The Role of the CPN in The Role of the CPN in Primary HealthcarePrimary Healthcare

Tristan Griffin CPN/RGNTristan Griffin CPN/RGN

Defence School of Defence School of Postgraduate Medical StudiesPostgraduate Medical Studies

Learning outcomeLearning outcome

• 1. Critically analyse the role and 1. Critically analyse the role and responsibilities of the nurse in responsibilities of the nurse in partnership and collaboration with partnership and collaboration with other members of the primary health other members of the primary health care team within a legal and ethical care team within a legal and ethical framework.framework.

Mental illnessMental illness

• Whenever a person’s abnormal Whenever a person’s abnormal thoughts, feelings or sensory thoughts, feelings or sensory impressions cause him objective or impressions cause him objective or subjective harm that is more than subjective harm that is more than transitory, a mental illness may be transitory, a mental illness may be said to be present.said to be present.

Oxford Handbook of Clinical Specialties 2003Oxford Handbook of Clinical Specialties 2003

Mental HealthMental Health

An ability to love and be lovedAn ability to love and be loved

The power to embrace change and The power to embrace change and uncertaintyuncertainty

A gift for risk takingA gift for risk taking

A wide range of emotional responsesA wide range of emotional responses

Efficient contact with realityEfficient contact with reality

A rich fantasy worldA rich fantasy world

Mental Health cont’Mental Health cont’

Self knowledgeSelf knowledgeLearning from experience (the Learning from experience (the

strength to be wrong).strength to be wrong).Security and statusSecurity and statusSelf expressionSelf expressionThe ability to get on with othersThe ability to get on with othersA sense of humour!A sense of humour!OHCSOHCS

RMNs and CPNsRMNs and CPNs

• RMN is a 1RMN is a 1stst level Registered Nursing level Registered Nursing Qual. Now RN(MH)Qual. Now RN(MH)

• CPN is an additional qual/experience.CPN is an additional qual/experience.• RMNs on wards.RMNs on wards.• CPNs are senior nursesCPNs are senior nurses• CPNs are often autonomous practitionersCPNs are often autonomous practitioners• In Primary Care you will see CPNsIn Primary Care you will see CPNs• STAY AWAY FROM THEM!STAY AWAY FROM THEM!

QUALIFICATIONS/THERAPIESQUALIFICATIONS/THERAPIES

• RMN, RN(MH)RMN, RN(MH)• Dip N (MH)Dip N (MH)• BSc/MScBSc/MSc• CBT – up to MastersCBT – up to Masters• EMDR – Level 1-3EMDR – Level 1-3• CounsellingCounselling• Brief/ Solution TherapyBrief/ Solution Therapy• NLPNLP• Motivational InterviewingMotivational Interviewing• Other Post -Reg CoursesOther Post -Reg Courses• Nurse prescribers?Nurse prescribers?

NHSNHS

• Primary ServicesPrimary Services • Community Community (General)(General)

• Community (Spec.)Community (Spec.)

• LiaisonLiaison

• Crisis InterventionCrisis Intervention

• Assertive OutreachAssertive Outreach

• GP led /Shared CareGP led /Shared Care

• CPNCPN

NHSNHS

• Secondary Secondary ServicesServices

• Acute In PatientsAcute In Patients

• Older AdultsOlder Adults

• RehabRehab

• Substance MisuseSubstance Misuse

• Consultant LedConsultant Led

• RMNRMN

COMMUNITY MENTAL HEALTHCOMMUNITY MENTAL HEALTH

• Absence/Presence of Mental IllnessAbsence/Presence of Mental Illness

• Assessment of RiskAssessment of Risk

• Provision of treatmentProvision of treatment

• Management adviceManagement advice

• Occupational Mental Health adviceOccupational Mental Health advice

Community MH servicesCommunity MH services

• Responsive Community Psychiatric Responsive Community Psychiatric teamsteams

• Crisis intervention teamsCrisis intervention teams

• Substance abuse teamsSubstance abuse teams

• Drop in servicesDrop in services

• Telephone helplinesTelephone helplines

• Self-help groupsSelf-help groups

• Mental illness hostelsMental illness hostels

Community MH cont’Community MH cont’

• Occupation centresOccupation centres

• Sheltered workSheltered work

• Supervised living quartersSupervised living quarters

• Self-running group homesSelf-running group homes

The CMHTThe CMHT

• Generic teams providing MH care to Generic teams providing MH care to the working age population in a the working age population in a geographical area. Similar teams for geographical area. Similar teams for older people, referred to as ‘CMHT older people, referred to as ‘CMHT Older People’.Older People’.

Assertive outreach teamAssertive outreach team

• Specialist teams providing assertive Specialist teams providing assertive and intensive treatment to mentally and intensive treatment to mentally ill people who frequently relapse and ill people who frequently relapse and require in-patient treatment, or those require in-patient treatment, or those who are resistant to psychiatric who are resistant to psychiatric treatmenttreatment

Home treatment/crisis Home treatment/crisis teamsteams

• These provide intensive care and These provide intensive care and support to people who would support to people who would otherwise require admission to otherwise require admission to psychiatric hosp, or to vulnerable psychiatric hosp, or to vulnerable people who have been discharged people who have been discharged from hospitalfrom hospital

Early intervention teamsEarly intervention teams

• Specialist treatment, information and Specialist treatment, information and support to people experiencing their support to people experiencing their first psychotic illness.first psychotic illness.

Collaborative workingCollaborative working

• The MDT will include:The MDT will include:

CPN/Psychiatrists/PsychologistsCPN/Psychiatrists/Psychologists

Social workersSocial workers

Occupational therapistsOccupational therapists

Housing, welfare and support workersHousing, welfare and support workers

Community workers/key figuresCommunity workers/key figures

Those who work with refugees or asylum Those who work with refugees or asylum seekersseekers

TeamworkTeamwork

Clear and agreed aim, policies and Clear and agreed aim, policies and proceduresprocedures

High levels of communication and High levels of communication and member participationmember participation

Integration and mutual respectIntegration and mutual respect

Sufficient staffSufficient staff

MDT’sMDT’s

• The effective MDT will contribute to:The effective MDT will contribute to:

Reduced mortalityReduced mortality

Greater continuity of careGreater continuity of care

Consistent communication with Consistent communication with patients and familiespatients and families

They will share and develop knowledge They will share and develop knowledge and skillsand skills

The resultThe result

Fewer suicidesFewer suicides

Continuity of careContinuity of care

Less admission to hospitalLess admission to hospital

Shorter staysShorter stays

Patient satisfactionPatient satisfaction

Lower costsLower costs

So how do we help our So how do we help our patients?patients?

• ‘‘Comprehensive nursing assessment Comprehensive nursing assessment identifying nursing issues and action identifying nursing issues and action plans’plans’

• Dave’s storyDave’s story

• Ruth’s storyRuth’s story

• Tom’s storyTom’s story

Ethical decision makingEthical decision making

Does your decision conflict with core ethical Does your decision conflict with core ethical values?values?

Think of someone who’s moral judgement you Think of someone who’s moral judgement you respectrespect

How will your decision affect others?How will your decision affect others?Legal?Legal?Rules, policies, proceduresRules, policies, proceduresThe media?The media?Can you be proud of your decision?Can you be proud of your decision?Can you defend it?Can you defend it?Will you sleep soundly tonight?Will you sleep soundly tonight?

And so….And so….

..and so it is with psychiatrists, ..and so it is with psychiatrists, psychologists and psychiatric nurses psychologists and psychiatric nurses who play such a role in mitigat(ing) who play such a role in mitigat(ing) our madness, giving meaning, our madness, giving meaning, purpose and dignity to the mental purpose and dignity to the mental sufferings of so many of us…sufferings of so many of us…

OHCSOHCS