Rehabilitation in Psychosis: Rebuilding & Transforming
Lives
Dr Sridevi Kalidindi PhD, FRCPsych
•
•
•
•
•
•
Chair, Faculty of Rehabilitation & Social Psychiatry;
Co-Chair, Joint Commissioning Panel –Mental Health;
Consultant Psychiatrist in Rehabilitation & Recovery; Visiting Lecturer
IOPPN
Trust Clinical Liaison Lead for Contracts
Sridevi.kalidindi@slam.nhs.uk
http://www.rcpsych.ac.uk/workinpsychiatry/faculties/rehabilitationandsocial.a
spx
Rehabilitation in Psychosis – Co-producing
Transformed Lives. “Thank you for giving
me my life back”
• Real life stories: Clinical and service user
innovation – the long(er) view
• Severe personality disorder and psychosis
• Autistic spectrum disorder and psychosis
• Substance misuse and psychosis
• BME, substance misuse and psychosis
People with complex psychosis
and complex needs
 Psychosis
 Treatment resistance
 Negative symptoms
 Comorbidities – mental and physical health
 Functional impairments
 Challenging behaviour
 Difficult to engage
 Risk
 10-14% of EIP require rehabilitation
 10-20% of secondary care; Account for 25%-50%
of the annual UK mental health budget (MH
Strategies 2012)
Specialist skills of rehabilitation services
http://www.rcpsych.ac.uk/workinpsychiatry/faculties/rehabilitationandsocial.aspx
Skills of a Community
Rehabilitation Team
(see guidance)
• Leadership; the long(er)
view
• ‘Pull through’ to less
restrictive, more
independent, socially
inclusive and meaningful
lives
• Public Relations
• Internal to the team
• Patients & carers
• Working with other teams
• Provider facing
• Managing transition
• Commissioner facing
• Census, performance
management; systemic
blocks, challenge
discrimination - educate
• placements/care
packages/ funding panel
• OATs
• local service
development
• cost of unmet need
(Campion 2012)
Whole system approach to mental health
rehabilitation services
A National Strategy
National commissioning
Guidance
(Waxing and waning rehabilitation
services nationally)
www.jcpmh.info
Out-of-Area Treatment
In Sight, In Mind – Toolkit for OATs
Setting National Standards
• AIMS – Rehab; CQC
• Community Rehab standards
underway
• NICE guidance eg.
• i) Transition from Hospital
• to Care Home
• ii) New – NICE guidance service specification (2016!)
A Pathway Approach
Many local examples of good innovative
pathways, both in-patient and community
National pathway:
High level within the commissioning guidance
Detailed - under construction. Careful not to stifle local
innovation, based on local needs
Earlier intervention is key.
Criteria – 2 acute admissions in one year, > 30 day
admission
Faculty of Rehabilitation & Social
Psychiatry
• National review of
Rehabilitation (all
types)
• National review for
Mental Health
Supported Housing
• National Survey of
Rehabilitation
Services
• Employment
– DWP, Expert Review;
Training for assessing
Doctors
• Recruitment,
Education and
Training
• International
Rehabilitation
International Rehabilitation Psychiatry
#FundaMentalSDG
United Nations Sustainable Development Goals
2015 Development Agenda
www.fundamentalsdg.org
Rehabilitation in Psychosis
– Co-producing Transformed
Lives