The In Reach and Home Treatment Teams (IRHTT’s) are a community based service who provide care for people predominantly over the age of 65 who are experiencing a mental health crisis.
They work with people who are experiencing a functional mental health difficulty (i.e. not dementia) who without the team’s support would otherwise be at risk of a mental health admission. There are the equivalent specialist teams for people experiencing a crisis due to their diagnosis of dementia There are three separate teams providing a comprehensive service to all areas within Derbyshire.
The primary aim of the In Reach and Home Treatment Teams (IRHTT) is to improve the well-being of people with mental health problems at times of crisis, by delivering rapid assessment and intensive support. In the process, the team aims to reduce the need for admission into specialist mental health hospital beds. Evidence suggests that people with mental health problems are best supported within their home environment where possible.
The other aim of the IRHTT’s is to reduce the length of time spent in hospital if someone did require admission. They work into the inpatient mental health wards to support with effective discharge planning and early discharge home with intensive home support.
The service is delivered in an individual’s home, wherever that home may be. The team is flexible and highly responsive, providing a same-day response. The service is available 7 days a week, 365 days a year between the hours of 9am to 5pm.
The service starts with a specialist assessment. From there, an individual person-centred plan of care is developed, in collaboration with the person and their loved ones. Where home treatment is part of the plan, intensive support will be provided. The frequency of this is tailored to the persons needs but can be daily to start with and the frequency is gradually reduce as the person improves.
The assessments, interventions and treatments offered by the team are informed by evidence-based best practice (from research and guidance including that provided by the National Institute for Clinical Excellence – NICE).
Individuals requiring the service will be experiencing a breakdown to the point of crisis because of a functional mental health problem (e.g. adjustment reaction, anxiety, depression, psychosis, schizophrenia, bipolar disorder, personality disorder). Other community services will be unable to support them safely at home and hospital admission is a possible pathway for their care.
Others who will benefit from the service include individuals who are in hospital but who could be discharged sooner with a short period of intensive support. The team will help to ensure a rapid and safe discharge back home.
Specific interventions, or action the team may offer include:
- Focusing on the immediate crisis, and where able to, identifying the likely triggers to aid in problem solving and looking at possible solutions
- Collaborating to develop a care plan including the use of advance statements (written statements setting down an individual's preferences, wishes, beliefs and values regarding their future care).
- Developing a Safety plan with the person, loved ones/ family and carers, in formulating a solution focused approach to risk and relapse.
- If indicated then discussing option of and the purpose of admission to inpatient care
- Offering education, advice and support
- Signposting to leisure, education, training, and occupational activities, including volunteering and a range of self-help and non-statutory resources, as well as Day Services, Sitting Service, Voluntary Sector Services and Adult Care Services.
- Review of medication and treatment options
- Exploring factors which might cause stress and ways to prevent and manage relapse
- Encouraging individuals to develop a range of coping strategies and ways to keep safe
- Enabling individuals and carers to access other support services which may be of help.
- Advice and guidance on building and maintaining wellness and self-management of care.
The team works closely with community mental health teams (the triage and access point), and in an integrated way with key partners – including adult social care, integrated care services, GPs and primary care, and the voluntary sector.
The team also has a strong role in enabling people who are admitted to hospital to return home as soon as possible, to reduce the impact of negative outcomes that can result from being in hospital. Consequently, the team works closely with inpatient services.
Referrals into the service are through the Community Mental Health Teams (CMHT) and old age consultant psychiatrists. The service is for people with a functional mental health problem or symptoms consistent with a functional mental health problem.
If you are concerned about someone’s mental health, please speak to their GP. Their GP will then be able to contact the relevant neighbourhood mental health team, where the duty triage system will determine the best pathway of care for an individual.
