Model of Care for People with Severe and Enduring Mental Illness and Complex Needs
Traditionally large psychiatric hospitals catered for service users with severe and enduring mental illness and complex needs. Recent changes in mental health policy have meant that almost all of the larger psychiatrist hospitals have been closed down and replaced with smaller acute inpatient units and the development of community based mental health services. Overall these changes have significantly improved outcomes for many service users. However, while some service users with complex mental health needs can be successfully discharged to their community, there are a small but significant number who are repeatedly admitted to acute inpatient units, where many remain for long periods of time. As a result of this, the HSE Mental Health Services initiated a national project to develop a Model of Care for People with Severe and Enduring Mental Illness and Complex Needs. It arose from the recognition that those with the most severe and enduring mental illness require specialist rehabilitation services to assist their recovery. This Model of Care specifically aims to address the requirements for people with severe and enduring mental illness and complex needs through the enhancement of rehabilitation and recovery services in Ireland.
Specialised Rehabilitation Units
A significant component of the rehabilitation care pathway identified within the Model of Care is the Specialised Rehabilitation Unit (SRU). In October 2018 the HSE Mental Health Services commissioned two National SRUs, one in Highfield Healthcare and one in Bloomfield Health Services to provide specialist inpatient rehabilitation and recovery services for service users with ongoing complex needs.
A SRU is designed as an inpatient approved centre providing 24-hour care. Its primary focus is on active recovery focused medium-term rehabilitation with expected length of stay being 1 to 3 years. They offer a wide range of treatments and supports such a psychological interventions, self-care and living skills, medication management, peer support, creative therapies and physical health promotion.
However, it is vital that SRUs are not viewed as standalone units, but rather as part of a whole-system rehabilitation care pathway to ensure successful rehabilitation and recovery for people with complex mental health needs. The main aim of a SRU is to enable service users to progress towards step down community rehabilitation residences and/or independent living within their own community. HSE Mental Health Services continue to work closely with community health organisations (CHOs), local mental health management teams and Community Rehabilitation Mental Health Teams to support the national SRUs and also the enhancement of community rehabilitation services for service users with complex mental health needs.
National Specialised Rehabilitation Units Referral Process
As part of the national SRU process, HSE Mental Health Services has established a National SRU Referral Committee. All SRU referrals must be made to the National SRU Referral Committee using the Standardised SRU Referral Form. The National SRU Referral Committee is responsible for reviewing , screening and considering all SRU applications prior to any referrals being forwarded to either of the national SRU multidisciplinary teams for assessment .The process for referral to the National SRUs is clearly outlined in The Guidelines for the Management of National Specialised Rehabilitation Placements