a case study looking at the joint working between the Manchester Mental Health and Homeless Team and Change Grow Live, drug and alcohol service.
MMHHT MHP Case Study | |
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Report Date: |
23/03/2023 |
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Location: |
Manchester |
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Author: |
Jade Snowdon |
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OHID Dual Diagnosis: Overview |
| Greater Manchester Mental Health NHS Foundation Trust (GMMH) provides a range of mental health, addiction and dual diagnosis services within Greater Manchester and beyond. These include homelessness services, community mental health, psychology, offender health and a range of specialist addiction services from drug and alcohol addiction to gambling. The RSDA Pathway (rough sleeper drug and alcohol) is a pathway within the core Manchester Mental Health and Homeless Team (MMHHT) offering mental health support for people who are known to Change Grow Live (CGL) drug services and are rough sleeping or in temporary ABEN (A Bed Every Night) accommodation, this pathway comprises of joint workings with staff members from CGL in order to provide a comprehensive and joined up approach to service users . The Mental Health Practitioner (MHP) Role The MHPs (mental health pratitioner) work with service users and liaise with staff to support recovery, engagement and understanding of the complex challenges for people with dual diagnosis needs and those who support them. Their work includes engagement, assessment, and support for service users to help people access appropriate pathways to assist them in achieving improved outcomes. In addition to this the team also deliver training for staff within the CGL service to promote mental health awareness |
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Background |
| Background to the person’s case – how they came to be referred to the service, notable clinical picture, concerns, risks etc Mr Z is a 33 year old male who has lived in Greater Manchester most of his adult life. Growing up he had a difficult childhood and experienced emotional and physical abuse. He has a complex mental health history which is complicated by poly drug use. Mr Z’s primary diagnosis is Emotionally Unstable Personality Disorder, and he currently experiences paranoid ideation, low mood and auditory hallucinations of a derogatory nature. Due to a significant life bereavement and ensuing episode of psychosis, Mr Z has had serious self-harm/suicide attempts and overdoses which resulted in two section 2 admissions in 2019/20. He was under the care of a Salford Community Mental Health Team, but was discharged following a change of care coordinator which resulted in lack of engagement exacerbated by homelessness. Mr Z came known to the MMHHT team after presenting to A&E due to an episode of psychosis and thoughts to self-harm. Over time the MHP has developed a strong relationship with Mr Z and he now has very good engagement with mental health services. Mr Z currently resides in temporary accommodation and his long-term goal is to acquire his own tenancy through the private rented scheme. It has taken a number of months to help support Mr Z to the stage where he feels able to engage with other services and he is now in the phase of his recovery to address his substance misuse. He currently takes crack cocaine, diazepam and intermittent GBL use. Mr Z’s drug use increases his vulnerability as he is currently financing drug debts accumulated through periods of high usage. This year there were also safeguarding concerns for his physical safety after he received threats of harm from previous peers due to his drug taking behaviour. However, Mr Z is a very low risk to others. Due to his drug use Mr Z also has physical health concerns including kidney stones. |
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Interventions and Support |
| What happened next, what did you do, what was your role, who else was included, why etc The MHP’s work with Mr Z was initially focused on developing trust to re-engage him within mental health services and to obtain suitable accommodation so they could better stabilise his mental health and commence mental health medication. After the initial assessment was conducted, a review with a consultant psychiatrist was organised to re-commence Mr Z on anti-psychotics. Mr Z was started on a small dose of Olanzapine, which was later increased after his negative symptoms were notably improved. However, as Mr Z engages in chaotic drug use it was agreed when he was ready he would consider CGL intervention, which he initially declined due to feeling unsettled and overwhelmed. As per person centre practice the MHP supported this decision and regularly reviewed this stance so a timely referral could be submitted once he was ready. Mr Z finds it challenging to maintain temporary accommodation due to his drug taking pattern and paranoid ideation associated with sharing facilities with other residents. When intoxicated, Mr Z also loses track of time stays out for extended periods of time and thus breaches his tenancy agreement resulting in eviction. He is currently on his final warning before cessation of duty. A large proportion of the MHP’s time with Mr Z has been dedicated to advocating on his behalf for housing and providing emotional support. Therefore, CGL intervention and multi-agency working was imperative to utilize their specialised knowledge and expertise to support Mr Z to reduce his drug use safely with the goal of promoting his physical well-being and prevent homelessness. After the safeguarding concern mentioned previously, Mr Z felt prepared to engage with CGL. A referral was made through the OHID Pathway and was triaged and allocated for an assessment in very timely manner. After the assessment, CGL quickly agreed to keep Mr Z’s assessor as his allocated drug worker to commence therapeutic work. It was hoped a regular key worker would be able to promote stability and reduce feelings of paranoia and stress. This could only be accomplished with both agencies working collaboratively and sharing information. Mr Z’s next goal is to register with a local GP so a referral can be made to a Community Mental Health Team, who will be able to provide him with regular medication reviews and continued therapeutic intervention. It is felt that once Mr Z has stable accommodation and continues to engage with drug services, he will not require supported accommodation under the Care Act 2014. Therefore, the OHID pathway has helped to facilitate independence in trauma informed, least restrictive manner. |
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Outcome |
| What happened Due to housing stressors unfortunately Mr Z had an accidental overdose of diazepam and GBL which was quickly communicated with CGL to collectively create a safety plan and update risk. He was also regularly discussed in the MMHHT red zone meetings to ensure that all the risks were being monitored closely and both the team manager and the MHP worked closely with CGL and other agencies to ensure his mental health needs were being met alongside his substance misuse. Mr Z was also regularly considered in the MMHHT multi-disciplinary team meetings to ensure all professionals including psychiatry, nursing and social work were able to provide advice and risk management plans. Mr Z currently resides in hotel where he feels happy and supported. However he has been relocated outside of Manchester, so his CGL worker continues to support Mr Z via telephone as requested. The long-term goal is to obtain Mr Z a detox to maximise his physical and mental health. The MHP and CGL worker continue to participate in joint visits to collaboratively achieve this goal in congruence with Mr Z’s timeline and circumstances to provide the optimal opportunity to be able to maintain sobriety. |
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Shared Learning and Recommendations |
| Any identified good practice, joint working, positive outcomes. Any gaps, unmet needs, shared learning, recommendations etc This piece of work particularly evidences the benefits of swift intervention, which is facilitated by the OHID pathway due to strong links developed with CGL and the MMHHT. Joint working was paramount in this case due to Mr Z’s diagnosis and paranoid ideation. Therefore, as the professionals involved Mr Z’s care worked positively together in a timely manner Mr Z was able to quickly develop trust and rapport with his CGL worker and was able engage in substance misuse intervention. Additionally as the meeting was conducted at the Mustard Tree HUB, the professionals were easily accessible to one another to liaise and discuss risk/overview of support needs prior to the assessment. This case study demonstrates the professionals and service user benefitting from one another’s expertise to provide person-centred and trauma informed care. Due to the MHP building a foundation of a positive relationship with Mr Z it meant they could then draw upon CGL’s knowledge and vital guidance when the time was right. The RSDA pathway in this case was utilized to promote improved mental/physical health, prevent homelessness and reduced risk of safeguarding due to the successes of reinforcing clearly defined roles, open communication and efficient intervention. |
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