Standards for Community Mental Health
Rehabilitation Services
First Edition
Editors: Beth Thibaut, Lauren McKenzie & Unnati Pathak
Published: July 2022
Publication Number: 410
1
A manual of standards written primarily for:
Community Mental Health Rehabilitation Services
Also of interest to:
Patients, carers, commissioners, policy makers, and researchers.
First Edition published in July 2022
Correspondence:
Rehabilitation, Quality Network for Rehabilitation Mental Health Services
Royal College of Psychiatrists’ Centre for Quality Improvement
21 Prescot Street
London E1 8BB
Email: rehab@rcpsych.ac.uk
A full copy of this document is available on our website at:
News and events (rcpsych.ac.uk)
The Rehabilitation Project Team would like to express its thanks to its carer and
service user representatives, members of staff from: Assertive Outreach and
Rehabilitation Team at South London & Maudsley, Bristol Community
Rehabilitation Team, Camden Community Rehab Team, Community Enhancing
Recovery Team at Sheffield Health and Islington Community Rehab Team as well
as the members of the Rehabilitation standards.
2
Contents
Foreword .................................................... 3
Introduction ................................................ 4
How to Read this Document ......................... 6
Standards for Community Mental Health
Rehabilitation Services ................................. 7
Access, Assessment, Care & Treatment .......... 7
Glossary .................................................... 35
References ................................................ 39
3
Katherine Barrett
Patient Representative
Member of the Advisory Group
Quality Network for Mental Health
Rehabilitation Services
Foreword
Welcome to this first edition of the Royal College of Psychiatrists’ Centre for Quality
Improvement’s ‘Standards for community mental health rehabilitation teams’. The
NICE Guideline (NICE Clinical Guideline 181; Mental health rehabilitation for people with
complex psychosis, 2020) recommends that all mental health systems should include a
local rehabilitation pathway for people with more complex mental health problems,
comprising both inpatient rehabilitation units and community rehabilitation teams that
provide specialist clinical input to people living in supported accommodation. These new
community rehabilitation team standards have therefore been developed to
complement those for inpatient rehabilitation services, which are now in their fourth
edition, and will ensure that the existing rigorous and supportive quality assessment and
improvement processes that we have been using for inpatient rehabilitation services are
extended to community rehabilitation services for the first time. This is an important
development, since the number of community mental health rehabilitation teams has
been growing in recent years; currently, around two-thirds of NHS mental health trusts
have one and it is expected that all trusts will have one within the next two years (Getting
It Right First Time Programme for Mental Health Rehabilitation Specialty Report, 2022).
The community rehabilitation team standards were developed through a series of
consultations with expert stakeholders to ensure they are relevant, useful and congruent
with both the existing inpatient rehabilitation standards and with NICE Guidance (NICE,
2020). The standards are used to assist teams to review their existing practice and
identify areas where they may need to improve their practice. Evidence from local service
policies, case note reviews, questionnaires and interviews with front-line staff, service
users and carers by teams of trained peer reviewers is collated to inform whether a service
can be formally accredited with the REHAB Quality Network kitemark. Alongside the
standards and accreditation processes, members of the REHAB Quality Network can also
access our regular quality improvement events where clinical experiences can be shared
and approaches and interventions to enhance service quality are disseminated. As well as
providing a process for recognising services that are delivering good quality care, the
primary aim of the REHAB accreditation process and wider activities of the Quality
Network is to optimise the quality of services delivered to people with complex mental
health problems.
The REHAB Quality Network depends on the invaluable contributions and enthusiasm of
members and I would like to take this opportunity to thank you for all your support to
date.
We look forward to seeing you at a Quality Forum soon!
Professor Helen Killaspy
Chair, Advisory Group
REHAB Quality Network
Royal College Centre for Quality Improvement
Maurice Arbuthnott
Patient Representative
Member of the Accreditation Committee
Quality Network for Mental Health
Rehabilitation Services
for The Quality Network for Mental
Health Rehabilitation services
4
Introduction
The Quality Network for Mental Health Rehabilitation Services (REHAB) works
with wards and units to improve the quality-of-care patients with complex and
enduring mental illness receive. The network engages staff, patients, and their
carers in a comprehensive process of self and peer review, to enable services to
identify areas of good practice and areas for development. Member services are
encouraged to use peer review visits, and other member events, to share
knowledge and ideas with others, thereby creating a mutually supportive
environment which encourages learning, and leads to positive change.
The network also offers accreditation for those members who can demonstrate a
high level of compliance with the standards. The first edition standards are drawn
from key documents and expert consensus, as well as from the 4
th
edition
inpatient standards and from the work completed within the College Centre for
Quality Improvement (CCQI.) The standards have been subject to extensive
consultation with multidisciplinary professionals involved in the provision of
inpatient and community mental health services, and with experts by experience
and carers who have used services in the past.
Who are these standards for?
These standards are for service providers and commissioners of mental health
rehabilitation services, to help them ensure they provide high quality patient-
centred care to people with complex mental illness and their carers. These
standards are designed to be applicable to all community rehabilitation services.
It is recognised that there are a wide range of services within the ‘mental health
rehabilitation’ umbrella which have different functions, purposes, and work with
different patient groups.
How were these standards developed?
The standards have been developed with extensive consultation with
multidisciplinary professionals involved in the provision of inpatient and
community mental health rehabilitation services, and with experts by experience
who have used services in the past.
5
The standards were developed in five key stages:
1. Standard mapping – The Rehabilitation project team reviewed the
previous edition of inpatient standards alongside key documents and
guidelines to create a working sheet, to allow members to comment on
existing standards and create new standards for consideration.
2. Electronic consultation – All Rehabilitation members and contacts were
provided the opportunity to review the working sheet electronically and
provide their ideas and feedback.
3. Standards working group consultation – Member services, experts by
experience and members of the Rehabilitation Advisory Group and
Accreditation Committee met remotely to review member comments and
worked together to make key changes and create new standards, resulting
in the first draft of the first edition standards.
4. Advisory Group Review – The Rehabilitation Advisory Group reviewed the
first draft created and made changes to key areas where necessary.
5. Review within the CCQI – The standards were then reviewed within the
College Centre for Quality Improvement (CCQI) and following consultation
with the Rehabilitation project team, were approved for use.
6
How to Read this
Document
Standard Category
To achieve every standard listed is aspirational, and it is not expected that a
service would meet every standard on the day of their peer-review visit.
Every standard has been categorised as either type 1, 2 or 3. The meanings of
these types are as follows:
Type 1 Failure to meet these standards would result in a significant threat
to patient safety, rights or dignity and/or would breach the law.
Type 2 Standards that a service would be expected to meet.
Type 3 Standards that are aspirational and/or standards that are not the
direct responsibility of the service.
To achieve accreditation, services are required to meet 100% of type 1, 80% of type
2 and 60% of type 3 standards.
For reference purposes, the standards which either reflect or reference the core
standards have their original core numbering in italics.
The key below can be used to help identify modified and new standards in this
edition.
Key
M
Standard modified since last edition
N
New standard since last edition
7
Standards for
Community Mental
Health Rehabilitation
Services
NUMBER
TYPE
STANDARD
Ref.
Access, Assessment, Care & Treatment
1.1
2
The service reviews data at least annually about the
people who use it. Data are compared with local
population statistics and action taken to address any
inequalities of access that are identified
1,2
1.2
2
The service provides information about how to make a
referral, and waiting times for assessment and
treatment.
2,5,6,7,
8
1.3
2
The team assess patients, who are referred to the
service, within an agreed timeframe.
2, 10,11
8
1.4
1
There are systems in place to monitor waiting times
and ensure adherence to local and national waiting
times standards.
Guidance: There is accurate and accessible information for
everyone on waiting times from referral to assessment and
from assessment to treatment
11
Access and Assessment
Preparing for the Assessment
2.1
1
Patients are given accessible written information
which staff members talk through with them as soon
as is practically possible. The information includes:
• Their rights regarding consent to treatment;
• Their rights under the Mental Health Act, where
applicable ;
• How to access advocacy services;
• How to access a second opinion;
• Interpreting services;
• How to view their records;
• How to raise concerns, complaints and give
compliments
2,8,13,
14,15,
16,
Care & Treatment
Initial Assessment
3.1
1
Patients are made to feel at ease at their initial
meeting.
Guidance: Staff members introduce themselves to patients
and address patients using the name and title they prefer.
2, 17,
18
9
3.2
1
Patients have a comprehensive evidence based
assessment, which is produced collaboratively and
includes their:
- Mental health and medication
- Psychosocial and psychological needs
- Strengths and areas for development
- Suicide risk.
2,3,13,
16,19
3.3
1
A physical health review takes place as part of the
initial assessment, or as soon as possible.
2, 4
20,21,
3.4
1
Patients have a risk assessment and management
plan which is co-produced, updated regularly and
shared where necessary with relevant agencies (with
consideration of confidentiality). The assessment
considers risk to self, risk to others and risk from
others.
2,3,8,
22,23
3.5
1
All patients have a documented diagnosis and a
description of person's current situation, including
presenting problems, unmet needs, strength & goals.
Where a complete assessment is not in place, a
working diagnosis and a preliminary formulation is
devised.
2,24
.
10
3.6
2
The team sends correspondence detailing the
outcomes of the assessment to the referrer, the GP
and other relevant services within a week of the
completion of the assessment and a decision is made.
The patient is also informed in this time frame.
25
3.7
M
2
Immediate social stressors and social networks are
identified and recorded, including financial, housing,
educational and vocational needs
77
3.8
1
The patient is asked if they have a carer, and if so, the
carer’s name is recorded
77, 9
3.9
M
1
Assessments and care plans are completed
collaboratively and identify goals with positive risk in
mind. If interventions are time limited, this is made
clear to the patient.
78
11
Following up patients who do not attend
appointments
4.1
1
If a patient does not attend for an
assessment/appointment, the assessor contacts the
patient and, if necessary, the referrer.
Guidance: If the patient is likely to be considered a risk to
themselves or others, the team contacts the referrer immediately
to discuss a risk action plan.
2,3,26
Reviews and Care Planning
5.1
1
Patients and carers (with consent) know who is
coordinating their care and how to contact them if
they have any questions.
27
5.2
1
The team has a timetabled meeting at least once a
week to discuss allocation of referrals, current
assessments and reviews.
Guidance: Referrals that are urgent or that the team feel do
not require discussion can be allocated before the meeting.
2,26,28
5.3
1
Every patient has a written care plan, reflecting their
individual needs. Staff members collaborate with
patients and their carers (with patient consent) when
developing the care plan and they are offered a copy.
Guidance: The care plan clearly outlines:
• Agreed intervention strategies for physical and mental health;
• Measurable goals and outcomes;
• Strategies for self-management;
• Any advance directives or statements that the patient has made;
• Crisis and contingency plans;
• Review dates and discharge framework.
2,13,29,
30
12
5.4
M
1
There is a clinical review meeting for each patient at
least every 6 months, or more regularly if necessary,
which their family (with patient consent) and/or
support staff from their supported placement are
invited.
The team reviews and updates care plans via a care
review or CPA meeting every 6 months.
78
Therapies and Activities
6.1.1
1
Patients continue evidence-based interventions,
which are appropriate for their bio-psychosocial needs,
within an agreed timeframe. Any exceptions are
documented in the case notes.
2,10,15,
31,32
6.1.2
1
There is dedicated sessional time from psychologists
(1) to provide assessment and formulation of patients'
psychological needs;
(2) to ensure the safe and effective provision of
evidence based psychological interventions adapted
to patients' needs through a defined pathway.
33,34
6.1.3
2
There is dedicated sessional time with psychologists
(3) to support a whole team approach for
psychological management.
33,34
6.1.4
1
There is dedicated sessional input from Occupational
therapists (1) to provide an occupational assessment
for those patients who require it;
(2) to ensure the safe and effective provision of
evidence based occupational interventions adapted to
patients' needs.
2,14
13
6.1.5
1
The team supports patients who want to undertake
structured activities such as work, education and
volunteering.
2,17,31,
36
6.1.6
1
Patients (and carers, with patient consent) are offered
written and verbal information about the patient’s
mental illness and treatment.
Guidance: Verbal information could be provided in a 1:1
meeting with a staff member or in a psycho-education
group. Written information could include leaflets or
websites.
2,7,8,
17,30,
35
6.1.7
1
The team supports patients to undertake activities to
support them to build their social and community
networks.
2, 17,
31, 36
6.1.8
1
All staff members who deliver therapies and activities
are appropriately trained and supervised.
25, 31,
34, 35
6.1.9
1
Patients' preferences are central to the selection of
medication, therapies and activities, and are acted
upon as far as possible
11
6.1.10
2
All healthcare professionals have received training and
supervision in providing psychologically informed care
e.g. case formulation, and have a evidence‐based low‐
intensity therapies training available to them.
9, 13
14
6.1.11
1
The service provides individualised smoking cessation
support for patients
7, 39,
40
Medication
6.2.1
1
When medication is prescribed, specific treatment
goals are set with the patient, the risks (including
interactions) and benefits are reviewed, a timescale for
response is set and patient consent is recorded.
2
6.2.2
1
Patients have their medications reviewed regularly.
Medication reviews include an assessment of
therapeutic response, safety, management of side
effects and adherence to medication regime. patient's
rights to consent or refuse medication and
opportunities to reduce medication is also reviewed.
Guidance: Side effect monitoring tools can be used to
support reviews.
2, 25
6.2.3
3
Patients, carers and prescribers can contact a
specialist pharmacist to discuss medications.
2, 25
15
6.2.4
M
1
For patients who are taking antipsychotic medication,
the team monitors the effects of medication and
liaises with their primary care practitioner to ensure
routine physical health monitoring takes place.
Thereafter, the responsibility for this monitoring may
be transferred to primary care under shared care
arrangements.
7
6.2.5
2
The service has a shared care protocol with primary
care which defines responsibility for prescription and
administration of medication.
2, 28
6.2.6
1
The team supports patients to gain optimum
independence in managing their medication. This
should be guided by a self-medication policy which
provides clear guidance for staff on the individual steps
of the graduated self-medication programme and staff
responsibilities in supervising each step.
78
Physical Healthcare
7.1
1
Staff members arrange for patients to access
screening, monitoring and treatment for physical
health problems through primary/secondary care
services. This is documented in the patient's care plan.
41, 4
16
7.2
1
Patients are offered personalised healthy lifestyle
interventions, such as advice on healthy eating,
physical activity, alcohol and substance misuse and
access to smoking cessation services. This is
documented in the patient's care plan.
7, 39,
40
7.3
1
The team, including bank and agency staff, are able to
identify and manage an acute physical health
emergency.
2
7.4
1
Patients who are prescribed mood stabilisers or
antipsychotics have the appropriate physical health
assessments at the start of treatment (baseline), at 6
weeks, at 3 months and then annually (or every six
months for young people) unless a physical health
abnormality arises.
2, 7, 40,
41, 43
Risk and Safeguarding
8.1
1
The team records which patients are responsible for
the care of children and vulnerable adults and takes
appropriate safeguarding action when necessary.
Actions agreed are verbally followed up within the
community rehab team.
17, 44,
45
Discharge Planning and Transfer of Care
17
9.1
1
A discharge letter is sent to the patient and all relevant
parties within 10 days of discharge. The letter includes
the plan for:
• On-going support in the community/aftercare
arrangements;
• Crisis and contingency arrangements including
details of who to contact;
• Medication, including monitoring arrangements;
• Details of when, where and who will follow up with
the patient as appropriate;
•Interventions offered;
•What the patient has achieved
2, 17, 46
9.2
1
The community team makes sure that patients who
are discharged from hospital are followed up within 3
days.
2, 47,
48, 76
9.3
1
When patients are transferred between community
services there is a face to face handover with the
patient and representatives of both teams which
ensures that the new team have an up to date care
plan and risk assessment.
50
18
9.4
1
Teams provide specific transition support to patients
when their care is being transferred to another
community team, or back to the care of their GP.
2,46
9.5
1
There is active collaboration between Children and
Young People's Mental Health Services and Working
Age Adult Services for patients who are approaching
the age for transfer between services. This starts at
least 6 months before the date of transfer.
49
9.6
M
2
Onward care planning is discussed at the first review
meeting and as appropriate at subsequent meetings.
11
9.7
3
At any one time fewer than 10% of patients are delayed
transfers due to a lack of appropriately supported
accommodation places.
78
9.8
M
2
Discharge/transfer planning starts early and is
carefully thought through so that the patient feels well
supported to make the transition.
78
Interface with other services
10.1
1
Patients can access help, from mental health services,
24 hours a day, 7 days a week.
Guidance: Out of hours, this may involve crisis/home
treatment teams, psychiatric liaison teams.
2, 11, 45
10.2
1
The team supports patients to access;
housing support;
support with finances, benefits and debt
management;
social services.
2, 27
19
10.3
1
The service/organisation has a care pathway for the
care of women in the perinatal period (pregnancy and
12 months post-partum) that includes:
Assessment;
Care and treatment (particularly relating to
prescribing psychotropic medication);
Referral to a specialist perinatal team/unit unless there
is a specific reason not to do so.
2, 5
10.4
M
2
The service ensures effective links are developed with
referrer agencies e.g. CMHT, third sector organisations,
forensic services.
Guidance: This would be through regular meetings.
78
10.5
1
The service provides patients access to peer support
within the service or elsewhere.
11
10.6
2
The service has access to a local inpatient
rehabilitation unit.
78
10.7
M
2
The service fosters good working relationships with
supported accommodation managers through regular
meetings.
78
10.8
M
3
The team actively searches for other service users
within the trust who are suitable for community rehab.
78
Capacity and Consent
20
11.1
1
Assessments of patients' capacity (and competency for
patients under the age of 16) to consent to care and
treatment is performed in accordance with current
legislation.
2,8,14,17
,51
11.2
2
There are agreements with other agencies for patients
to re‐access the service if needed, without following
the initial referral pathway.
Guidance: There may be exceptions where patients require
a generic assessment, and it may be appropriate to follow
the initial pathway.
78
Patient Involvement
12.1
1
The service regularly asks patients and carers for their
feedback about their experiences of using the service
and this is used to improve the service.
Guidance: Feedback can be gathered at each CPA review
and at discharge.
8,52
12.2
2
Services are developed in partnership with
appropriately experienced patient and carers and have
an active role in decision making.
36,52,53
12.3
1
Patients are actively involved in shared decision-
making about their mental and physical health care,
treatment and discharge planning and supported in
self-management.
7, 8, 17,
36, 52
12.4
3
Where appropriate a shared care approach for service
users is utilised.
78
Carer Engagement and Support
21
13.1
1
Carers (with patient consent) are involved in
discussions and decisions about the patient’s care,
treatment and discharge planning.
55
13.2
1
Carers are supported to access a statutory carers'
assessment, provided by an appropriate agency.
Guidance: This advice is offered at the time of the patient’s
initial assessment, or at the first opportunity.
55
13.3
2
Carers are offered individual time with staff members
to discuss concerns, family history and their own
needs.
2, 16, 55
13.4
1
The team provides each carer with accessible carer’s
information.
Guidance: Information is provided verbally and in writing
(e.g. carer's pack). This includes the names and contact
details of key staff members in the team and who to contact
in an emergency. It also includes other local sources of
advice and support such as local carers' groups, carers'
workshops and relevant charities.
3, 4, 7,
55
13.5
3
The service actively encourages carers to attend carer
support networks or groups. There is a designated
staff member to support carers.
3,26,53,
54,55
13.6
1
The service ensures that children and other
dependants are supported appropriately.
Guidance: This could include offering appropriate written
information to children, or supporting the patient to
communicate with their children about their mental health
3 , 28
Treating patients with compassion, dignity, and
respect
22
14.1
1
Staff members treat patients and carers with
compassion, dignity and respect.
52, 64
14.2
1
Patients feel listened to and understood by staff
members.
27
Providing information to patients and carers
15.1
1
Patients are asked if they and their carers wish to have
copies of correspondence about their health and
treatment.
18, 45
15.2
2
The service uses interpreters who are sufficiently
knowledgeable and skilled to provide a full and
accurate translation. The patient's relatives are not
used in this role unless there are exceptional
circumstances.
2, 17, 45
15.3
M
2
Patients are supported to make collaborative crisis
plans, care plans and if they wish advanced directives.
Where collaboration is not possible this is reviewed
regularly, and differences of opinion are recorded.
2, 8, 12,
16, 15
Patient Confidentiality
16.1
1
Confidentiality and its limits are explained to the
patient and carer on transfer to the community
service, both verbally and in writing. Patient
preferences for sharing information with 3rd parties
are respected and reviewed regularly and written
information is provided for carers.
2, 17, 57
23
16.2
1
The team knows how to respond to carers when the
patient does not consent to their involvement. This is
documented clearly, reviewed regularly and shared
with all relevant parties.
2, 18
16.3
1
All patient information is kept in accordance with
current legislation.
Guidance: This includes transfer of patient identifiable
information by electronic means. Staff members ensure
that no confidential data is visible beyond the team by
locking cabinets and offices, using swipe cards and having
password protected computer access.
17, 57
Service Environment
17.1
2
The environment is clean, comfortable and
welcoming.
2, 57, 61
17.2
1
Clinical rooms are private and conversations cannot be
over-heard.
26
17.3
1
The environment complies with current legislation on
disabled access.
Guidance: Relevant assistive technology equipment, such
handrails, are provided to meet individual needs and to
maximise independence and there is access to disabled
toilets
4, 17, 55,
58
17.4
1
Staff members follow a lone working policy and feel
safe when conducting home visits.
2, 45, 59
24
17.5
1
There is an alarm system in place (e.g. panic buttons or
personal alarms) and this is easily accessible for
patients, carers and staff members.
2, 17
17.6
1
The service entrance and key clinical areas are clearly
signposted
11
17.7
1
The team base has suitable toilet facilities which are
fully accessible with respect to gender identity
10, 28
17.8
1
There are sufficient IT resources (e.g. PCs & Laptops) to
provide all practitioners with easy access to key
information e.g. information about services, conditions
and treatment, patient records, clinical outcome and
service performance measurements. Dedicated IT
support is also available.
11
17.9
2
There is sufficient working desk space for team
members to undertake their administrative work and
sufficient space for team working e.g. team meetings,
formulations etc.
78
Leadership, team-working and culture
18.1
3
Staff members are able to access reflective practice
groups at least every 6 weeks where teams can meet
together to think about team dynamics and develop
their clinical practice.
2,
25
18.2
1
Staff members feel able to challenge decisions and to
raise any concerns they may have about standards of
care. They are aware of the processes to follow when
raising concerns or whistleblowing. The staff member
managing the process is trained to respond effectively.
3, 57,
62, 63
18.3
1
The team has protected time for team building and
discussing service development at least once a year.
2, 11
Staffing Levels
19.1
1
The service has a mechanism for responding to
low/unsafe staffing levels, when they fall below
minimum agreed levels (as described in service
specification), including:
• A method for the team to report concerns about
staffing levels;
• Access to additional staff members;
• An agreed contingency plan, such as the minor and
temporary reduction of non-essential services.
2, 65
19.2
1
When a staff member is on leave, the team puts a plan
in place to provide adequate cover for the patients
who are allocated to that staff member.
2
26
19.3
1
There is an identified senior clinician available at all
times who can attend the team base within an hour.
Guidance: Some services may have an agreement with a
local GP to provide this medical cover.
2, 17
19.4
The community rehabilitation team consists of the
following staff:
19.4a
1
Senior Leadership Team. Guidance: Senior clinician
from each speciality.
84, 85
19.4b
1
Registered Mental Health Nurse(s)
84, 85
19.4c
1
Social Worker(s) (They may be based within the Local
Authority)
84, 85
19.4d
1
Occupational Therapist(s)
84, 85
19.4e
1
Psychologist(s)
84, 85
27
19.4f
1
Support Worker(s)
Guidance: An unqualified professional, e.g. healthcare
assistant, occupational therapy assistant, psychology
assistant etc.
84,85
19.4g
1
Consultant Psychiatrist(s), Guidance: with
accreditation or endorsement in rehabilitation
psychiatry.
84,85
19.4h
1
GP Link Worker(s) (This could be a responsibility held
by a member of the staff team or someone outside the
team e.g. pharmacist)
28
19.4i
M
3
Independent Prescriber(s).
28
19.4j
2
Approved Mental Health Professional(s) (AMHPs)
84,85
19.4k
1
Administrative assistance to meet the needs of the
service
10
19.5
2
Full time staff should care coordinate no more than 30
clients (reduced pro-rata for part time staff). The team
manager should manage caseloads regularly.
78
28
Staff Recruitment, Induction and Supervision
20.1
2
Appropriately experienced patient or carer
representatives are involved in the interview process
for recruiting staff members.
13
20.2
1
New staff members, including bank staff, receive an
induction based on an agreed list of core
competencies.
Guidance: This should include arrangements for shadowing
colleagues on the team; jointly working with a more
experienced colleague; being observed and receiving
enhanced supervision until core competencies have been
assessed as met.
15, 37,
65, 66
20.3
1
All clinical staff members receive clinical supervision at
least monthly, or as otherwise specified by their
professional body.
Guidance: Supervision should be profession-specific as per
professional guidelines and provided by someone with
appropriate clinical experience and qualifications.
2, 17, 38
20.4
2
All staff members receive line management
supervision at least monthly.
2
20.5
M
1
Consultant psychiatrists should have access to regular
peer support groups, case-based discussion forums
and other CPD activities in line with GMC good
medical practice guidance.
78
Staff Wellbeing
21.1
1
The service actively supports staff health and well-
being.
Guidance: For example, providing access to support
services, providing access to physical activity programmes,
monitoring staff sickness and burnout, assessing and
improving morale, monitoring turnover, reviewing feedback
from exit reports and taking action where needed.
37,65,
68,68,
69
29
21.2
M
1
Staff members are able to take breaks during their
shift that comply with the European Working Time
Directive.
Guidance: They have the right to one uninterrupted 20
minute rest break during their working day, if they work
more than 6 hours a day. Adequate cover is provided to
ensure staff members can take their breaks.
2, 17,
70
21.3
1
Staff members, patients and carers who are affected
by a serious incident are offered post incident support.
16, 70,
71
Staff Training and Development
22.1
1
Staff members receive training consistent with their
role, which is recorded in their personal development
plan and is refreshed in accordance with local
guidelines. This training includes:
22.1a
1
The use of legal frameworks, such as the Mental
Health Act (or equivalent) and the Mental Capacity Act
(or equivalent).
5, 51
22.1b
1
Physical health assessment.
Guidance: This includes training in understanding physical
health problems, understanding physical observations and
when to refer the patient for specialist input.
2, 7, 71
22.1c
1
Safeguarding vulnerable adults and children; This
includes recognising and responding to the signs of
abuse, exploitation or neglect.
2, 22,
23, 72
30
22.1d
1
Risk assessment and risk management.
Guidance: This includes: Assessing and managing suicide
risk and self-harm; Prevention and management of
aggression and violence.
2, 23,
24, 72
22.1e
1
Understanding individual communication
needs/preferences within equality framework.
2, 45
22.1f
1
Statutory and mandatory training.
Guidance: Includes equality and diversity, information
governance, basic life support.
2, 17
22.1g
2
Carer awareness, family and friends inclusive practice
and social systems, including carers' rights in relation
to confidentiality.
16, 54
22.1h
2
Screening for substance misuse issues and referring
and liaising with substance misuse services where
appropriate.
78
31
22.1 i
1
Medication storage, administration, legal issues,
encouraging concordance and awareness of side
effects.
2
22.1 j
1
The basic principles of rehabilitation and recovery.
83
22.2
2
Experts by experience are involved in delivering and
developing staff training face-to-face.
13
22.3
1
Medication competency assessments are completed
on at least a three yearly basis using a competency-
based tool.
78
Service Management
23.1
1
Clinical outcome measurement, including progress
against user defined goals, has a minimum
requirement for collection at assessment, after 6
months, 12 months and then annually until discharge.
Staff can access this data.
2
32
23.2
2
Staff members review patients' progress against
patient-defined goals in collaboration with the patient
at the start of treatment, during clinical review
meetings and at discharge.
2, 38
23.3
2
The service's clinical outcome data are reviewed at
least 6 monthly. The data is shared with
commissioners, the team, patients and carers, and
used to make improvements to the service.
2, 38
The service learns from feedback, complaints, and
incidents
24.1
1
Systems are in place to enable staff members to
quickly and effectively report incidents and managers
encourage staff members to do this.
2, 40,
70, 73
24.2
1
When mistakes are made in care this is discussed with
the patient themselves and their carer, in line with the
Duty of Candour agreement.
74
24.3
1
Lessons learned from untoward incidents are shared
with the team and the wider organisation. There is
evidence that changes have been made as a result of
sharing the lessons.
8, 71,
73, 75
24.4
2
The team use quality improvement (QI) methods to
implement service improvements.
81
33
24.5
2
The community team actively encourage patients and
carers to be involved in QI initiatives.
81
Audit and Service Evaluation
25.1
1
The team uses recommended metrics and measures
to monitor the service's performance and outcomes.
This should include the number of patients taken by
the team and transferred from the team, as well as any
delayed transfers.
3, 11,
28
25.2
2
The service has audited the provision of carer
education and support programmes in the last 3 years.
28
Accommodation
26.1
1
The care manager/care co-ordinator must review the
appropriateness of patient's accommodation every six
months. Where the person is considered ready for
move on, this should be discussed and appropriate
accommodation identified.
78
26.2
M
1
All patients located outside of the local area have
placement reviews at least annually.
78
26.3
1
Patients are available to visit new accommodation
placements and have graded leave so that they are
able to stay overnight, where appropriate before
transfer.
78
General Management
34
27.1
2
There is a senior rehab clinician on the service's
funding panel who reviews whether patients can be
managed locally, within the rehab pathway, before
agreeing to an out of area placement.
78
27.2
1
The team follows an agreed protocol with local police,
which ensures effective liaison on incidents of criminal
activity/harassment/violence.
11
27.3
1
The service has a strategy for proactively assessing and
meeting social care needs, or referring to statutory
agencies who can do this
78
35
Glossary
TERM
DEFINITION
Advance directive
A set of written instructions that a person gives
that specify what actions should be taken for their
health if they are no longer able to make decisions
due to illness or incapacity.
Advocacy
A service which seeks to ensure that patients are
able to speak out, to express their views and
defend their rights.
Art/creative therapies
A form of psychotherapy that uses art media (e.g.
paints) to help people express, understand and
address emotional difficulties.
Assistive technology
Devices that promote greater independence by
enabling people to perform tasks that they were
formerly unable to/or found difficult to accomplish.
Bank and agency staff
Non-permanent staff members.
Care plan
An agreement between an individual and their
health professional (and/or social services) to help
them manage their health day-to-day. It can be a
written document or something recorded in the
patient notes.
Care Programme
Approach (CPA)
A way of coordinating care for people with mental
health problems and/or a range of different needs.
Carer
In this document a carer refers to anyone who has
a close relationship with the patient or who cares
for them.
Carer’s Assessment
An assessment that looks at how caring affects a
carer’s life, including for example physical, mental
and emotional needs, the support they may need
and whether they are able or willing to carry on
caring.
Clinical supervision
A regular meeting between a staff member and
their clinical supervisor. A clinical supervisor's key
duties are to monitor employees' work with
patients and to maintain ethical and professional
standards in clinical practice.
36
Community meeting
A meeting of patients and staff members which is
held on the ward.
Co-produced
Refers to engaging and communicating with the
service user and their family members (where
appropriate) in the development of their care plan
to ensure that support is person-centred.
De-escalation
Talking with an angry or agitated service user in
such a way that violence is averted, and the person
regains a sense of calm and self-control.
Duty of Candour
Legislation to ensure that services are open and
transparent with people who use services about
their care and treatment, including when it goes
wrong.
European Working
Time Directive
Initiative designed to prevent employers requiring
their workforce to work excessively long hours,
with implications for health and safety.
Experts by experience
People who have personal experience of using or
caring for someone who uses health, mental health
and/or social care services.
GP
General Practitioner or ‘family doctor’.
Independent Mental
Health Advocate
(IMHA)
An IMHA is an independent advocate who is
trained to work within the framework of the Mental
Health Act 1983 to support people to understand
their rights under the Act and participate in
decisions about their care and treatment.
Ligature points
Anything which could be used to attach a cord,
rope or other material for the purpose of hanging
or strangulation. Ligature points include shower
rails, coat hooks, pipes and radiators, bed steads,
window and door frames, ceiling fittings, handles,
hinges and closures.
Managerial
supervision
Supervision involving issues relating to the job
description or the workplace.
A managerial supervisor’s key duties are;
prioritising workloads, monitoring work and work
performance, sharing information relevant to work,
clarifying task boundaries and identifying training
and development needs.
Mental Capacity Act
(MCA)
A law which is designed to protect and empower
individuals who may lack the mental capacity to
make their own decisions about their care and
treatment.
37
Mental Health Act
(MHA)
A law under which people can be admitted or kept
in hospital, or treated against their wishes, if this is
in their best interests or for the safety of
themselves or others.
Multi-Disciplinary
Team (MDT)
A team made up of different kinds of health
professionals who have specialised skills and
expertise.
NICE
National Institute for Clinical Excellence. Publishes
guidance for health services in England and Wales.
Peer support network
Groups where other people in a similar situation
can meet up to talk, ask for advice and offer
support to each other.
PRN medication
Medicines that are taken ‘as needed’. “PRN” is a
Latin term that standard for “pro re nata” which
means “as the thing is needed”.
Psychoeducation
The process of providing education and
information to those seeking or receiving mental
health services, such as people diagnosed with
mental health conditions and their family
members.
Recovery colleges
A service that gives people with mental health
problems the opportunity to access education and
training programmes designed to help them in
their recovery.
Reflective practice
The ability for people to be able to reflect on their
own actions and the actions of others to engage in
continuous learning and development.
Restrictive
intervention
Deliberate acts on the part of other person(s) that
restrict a patient’s movement, liberty and/or
freedom to act independently in order to 1) Take
control of a dangerous situations where there is a
real possibility of harm to the person or others if no
action is taken, and 2) End or reduce significantly
the danger to the patient or others.
Risk assessment
A systematic way of looking at the potential risks
that may be associated with a particular activity or
situation.
Safeguarding
Protecting people's health, wellbeing and human
rights, and enabling them to live free from harm,
abuse and neglect.
38
Signpost
To tell a person how to access a related service.
39
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