScotlandChiefExecutive,NH SQ ualityImprovementScotlandChiefExecutives ,NHSL ocalAuthoritiesCrownOfficeChiefExecutive ,ScottishPrisonServiceDirector,MentalWel fareCommissionforScotlandDirectorsofSoci alWork/ChiefSocialWorkOfficersHomeOffice InformationGovernanceManagersMedicalDire ctor, ,ScottishDivisionScottishCommissionforth eRegulationofCareScottishPartnershipForu mScottishSocialServicesCouncilEnquir~sto .)

2 MrsFionaTyrrellMentalHealthDivisionRoom3 (CareandTreatment)(Scotland)Act2003, thisCELinrespectoftheCareProgrammeApproa ch(paragraphs8 to13). , , is cliniciansperformanceif askedtodosobyanNHSB oardorif (seeparagraphs14to16)meanthatinfuturemor eroutineperformanceinformationshouldbeav ailableandwhenthatis thecaseHealthBoardswillbegivenaccesstoth atinformationona copyofthisletteris attachedat(weblink)andresponsestothecons ultationprocessareavailableontheForensic Networkwebsiteat(webaddress). thecontextofthenewdutiesonNHSB oardsestablishedundertheManagementofOffe nders(Scotland)Act2005whichgivesaStAndre w'sHouse,RegentRoad,EdinburghEH13 DGr-)*\ABQ"""~tt . ~~ '!>~.!'~Vv.~..t\I~VESTORISI>EOPLH() ."q'T.~statutorybasisfortheMulti-AgencyP ublicProtectionArrangements(MAPPA).Bycom plyingwiththerecommendationsin theCPAC onsultationReport,NHSB oardswillbeabletomeetmanyoralloftheirobl igationsunderMAPPAin ,takingaccountoftheresponsestotheconsult ationexercise,acceptsandendorsestherecom mendationsmadein oftheCPAC onsultationReportis adoptedaspolicy(thisis attachedasAnnexC1.

3 NHSB oardsshouldconsiderthedocumentationtobea dvisorypendingthefurtheroutcomeofthework withtheRMA(seebelow).Thedocumentationis nc%20ap (CORO),HospitalDirection(HD),Transferfor TreatmentDirection(TTD)andInterimCompuls ionOrder(ICO). (atthisstagethoseonthesexoffendersregist er) patient,butforothercasesthearrangementsb eingdevelopedunderIntegratedCarePathways forcaremanagementwillbea ( ) availableat( ).It focusesonthewayin whichthesystemworkstoproduce, currentlyworkingwiththeRiskManagementAut horitytodevelopa systemofriskassessmentandmanagementplann ing(RMAR ecommendation7) (RMAR ecommendation8).StAndrew'sHouse,RegentRo ad, ~WSTORI!\' J> :);.-Ensurethattheyhaveappropriatelocala rrangementsinplaceinrespectofclinicalgov ernanceforforensicmentalhealthservices.) .-ImplementthenewguidanceinrespectofCare ProgrammeApproachforpatientsforwhotheywi llbecometheresponsibleauthorityundertheM anagementofOffenders(Scotland) :);.-CompletetheworkwiththeRiskManagemen tAuthorityinrespectofrecommendations7 and8 oftheRMAR eport.

4 -Publisha revisedversionoftheMemorandumofProcedure totakeaccountofthevariouschangestothepol icyframework.);.-ConsultwiththeRoyalColl egeofPsychiatristsandtheForensicNetworki ndevelopingtrainingonforensicservices, 'sHouse,RegentRoad, (CGRM) :ySafeandeffectivecareandservices:carean dservicesaresafe, ,wellbeingandcareexperience:careandservi cesareprovidedinpartnershipwithpatients, carersandthepublic,treatingthemwithdigni tyandrespectatalltimes,andtakingintoacco untindividualneeds, :NHSS cotlandis :yFocusingontheNHSB oard' , 'sHouse,RegentRoad, ,tf"-"It"% J:.>"..,<. ~ ;,.. (RMAR ecommendation1).;,..NHSB oardshostingregionalservicesmustbeableto demonstratetherobustnessofclinicalgovern ancearrangementstotheirfellowNHSB oards.;,..If anNHSB oardcommissionsforensicservicesfromanoth erNHSB oardorotherproviderit ;,.. ;,..NHSB oardsshouldensurethatthereareappropriate resourcesinplacewhetherwithininpatientse ttingsorin thecommunitytoallowforthesafecareandtrea tmentofpatientsandtheprotectionofthepubl ic.

5 (RMAR eportRecommendation9).Supportstructures; ,..NHSB oardsarerequiredtohaveeffectivestructure sinplacetoensureeffectiveclinicalgoverna ncesupportandreportingstructures.(NHSQIS 2005).(RMAR eportRecommendation2);,..Individualclini ciansandserviceshavea responsibilitytoaccessandmakebestuseofth esesupportstructures.;,..Identifyinga clinicalleadfordrivingforwardclinicalgov ernancewithinserviceshasbeena successfulmechanismadoptedbyotherclinica lspecialties.;,.. (RMAR eportRecommendation10).;,.. 'sHouse,RegentRoad, ()~--~l)1;VESTORI~ PEOI> (Takenfromconsultationreportpreparedbyth eForensicNetwork) (CPA)shouldbeadoptedasthemechanismofregu larreviewforallrestrictedpatientsinScotl and, hospitaldisposalisrecommendedmayalsobene fitfromtheCareProgrammeApproachbutin thiscasetheuseoftheCPAis - 10weeksafteradmissiontohospitalandreview meetingsshouldbeheldata ,foreachpatient,tobea is toorganisemeetingsina 'sHouse,RegentRoad, - Responsibilitiesof theCareCo-ordinatorIt is importantthattheCareCo-ordinatorhasa keyrolein theclinicalcareofthepatient(oftentheywil lbethepatient'skey-worker)

6 OProvidescontinuityofcareco-ordinationoM aintainsregularcontactwiththepatientoEns uresmembersoftherelevantclinicalteamhave accesstorelevantdocumentationoEnsurestha tthepatientsnamedpersonandrelevantothers haveaccesstorelevantinformationaboutthep atientscareandareappropriatelyinvitedtom eetingsoAlertsclinicalteammemberswithany difficultiesin fulfilmentofthecareplanoAdvisescolleague sofanychangesofcircumstancesoranymatters whichmayrequiremodificationtothecareplan betweenCPAmeetingsoEnsuresthatappropriat eagenciesinvolvedinthepatientscarehaveap propriateaccesstotheCareProgrammeApproac hcareplanandareinvitedtoreviewsoEnsurest hatreviewsarearrangedoActivelyparticipat esinreviewsoEnsuresthateveryeffortismade tofacilitatepatientinvolvementandaccesst oindependentadvocacyoEnsuresthatrequisit edocumentationisupdatedwithinspecifiedti mescalesanddistributedaccordinglyoHasa clearunderstandingofprofessionalboundari es, : Pre-CPAmeetin~- primarilyfocussedonthirdpartyinformation orsensitiveinformationatwhichthepatienti s notpresent CPAmeetinq- atwhichthepatient,theirnamedpersonand/or advocatearepresentA thepreCPAmeetingtheremaybematerialthatme mbersofthemultidisciplinaryteamfeeluncom fortableinsharingin frontofthepatient,althoughit is vitalthatthePre-CPAmeetingdeterminesthat if it is appropriatethatthisinformationis sharedwiththepatientandis includedin is theresponsibilityofthechairofthemeetingt odecideif informationin briefminute, 'sHouse,RegentRoad, is envisagedthattheywilltakepartorcontribut einformationthatwillbeconsideredin , discretiononwhochairsthemeeting,box2 offerssuggestedcompetenciesforaneffectiv echair.

7 Inmostcasesit willeitherbetheResponsibleMedicalOfficer , verbalsummaryofwrittensubmissionsprepare dinadvanceofthemeetingandpresentedbythos einvolvedin - Competenciesforchairinga CPAmeetingoFamiliarwiththeclinicalcaseoA bletoensuresthatobjectivesofthemeetingan ddetailsofthecareplanaresetandagreedbyme mbersoAbletoidentify,coordinateandsteert hemeetingoAbletoensurethatallmembersofth eteamfullyparticipatein themeetingoAbletoensurethatteammembersre mainfocussedonthemeetingandpresentinform ationontheirobjectivesinrespectoftheproc essoHastheskillsandattributestoleadalarg emeeting,keepingfocusandtimekeepingoAble toadopta facilitativestylewhenchairingmeetingstoe ncouragefullandfrankdiscussionoKnowswhen tobedecisiveoAbletotackleconflictatanear lystageoAbletocommunicateeffectivelyoral lyoAbletonegotiateandinfluenceotherstore viewandsetobjectivesoAbletotakesounddeci sionsoHasbothanalyticandstrategicability oSensitivetotheneedsofthepatientsandcare rsIt isnotenvisagedthatthereneedstobea fullrepetitionofthepatient' is pastpsychiatrichistorysummaryandalsoa maybethatinpartoftheCPAmeetingorpreCPAme etinga presentationofthepastinformationis given,eitherbecauseit isthefirstCPAinthatparticularsettingfoll owinga , 'sHouse,RegentRoad,EdinburghEHl3 DGr~"\0'0 ,,~Y.

8 L"/r}~ A."'1 ~l'INVE<:;:TORI~PEOPLEIJ/SA'O\'\;.., part9 careplan(section137oftheMentalHealth(Car eandTreatment)(Scotland)Act2003).Animpor tantprincipleis thatthereshouldnotberepetitionoftheCPApr ocess, ,coveringparticulartreatmentintervention s(egnursingcareplan).Wherea moredetailedcareplanexiststhereshouldbea trafficlightapproachis ,in thecaseofrecurrenceofsymptomsofmajorment alillness,a greenlightwouldbeidentifiedwherethereis noevidenceofrecurrenceofmajormentalillne ss:A howevermembersoftheclinicalteamidentifyf actorsthatmightsignifytheearlyreturnofsy mptoms, redlightcontingencywouldbethepresenceofa 'sHouse,RegentRoad, ~~ 0~-,'"IXVEsnJRIX J~ TrafficLightApproachtoContingencyPlannin g(ThisreplicatestheContingencyPlanningse ctionoftheCPAD ocumentationandprovidesanexampleofwhatth eriskindicatorsandrelevanttrafficlightsm ightbeforanin-patient,it is importanttonotethattheseshouldbetailored toindividualcircumstancesforeachcase)EXA MPLE:MrBloggsisa restrictedpatientwithina ' (RelapseIndicators)ContingencyActionsSym ptomsofMentalGreen:Noevidenceofsymptomso fpsychosisordepression ContinuecurrenttreatmentIllness.

9 Prolongedperiodsofanxiety,suspiciousness ,pre-occupiedorwithdrawn Suspendunescortedtimeout,informRMOwithin 24hours(DrJSmith,tel:032562561479)Hed:Co mmandhallucinations,delusionsregardingal iens Suspendalltimeoutofclinic,increaseobserv ationlevels, (tel:03216416548241)SubstancesGreen:Nopo sitiveurinedrugscreensdespiteregularmoni toring Continuecurrenttreatment: ,informRMOwithinhasbeentakingsubstanceso nward24hours(DrJ Smith,tel:032562561479)I~(!d:Cleareviden ceintoxicatedwithillicitsubstancesonward Suspendalltimeoutofclinic,increaseobserv ationlevels, (tel:03216416548241) ,informRMO: (DrJ Smith,tel:032562561479)withPsychological orOccupationalTherapies0 Suspendalltimeoutofclinic,increaseobserv ationlevels,I~(!d: Clearevidenceofnon-compliancewithmedicat ion, (tel:03216416548241)Thistableprovidesexa mplesofpossibleentriesandisnotproposedas a 'sHouse,RegentRoad, TrafficLightApproachtoContingencyPlannin g(ThisreplicatestheContingencyPlanningse ctionoftheCPAD ocumentationandprovidesanexampleofwhatth eriskindicatorsandrelevanttrafficlightsm ightbeforanin-patient,it is importanttonotethattheseshouldbetailored toindividualcircumstancesforeachcase)EXA MPLE:MrBloggsisa ' (RelapseIndicators)ContingencyActionsSym ptomsofMentalGreen:Noevidenceofsymptomso fpsychosisordepression ContinuecurrenttreatmentIllness: Prolongedperiodsofanxiety,suspiciousness ,pre-occupiedorwithdrawn ReviewbyClinicalTeam,informRMOwithin24ho urs(DrJSmith,tel:032562561479)Red:Comman dhallucinations,delusionsregardingaliens EmergencyRecallInformDutyRMOimmediately( tel:03216416548241)SubstancesGreen:Nopos itiveurinedrugscreensdespiteregularmonit oring Continuecurrenttreatment: emptycanormisseddrugtest (DrJSmith,tel.)))

10 032562561479)I-{f~d:Clearevidenceintoxic atedwithillicitsubstancespositivetest. , (te/:03216416548241)EngagementwithGreen: Compliantwithmedicationandkeepingallappo intments ContinuecurrenttreatmentTeam: Suspectednon-compliancewithmedication,mi ssed InformRMOwithin24hours(DrJ Smith,tel:032562561479)appointment(s) (tel:032164 Red:Refusingmedication,refusingtoattenda ppointments16548241)Thistableprovidesexa mplesofpossibleentriesandisnotproposedas a 'sHouse,RegentRoad,EdinburghEH1 ~rESTORIS" pasthistoricalsummary,a riskassessmentdocument,recentreportsbyth osemembersofthemultidisciplinaryteamregu larlyinvolvedin thecase,detailedmultiprofessionalcarepla n,minutesofthirdpartydiscussionsheldin theCPAdocumentanda copyofa proformafortheCPAdocumentis a livingdocumentandis intendedtobedistributedtoallthoseinvolve dinthecareofthepatientincludingthepatien t, alsoidentifiesthenextofkin,namedpersonan dessentialcontacts,suchastheGP,CPACo-ord inator, statementoftheindexoffence,indexoffendin gbehaviourorindexallegedoffenceanda 'scurrentlegalstatus,thedateoftheconvict ionorinsanityacquittalandclarityregardin gwhetherthepatientis subjecttothesexoffendersregisterorschedu le1 descriptionofwhatcompulsorymeasuresareau thorised.}