Supporting mental health patients; personalised care planning and Patient Activation Measures (PAM®)
Case study summary
Key learnings from a small pilot project at Oakridge Park Medical Centre supporting patients with mental health issues isolated by COVID-19:
- A new way of reaching patients via a telephone consultation facilitated a more holistic approach to care.
- Adopting a personalised care holistic approach incorporating planning templates based on NHS Person-Centred Care and Support Planning approaches and Patient Activation Measures (PAM®) survey tool, ensured patients’ needs could be fully assessed with appropriate care offered.
- Expansion of the project is planned to widen its offer of holistic and effective care to more patients with mental health issues within the Primary Care Network.
Background to learning
COVID-19 and lockdown have had an enormous impact on the mental health and wellbeing of people of all ages. The absence of a number of the usual support arrangements and a significant loss of social interaction has been especially challenging for people experiencing mental health issues. Oakridge Park Medical Centre, with the support of the National Association of Primary Care (NAPC), piloted a small project to support patients with mental health issues who were also isolated by the pandemic.
This case study explores how the project encouraged a new way of reaching patients, which facilitated holistic care.
Learning and advice to be shared
As a component of their pandemic work Oakridge Park Medical Centre identified 35 patients who were identified as both being at a high-risk of Covid-19 complications and having a mental health diagnosis in their medical record. Each person was telephoned by a practice nurse or paramedic and asked about their well-being, living situation, access to food and medicines, and any other concerns arising. The team also used this opportunity to incorporate planning templates based on NHS Person-Centred Care and Support Planning approaches and Patient Activation Measures (PAM®) survey tool, which helps to measure the spectrum of knowledge, skills and confidence in patients and captures the extent to which people feel engaged and confident in taking care of their condition. Evidence shows that an understanding of this helps in supporting people in the most appropriate way. Each phone call varied in length between 10– 60 minutes; shorter calls reflected instances where a patient chose not to take up the offer of discussing a care plan.
In adopting this personalised care holistic approach, the patient’s needs could be fully assessed with appropriate care offered. 73% of the patients contacted were identified as having unmet needs that either a social prescriber or the Mental Health team could then support. For example, where social prescribing needs were identified, patients were referred or signposted to the relevant community-based organisation for support. Supporting mental health in this way is a key component of The Community Mental Health Framework for Adults and Older Adults (2019).
42% of patients were identified as feeling mentally unwell and/or had experienced suicidal thoughts; based on the identified urgency, the patient was offered an appointment with their General Practitioner or referred to the Mental Health Team to intervene and offer support as part of suicide prevention (PHE 2020).
A number of patients identified through the project had completed a Care Plan and PAM® survey last year, with social prescribing and other support needs addressed. This allowed staff to compare patients’ recent care plans and PAM® survey results and highlighted that improvements had been made in patients’ mental health over the year.
Would it be beneficial to retain these changes?
Going forward, Oakridge Park Medical Centre is looking to expand the project and widen its offer of holistic and effective care to more patients with mental health issues within their Primary Care Network. With a predicted rise in people suffering from adverse mental health as a consequence of COVID-19, services will need to be prepared to support an increase in patients. This streamlined approach to care could provide an effective response for the appropriate patients.
Case study by Luci Partridge, Practice Nurse, Oakridge Park Medical Centre. For any further detail on this case study or to connect with Luci, please contact: email@example.com