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Community mental health team (CMHT) older people’s service (North Kirklees)
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About the service
North Kirklees community mental health team (CMHT) provides assessment, support and care for people aged over 65 with dementia and/or mental health conditions.
The team aims to provide mental health services which put the individual first and recognise the needs of the diverse population of Kirklees. Members of staff from South West Yorkshire Partnership NHS Foundation Trust work with staff from Kirklees Council to form a specialist integrated team.
Our timely and effective support promotes recovery and wellbeing and prevents relapse.
We encourage independence, maintain dignity, privacy, respect and ensure that the individual is given a choice in their care.
Why would someone choose the service?
- The team provides a caring, empathic approach which ensures the needs of the service user are addressed in a timely and effective manner.
- The team makes sure service user feels respected and listened to and is involved in all aspects of their care.
- Following the initial assessment, the service user is allocated a care coordinator who is responsible for coordinating and signposting the service user to appropriate services to encourage recovery. The care coordinator develops a relationship with the service user to make sure their needs are met and understands their goals and aspirations for their future health and wellbeing.
- The care coordinator works within a team where the skills of other professionals are used to provide the best care possible.
Staff you may meet
- Dietitians use the science of food to help people to make good choices about food and lifestyle. Nutrition is an important part of recovery and wellbeing. All service users admitted to a Trust ward have their nutritional state assessed.
- There are more than 60 different specialities that doctors work within the NHS. Each is unique but there are many characteristics which are common. Roles range from working in a hospital to being based in the community as a GP.
- There are many people who work behind the scenes to keep services running and you may meet them in hospital or community settings. They include porters, cleaners, plumbers, electricians, decorators receptionists and secretaries who all work to make sure healthcare settings are kept clean, tidy and safe.
- Nurses who choose to specialise in the mental health branch of nursing work with GPs, psychiatrists, psychologists, and others, to help care for patients. Increasingly, care is given in the community, with mental health nurses visiting patients and their families at home, in residential centres, in prisons or in specialist clinics or units.
- Nursing or healthcare assistants work in hospital or community settings under the guidance of a qualified healthcare professional. They help doctors, nurses and therapists give people the care and treatment they need.
- Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific, purposeful activity to prevent disability and promote independent function in all aspects of daily life.
- Physiotherapists help people to improve their range of movement in order to promote health and well being. This can help people to live more independently.
- Adult psychotherapists work with people to assess and treat a range of emotional, social or mental health issues. They help people tackle problems such as behavioural issues, common challenges such as anxiety and depression or more complex or severe issues, such as psychosis or a personality disorder diagnosis.
- Social workers help, support and protect people who are facing difficulties in their lives. They help people to take positive steps to overcome problems and improve their lives. This could involve assessing and reviewing a service user’s situation, building relationships with service users and their families and agreeing what practical support someone needs.
Why a professional should choose the service
- We endeavour to meet all CQUIN targets: The assessment and referral sector assess all non-urgent referrals within the 14 calendar day target which meets the regional CQUIN Indicator 2.
- Supervision/appraisal: Staff receive supervision which allows them to reflect, develop their skills and knowledge base in this specialist clinical field.
- Ongoing assessment and care coordination – Care Programme Approach: The service places the service user at the heart of all interventions and care delivery.
- Compliance with mandatory training which is maintained and monitored to a high standard.
Support offered
- Dedicated assessment and referral team
- Ongoing assessment and care coordination (planning care between the service user and staff)
- Individual treatment programmes
- Discharge planning (planning how a service user will be cared for once they have been discharged from hospital)
- Psychosocial interventions (using educational or behavioural approaches to treat a condition)
- Supportive counselling
- Medication management, advice and support
- Information and advice (signposting to other services who may be able to help further)
- Support with welfare benefits
- Support with accommodation needs
- Support for carers
- Promoting independent living skills
- Development of leisure and social skills
- Referral to other services
- Best interest assessments (making sure that decisions made are done in the service user’s best interests)
- Capacity assessment (assessing capabilities)
- Supporting inpatient bed management
Outcomes
- To promote an increased awareness and education around the individual’s mental health needs and to promote recovery through an understanding of their strengths and weaknesses.
- To identify signs of relapse and to make sure the individual is aware of how to access services in the future to maintain their wellbeing.
- The CMHT aims to provide timely interventions which are regularly assessed in line with the Care Programme Approach (CPA – a specific way of assessing and reviewing someone’s needs) policy.
- The service promotes independence and involves the service user in their care plan and discharge plan. This enables them to engage with community services to encourage self-management and responsibility for their own wellbeing.
Referrals accepted from:
AHPs, Carers/family, CMHTs, Courts, Drug/alcohol agencies, GP staff, GPs, Health visitors, Hospital staff, Housing associations, Local authority staff, Other Trust services, Patients(self-referral), Police, Single Point of Access team, Voluntary services, Youth Offending Team
Referral criteria:
Referrals are made through the Kirklees single point of access who will then send a letter to the referrer confirming they have received the referral. The service user must be aware of the referral being made.
Referrals will be accepted from any professional for individuals aged 65 and over. Professionals are expected to explore the individual’s current treatment and medical history with the person’s GP before making a referral.
When an individual self-refers or someone does so on their behalf, the team will explain that the referral will only be accepted after a consultation with the individual’s GP.
In exceptional cases, where an individual does not consent but is felt to be at risk to themselves or others due to a mental health condition, the team will accept the referral only after consultation with the individual’s GP and/or an approved mental health professional.
The service prefers referrals made in writing and this can be done using a form, however, verbal referrals will also be accepted based on urgency, circumstance or need.
If the information is missing from the referral form, the referral may be delayed or rejected.