crisis and acute mental health alternative and ... · crisis and acute mental health alternative...
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Crisis and acute mental health alternative and complementary services: case study pack
NHS England and NHS Improvement
2
ContentsA&E alternatives
Open access / drop in options:
Community centres / Crisis cafes
▪ Life Rooms, Merseyside
▪ The Cavern, Gloucester
▪ Mind Crisis Cafes, Northamptonshire
▪ Safe Havens, Aldershot
Crisis Assessment Units
▪ Crisis assessment suite, Teeside
▪ Crisis walk-in service, Grimsby
Options that require referral or booking in an appointment:
Sanctuaries/Safe Havens
▪ Haven, Bradford
▪ Sanctuary, Cambridge
▪ Mosaic - Crisis café
▪ Hub – Humber
▪ Leeds Survivor-Led Crisis Service, Dial House
▪ Dial House @ Touchstone, Leeds (support for people from BAME backgrounds)
Inpatient admission alternatives:Acute Day Services
▪ Acute Day Unit, Hertfordshire Partnership Trust
Crisis Houses
▪ The Warren, Northampton
▪ Tower Hamlets crisis house and home
treatment team partnership
▪ Drayton park women’s crisis house, Islington
This pack includes case studies to support implementation
of the Long Term Plan (LTP) ambition to have a range of
crisis and acute mental health ‘alternative’ provision that
complement traditional NHS crisis teams and acute inpatient
services. Over the 5 years of the LTP, every area will be
expected to increase the range of alternatives available
locally, and have the flexibility to choose which models are
most appropriate locally. The alternative services will require
co-production with service users, employment of peer
support workers, a prominent role for local voluntary sector
organisations, and will be expected to include options that
are tailored to meet needs of specific locally identified
priority demographics and inequalities.
The case studies in this pack have not had external
evaluation by NHS England / NHS Improvement (unless
stated), but have been included as they are highly valued by
the local system in which they operate.
Open access / drop in options
- the services in this section are community resources open to all – they provide more preventative, non-clinical and social functions, and a safe space for people to go or to be with other people, to prevent needs from escalating to crisis point, or to support (often social support) for their recovery.
- Some of these services are referred to as ‘crisis cafes’ offering similar functions to the more general community centres. While some of the examples in this pack wouldn’t necessary define themselves as ‘crisis cafés’ they do offer similar benefits. (See next slide for more detail about typical characteristics of crisis cafes).
- The open access nature of these services means that while they do see some people who are ‘in crisis’, they are usually suitable for people with relatively lower level of need, or who might want to drop in regularly. They may not, however, always be suitable for higher levels of acuity (depending on staffing/skill mix)
- other open access options – referred to in this pack as ‘crisis assessment units’ may be staffed by more qualified clinical staff, and may therefore also be able to see people with higher levels of acuity. Some of these examples in this pack are used as a formal place of safety, e.g. for conveyance by police and ambulance for people who are or may otherwise have been subject to detention under s.136 of the Mental Health Act
Crisis cafes offer mental health support to people, often in the evenings and weekends, when they
may need help most. They aim to support people to reduce any immediate crisis and to safety plan;
drawing on strengths, resilience, and coping mechanisms to manage their mental health and
wellbeing. As well as offering support, professionals may also be able to refer and direct onwards to
further services if required. The term ‘crisis café’ can sometimes be used interchangeably with ‘safe
haven’ or ‘sanctuary’ (see later slides for different examples).
Typical characteristics:
• ‘Open drop-in’: anyone who needs support is welcome to drop in, but referrals can also be
made through mental health teams, A&E, GPs, social care, conveyance by police ambulance.
• Some places have ‘café’ style setting with other people around, others may prefer 1:1 calm,
quiet space (that might look more like a living room).
• Often have at least one mental health professional to facilitate – mental health nurses and
social workers are often available if needed.
• Staffed by Band 3-6 support / peer support workers and voluntary sector staff.
• Open afternoons/evenings, often during times of peak demand (such as when A&E
attendances might be highest), e.g. between 5pm-1am, often with weekend sessions available.
• As well as coping strategies, services can offer a listening ear and low-level interventions such
as board games, adult colouring and inclusive activities such as quiz nights.
• 1-1 sessions and telephone support may also be available.
4
Crisis Cafes
Some areas who have set up local crisis cafes report that they have played an important
part in the local crisis pathway to reduce frequent A&E attendances, admissions,
reductions in out of area placements and high levels of satisfaction with the service.
Case study, community centre
to support mental health
5
Life Rooms (1/2), (Walton,
Southport and Bootle)
Support on offer:
• Recovery College: Free
courses to support wellbeing
• Pathways Advice: Support
and guidance in relation to
next steps, including support
to into a number of different
community partners who
provide help in many different
areas including housing, debt
and employment
• Volunteering: Support into
volunteering opportunities
• Employment support
• Peer support: 1:1 supportive
conversations with a peer
support worker
• Library facilities
• Café
• 93,000 visitors across the three sites since opening in 2016.
• Run by Mersey Care NHS Foundation Trust.
• Drop-in service and can be referred by clinicians and GPs.
• Staffed by socially focussed roles including Employment
Advisors, Support workers, Pathway Advisors and other,
more specific roles.
• Open Monday to Friday 9.30am-4.30pm.
• Entire service co-produced, co-delivered and co-evaluated.
Six primary aims:1. Raise the profile of mental wellbeing, empower service
users within the community, and contribute towards
ending the stigma surrounding mental health.
2. Promote mental wellbeing through non-clinical
opportunities
3. Improve access to meaningful occupation or employment
opportunities.
4. Contribute to a stronger community through partnerships.
5. Promote diversity and access to mental health support for
marginalised groups.
6. Contribute to the development of mental health services,
prioritising a community model.
Case Study Life Rooms, (Walton, Southport and Bootle) 2/2
6
Impact on health and care
systems:
• Early evaluation work
illustrates that,
after using the Life Rooms,
Mersey Care service users
evidence a reduction in
clinical cost when compared
with Mersey Care service
users who did not use the
Life Rooms.
Impact on community:
• Over 100 community
partnerships have
developed as part of the
Life Rooms model.
These present some
favourable outcomes in
terms of building
effective working
practices in community
Support.
Impact on the person, their carers
and families:
• Life Rooms people and environment are felt to be positive influences
• The Life Rooms are felt as non judgemental and a safe space to share experiences
• Self development and self awareness are identified as significant outcomes for users of the Life Rooms
• Social inclusion offers positive impact on the lives of individuals; the Life Rooms are seen as places to facilitate
this
• Development of personal goals is identified as a positive outcome of the Life Rooms on individuals
• Initial SWEMWBS analysis indicates a medium effect in the context of improved wellbeing for Life Rooms
users.
Contact: Michael Crilly,
Case study, community centre /
crisis cafe
7
Support at the Cavern, Kingfisher Treasure Seekers, Gloucester320 people reported that they were seriously considering suicide, and seeking help from Support at the
Cavern that evening may have prevented it.
• In order to provide a truly inclusive mental health service, the Support at the Cavern accepts walk-ins and
referrals from MH teams, A&E, GPs adult social care and the police. The service is also free to use.
• There are calm, ‘living-room’ style spaces for 1:1 sessions, as well as a ‘café/bar’ style space for people to
hang out and be around others if they prefer
• Attendees can also access other services which affect their well-being, for example, joining the Cavern
Gift Shop’s employment training programme.
• Staff help people feel less isolated, cope with anxiety, meet new people and provide support at a time of
day when little low level or early intervention support is available from the statutory services.
• Gloucestershire CCG provides grant funding and the service is run by Kingfisher Treasure Seekers.
• Café is run by trained staff and volunteers, but has close links with MH teams and NHS, for when more
intensive support is needed.
• The mental health support sessions run from 6pm-11pm, but the Cavern is open all day for everyone
• There have been 31279 visits since July 2016 (until end of April 2019).
“Places like The
Cavern which give
people informal support
in a friendly environment,
are key in our work with
our partners to do all we
can to promote good
mental health and help
reduce and prevent
suicide.”
Contact Katie Tucker, Director
View in presentation mode to watch
video or click here:
https://vimeo.com/290345054
Case study
8
Mind Crisis Cafes, Northamptonshire 1/2Piloted from September 2017 and now commissioned until 30th April
2019
Run in conjunction with Northamptonshire Mind, Mind staff trained
and supported.
Provides 16 Crisis Café sessions per week across the county (520
sessions Feb 18-Sep 18)
Provides genuine alternative to A&E, GP, EMAS and Police.
System:
• Alternative to A&E, GP, Police and EMAS
• Strengthens 3rd sector links and skills
• Builds out of hours resilience
Finances:
• The service costs £24,363 per month to operate
• Saving of between £7,978 and £22,425 per month
• Across the year saving of between £95,746 and £269,105 on
A&E tariff, Police, East Midlands Ambulance Service and Urgent
Care and Assessment Team only
• The wider systems savings (GP time, NHS 111, etc) have not
been included
Crisis Café Posters have been
sent to all mental health service
bases, all GP practices and any
areas where service users
would usually attend (out of
hours, A&E, etc) to advertise
the alternatives.
2,584 people visited the cafes
between February 2018 and
September 2018.
Case study Mind Crisis Cafes, Northamptonshire 2/2
Contact: Jen Holling
Northamptonshire Foundation Trust
Email: [email protected] /
48% decrease in ED attendances of cohort of 92 people for whom data could be obtained
10
Aldershot safe haven – independent evaluation (1/2) • 13% of people attended in crisis,
• 56% attended the service to prevent themselves from escalating into crisis
• 23% were recorded as presenting at the service for social reasons
A place for individuals to drop in without an appointment, operates from 18:00-23:00 Monday to Friday and 12:30-23:00 at weekends and bank holidays, 365 days a year.
Annual running costs £237,000
Full evaluation document here
Average reduction of 16% in admissions to acute in-patient psychiatric beds in the Safe Haven service catchment area.
96% of the service users completing the survey stated that they were likely, or extremely likely, to recommend the service to their family or friends.
Case study:
Contact: Nick Parkin, Senior Commissioning Manager [email protected]
11
Aldershot safe haven – economic evaluation (2/2)
• If the Service prevented only 5% of the 552 crisis attendances from resulting in a psychiatric admission (with an average length of stay of 42.2 days), this would equate to £439,088 in costs avoided (Aug 16 – July 17).
• To cover the annual cost of £237,000 the service would need to prevent 15 admissions per year (or just over one admission per month).
• There may also be avoided costs related to other health services, for example GP attendances or community mental health resources, and attendances to A&E that may have converted into an emergency admission
• There will also be cost savings related to the reduction in section 136 detentions (that could also result in admission avoidance)).
• The benefits calculated in this example do not even consider the impact of the much greater number of people attending to prevention escalation to crisis.
If only 5% (27.6) of the 552 ‘crisis’ attendances are prevented
from turning into MH admissions
Assume 13% of
attendances
(‘crisis’
attendances) to
Haven would
otherwise have
attended A&E
ED attendance costs
avoided £72,864
(£132 per ED
attendances x 552
crisis attendances)
Table of costs used locally:Other Safe Havens can be found in Guildford, Woking and Epsom
These are open access ‘walk-in’ NHS facilities where people experiencing a mental health crisis can access support and assessment of their needs. They are sometimes viewed as an ‘A&E equivalent’ for mental health and are staffed primarily by NHS mental health nurses and other qualified professionals. The examples in this pack are also formally designated health-based places of safety for people detained under s.136 of the Mental Health Act (as well being as a walk-in service for anyone).
As well as self-referral, other system partners such as police and ambulance have found these options valuable where they exist, to transport people to place of safety that they need, without necessarily having had to have a prior assessment of referral from another NHS service.
Typical characteristics:• A CAU is usually staffed by registered clinicians and Section 136 staff.• Available 24/7, 365 days a year.• Referrals come from police, A&E departments, and self referrals can also be accepted.• A flexible range of evidence based care interventions are delivered using a psychosocial
approach, along with medical assessment, treatment and monitoring which aims to resolve the current acute crisis.
• Each service user will have a care plan which will be individualised to their acute needs.
12
Crisis Assessment Units
Services have seen a reduction in S136 MH assessment wait times, police wait times,
inpatient admissions and potential A&E admissions are often diverted.
Case study
13
Tees, Esk and Wear Valleys Crisis Assessment Suite, Teeside
• Prompt, open access assessments in a health based place of safety available
24/7 as an alternative to A&E.
• For individuals with urgent mental health needs, who are either detained under
Section 136 MHA or who self-present to Roseberry Park Hospital (RPH/CAS).
• Operates 24/7 on 365 days a year staffed, by Crisis Clinicians and Support
workers
• Works alongside the four Teesside Crisis Teams &Street Triage team.
Average wait time for S136 MH Assessment reduced
from average 4 hours to 30 minutes.
Median Police wait time from over 4 hours to 20
minutes.
Total number of Complaints reduced by 83%.
Inpatient admissions reduced by 8.5% in 1 year.
Significant numbers of potential A&E attendees were diverted from Acute Trusts as the North East
Ambulance Service (NEAS) access CAS directly (232
patients in 2016/17).
CAS assessments increased by 3.9% from 2219 to 2306 in 1 year.
Contact: Jane O’neil
janeo'[email protected]
(1/2)
14
Referral Sources
CAS referrals increasing
Community CRT referrals
decreased and stabilised
but likely to increase
505 referrals monthly (40%
of which received by the CAS)
Across all teams: 43%
referrals from CPN / MDT /
specialist team
22% referrals from GP
9% self-referrals
3% carer or concerns
other referrals
23% other sources incl.
police, hospitals and
LA
For CAS: 49% self-referrals
and 33% police
referrals
Weighted population:
462,983
IHT increasing
Case study
Tees, Esk and Wear Valleys Crisis Assessment Suite, Teesides.136 detentions
Lessons learned from clinicians and service manager
▪ The people using CAS are not necessarily the same people who were using the crisis
service – suggesting there was previously unmet demand
▪ That all of the Crisis & Street triage services need to be centrally managed to ensure that we
can move staff to meet demand – daily telecon meetings across urgent mental health
services and staff re-deployed accordingly
▪ That some level of triage might be helpful to ensure people get the correct level of service.
▪ You need very strong relationships with the referring partners.
(2/2)
Case study
15
NAViGO CIC, Crisis walk-in service,
Grimsby
1 x 8a Access team lead
1 x band 7 Clinical Lead
13 x band 6/5 crisis/home treatment
made up of RNMH/SW
3 x band 3 meeter greeters
3 x band 3 home treatment support
workers
NAViGO operate a 24/7 open access crisis service away from the
ED at the NAViGO DGH. The crisis service is based on the
designated acute mental health site and is part of the Access Team
which includes:
• Adult Crisis Home Treatment Team
• Older Peoples Crisis Home Treatment Team
• AMHP
• Hospital Liaison ( based at the DGH 7 days a week 08.00 – 20.30)
• Single Point of Access (SPA)
• Also have a new Safe Space away from the site opened 3 weeks
ago so watch this space for exciting updates and this is staffed by
MIND operating 3 evenings a week Wed, Thur, Fri from 18.00-
01.00 supported by Crisis.
NAViGO CIC services are commissioned by the local CCG, and
additional monies via funding streams (such as core 24).
The route of referral is open to anyone, self-
referral, GPs, family/carers, other Mental Health
services, SPA, Police etc. They also operate a
walk in service 24/7 in that anyone can ring and
speak to a crisis worker or walk in to Harrison
House and self-refer. The Police can bring
people to the acute MH site following an initial
phone call and the ambulance service can bring
people direct who are not in need of medical
attention. They advocate that no one in a mental
health crisis should go to an ED unless they
have a medical need (e.g self harm / overdose).
63
presentations a
week for
mental health
crisis.
Only 3 of these
presented at A
and E.
Contact: Ellie Walsh [email protected]
Options that require referral or booking in an appointment
- services that accept only people who are referred following triage of
their needs, may have the benefit of helping to ensure that the service
is being used specifically by the people who’s needs it is designed to
meet
- might be able to manage a slightly higher level of acuity than open
drop in services
- initial triage and appropriate referral can help to ensure people are
accessing care in the right place as a coherent part of the local crisis
pathway. Some crisis pathways include a single point of access from
which people are supported to get to the right place for their needs &
preferences, one of which might be a safe haven / sanctuary style
service
A sanctuary or safe haven provides a safe, homely place for individuals experiencing crisis to go as an
alternative to attending A&E. Primarily a physical location of safety, offering practical and emotional support
during the evening (although they don’t provide accommodation), they often include a 24 hour crisis support
line too. The term ‘safe haven’ may sometimes be used interchangeably with ‘crisis café’.
Characteristics:
• Peer support workers and VCS staff run the services, with clinical support available too.
• Opening times typically range between 6pm-6am, while phone lines may operate 24 hours a day.
• Some may allow self referrals and drop-ins, while others need a referral from a first response team. In
some, service users will need to call and check availability first.
• Some have no limit to how long people can stay, and staff may be able to refer onto other services for
support during closing times. Others may for instance, have 1-2hr slots that you can book in to.
• Staff offer self-help guidance and tools to support people to manage thoughts of self-harm, low mood
and anxiety. They also provide 1-1 or group therapy sessions, while also working with people to create
a brief ‘recovery plan’.
• Some services also provide follow-up phone calls to check how the person is coping and, if necessary,
offer additional support to access further help.
• A Sanctuary may have a communal area (much like a living room), with a TV, board games and
refreshments so service users can relax and ‘just be’.
17
Safe Havens/Sanctuaries
Areas with sanctuary services have reported a reduction in the number of hospital admissions and
a reduction in the use of emergency services, including A&E, by providing an alternative safe place
for people in distress, as well as very positive patient experience scores.
Case study
18
Haven at The Cellar Trust, Bradford (1/2)
• A calm and friendly alternative to A&E for people in mental
distress from 10am to 6pm, 365 days a year.
• Run in partnership with Bradford District Care NHS
Foundation Trust and Bradford Metropolitan District Council.
• Access through the First Response team or A&E.
• Communal areas and a mindfulness room available for 1:1
sessions.
• Staffed by trained peer support workers and support workers
3 or 4 staff on site and deliver an average of 5x 1-1 sessions
a day but frequently up to 10.
• Staff help to de-escalate person’s level of distress and
develop a wellness plan
• 7 day follow up calls following visit and an 8-week after care
peer support group on offer too.
• Co-located with a nurse from the Intensive Home Treatment
Team and Duty Social Worker. designed to be brief
interventions, which then hook people into other support and
that works for most people
I have been waiting
since 2002 for help
and have experienced
difficulties accessing
it. I feel very much
today that I was
listened to effectively
and compassionately
and am at last feeling
hope
74% of people reported a significant reduction in distress.
Engaged with 66 of A&Es frequent attenders
69% of the people attending were referred due to suicidal or self harm ideation, but 72% not in secondary MH services
Avg 34.3% reduction in regular attenders using Bradford Teaching Hospitals and Airdale Hospital A&E
976 people supported in 2018/19, with 2367 interventions
83% of people said they felt better able to manage crisis in future as a result
View in presentation mode to watch
video or click here:
https://youtu.be/By_3Tu-rU9M
Quarterly open days and consultancy
available. Contact: Kim Shutler, CEO,
The Cellar Trust
19
• 0.5 x service manager
• 3 x Senior part-time Peer Support Workers (shift
supervisors)
• 4 part-time x Peer Support Workers
6.3 WTE
Total costs: c£255k per annum
Case study Haven, Bradford (2/2)
Model• 365 days per year, 10am-6,30pm
• Serves Bradford District, Bradford City and Airedale, Wharefdale
and Craven CCGs which has a population of around 580,000 and
covers inner city and rural areas
• 1 of 3 Safe Spaces (funded from different pots and via 3 different
VCS providers) – Mind Sanctuary offers support 6pm-1am.
• Usually more demand later in the afternoon than the mornings
• www.thecellartrust.org @TheCellarTrust
Peer support workforce
• The majority of positive feedback is about the peer support element
of the service.
• In supporting peer support workforce, it is important to consider that
sometimes people might have periods of being unwell. We have
learnt a lot about how to manage this and keep people well as well
as how to manage challenges around boundaries.
• A lot of potential in the volunteer peer support workforce. One of the
next steps could be to have a 0.6FTE Peer Support Volunteer
Coordinator as a high level of supervision and support is needed.
Part of crisis / acute pathway – what needs does the Haven meet?
• Service is referral only which was deliberate – as ensures
appropriate level of acuity / risk & meets specific need within pathway
• Not a general drop in – this would be a different, more preventative
function which may involve and typically see people with less acute
needs
• The service being referral-only has worked in one sense but has
created barriers to access for others
• 24% of interventions are with people identified as A&E Frequent
Attenders which uses a different approach to the brief intervention.
Location and accessibility
• DHSC capital funding for the digital infrastructure to be able
to offer support via webinar and messenger later this year.
• Currently piloting ‘outposts’ inc 1 day a week in Keighley and
peer support working into A&E’s (winter pressures funding)
• Encourage most people to make their own way which is ok
as we are well linked in terms of public transport and we
operate in the day time.
• Still spend around £10k per annum on taxis which is key and
if we didn’t have it, it would be a big barrier to access.
Learning and reflections for the future
Case Study
20
The Sanctuary – Cambridge and Peterborough
The Sanctuary aims to provide a safe, calm
environment offering emotional and practical help to
individuals experiencing crisis. In order to provide
an equitable service that is easily accessible, there
are 2 sanctuary bases, one in Cambridge and one
in Peterborough operating 7 evenings a week (6PM
– 1AM). The service is available to all 16+ where
clinically appropriate.
Referrals to this service will only come through the
First Response who will conduct a risk assessment
and provide the triage/gatekeeping function.
The service will identify other sources of support
and, with the consent of the patient, submit an
onward referral. Each sanctuary will be staffed with
a minimum of 3 members of staff per shift. These
staff will be supported by a team of volunteers.
The service accepts
• People experiencing anxiety/panic attacks
• Those with suicidal thoughts who don’t feel ‘safe’, but don’t want to
end their lives
• Those who have self-harmed but don’t require medical attention
• Those who are dissociating (but not psychotic)
• Those who are intensely depressed
• People hearing voices who know that the voices are not real
• Those experiencing PTSD
• People at a point where they feel they can’t cope but on assessment
by the First Response team (local single point of access for those
experiencing crisis) did not have the risk factors necessitating a
hospital admission
“This place has helped me come so far in my recovery. If it wasn’t for this place I might
not have made the year. It has made a difference to me. I feel like I’m not alone”Token System
Individuals can select a token that best represents the service/support they received at the Sanctuary: Green denotes good, amber denotes OK, red denotes poor
Sanctuary Cafe
A supportive space, held once a month for individuals to share their experiences of using the Sanctuary
Outcomes/feedback statements
Feedback is collected either verbally or in writing, for every individual (where appropriate), at every visit to the Sanctuary.
Cost - £365K
(commissioned
by C&P CCG)
View in presentation mode to watch
video or click here:
https://youtu.be/0DakfPALoVw
Contact: Modestas Kavaliauskas
[email protected] or Hannah Turner
Case Study
21
Mosaic Clubhouse – The Evening Sanctuary,
Lambeth
• Staffed by Mosaic Support workers and peer
supporters.
• Open 6pm-2am, 7 days a week.
• Referrals must come from: psychiatric liaison
teams in A&E; Lambeth Home Treatment teams;
CMHTs; Street triage; GPs; SLAM NHS Trust
mental health line.
• Support includes one on one sessions and an
information/signposting service.
• Attendees can access snacks and refreshments,
as well as various activities such as exercise
classes, art, videos, DVD and music, or relax in a
quiet space.
View in presentation mode to watch
video or click here:
https://youtu.be/v_Oukng_qnQ
Contact Beverley Randall b.randall@mosaic-
clubhouse.org
Case Study
22
Crisis Pad, Humber
• Operated by Humbercare, a local third
sector provider, in partnership with
Humber NHS Foundation Trust.
• Open 6pm-2am, 7 days a week.
• Staffed by qualified practitioners,
assistants and volunteers.
• Facilities include a communal lounge,
shower, snacks and refreshments and
three individual therapy rooms.
• Staff provide: signposting to other
agencies; emotional support; support for
people to manage a crisis; self-help
booklets; a follow-up appointment; a
friendly and welcoming environment;
one-to-one time and group therapy.
• Referrals must come through the Mental
Health Response Service.
• Advice and support available to carers
and family members.
“Staff at [the] Crisis Pad … have made
me feel very welcome and safe. Kept
my mind off bad thoughts, also lifted my
mood and made me feel a bit of joy”
0
20
40
60
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17
Number of referrals to the Crisis pad
100% said they were
treated with dignity at
all times.
98% said they were
happy with the way
staff listened to and
respected them.
98% said it provided a
safe, secure and
welcoming
environment.
Contact: Adrian Elsworth,
Case Study
23
Leeds Survivor-Led Crisis Service, Dial House Operating since 1999, Leeds Survivor-Led Crisis Service (LSLCS) is a mental health charity based in
Leeds, providing out-of-hours support to people in acute mental health crisis from Dial House, a place of
sanctuary which is governed and managed by people with direct experience of mental health problems.
Visitors can access a relaxing and homely environment and have an hour of one-to-one support from the
team of Crisis Support Workers. It was established as an alternative to hospital and statutory services for
people in acute mental health crisis and helps to prevent A&E attendance, police involvement and
hospital admission.
What needs can the service meet?
• The service has an open attitude to
‘crisis’, seeing it as something that
could be related to a person’s mental
health problems being particularly bad,
or a ‘life crisis’ such as relationship
breakdown, losing a job etc.
• Specialist knowledge and experience of
20 years in supporting survivors of
trauma and people at high risk of
suicide and self harm.
Special features:
• Family room so parents in crisis
can bring children with them
• Transport visitors to and from the
house by taxi to ensure their
journeys are safe and
comfortable
• Support deaf visitors using BSL
• There is more information on the
specific support offered to people
from BAME groups on the next
slide.
The video and website available
here provide more information on
the services and facilities available.
Funding:
Funding is primarily from Leeds
CCG, with additional funding from
the Lottery, charitable trusts,
consultancy fees and donations
Accessing the service:
• 6pm–2am every Monday, Wednesday, Friday,
Saturday and Sunday evenings.
• Self-referral: First time visitors can turn up at the door between 6pm and
7pm, whereas people who have been before are asked to contact the
service first as it has space to support up to ten visitors per night. People are
welcome to use Dial House as little or as often as the person feels is useful,
although the service emphasises their need to prioritise people according to
need on a given night. If the service is full, staff can provide support over the
phone via the ‘Connect Helpline’ and Teen Connect, which is open until 2.00
am every night of the year.
• Dial House has a strong relationship with the local crisis team, which often
refers people to them.
68% of their visitors are suicidal
50% are self-injuring
“I haven’t been in hospital for ages. Dial House has kept me out of hospital. I used to be admitted at weekends when I had
done something destructive. Now I make Dial House my first choice.”
View in presentation mode to watch
video or click here:
https://youtu.be/MJEs3-GLdkA
Proven track record over 20 years; pioneering, multi award winning
and referenced in Mind Listening to Experience and Department of
Health Crisis Care Concordat Implementation guidance. Offers
consultancy to other areas wishing to develop crisis services.
In 2018, an independent Social Return on Investment Analysis was
conducted on LSLCS services which concluded that for every £1 invested in
LSLCLS, the social return is £7.50-£12.50.
Contact Fiona
Venner
<Fiona.Venner@lslc
s.org.uk>
Case Study
24
Dial House @ Touchstone, Leeds
DH@T brings together LSLCS’s expertise in providing
crisis services and Touchstone’s experience of
supporting people from Black, Asian and minority
ethnic (BAME) groups. It is a culturally specific out of
hours service, where BAME staff provide crisis
support to visitors from BAME groups. It has a bridge
to the flagship crisis service, Dial House (previous
slide), supported by some staff working across both
services.
The service is held in a place of sanctuary and
provides emotional support and information for
anyone from a BAME group, including refugees and
asylum seekers. It is open Tues and Thurs, 6pm-
12am, and is staffed by a manager, senior crisis
support worker and three crisis support workers who
are all from BAME groups.
Open Tuesdays and Thursdays 6pm – 12am.
Activity:
• Between 2013-17,177 visitors made 1615 visits to
DH@T.
• It has also made the core Dial House service
more accessible: From 2011-12 just 3% of visitors
were from BAME groups, which increased to 21%
by 2016-17 after the opening of DH@T in 2013.
• While the top referrer to the core Dial House
service is the statutory NHS crisis team, the main
way people are signed posted to DH@T is by
friends – the team see this as a reflection of key
cultural difference within the communities they are
supporting.
• From their experience they have found that word
of mouth, emphasising confidentiality/trust
building, and community have all been key in the
success of the service.
• Their visitors value a BAME-led environment and
the staff’s understanding of the importance of non-
stigmatising language, and of faith and spirituality,
which are often a defining aspect of people’s lives
and identities.
• The most significant impact has been the
reduction in reported loneliness and isolation
Lottery
funding of
£500k for 5
years was
first
awarded in
2013.
Contact Carol Gatewood [email protected]
Inpatient
Admission
Alternatives
25
Acute day services provide assessment and treatment to people experiencing a mental health
crisis who would otherwise require admission to an inpatient service. People can also be
referred to acute day services to shorten their time spent in an inpatient setting. The treatment
that is provided in acute day services should be the same as that which could be accessed in an
inpatient service. These services can be provided as a part of an acute hospital unit or as a
separate unit. In some areas, they can also support relapse prevention or recovery work for
people in community services who would not otherwise need the intensity of support or
treatment from a CRHTT.
Characteristics:
• ADS teams are usually multi-disciplinary, including occupational therapists, nurses, support
workers, psychologists and doctors
• The units are open seven days a week, all year round.
• Service users can be referred to an acute day unit by their community team, GP or via the
Crisis Team. Sometimes, a service user may be referred to an acute day unit from another
acute division service (e.g. from an inpatient ward or upon discharge form a crisis house).
• Interventions include: Care planning with a named nurse including weekly 1-1 sessions;
Weekly consultant review; Physical health assessment; Occupational Therapy assessment;
Clozapine 26
Acute Day Services
Acute day services often concentrate on preventing a deterioration in mental health and facilitating early discharge from inpatient acute mental health care. Use of day services helps to manage discharge and avoid delays.
Case study
27
Acute Day Treatment Unit, Hertfordshire Partnership Trust
Herts Acute Day unit works closely with the provider’s crisis team and acute inpatient
service. It supports adults who are experiencing an acute phase of mental disorder severe
enough to require inpatient admission (if the ADU was not available) and whose needs
exceed the provisions of the home treatment team alone. It also provides respite for
carers.
It’s key objectives are to:
• Reduce inpatient admissions by providing an effective and genuine alternative to
inpatient care
• Facilitate early discharge/reduce unnecessary length of stay in hospital
• Improve service users’ experience of care by offering services and therapeutic
interventions based on a holistic, multi-disciplinary assessment of people in the acute
phase of illness.
Operating model and special features:
• Open 7 days a week – 8:30-7pm on week days and 9-5pm at weekends
• Supports voluntary patients who are referred via the crisis or liaison team (trusted
assessor). Level of support is initially high and slowly reduced over several weeks.
• Needs-led: Everyone in the service gets a combination of specific interventions via a
therapy programme which changes in accordance with the needs of the people in the
service that week. Interventions include psychological therapies, anxiety
management, DBT, relaxation techniques and meaningful activities e.g. music
appreciation
• Weekly care planning meetings led by clients who identify their own recovery goals
• ‘Moving on’ group – which provides practical support for those approaching discharge
Staffing Model: ~14.5 WTE – for a
max caseloads of 30 patients
(however not all requiring full time
support from the ADU at any one
time)
• Nursing: 1 x B7; 2.5 x B6; 1 x B5
• OT: 2 x B6; 1 x B5 (rotational
post); 1 x B3/4 OT technician
• support worker: 1 x B4; 2.5 x B3
• Team admin: 1 x B4
• Medical: 1 x associate specialist;
6 consultant sessions (provided
by 2 consultants working across
crisis teams)
“A special unit, with special
staff. You are treated as an
individual. Extensive
advice and input, all under
one roof”
Contact Teresa Maher, Team
Leader [email protected]
Crisis and recovery houses are community-based residential settings that give clinical and social support to people during a
crisis. Some crisis houses may provide specialist care for a specific population, such as women, but most are accessible to the
general population. Care is usually provided in supported housing in partnership with voluntary or social care organisations. The
function of the Crisis House is to serve as an alternative to admission into hospital, that may offer a less medicalised or
institutionalised environment. The service is aimed at supporting people who are experiencing a mental health crisis which
would result in them requiring admission, but who could be supported positively and safely in the crisis house instead. The crisis
house provides a safe alternative to home where people can recover from their crisis, be reminded of useful skills, maintain their
independence and access appropriate support.
Typical Characteristics:
• Often staffed by VCS/Support worker staff who access clinical supervision and have clinical in-reach from rapid response .
crisis teams, as well as links to Home Treatment teams.
• 24/7, residential service
• Usually need a referral from a health professional or social worker (some may be open to self-referral)
• Staff will provide a comprehensive mental health assessment, medication review, informal counselling, occupational
activity and group therapy. They can also have links with acute day services which offer one-to-one and group therapy.
28
Crisis Houses
Research has shown that people receiving care in a crisis house can have more positive experiences and create better therapeutic relationships than people receiving care in an inpatient ward. Crisis houses are also less expensive than inpatient beds and out of area placements, and recent studies show that they can improve clinical outcomes
Broadly speaking there are 4 categories of crisis house, some may be a hybrid of the following: 1. clinical crisis houses, providing residential services with staff onsite through the night and have a high level of
clinical staff involved in providing onsite care; 2. specialist crisis houses, which share similar features to clinical crisis houses but are imed at specific groups such
as women and people with early psychosis; 3. crisis team beds, which provide a small number of beds aimed at short stays and are fully integrated with Crisis
resolution and home treatment (CRHT) teams and 4. non-clinical alternatives, which are mainly managed by the voluntary sector with few clinical staff but many
have also forged strong links with CRHT teams.
Case study
29
The Warren, Northampton (1/2)
Staffing Model: 12 x Band 4 support workers overseen by a
Band 7 operational manager. The Urgent Care and Assessment
Team provide medical oversight, with interventions provided by
the Home Treatment Team as required.
In 2016 Northamptonshire Healthcare NHS Foundation Trust opened a 7-bedded crisis house providing an alternative to acute
mental health admission for people experiencing a mental health crisis in the south of the county. The house offers short term
admissions of between 2 and 5 days, it is a homely environment designed with service users and carers and is staffed by
support workers rather than nurses.
Prior to the house opening, the options for managing an acute crisis were limited to either a period of home treatment or an
admission to mental health inpatient services.
Activity and Impact:
Between August 2016 and November 2017 The Warren
accepted over 290 referrals with an estimated 74% of these
identified as avoiding an acute admission to hospital.
The average length of stay in the house was 5.9 days, which is
much lower than an average acute inpatient admission, whilst
also costing significantly less per day (£250 compared with
£456 for an in-area bed and £509 for an out of area bed).
The establishment of the house appeared to prevent the 20%
increase in bed occupancy in the south of the county that was
experienced in the north of the county in 2017.
The Trust recently worked with the Economics team at NHS
Improvement to evaluate the economic impact of the house.
The full report can be found here, estimating that The Warren
helped to avoid costs up to a potential £200K per quarter.
Other benefits are evidenced by the excellent feedback from
service users and carers, many of whom see it as a place of
safety at a vulnerable time. Service users said that hospital
admissions could be traumatic and disempowering even when
care quality is good, while the house, located in a residential
area, is designed to feel more like a home than a healthcare
facility.
A service user
shared his
experience of The
Warren in a blog
on Sane’s website.
The house has separate gender
corridors and an additional room
that could be used for any gender
dependent on demand or for
someone who does not identify
with a specific gender.
The house serves the south of the county, which has a
population of around 345,000 people. Following success of the
crisis house, the local trust is seeking to expand to have a
house in the north half of the county
One-off capital costs: £234,280, Recurrent costs: £427,319
Estimated costs avoided following introduction of the crisis house
Case Study
The Warren, Northampton (2/2)
30
Contact: Jen Holling
Northamptonshire Foundation Trust
Email: [email protected] / [email protected]
31
The Tower Hamlets Crisis House (voluntary sector), in partnership with the local home treatment team, offers a brief residential alternative to
psychiatric hospital admission. The service collected clinician-reported (Health of the Nation Outcome Scales; HoNOS) and patient-reported
(DIALOG) outcome scores from successive admissions between June 2015 and December 2016, to assess the effectiveness of the service model.
Results A statistically significant improvement in nine out of ten domains of HoNOS and three out of eight domains of DIALOG were found.
Conclusion: A partnership between a home treatment team and crisis house can result in positive outcomes for patients, as determined by both
clinicians and patients. Link to the published study
Lower score better:
improvement in all
domains (statistically
significant in 9)
2 point scores
obtained for 91/153
(59.5%) patients
Higher score better:
improvement in all
domains,
(statistically
significant in 3)
scores obtained for
62/153 (40.5%)
patients
Case study: Tower Hamlets Crisis House and Home Treatment
Team Partnership, effectiveness and clinical outcomes
Contact
Is Crisis House providing a true alternative?
41%
7%45%
4% 2%0%
TH 2011 census
asian british
black british
white
mixed
other
not known
*Babayeva, Murguia, Bhattacharya
(2015) Evaluation of Impact of Crisis
House (within a Home Treatment Team)
In offering a true alternative to acute
psychiatric inpatient admission, RCPsych
International Congress
Diagnosis
Ethnicity
CHopened
Occupancy data in context of population growth of 263k (2012) to 328K in 2020 - approx. 25% growth in 8 years in T Hamlets
Case study
33
Drayton Park Women’s Crisis House, Camden and Islington NHS Foundation Trust, Islington (1/2)
Drayton Park Women’s Crisis House and Resource Centre’ founded in 1995 as an alternative to hospital for women in
mental health crisis’.
Drayton Park is a residential crisis house for women who would otherwise be admitted to hospital . The crisis house has
developed over the 25 years a trauma informed approach (see slide below for the Drayton Park Model designed by Shirley
McNicholas)
Special features:
The service has a women only team and the team are recruited based on skills, attitudes and experiences and not professional qualifications.
The service can also accommodate children if safe and therapeutic to do so.
Women who have used services were involved in the development of this service and continue to be via the Women’s Strategy Group and the
Black Women’s forum.
Women are offered a weekly support group to return to whenever they wish to offer a women only space after they leave.
The service has been robustly evaluated formally and has proven to be a high quality true alternative to hospital admission. ‘Drayton Park , an
alternative to hospital admission for women in acute mental health crisis’ Helen Killaspy etc at Psychiatric bulletins Volume 24 , Issue 3 March
2000.
Accessing the service:
The service takes referrals from all sources included self referral for women living in Camden and Islington and assessments are offered at the
house. Assessment and the service includes routine inquiry of past or current abuse and embeds the understanding that these experiences will
have led to the mental health problem or contributed to them.
Women are offered to stay for a week and during that time are offered one to one time daily, some group work . They are also offered body work
by massage therapists and access to other professionals if needed such as a counsellor, psychiatrist or psychologist to enhance the work of the
core team.
Women stay on average 19 days and have their own bedroom and bathroom en-suite. The service is provided within a homely setting with art
work reflecting the diversity for the women who stay.
Measuring the impact and improving quality
An assessment framework has been designed in collaboration with women who have used
services and an ‘Agreement Plan’ is produced on admission, focusing on what can be
achieved together.
Service users’ views are regularly obtained through service user feedback, daily house
meetings and the monthly service user forum. Many women have been involved in the
ongoing development of the service, such as the self-harm minimisation policy. Service users
are also involved with interviewing staff.
For more information, visit the Camden and Islington NHS Foundation Trust website
34
Drayton Park Women’s Crisis House, Camden and Islington NHS Foundation Trust Islington (2/2)
Contact: Shirley McNicholas,