Trust introduces a series of measures to reduce pressure on emergency services exercised by mental health patients, reducing 20 per cent bed occupancy

Outline:

CRISIS COMMUNITY SERVICES were a series of co-produced measures put in place in the Northamptonshire community to prevent or support people in mental health crisis to get the right care and aim to reduce the burden on acute inpatient mental health and emergency services. CRISIS HOUSE (known as ‘The Warren’) was launched in August 2016 to offer an alternative to acute mental health admission for those in crisis.

Rooms are available in a dedicated bungalow for short stays where individuals can engage in collaborative, non-judgemental recovery. Building on this success, CRISIS CAFES were piloted in January 2017 in collaboration with MIND with the primary aim to provide a safe out of hours space for service users to seek help for a mental health crisis without having to rely on A&E departments, or other emergency services. 

Due to success and positive feedback from service users, this was rolled out further in 2017 and 2018, thereby now providing Crisis Café coverage all week across the county. The provision of these safe community spaces for those in crisis has resulted in significant financial system savings, and there is also evidence of reduced admissions and therefore reduction in bed occupancy.

Challenges:

Since 2015/16, Northamptonshire has seen a 7% increase in bed occupancy and 12% increase in the number of people in contact with mental health services. With below average acute bed numbers relative to local need, NHFT struggled with limited inpatient capacity and admitted patients out of area to deal with demand. Additional challenges of crisis care management included overburdened A&E and other emergency services.

A lack of out of hours mental health provision meant patients experiencing or at risk of crisis had few safe options. NHFT Mental Health Directorate is passionate about developing services based on the IMROC/NHS principles of recovery (evidence pg 1), and believes co-production with patients and carers results in services and care plans that deliver against outcomes which truly matter to patients.

The aim was to create services that deliver the right help, at the right time, in the right place for the individual; that are able to refer or access multi-agency resource from one location, just as would be available in the event of a physical health crisis. Additionally, our aim was to reduce burden on acute inpatient mental health, out of hours and emergency services, and deliver financial savings to the local system.

Outcomes:

Crisis House and Cafés were co-produced with individuals who have lived experience of crisis services. These experts by experience helped to define a series of ‘I Statements’ (evidence pg26) which can be measured as patient outcomes of the services. The feedback received from service users (evidence pgs 6,8,17,21) demonstrates the successful development of a service that works for individuals in crisis, and would be recommended by them.

Our other aim was to reduce the burden on acute inpatient mental health, A&E, ambulance services, police and other out of hours service provision from individuals in mental health crisis, and we are proud of the following outcomes:

• 74% of the admissions to Crisis House between August 2016 and November 2017 avoided acute admission to hospital

• Establishment of Crisis House has prevented the 20% increase in bed occupancy seen in the North of the county from happening in the South.

• Crisis Cafés played a significant role in the attainment of a first year ‘Frequent Attenders CQUIN’ achievement of 44% across the county

• The co-production of Crisis House was referenced by the CQC in its 2018 report of our Outstanding ‘Caring’ and ‘Well-Led’ ratings

Spread:

The successful embedding of the Crisis House paved the way for Crisis Cafés - it was felt by staff and service users alike that if there was somewhere for individuals to self-refer to when needed, they may be able to access the right help and support quicker, in a safe environment, and avoid going into crisis.

The first Crisis Café opened in Northampton in January 2017, and its successes and learnings allowed for Crisis Cafés to open across the rest of the county – in Kettering, Rushden, Daventry, Corby and Wellingborough. The responsive nature of Crisis Cafés also provides an accessible option to wider strategic partners including the police and ambulance services who can now take service users in distress directly to a café where appropriate.

Internal Trust teams have been engaged, allowing the MIND café staff to be able to refer service users directly into the Trust’s Urgent Care and Assessment teams when needed. This has also allowed for wider planned care services to be able to offer the cafés as part of their risk management and crisis planning.

Value:

• Crisis House has saved up to £800,000 in one year in avoiding further acute outflows and preventing requirements for acute mental health service interventions.

• Crisis House has a bed day cost of £195 per 24 hours – significantly less than NHS reference bed day costs for acute mental health services

• Crisis Café usage extrapolated across the year has resulted in a system saving of between £20,592 and £160,716

As well as clear financial savings and efficiencies in reduced acute A&E, police and ambulance contacts, the value of the Crisis Cafés can clearly be measured by the positive patient experience results. One commented, “It helps me… I haven’t made one visit to A&E this month and that, for me, is progress.” Another stated that they had not self-harmed once in the ten days since visiting a Crisis Café (evidence pg21).

A carer who was heavily involved in the co-production of the Crisis House stated, “It embodies recovery in so many ways: recovery for the service users using The Warren, recovery within NHFT’s mental health services by means of organisational change, and recovery for all those who built the framework from which The Warren grew”

Involvement:

The Crisis House service model was designed in collaboration with service users and carers who have a lived experience of mental health services when they are in crisis. For example, preferences of service users and carers were taken into account ensuring the house had separate gender corridors, but also a space where someone who does not identify with standard gender definitions can be supported as required.

This collaboration not only formed a key part of the service development from the point of business plan design, but also mobilisation to opening and reference group review. The input of service users and carers defined a series of ‘I Statements’ (evidence pg26) to be measured as outcomes of the services. We continue to hold monthly user forums to gauge the impact of all areas of the crisis services and develop them accordingly.

The Crisis Cafés were developed and are run in partnership with MIND, to ensure the Cafés meet the needs of users at all levels of crisis. Additionally, the Crisis Concordat group has been fully engaged throughout the developments and this has assisted to ensure partners such as the police and ambulance services are able to use the resource effectively.