Appendix IV - Department of Health and Children

Appendix IVNorth Lee / North Cork Mental Health ServicesRegional Director of Operations, HSE SouthDeveloping an integrated Mental Health Servicein line with “A Vision for Change”.Easy Access Public Confidence Staff PrideOffice of the Regional Director of Operations | HSE South | HSE Offices | Model Business Park | Model Farm Road | CorkTel: 021 492 8500 | Fax: 021 492 8515 | Email: RDO.South@hse.ie

IntroductionThe North Lee and North Cork catchment areas were combined with the appointment of an Executive ClinicalDirector in 2009 and a Local Health Officer was appointed in 2010. The budgets and managements structures ofthe two original catchment areas were not combined; it was anticipated that further changes would be requiredwith the expected separation of Cork and Kerry into two distinct management structures, each to be called anintegrated service area.Integrated Service AreaThe Integrated Service Area (I.S.A.) model has now been instituted in Cork and Kerry, whereby both are managedseparately. An I.S.A. Manager, Mr. Ger Reaney, has been appointed to oversee Cork and an OperationsManager, Ms. Gretta Crowley, now has direct responsibility for the Mental Health budget and operations. An ECDwill be appointed to cover the whole of the Cork I.S.A., but pending this North Lee/North Cork remains the remit ofDr. Maeve Rooney and South Lee/West Cork (as well as Kerry) remains the responsibility of Dr. EamonnMoloney.North Lee Mental Health ServicesThe North Lee Mental Health Services provide psychiatric services for the north side of Cork city, including someof the city centre and a relatively narrow area which extends beyond Macroom to the West and all the way toYoughal to the East.The service population is 167,536 comprising of five Sectors, as follows:SectorPopulationCity North (combining City North East & City North West) 55,134Cobh/Glenville: 41,774Macroom/Blarney: 36,311Midleton/Youghal 36,385In-patient facilities are located at:• St. Michael’s Acute Admission Unit, Mercy University Hospital.• Continuing Care Centre – Owenacurra Centre, Midleton.• Carraig Mór Psychiatric Intensive Care Unit.The total WTE’s for North Lee Mental Health Services is 337 and the service operates under a budget ofapproximately €23 million.

St. Michael’s Acute Admission UnitSt. Michael’s Unit is a modern fifty bed unit within the Mercy University Hospital, Cork and is operated under aLease Agreement between the Mercy and the HSE. It is the main mental health facility catering for the north sideof Cork City, Midleton/Youghal, Macroom/Blarney and Cobh/Glenville areas.St. Michael’s Unit is staffed by the following:Nursing:Occupational Therapists:Social Work:Art Therapist:35 WTE1.0 WTE0.5 WTE0.3 WTEInpatients are reviewed regularly by various members of the Community Mental Health Team, to maintaincontinuity of care. Nursing, Occupational Therapy, Art Therapy and Clinical Psychology staff have collaborated toprovide a comprehensive range of therapeutic programmes for inpatients. In addition, each resident has a wardbasedTherapy Programme in conjunction with Occupational Therapy, nursing and clinical psychology staff. Thistracks progress in therapeutic interventions and groups.A new post of Assessment Nurse has been developed within the Unit. This provides for triage assessment ofindividuals presenting to the Unit. The Assessment Nurse also liaises with the primary care teams. A Crisis Nurseoperates from the Emergency Department, Mercy University Hospital. This nurse provides assessment andsupport to individuals during their crisis period, in addition to liaising with General Practitioners. A nurse leads aclozapine clinic which operates from the Unit.The following nursing specialities are provided by North Lee Mental Health Services: Community Mental HealthNurses, Prison Liaison Nurse, Triage Nurse, GP Liaison Nurse, Crisis Nurse, Substance Misuse NurseCounsellors and Clozapine Clinic Nurse.Catchment AreasCity NorthThe Sector headquarters is located at Block 7, St. Mary’s Orthopaedic Hospital and is staffed, as follows:Consultant Psychiatrists: 2N.C.H.D.’s: 4C.M.H.N.’s: 4Clinical Psychologist: 2Social Worker: 2Occupational Therapist 2.8Addiction Counsellor: 0.6Day facility Nurse staffing: 11There is a day hospital in Block 7 for short term individual and group interventions Other facilities in this catchmentarea are:Inniscarrig Day CentreInniscarraig Day Centre opened in November 2008 and is located in the Erinville building, Western Rd, Cork toprovide a support service for people with long term and enduring mental health illness.Inniscarraig Centre Staff consists - of a Clinic Nurse Manager, 3 Staff nurses based in the Unit full-time, withmultidisciplinary input from Community Mental Health Nurses, Social Workers, Occupational Therapy and Arttherapy. Inniscarraig Centre also provides links with the Cork Mental Health Association, the Cork Anti-PovertyResource Network, the Irish Advocacy Network, the Basement Resource Centre and GROW. Inniscarraig centreoperates from Monday to Friday 9am to 5.30pm and offers a flexible programme of care activities for clients in acommunity setting.The total number of clients who attend Inniscarraig Centre is approximately 70. Average daily attendance is 35.

Groups provided at the Centre:• Mixed Support Group• Community Integration Programme• Women’s Support Group• Relatives’ Group• Cookery ProgrammeHome Based Crisis Team• The HBCT was set up in 2007 following receipt of Development Funding and is located at IniscarrigHouse, Western Road, Cork. It provides home based crisis assessment and multidisciplinary treatmentand intervention for individuals presenting with acute psychiatric illness. The HBCT aims to treatindividuals in the community for approximately four weeks. It provides an alternative to hospitaladmission for individuals presenting in crisis, who reside in the north of the city.HBCT is made up as follows:Consultant Psychiatrist: 1N.C.H.D. 1C.M.H.N. 3Social Worker 1Occupational Therapist 1Clerical Officer 1Macroom/BlarneyCúnamh Day Hospital / Day Centre, MacroomCúnamh provides a day hospital for service users in Macroom and the surrounding area as well as some supportfor those with enduring mental illness. There is space for up to 30 attenders in a week. In addition the buildingprovides site headquarters. Patients are seen in comfortable, pleasant surroundings by the various disciplines.Attenders are encouraged to develop their creative skills, whether through art, music literature or gardening – anintervention which serves to improve their mental health, increase their self-esteem and to enhance their quality oflife.Staffing:WTE’sConsultant Psychiatrist: 1N.C.H.D. 2C.M.H.N. 2Social Worker 1Clinical Psychologist: .8Occupational Therapist .6Addiction Counsellor: .4Day facility Nurse staffing: 3A.D.O.N. .25Art therapist .2Groups include:• Anxiety Management• Relaxation techniques• Depression• Healthy Lifestyles• Being Well Programme• Self-Esteem & Confidence• Assertiveness• Stress Management• Art and Minds Projects.• GardeningA clozapine clinic (which includes regular full mental state assessment) has been developed, and this has greatlyfacilitated patient care.

Individuals living in the Blarney area have access to Iniscarraig Day centre and the Day hospital in Block 7.St. Colman’s House, MacroomThe hostel provides residential accommodation for fifteen clients of the psychiatric services. This is a high supporthostel and has 24 hour nurse staffing supervision.Cobh/GlenvilleSlí Nua is an established mental health facility situated behind Cobh Cathedral in Cobh. The centre offers anadult mental health service aiming to promote positive mental health in the local area. Services include group andindividual work depending on clinical needs.The Cobh/Glenville Sector Outpatient Clinic is held in a HSE Health Centre, Bishop St, Cobh.Out-patient clinics are held on a weekly basis in the HSE Health Centre, Bishop Street, Cobh and also in the outpatientdepartment, Mercy University Hospital.Staffing:Consultant Psychiatrist: 1N.C.H.D. 2A.D.O.N. .25C.M.H.N. 2Clinical Psychologist: 1Social Worker: .5O.T. .6Addiction Counsellor: .5Day facility nurse staffing: 2Midleton / YoughalOwenacurra Day Centre / Day HospitalThe Owenacurra Day Centre/Hospital is a community based facility situated in the grounds of Midleton CommunityHospital. It provides a facility for mental health users in Midleton/Youghal area.Owenacurra Staff comprises:Consultant Psychiatrist: 1N.C.H.D. 2Occupational Therapist 1Social Worker .8C.M.H.N. 2Clinical Psychologist: 1A.D.O.N. .25Day facility Nurse staffing: 4AimTo provide a multidisciplinary assessment and treatment of the mental and physical health needs of the client.Groups provided include• Relaxation• Food and Mood group• Gardening• Social Outings.• Music• Creative Writing• Drama• Photography

• Weight Loss groupOwenacurra Day Hospital also provides sessional work e.g. for anxiety management, coping with bi-polardisorder, nutritional consultations and interventions for eating disorders. Interpersonal Psychotherapy Training isconducted on this premises, for Mental Health disciplines in Cork. Cognitive Behavioural Therapy and RationalEmotive Behaviour Therapy are also available (with training provided to staff in the latter). Clinic Days run Mondayand Thursday in Midleton and alternate days in Youghal. A clozapine clinic runs once a month.Referrals:Clients are referred by GP’s, St. Michaels Unit and Clinics.The North Cork Mental Health ServiceSt Stephen’s Hospital is a complex standing on a 42 hectare (104 acre) block of land in the Upper Glanmire Area,some 6 km north of Cork City. The hospital and surrounding land is owned by the HSE. It was built by the DOHas a Sanatorium circa 1950 and used for that purpose for approx 20 yrs.There are a number of units on campus:Unit 1 Senile Dementia unit (Not an approved centre) 23 bedsUnit 2 High dependency psycho-geriatric unit 26 bedsUnit 3 Male acute unit 13 bedsUnit 4 Female acute unit 13 bedsUnit 5 High dependency unit 13 bedsUnit 8 floor 2 High dependency psycho-geriatric unit 25Unit 8 floor 3 High dependency psycho-geriatric unit 14(closure planned)North Cork SectorsThe North Cork Mental Health Services serves a population of 80,795. It is divided into 3 sectors:Mallow Sector Fermoy Sector Kanturk Sector29,737 28,594 22,464(Census 2006 figs)RehabilitationThe NCMHS is served by a Rehab Team which is lead by a Consultant Psychiatrist with a special interest inRehabilitation – other members of the team include medical, nursing, OT with limited psychology input.Residential Care/Day centre for the Enduring Mentally IllCommunity Residences have been developed to transfer long stay patients into more appropriate accommodationin the community. The most recent is Cois Alla, a 14 bed residence in Kanturk, which is the result of acollaboration between the Mental Health Association and the H.S.E. In addition a day care centre, Valley View (onthe grounds of St. Stephen’s Hospital) provides spaces for 40 clients with enduring mental illness. Other daycentres are provided within the sectors.Housing ProjectsSolas Nua, MallowCois Alla, KanturkCarrickabrick Lodge, Fermoy14 bed unit14 bed unit14 bed unitCommunity Residences (Low Support)8, Moher Crescent, Mitchelstown 3 places26, O’Callaghan Park, Kanturk 2 placesArd na Greine, Sarsfield Court3 places3, Batchelors Walk, Mallow 4 placesHazelwood, Glanmire. Cork4 places19, Oakfield Avenue, Glanmire 3 places

Community Mental Health TeamsFermoy SectorSector Headquarters: Pearse Square, Fermoy.Day centre: Blackwater Day Centre (15 places) and Tearmon Ui Chaoimh, Mitchelstown (14places)WTEsConsultant Psychiatrist 1NCHDs 3CMHN 2.5Clinical Psychologist 0.8Social Worker 0.33Occupational Therapist 1Day facility Nursing 6.23Clinical Nurse Specialist 1.65Liaison/Self harm post 0.16Mallow SectorSector Headquarters: 9, West End, Mallow – transfer to Mallow Primary Care Centre at end of March 11Day Centre:Norwood DCC, Mallow (15 places)Turas Nua DCC, Charleville (15 places)WTEsConsultant Psychiatrist 1NCHDs 2CMHN 4Clinical Psychologist 0.5Social Worker 0.33Occupational Therapist 1Day facility Nursing 5.62Clinical Nurse Specialist 2Liaison/Self harm post 0.16Kanturk SectorSector Headquarters:Day Centre:Rented rooms in Convent Lodge, KanturkDuhallow Day Centre (15 places)WTEsConsultant Psychiatrist 1NCHDs 2CMHN 2Clinical Psychologist 0.8Social Worker 0.33Occupational Therapist 1Day facility Nursing 3Clinical Nurse Specialist 1.65Liaison/Self harm post 0.16

Child & Adolescent Mental Health ServicesInpatient UnitEist Linn, the new Child & Adolescent inpatient unit, opened this year on the 14 th of March 2011 with a capitalspend of 2.2 million. It has bed capacity for 12 children, up to the age of 18. It will provide 20 beds in May/June2011, when the full complement of staff is reached including a second consultant. As a regional service, it acceptsadmissions from the whole of the H.S.E. South. The advent of this unit will help avoid future admissions of childrento adult units except in extreme, exceptional circumstances.Community Child & Adolescent TeamsThe main work of Child & Adolescent Mental Health services continues to be in the community. Across theExtended Catchment area, there are three Child & Adolescent Mental Health teams in place.Primary Care – integrationOne of the main aims of the North Lee/North Expanded Catchment Areas is to enhance integration with primarycare teams – to improve the service we provide to patients and G.P.s. Specific benefits are continuity of care,prevention of chronic decline by earlier intervention and improved cost-effectiveness.The most important components of enhanced integration are improved communication and teamwork. We alreadyhave close liaison between Community Mental Health teams and G.P.s in many sectors. These are now beingdeveloped more formally through Primary Care team meetings, which occur once per month, and are attended bymembers of the community mental health team. These meetings focus directly on clinical care; with closetimekeeping and a clear agenda outlining which clinical cases will be discussed. They are perceived as clinicallyuseful and this has served as an incentive to participation.In addition, some Mental Health Clinical Nurse Specialists have physically moved into G.P. surgeries to provideCognitive Behavioural Therapy and counselling at primary care level.Our expanding Home Care crisis team now takes direct referrals from G.P.s and this has greatly enhanced G.P.satisfaction and provided them with a practical alternative to sending patients in crisis directly to hospital. Thusbeyond the service it provides, the Home Care Crisis team provides an educational role, demonstrating to G.P.sand families that many difficult cases can be managed without recourse to hospital admission.The other aspect of integration is the transfer of Sector Headquarters and offices to Primary care centres. TheMallow Community Mental Health team will transfer to Mallow Primary Care Centre at the end of March, with plansafoot for Newmarket, Macroom and Fermoy. This facilitates the development of “one-stop-shops”, easing accessfor the public to mental health professionals and avoiding stigma.

Further Developments in the North Lee/North Cork AreaThe Home Based Crisis Team in North Lee Mental Health Services provides an alternative (in certaincases) to hospital admission. It is perceived by patients, families and treating G.P.s as an effectiveintervention. This provides a basis for further expansion.Plans are currently in progress to reduce the bed capacity at the Owenacurra Centre, Midleton. Areview of over 65’s has been undertaken with a view to accommodating them in more suitableaccommodation.In June 2006 Cois Alla (Social Housing Project) opened in Kanturk. This is a 14 bedded unit (includingfour independent flatlets). This project was a joint venture between the Cork Mental Health Associationand the HSE, South and has facilitated the closure of a ward at St Stephen’s Hospital. A similar projectwith Cluid in the Fermoy sector culminated in the opening of a 14 bedded unit in the summer of 08.Lios Rua housing accommodation: This is an initiative between the HSE and Cluid HousingDevelopment to secure two 3 bedroom properties. The initiative will involve full assessment of allresidents in long stay accommodation and encourage them to move to a more independent way ofliving. This would help the service develop a more transitional service in high support hostels, by havingsuitable accommodation available to those who are ready to leave, but who would not be able to livewithout any support or who would not be able to access private/public accommodation.Dialectical Behaviour Therapy intervention – treating persons with Borderline Personality Disorder. Thisdisorder is recognized as extremely distressing for clients and very difficult for clinicians to treat,resulting in frequent readmissions. The ‘Endeavour Programme’ is a structured treatment developedfrom Dialectical Behaviour Therapy (DBT), helping service users reduce self harm and self destructivebehaviours, using a combination of group skills training, individual therapy and phone coaching. 6multidisciplinary staff members, have trained in the UK to run this programme. The first cohort of 13service users commenced the 12 month programme in September 2010. In March 2011, 3 additionalservice users will join the programme.Interpersonal Psychotherapy (I.P.T.). This is an evidence based short term psychotherapeuticintervention recommended by NICE guidelines (U.K.) for the treatment of depression (as well as eatingdisorders), which significantly reduces relapse rates. I.P.T. is extremely cost-effective (a week ofintensive training is followed by regular supervision) and provides a structure for all members of theCommunity Mental Health team to provide psychological interventions to clients. It comprises aneducational component to help the client understand depression as a disorder and an interventioncomponent, whereby the client develops skills in interpersonal relationships (e.g. where there is conflict,transition or bereavement). These skills tend to generalise to other areas. Since 2008 sixteen MentalHealth professionals have trained in I.P.T. and continue to apply their skills during the course of theirroutine work in Community Mental Health teams. It is planned that a further sixteen will be trained in thenext module in April.A General Adult Consultant with a special interest in rehabilitation commenced with the North CorkMental Health Services in 2007. An Occupational therapist has been appointed to this team as well asan NCHD and 3 community mental health nurses. The team receives some input from psychology. Thisdevelopment has given further impetus to the transfer of long stay patients to the community, byproviding people with the support they need to manage living independently.