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Trust undergoes a service transformation to ensure young people are not in Tier 4 units longer than necessary, resulting in no admissions for almost three years

Challenge

    • With in-patient units at full capacity, some young people in crisis were admitted to adult psychiatric wards or kept in police cells
    • These had harmful effects
    • Need to ensure that young people are not in beds or Tier 4 units longer than necessary

Action

    • Introduced a new Crisis and intensive home treatment team to provide brief intensive home based treatment for those young people at the highest level of need and risk

Result

    • No child or young person in a Tier 4 bed for almost three years
    • No children and young people (CYP) in police cells
    • CYP were seen within two hours of admission
    • Rated outstanding by the CCG

Inpatient services for young people with severe mental health difficulties have been found to be effective (Green et al., 2007; Blanz & Schmidt, 2000). However, in recent years a shift has occurred whereby greater emphasis has been placed upon the viability of community-based care, in an effort to improve patient wellbeing and increase cost effective healthcare and patient satisfaction (Munton et al., 2011; Ryan, 2015; McDougall & Cotgrove, 2014).This change in emphasis has been partly due to economic pressures and resource constraints resulting in a reduction in expensive in-patient beds (Priebe et al., 2008; McDougall et al., 2008).

With in-patient units at full capacity, some young people in crisis have been admitted to adult psychiatric wards (O’Herlihy et al., 2003) or kept in police cells (RCPsych, 2015) which have been associated with well-documented detrimental effects (Street & Svanberg, 2003)). As a result of these pressures, the need for easier access and increased flexibility to crisis services has been stressed (Lavis & Hewson, 2011; RCPsych, 2015). The North East Lincolnshire Child and Adolescent Mental Health Service (NEL CAMHS) underwent a service transformation in April 2013.

In August 2013, a new Tier 3+ service became operational which was set up to provide brief intensive home based treatment for those young people at the highest level of need and risk. The service aimed to prevent hospital admission by positively managing risk, reduce admissions year on year to Tier 4 beds and ensure that young people are not in medical beds or Tier 4 units longer than necessary. Almost immediately this project was a success so much so we havent had any child or young person in a Tier 4 bed for almost 3 years.

Challenges

Staff reluctance to change old way of doing things this meant we had to positive risk take which is always scary at first Trust felt this new model was controversial

Actions

Employed new staff for the new team willing to change things if they didnt work until we got a way of acheiving optimal staffing of the 24/7 rota

Developed a lessons learnt after every s 136 to help integrate with other agencies and work together better eg. police and A & E staff.

New building which houses all of the CAMHS team so we can all support and use our speciaisms to advise

Results

Massive reduction in Tier 4 need therefore reduction in costs

No CYP in police cells

CYPs seen within 2 hours

24/7 having to be away from family and friends during a crisis all in the past 3 years

Value

Massive reduction in Tier 4 need therefore reduction in costs commissioners projected that we would have needed 44 Tier 4 beds so we have saved this cost

No CYP in police cells value in no young person with mental health difficulties has been put in police cells, CYPs seen within 2 hours 24/7- prevents crisis escalating possible preventatvie Tier 4 admission value in that CYP receives the care they need at the right time in the right place. reduces the risk of being away from (biggest support usually) family and friends during a crisis

Research shows a significant reduction in crisis presentation after Crisis and Intensive home treatment team have been involved.

Re refferal rates are very low at 0.05 all in the past 3 years

Outstanding CQC rating

Norman Lamb visited and thinks we have an excellent model

Other providers and commissioners often visit our service to look at our model and how thiey can acheive similar results.

In detail

Ambition and spread

Inpatient services for young people with severe mental health difficulties have been found to be effective (Green et al., 2007; Blanz & Schmidt, 2000). However, in recent years a shift has occurred whereby greater emphasis has been placed upon the viability of community-based care, in an effort to improve patient wellbeing and increase cost effective healthcare and patient satisfaction (Munton et al., 2011; Ryan, 2015; McDougall & Cotgrove, 2014).

This change in emphasis has been partly due to economic pressures and resource constraints resulting in a reduction in expensive in-patient beds (Priebe et al., 2008; McDougall et al., 2008). With in-patient units at full capacity, some young people in crisis have been admitted to adult psychiatric wards (O’Herlihy et al., 2003) or kept in police cells (RCPsych, 2015) which have been associated with well-documented detrimental effects (Street & Svanberg, 2003)). We did not have any Tier 4 beds local to our area we often had to send CYP out of area many miles away from family and friends, this often escalated the crisis and they ended up being away for many months.

We wanted to find a local solution to this one that would be beneficial for our local population.

Value

As a result of these pressures, the need for easier access and increased flexibility to crisis services has been stressed (Lavis & Hewson, 2011; RCPsych, 2015). The North East Lincolnshire Child and Adolescent Mental Health Service (NEL CAMHS) underwent a service transformation in April 2013. In August 2013 a new Crisis and intensive home treatment team became operational which was set up to provide brief intensive home based treatment for those young people at the highest level of need and risk.

The service aimed to prevent hospital admission by positively managing risk, reduce admissions year on year to Tier 4 beds and ensure that young people are not in medical beds or Tier 4 units longer than necessary. Almost immediately this project was a success so much so we havent had any child or young person in a Tier 4 bed for almost 3 years. The financial value has been estimated as the reduction in need for 44 Tier 4 beds however the value of providing crisis and intensive treatment to CYP’s in our area is nor measurable except in patient satisfaction and recovery outcomes which we can provide.

Involvement

Through the development of this team and the mental health concordat we have developed collaborative working with various other agencies and we now have excellent professional interactions. Patients have been involved in developing our service further and have participation and support groups to help this. Parents also have a parent participation group to also provide information about how they wish to see their services devlop in the future.

We believe we are providing an excellent service for the local population but this is nice when respected services also confirm this, we had an Outstanding CQC rating Norman Lamb visited and thinks we have an excellent model. Other providers and commissioners often visit our service to look at our model and how thiey can acheive similar results.

Categories

Focus of improvement

Service

Type of organisation

Year