Continuity of Care in Modern Healthcare - Essay Example

? Critical review of coroner’s report Continuity of care Continuity of care is largely taken to be a central objective in the provision of modern mental health service. This centrality arises from deinstitutionalization and the initiation of community care. Services that were initially offered within one institution like shelter and psychiatric treatment have become detached amongst a number of agencies. Eventually, the provision of smooth and consistent care has become challenging and continuity of care has surfaced as a central indicator of efficient, integrated community services. Moreover, discontinuities have been associated with adverse upshots. For illustration, suicides by people suffering from psychiatric disorders are attributed to lack of continuity of care (Bachrach 1981). Diana et al (2012) note that there is central agreement that continuity of care positively affect service users’ outcomes, although the relationships are not consistently covered. In addition, research on continuity of care and its relationship to outcomes have been hindered by lack of a unified definition of what constitutes continuity of care. Continuity of care for mental health services may be viewed from different points of view and ranges from intense treatment (hospitalization) to supportive interventions (outpatient therapy). Continuity of care is offered over a long period of time. The suitable medical, nursing and psychological services may be tendered within one organization or multiple organizations (Beresford and Carr 2012). The significance of continuity of care promotes stability, continuity, as well as comprehensiveness of mental health service to patients and maximizes the coordination of care and services. In the case of Liam john Wright, he was admitted in ward 2B and later taken from the ward to the secure acute observation area. Two weeks later, Liam was again transferred in a non secure ward within the mental health unit. It is apparent that Liam was taken in three wards in a period of two weeks. Continuity of care was hardly given to Liam as a patient necessitating such care. These transfers from one ward to another sufficiently show that continuity of care was not offered at the Logan hospital. With regard to Charlie’s case, an assessment was carried out to determine whether Charlie will be admitted to the emergency department ward. In Charlie case, only a single decision was made with regard to his admission. The doctor denied his admission to the emergency ward where he ought to receive continuity of care. In the case of Charlie, continuity of care cannot be adequately measured or evaluated as there is no evidence of it. The key goal of continuity of care is to offer treatment that permits patients to attain the highest level of functioning in the least restraining environment. In the recent years, there have been growing concerns that continuity of care should be multi-dimensional construct that should center on service users’ understanding (Hoult 1993). The reason is that the current measures of continuity of care tend to mirror a single aspect such as discharge from hospital (Hoult 1993). Apparently, little is known with regard to service users/ patients’ perspectives, main concern needs and experiences. Service user defined measures are a pertinent way of redressing the disparity involving survivor and service provider expertise. Having a service user defined outcome evaluation of continuity of care based on service users’ own definitions and priorities should help to place users; viewpoints at the heart of mental health services analysis. Mental state assessment Mental assessment of a patient suffering from psychiatry disorders ought to explore cognitive tasks in numerous domains. Some of the cognitive functions to be assessed are such as memory, visuospatial, attention, language, abnormal mood and delusions. In examining patient’s mental states, various tools like neuropsychiatric inventory, clinical dementia rating scale and executive interview test can be of pertinent use. Doctors should enquire about a patient’s history during the assessment and other pertinent information on deficits in functional capacity also ought to be sought. Vision and hearing should be analyzed; continence ought to be evaluated while falling should be deemed as a pertinent basis of morbidity (Boyd 2008). The doctor ought to learn whether that patient is capable of living a normal life such as driving an automobile, preparing a meal or other tasks that a mentally fit individual can perform. Mental health assessment may be gainfully enlarged from official occupational therapy assessment with measures of capacity for activities of daily living (Boyd 2008). The extent of disability owing to specific deficits depends considerably on the ability of family and other social pillars to compensate for lost function. As such, thorough evaluation of a patient’s social environment is a pertinent aspect of evaluation. In the cases of both Liam and Charlie, they were assessed on a single dimension, which is the clinician dimension only. The evaluation of a patient’s social environment seems to be ignored as the doctors and clinicians at Logan hospital did not take into consideration the pleas of Mrs. Powell and Mrs. Wright. This is an indication that the two patients; Liam and Charlie capacities of daily living were socially unfit, and it is for that reason that their family members wanted them admitted in hospitals. Additionally, the family members expressed concerns over the safety of their patients implying that the two had mental impairment that they considered as risky. Multidisciplinary teams play a critical role in the provision of care for mental patients with dual or multiple diagnoses as patients usually have complex social and clinical needs to be addressed during treatment. Suicide risk assessment Suicide risk assessment is the determination of a scientific judgment of risk in the very near future, which is founded on the weighing of a large collection of available medical detail. Suicide risk assessment is systematic, disciplined, and inductive process and an imperative exercise to estimate probability over short periods. Suicides and homicide are the most severe adverse upshots in mental health services. Most people who die by suicide have been diagnosed with a mental illness. Twenty five percent of people who commit suicide have a history of contact with mental health services within the previous one year. As a result, an actuarial approach in clinical practice is viewed as the sum of recorded risk factors (The National Confidential Inquiry 2013). Clinical and professional judgment tools in risk assessment strategies incorporate historical and present clinical information to inform risk assessments and foster the use of professional discretion. Suicide risk assessment tasks entail the identification of risk factors, protective factors as well as the warning signs. Risk factors for suicide relates to any event, condition or experience that enhances the likelihood that a problem will be formed, maintained or exacerbated (Burgis et al 2005). This description of suicide risk factor acknowledges that one or more risk factors in an individual’s life may enhance the likelihood of a suicidal behavior occurring at a later point in time. Suicide risk factors vary with gender, age, cultural and social influences. In the contemporary mental health service, clinical work with suicidal patients has become more and more challenging. As such, issues related to working with suicidal patients have posed considerable ethical and professional hazards for psychologists. Some of the concerns include provision of sufficient informed consent, carrying out competent suicide risk assessments, employing generically supported interventions, as well as using suitable risk management techniques (Malone et al 2000). In regards to the suicides of Charles and Liam, it is intricate to comment on whether suicide risk assessment was carried, although the report does not reveal any signs of such. There are numerous intricate clinical issues related to Liam and Charles suicide that could be attributable to family risk factors, behavioural risk factors and personal risk factors, and not necessarily to Logan hospital clinician. Jobes et al (2008) note that resistance to changing practices, diversity issues, changes in models of healthcare delivery and improvements in the standard of care are some of the complicated clinical subjects associated with suicide. Multidisciplinary team work In the contemporary mental health service, multidisciplinary team working is the agreed upon approach for mental health services to address complex needs in severe mental illness. In a multidisciplinary setting, the role of team members in community psychiatry, moral issues confronting working and explanation of the clinical responsibilities are well thought of (Commonwealth Australia 1996). A multidisciplinary working team helps in assimilation of the hospital and community based staff. The key responsibilities of a multidisciplinary team are such as acute care provision, visiting home patients, rehabilitation, as well as other facilities making up an integrated service (Vassallo et al 2004). Doctors in Logan hospital had a clinical responsibility in working in a multidisciplinary setting to examine Liam and Charles issues in guiding mainstay and fundamental interests of the patients. Multidisciplinary team work was highly needed in Logan hospital to make a sound decision for the well being of Liam and Charles. However, the hospital’s multidisciplinary team is not directly attributable to Liam and Charles inquest. The reason is that psychiatrists are faced with various dilemmas in collaborating with other health experts and lay persons in developing mental health services decisions. In other instances, multidisciplinary team work varies from the simple availability but separate functioning of every independent discipline group to more intricate arrangements contributed to by all disciplines sharing clinical functions in the provision of care. Family and carer’s role in the treatment and care of loved ones The involvement of consumers in their own health is acknowledged and recognized as a crucial aspect of successful service provision. The role played by family members and carers in prevention, early intercession, treatment and recuperation of mental health consumers is invaluable. For patients suffering from mental disorders, active participation of consumer’s carers and their families is fostered and comprises of all aspects of the mental health system (Fossey et al 2012). These include policy development and implementation, service planning and delivery of care. The phrase carer is a broad term that can refer to parents, partners, children, friends and other affiliates of the mental health consumer. Service delivery to mental health consumers is guided by the doctrines articulated in the consumer carer and family participation framework in the contemporary mental healthcare in Australia (Ash et al 2004). Family and carer input into the care of a consumer is a fundamental resource that informs valuable risk assessment, management, treatment and therapy. The input from family members and carers is essentially significant in the transition period into and out of custodial and inpatient settings (Bland, Renouf and Tullgren 2009). With regard to Liam, there a complete absence of family involvement. During the transition period when Liam is transferred through the various Logan hospital wards, there is no involvement of family members. Moreover, Mrs. Wright concerns that Liam Wright can abscond and eventually harm himself and others. Her invaluable insight that her family member/ patient might pose high risk to himself and to others was not taken into consideration. Despite her efforts to let the management understand the dangers in placing Liam in a non secure mental health unit, the hospital administration went ahead and placed Liam in non secure ward. In the case of Charles, there was also complete disregard of the input of family members. It is apparent that Charles was denied admission in spite of Mrs. Powell efforts requesting the management to grant his admission. It was shortly after these clinical decisions were made that both patients; Liam and Charles committed suicide by inquest. Although this analysis does not explore the role of family members and carers in contemporary mental hospitals in order to attribute guilt, it is apparent that Logan hospital decision to disregard input from patient’s family increased the likelihood of the patients’ deaths. It is essential for mental health service providers to consider the cultural needs of patients and how their needs are met appropriately. Healthcare service providers should recognize the need for a multi-dimensional approach to cultural know-how with actionable systems at professional, organisational and individual levels. In order to streamline the continuity of care, the hospital should have excellent cross sectoral collaboration linkages with partners such as the government and non government sectors. Additionally, hospitals should streamline their information and public relations to enhance access to information especially to family members and patient carers. Logan hospital should ensure that its workers are continually trained to efficiently respond to the needs of the health consumer, their family members and their carers. Bibliography Ash, D., et al., 2004. Mental Health Services in the Australian States and Territories In G. Meadows, Singh, Bruce (Ed.), Mental Health in Australia: Collaborative Community Practice (Chapter 6). Melbourne: Oxford University Press. Bachrach, L., 1981. Continuity of care for chronic mental patients: A conceptual analysis American Journal of Psychiatry, 138, 11: 1449-11456. Beresford, P. and Carr, S., 2012. Social Care, Service Users and User Involvement. London: Jessica Kingsley Publishers. Bland, R., Renouf, N, and Tullgren, A., 2009. Social work case management In Social work practice in mental health. Crows Nest: Allen & Unwin. Boyd, M.A., 2008. Psychiatric Nursing: Contemporary Practice. Sydney: Lippincott Williams & Wilkins. Burgis, S. et al., 2005. Lifetime risk of suicide ideation and attempts in an Australian community: Prevalence, suicidal process, and help-seeking behaviour. Journal of Affective Disorders, 86, 2-3: 215-224. Commonwealth Australia, 1996. National Standards for Mental Health Services Australian Government Publishing Service Canberra. Fossey, E. et al., 2012. Case Management In G. Meadows, et al (Ed.), Mental Health in Australia: Collaborative Community Practice. Melbourne: Oxford University Press. Hoult, J., 1993. Comprehensive services for the mentally ill. Current Opinion in Psychiatry, 6: 238-245. Jobes, D. A. et al. 2008. Professional Psychology: Research and Practice. American psychological association 39, 4: 405-413 Malone, K. et al, 2000. Protective factors against suicidal acts in major depression: Reasons for living. The American Journal of Psychiatry, 157, 7:1084. Vassallo, T. et al., 2004. Changeability, confidence, common sense and corroboration: comprehensive suicide risk assessment. Australasian Psychiatry, vol. 12, no. 4, pp. 352- 360. The National Confidential Inquiry, 2013. Quality of risk assessment prior to suicide and homicide a pilot study, June 2013. Retrieved on 20 august 2013 from. Read More