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Mental health patients should have local ‘named practitioner’, says NICE

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People with mental health problems should be assigned a “named practitioner” from their home town to help co-ordinate care, as part of efforts to streamline support, according to draft guidelines.

The draft recommendations, made by the National Institute for Health and Care Excellence, focus on supporting patients as they move between services, including when discharged from inpatient units.

They follow a recent review of acute inpatient psychiatric care, which revealed major problems with admissions and care in the community.

“Over 1,000 people with mental health problems commit suicide every year in England, sometimes just weeks after being discharged from hospital,” said Professor Gillian Leng, NICE’s deputy chief executive and director of health and social care – referring to a report published last year based on research by Manchester University.

“We can help reduce this number by better communication, and more joint working, between hospital and community mental health teams,” she said. “This guideline, when finalised, will help everyone needing mental health support have a better transition between services.”

One of the key recommendations made by NICE is that, when people are admitted to a hospital outside the area they live, they should have a “named practitioner” from home.

“Look for opportunities for hospital and care home practitioners to exchange information about the person”

Gillian Leng

This professional – which NICE confirmed could be a nurse – will be responsible for liaising with ward staff to ensure care planning, recovery goals and discharge plans are regularly reviewed.

The guidelines also emphasise the need to keep family, friends and carers in the loop and state that a “named practitioner” should also be responsible for this.

Recent research shows effective communication with families during the development of treatment plans can reduce suicide risks.

Practitioners, such as nurses, would be expected to work closely with families from the outset, ensuring they know why someone has been admitted to hospital, understand their condition, are involved in plans for discharge and know about sources of support for carers.

“This should be done in an empathetic, reassuring and non-judgemental way, acknowledging that a first admission can be particularly traumatic for families and carers,” said the draft guidelines.

The document also sets out general principles for mental health nurses and other professionals, such as what to consider when planning for an admission, developing crisis plans and preparing patients for discharge.

It includes the fact nurses admitting patients to hospital should discuss domestic arrangements that may be worrying them – for example, care for children, elderly relatives and pets, and other key issues like home security, tenancy issues and benefits.

The guidance highlighted the needs of particularly vulnerable groups such as children and young people, adults with learning disabilities and people with dementia, and the importance of good communication between hospital and community teams.

“When a person is being discharged to a care home, look for opportunities for hospital and care home practitioners to exchange information about the person,” said the guidance.

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Gillian Leng

“An example might be a hospital practitioner accompanying the person when they return to the care home,” it added.

The guidance also stressed the need to ensure mental health and other practitioners received the right training and support.

Commissioners should ensure all professionals involved in assessment for admission under the Mental Health Act, such as community psychiatric nurses, have opportunities for training, said the document.

It could include training delivered by service users, on-the-job learning and joint training for different types of professionals.

A consultation on the draft guidance – titled Transition between inpatient mental health settings and community or care home settings – closes on 27 April, with the final document expected to be published in the summer.

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