This clinical pathway, based on the Australian Clinical Guidelines for Early Psychosis, is linked to the early psychosis care bundle being developed by the Northern Sydney Local Health District Early Psychosis Team.1 The pathway will provide a basic flow of clinical care for patients who are experiencing early psychosis, or who are at ultra-high risk of developing psychosis.
Aim
To provide community mental health clinicians with a clinical pathway for early psychosis that is clear, concise, and easily understood, as evidenced by verbal feedback from clinicians and stakeholders after a trial of three months.
Benefits
- Clinicians can see at a glance the sequence of care for each phase of early psychosis.
- A detailed, formal process for the care of consumers experiencing any of the four stages of early psychosis will provide support and guidance for clinicians in the care of people with psychosis.
Background
This project was initiated following requests from clinicians at Cooma Community Mental Health Service for a concise way of presenting the care needed for people experiencing early psychosis. The Australian Clinical Guidelines for Early Psychosis are comprehensive but many clinicians lack the time required to read and understand them.1 Consequently, there was inconsistency among clinicians in the care provided. Many areas of healthcare have documented clinical pathways but there are relatively few for mental health.
Implementation
As an initial step, the project team conducted a literature search of clinical pathways for mental health services in Australia. The literature search found that while clinical pathways for psychosis can be valuable, there are currently no clinical pathways available for NSW mental health services.
The next phase of the project was to develop the clinical pathway in consultation with experts in mental health care across NSW:
- Clinical Nurse Educator, Julie Cameron, from the Southern Local Health District Mental Health and Drug and Alcohol Service, provided several early psychosis assessment and treatment tools to be used with the clinical pathway.
- Kira Van Klink, who manages the Cooma Mental Health and Drug and Alcohol Service, shared her experience and resources to develop a time map tool that can be used to map the consumer’s recovery and develop a relapse plan.
- Kira referred us to Beverley Moss, the Early Psychosis Coordinator at the Northern Sydney Local Health District Mental Health Service. Beverley is working on a phase of care bundle for early psychosis. Our clinical pathway is heavily based on this draft document to bring it in line with NSW mental health and drug and alcohol services for early psychosis.
- The Australian Guidelines for Early Psychosis, the Mental Health Outcomes and Assessment Tools and Mental Health Phase of Care Guide were also integrated into the pathway.1-3
The new pathway will be piloted at Cooma Mental Health and Drug and Alcohol Service.
Status
Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.
Dates
The project started on 20 May 2018.
Implementation sites
To be implemented initially at Cooma Mental Health and Drug and Alcohol Service for three months with adjustments made as necessary following input from the team. Following this three month period, the project will be implemented for trial across Cooma Mental Health and Drug and Alcohol Service teams for a further three months.
Partnerships
Northern Sydney Local Health District Mental Health Service
Evaluation
Evaluation will be via verbal and written feedback from clinicians using the tool.
Lessons learnt
Collaborating with other mental health experts has been hugely useful. In particular, we were able to integrate Beverley Moss’ care packages for the early stages of psychosis into the clinical pathway to provide continuity of practice across NSW mental health and drug and alcohol services.
References
- Early Psychosis Guidelines Writing Group and EPPIC National Support Program. Australian Clinical Guidelines for Early Psychosis. 2nd ed update. Melbourne: Orygen, The National Centre of Excellence in Youth Mental Health; 2016.
- NSW Minsitry of Health. Mental Health Outcomes and Assessment Tools (MH-OAT). North Sydney: NSW Health; 2014.
- Independent Hospital Pricing Authority. Australian Mental Health Care Classification: Mental health phase of care guide. v1.2 Sydney: IHPA; 2016.
Further reading
- Denton M, Wentworth S, Yellowlees P, et al. Clinical pathways in mental health. Australas Psychiatry. 1999 Apr;7(2):75-77. Doi: 10.1111/j.1440-1665.2006.02311.x
- Emmerson B, Frost A, Fawcett L, et al. Do clinical pathways improve clinical performance in mental health settings? Australas Psychiatry. 2006 Dec;14(4):395-8.
- Iedema R, and Degeling P. Quality of care: Clinical governance and pathways. Australian Health Review. 2001;24(3):12-15.
- Ong, J. Evidence Summary. Effectiveness of integrated care pathways in health care settings. The Joanna Briggs Institute EBP Database, 2016;5 BI4678.
- Rotter, et al. Clinical Pathways: Effects on clinical practice, length of stay and hospital costs. Cochrane Database of Systematic Reviews, 2010: Issue 3 Art no: CD006632. DOI:10.1002/14651858.CD00632.pub2.
- Van Herck P, Vanhaecht K, Dermeus W. Effects of clinical pathways: So they work? Journal of Integrated Care Pathways. 2004;8(3):95-105.
Contact
Meredith Fleming
Registered Nurse
Cooma Mental Health Service
Southern NSW Local Health District
Phone: 0429 309 240
Meredith.fleming@health.nsw.gov.au
