Providing Alternatives to Inpatient Care: the Intensive Home Treatment Team Pilot in Forth Valley

Abstract

The NHS in Scotland is divided into 15 health boards which both commission and provide a range of mental health services. Forth Valley Health Board, located in central Scotland, covers a growing population of approximately 275,000 people living in a mix of rural and urban settings. Mental health services are provided by NHS Forth Valley and three local authorities: Clackmannanshire, Falkirk, and Stirling Councils. Scottish health policy since devolution has emphasised the need to involve patients and the public in planning health care, and for partnership working in its provision (Scottish Executive, 2003). In T practice, partnership working in local areas is often led by the commitment of local authorities and the NHS to work jointly. Throughout Scotland, mental health services are being reviewed and developed locally in response to policy commitments to ‘provide care which is more personal and closer to home’ (Scottish Executive, 2005), and to ongoing requests from mental health service users for greater choice in care and treatment and crisis support outside hospitals. The Mental Health (Care and Treatment) (Scotland) Act 2003, enacted in October 2005, is another driver for the development of improved and more responsive crisis services and out-of-hours support. Local health strategies in Forth Valley include shifting the balance of care from hospitals to the community by reducing acute beds and enhancing community resources to provide more choices and more person-centred support for people with mental health problems (NHS Forth Valley, 2004). In acknowledgement of these demands, a local capacity planning exercise looked at possible ways forward and proposed a range of models. The IHTT was finally chosen to be piloted as it had wide local support from clinicians, mental health service users and their carers; it was comparatively easy to define,