Effective Services for people in mental health crisis

The Respite and Wellbeing HouseSwindon Mind

11.20 – 12.20 Sub Plenary Session

WSP2 – Effective Services for people in mental health crisis

Charter 1

Swindon Mind – The Respite and Wellbeing House

The Respite and Wellbeing House

• The types of Crisis House• The Non-Clinical Model – successful?• A brief history of Swindon Mind’s Crisis House• The Respite and Wellbeing House – evidence?• The Mental Health Crisis Care Concordat

The Crisis House ModelThese are community-based crisis services that offer residential support and include:Clinical crisis housesThey provide residential services with staff onsite through the night and have a high level of clinical staff involved in providing onsite care.Specialist crisis housesThese services share similar features to Clinical crisis houses but are aimed at specific groups such as women and people with early psychosis.Crisis team bedsThese services provide a small number of beds aimed at short stays and are fully integrated with CRHT teams.Non-clinical alternativesMainly managed by the voluntary sector with few clinical staff but many have also forged strong links with CRHT teams.

[accessed 12th Oct 2014] http://www.jcpmh.info/commissioning-tools/cases-for-change/crisis/what-works/crisis-houses/

The Non-Clinical Model

“One of the world’s great mysteries is why we don’t have more [crisis houses]”

Mind Guide to Crisis Services 2012

http://www.jcpmh.info/commissioning-tools/cases-for-change/crisis/what-works/crisis-houses/

The Non-Clinical Model – unsuccessful?

• Crisis houses however will be relevant for a relatively restricted population and may have modest benefits if home treatment is properly equipped and fully functional.

• Where crisis houses have been unsuccessful, this is where staffing is low and remote from inpatient units.

[accessed 12th Oct 2014] http://www.jcpmh.info/commissioning-tools/cases-for-change/crisis/what-works/crisis-houses/

The Clinical Model – successful?

The investigation also found:• NHS trust admitted patients to hospital without beds being available as no

beds could be found in the public or private sectors• The NHS continues to spend millions of pounds sending severely ill patients

to private hospitals, often hundreds of miles from home• Children and young people are being admitted to adult psychiatric wards

due to nationwide pressures on specialist children’s beds• Pressures to free-up beds are leading to patients being discharged too early,

social workers warn. At one trust bed pressures meant one patient was admitted eight times in 12 months

• Although the Royal College of Psychiatrists recommends occupancy levels of 85%, individual wards were running at up to 138%.

Andy McNicoll on October 16, 2013 in Mental Health, Mental Health Act, The state of mental healthcare

Mental health crisis services in England are “unsafe” and delivering substandard care to acutely unwell adults and children, an investigation by Community Care and BBC News has revealed.

The Non-Clinical Model –the evidence for

• Non- Clinical Crisis Houses have been found to be cheaper than standard Psychiatric services (Byford & Sharac, 2002: Fenton et al. 1998, 2002: Hawthorne et al. 1999)

• Patients who use crisis houses have been found to spend less time in Crisis houses than in standard wards (Byford & Sharac, 2010)

• Once admitted to a Crisis house, it has been found that there is a reduction in use of Psychiatric units and A & E departments (Hodgson, Carr & Wealleans, 2002)

• Patients who have used Crisis houses have shown to have an improvement in Psychological functioning and a decrease in symptoms (Meiser-Steadman, Howard & Cutting, 2006)

• Compared with standard care, Patients were more satisfied with Crisis house services and felt less coercion and negative pressure in Crisis houses (Osborn et al 2010)

• Those who use Crisis houses tend to admit themselves voluntarily, less likely to need 24 hour care or require supervision (Howard et al. 2008)

A brief history of Swindon Mind’s Crisis House

• A pilot in 2006 in partnership with Avon & Wiltshire Mental Health Partnership NHS Trust

• Based at Sandalwood Court, on-site to the hospital service• After an AWP internal restructure and estate management the Crisis House

was decommissioned (Aug 2013)• Our solution was the community based Respite and Wellbeing House

Service (Sept 2013)

RESPITE SUPPORT:

• Providing peace, rest, de-escalation of crisis, and a community of peers that can support

The Respite and Wellbeing House

WELLBEING SUPPORT:

• Person Centred and non-judgemental support – responding to assessment requirements and subsequent one to one’s whether informal (when guest needs more solitude, sleep and peace), or formal (when the guest appears sufficiently rested and ready to engage support).

• Peer Support – providing practical peer support during stay

• Solution-focused support– listen to concerns and issues and finding the solutions and options, identifying inner strengths and their own natural coping mechanisms.

• Wellbeing planning, that can include Five Ways to Wellbeing that provides step by step SMART goals.

The Respite and Wellbeing House

Every guest at the Respite and Wellbeing House has a;

• Five Ways to Wellbeing Plan

• Wellbeing and Resilience Action Plan (WRAP)

• Producing an Outcomes Case Study

Respite and Wellbeing House

Every guest at the Respite and Wellbeing House is;

• Monitored after leaving the Respite and Wellbeing House• By Phone Call or Email• Where applicable invited to an;

• Informal group meeting• Informal one to one meeting• Or Formal Five Ways to Wellbeing Planning Meeting

The Respite and Wellbeing House

Preventative Service – case study of cost avoidance

The Respite and Wellbeing House

Preventative Service

The Respite and Wellbeing House

The Respite and Wellbeing House

The Respite and Wellbeing House

Mental Health Crisis Care Concordat:Improving outcomes for people experiencing mental health crisis

• Access to support before crisis point • Urgent and emergency access to crisis care • Quality of treatment and care when in crisis • Recovery and staying well / preventing future crises

The following statements were developed by Mind, the mental health charity, with service users, families and carers in a consultation carried out for the Concordat.

Don’t wait for it to become a crisis!

One way to respite withFive Ways to Wellbeing