The Tidal Model in Mayo Mental Health Services, Ireland

The Tidal Model was first introduced into Mayo Mental Health Services in August, 2003. Since then it has steadily grown in popularity as more areas have adopted, and adapted it for their practice.

Staff find Tidal a useful and practical framework. With its key emphasis on the user voice and recovery Tidal has a definite niche in Irish Mental Health Policy (See: Mental Health Commission, 2005, Department of Health and Children, 2006, Quality Framework, 2007).

Some areas have built a nursing careplan around the Tidal Model Holistic Assessment and are finding this very satisfactory. Other areas have adapted Tidal and redrafted a nursing careplan compatible with this to fit their client group.

We hope in the future to be able to entice a researcher to come and evaluate its use in our service and the contribution it makes to clients recovery.

On this page below, we introduce you to some of our services in Mayo, Ireland. Click here to meet some of the team members.

Mary McHale,

Nurse Practice Development Co-ordinator

Westport Community Mental Health Centre

Westport Mental Health Centre is a community based mental health service and it serves the needs of those individuals who have mental health problems.

This service in the centre is provided by a multi-disciplinary team of skilled professionals who combine their unique expertise to provide integrated care to service users in the context of their local community.

A range of interventions for service users with specific disorders, drawing on evidence-based and best practice interventions is also provided. The team also ensure and co-ordinate additional specialist care required.

In Westport Community Mental Health Centre the needs of each service user is discussed jointly by the team in consultation with users and carers and this is done in order to construct a comprehensive care-plan, using the Tidal Model framework. This care-plan is written and agreed between all parties and it includes time frames, goals and aims of the users.

Mary Joyce, Clinical Nurse Manager, II

Adult Mental Health Unit (Admission Unit)

The Adult Mental Health Unit in Mayo Mental Health Services is a thirty three bedded unit situated in the General Hospital. It has a catchment area of all of Mayo with a population of 110,000 people.

Adult Mental Health Unit, Mayo General Hospital was the first area of Mayo Mental Health Services to adopt the Tidal Model in 2003. There was dissatisfaction with the model in use and a research study, Murphy et al, (2000) supported the change to a more appropriate model for a mental health setting.

Following discussion and consultation and a visit to the unit by Phil Barker a nursing careplan was drafted using the Tidal Model framework. The model was introduced with this new document and supported by education for staff. Through use in practice this careplan has been refined over time. An evaluation of the model was completed in December, 2003 and staff reported high levels of satisfaction with its use.

An audit of the documentation using an adapted version of the audit tool developed by Fletcher and Stevenson in Newcastle has been used recently and action planning has identified areas for improvement and shown the model to be used well.

Kathleen Doherty, Clinical Nurse Manager, II

Social Support

Social Support was established as a rehabilitation service in the mid 1980’s in the Castlebar area and was developed in response to the closure of the large mental hospital as outlined by “Planning for the Future”.

It is a rehabilitation service designed to support individuals with mental health difficulties to make the best use of his/her abilities in as normal a social context as possible with the skilled intervention of the multidisciplinary team, using best practice.

This service enables people to retain and regain hopeful and satisfying lives, pursue their aspirations and achieve their goals with the continued support of a 24 hour nursing presence.

Social Support caters for the needs of approximately 50 service users, ranging in age from 23 – 75 years.

Service users are accommodated in Health Service Executive houses, Mental Health Association houses, or live independently within the Castlebar area.

Social Support uses the Tidal Model of care as a framework to guide nursing care practice which focuses on collaborating with the individual, empowering the person by putting their experience of illness and health at the centre of their care plan and resolving problems and promoting positive mental health by providing interventions within the multi-disciplinary team.

Social Support Philosophy of Care

We aim to enable, empower and assist individuals in our care, to participate in their own health and wellness, in order to achieve and maintain their optimum potential. This is achieved by person centred programmes developed by the multi-disciplinary-team which acknowledges the right of each person to dignity, hope and respect.

Breege Finnerty & John McCormack, Clinical Nurse Managers, II

Castlebar Community Mental Health

Day Care Centre

We operate a five-day week service for people with enduring mental illness. Their ages range from 50 to 76 years of age. Our average daily attendance is 20 plus per day. The length of stay in Day Centre is determined on each person’s need for support and assistance with the functions of daily living. A verity of therapeutic interventions is offered to each person, depending on their needs.

The Model of Nursing Assessment and Plan of Care used in the centre is an adapted version of the Tidal Model, this was introduced in September ’05. Unlike the previous model we were using, this assessment is a personal account given by the person themselves in their own words.

We may know little or nothing about the person on presentation that we are trying to assist. We need to know what is happening for that person in their life and the experiences they are going through, and understand how they are feeling, their thoughts on their current circumstances. It also gives insight into how the person is feeling and coping with their illness.

The model is about taking steps, rather than setting goals sometimes unrealistic and unattainable due to the person’s illness or changing circumstances. Also with this Model, emphases is based on simple achievable small steps, necessary for a person to experience a change for the better out of their present situation to enable them to function at a comfortable acceptable level which improves their quality of life and empowers them to deal with whatever problems they may encounter. It gives the person a responsibility and commitment to play a key role in their recovery and maybe an opportunity for change from the circumstance, which brought them to this scenario.

For us nurses listening/communicating and adapting ourselves so we can offer support suited to the specials needs of that person is essential. The person and the nurse becomes a team and there is a trust and confidence built up between us. The time given to the person is reassuring and important and a key part of the nursing role.

Mary Lavelle, Clinical Nurse Manager, II

Ballina Day Services

Ballina Day Services provides care to people on an individual basis provided by two nurses. The Tidal Model has been used with great satisfaction in the past two years. It provides a systematic approach to do an assessment and is also an excellent tool to help build a rapport with people.

Mary Weir, Clinical Nurse Manager, II

Ballina Residential Services

In this centre residential care is provided as well an outreach service to many people. This centre has opted to use an adapted version of the Tidal Model. Staff in the centre collaborated to draft their careplan and following its use made some adjustments to the original draft. They find it helpful for their practice and it encourages people who use the service to become partners in their care.

Ann Leneghan & Conor Staunton, Clinical Nurse Managers, II

St Michaels Day Hospital

St Michaels Day Hospital is a very busy centre providing acute mental health care in Castlebar town.

St Michaels Day Hospital was one of the first areas after the admission unit to use the Tidal Model in their care provision.

Betty McGeough, Clinical Nurse Manager, II

Meet some of the Team