Lousia Ovington independent investigation report ... - NHS North East

CHAPTER 7 – PROVISION OF MENTAL HEALTH SERVICES
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The changeover from CPA to the newer version ‘care coordination’ in 1999 seems to
have been handled well and has complemented the partnership arrangements which
were established to develop integrated services with colleagues in social services.
The panel has heard evidence about the measures put in place to ensure effective
‘joint working’ which has included appointment of joint managers from both health
and social care. This is reflected in the development of policies for the new services
linked to the modernisation agenda.
The policies for the CMHT, crisis resolution service and the assertive outreach service
were in place at the relevant times and whilst they needed to be introduced in stages
across the localities, they appeared to be available if required.
However, the key issue in respect of both service provision and policy implementation
is not so much that they were in place, but how they were implemented in practice.
The effectiveness of CPA/care coordination has been considered in a separate chapter.
The panel recognises that whilst the referral of Louisa Ovington to the assertive
outreach team may have been desirable and may have helped to overcome some of
the issues around engagement, the operational policy is clear that the person being
referred must be suffering from a severe and persistent mental disorder and this had
not been established in Louisa Ovington’s case.
Perhaps the most significant policy change was the introduction of the CRT where the
emphasis was shifting from hospital to home based treatment. The CRT took on the
role of ‘Gatekeepers’ for the mental health service and there was an expectation that
they would provide a rapid assessment of crisis and either work with someone for a
short care spell or signpost to an appropriate service.
The policies, however, clearly promote joint working and in particular, the CRT policy
states:
Assessment will focus on the following areas:
• The presenting problems;
• Comprehensive assessment of risk;
• Clinical signs and symptoms;
• Family and carers needs and views;
• Determine the level of need and appropriateness of ongoing treatment;
• Level of intervention required;
• Risk management with regard to unsafe/inappropriate behaviour;