1. Cardiff and Vale Community Crisis House Jayne Bell – Team Leader South Cardiff/Vale CCRHTT Richard Bundy – Service Manager Gofal Cymru Leading innovation and quality in mental health services

2. Introduction Briefing on Gofal Cymru Briefing on Gofal Cymru Briefing on Community Crisis House Briefing on Community Crisis House Briefing on Collaborative Approach Briefing on Collaborative Approach Future development opportunities Future development opportunities Q & A session Q & A session Leading innovation and quality in mental health services

3. The Work of Gofal Celebrating18 years as a leading Mental Health Charity in Wales Celebrating18 years as a leading Mental Health Charity in Wales Working across eleven local authority areas and employing in excess of 100 people. Working across eleven local authority areas and employing in excess of 100 people. Providing a range of specialised services including - Providing a range of specialised services including - Employment schemes. Employment schemes. Tenancy Support. Tenancy Support. Supported Housing. Supported Housing. Lobbying Lobbying Crisis House Crisis House Leading innovation and quality in mental health services

4. Aims of the Crisis House People experiencing severe mental health difficulties should be supported in the least restrictive environment with the minimum of disruption to their lives. People experiencing severe mental health difficulties should be supported in the least restrictive environment with the minimum of disruption to their lives. To serve patients of the Crisis Resolution & Home Treatment Teams who act as gatekeeper to the service To serve patients of the Crisis Resolution & Home Treatment Teams who act as gatekeeper to the service Provide intensive support to clients in the Crisis House as an alternative to inpatient care in an un-institutionalized environment. Provide intensive support to clients in the Crisis House as an alternative to inpatient care in an un-institutionalized environment. Leading innovation and quality in mental health services

5. Aims of the Crisis House To provide practical and emotional support to individuals who are experiencing an acute psychiatric crisis. To provide practical and emotional support to individuals who are experiencing an acute psychiatric crisis. Avoid Hospital Admission. Avoid Hospital Admission. Promote service user choice. Promote service user choice. Be actively involved in provision of support to facilitate a return to the individuals home. Be actively involved in provision of support to facilitate a return to the individuals home. Leading innovation and quality in mental health services

6. Criteria for Admission Accepted by one of the CRHTT Accepted by one of the CRHTT Need to considered as appropriate for hospital admission. Need to considered as appropriate for hospital admission. Less likely to respond to those with mild anxiety disorders, Primary diagnosis of alcohol substance misuse, organic disorders. Less likely to respond to those with mild anxiety disorders, Primary diagnosis of alcohol substance misuse, organic disorders. No blanket rules – referral dependent upon assessment of CRHTT. No blanket rules – referral dependent upon assessment of CRHTT. Leading innovation and quality in mental health services

7. What the House Provides Twenty-four hour waking cover with high staff to resident ratio. Twenty-four hour waking cover with high staff to resident ratio. Therapeutic/homely environment. Therapeutic/homely environment. Intensive social and emotional support/planning. Intensive social and emotional support/planning. Support with daily living skills. Support with daily living skills. Signposting to services. Signposting to services. Liaison with carers. Liaison with carers. Observation and liaison with CRHTTs. Observation and liaison with CRHTTs. Leading innovation and quality in mental health services

8. Reasons for Referral Leading innovation and quality in mental health services Poor living conditions Risk cannot be managed by home visits alone Abusive relationship/something in the home is causing/exacerbating the crisis Self-neglect

9. Reasons for Referral Carers needing respite from crisis Less stigmatizing than hospital Easier to maintain social networks Ability to carry out a fuller assessment of daily living (ADLs) Leading innovation and quality in mental health services

10. Service User Perspective Significant number of service users with experience of hospital admission. Significant number of service users with experience of hospital admission. 95% of service users rated the house good or excellent in comparison to hospital. (89 % excellent) 95% of service users rated the house good or excellent in comparison to hospital. (89 % excellent) 99% felt they had good or excellent access to staff 99% felt they had good or excellent access to staff 95% felt the benefit to their mental health was good or excellent. (81% excellent) 95% felt the benefit to their mental health was good or excellent. (81% excellent) Leading innovation and quality in mental health services

11. Case Study-Background to Referral 19 year old male 19 year old male 1 st presentation to services 1 st presentation to services Difficult social system Difficult social system History of substance misuse, of a binge nature History of substance misuse, of a binge nature Petty crime Petty crime Leading innovation and quality in mental health services

12. Case Study - Assessment Initially seen by SHO who identified ongoing risk of potential suicide. Initially seen by SHO who identified ongoing risk of potential suicide. Seen on poisons unit after an attempted overdose, coupled with failed hanging attempt Seen on poisons unit after an attempted overdose, coupled with failed hanging attempt Lengthy assessment; uncommunicative, sullen, poor eye contact, embarrassed Lengthy assessment; uncommunicative, sullen, poor eye contact, embarrassed Would not divulge thoughts/feelings Let me go home Would not divulge thoughts/feelings Let me go home Leading innovation and quality in mental health services

13. Considerations Mothers feelings/observations/wishes. Scared to have son home vs wishing to avoid a compulsory admission. Mothers feelings/observations/wishes. Scared to have son home vs wishing to avoid a compulsory admission. Clients fear/pride etc. Preventing him being open and honest. Clients fear/pride etc. Preventing him being open and honest. The need to keep himself safe and to observe his mental health vs risk of labelling. The need to keep himself safe and to observe his mental health vs risk of labelling. Leading innovation and quality in mental health services

14. Crisis House Stay Visited twice daily by CRHT clinical staff. Visited twice daily by CRHT clinical staff. Reviewed by team Psychiatrist on 1 st full day in house Reviewed by team Psychiatrist on 1 st full day in house Prescribed only lorazepam and zopiclone PRN, given on the twice daily visits when deemed necessary. Prescribed only lorazepam and zopiclone PRN, given on the twice daily visits when deemed necessary. Stay extended to 10 days to accommodate his mothers days off work. Stay extended to 10 days to accommodate his mothers days off work. Leading innovation and quality in mental health services

15. Crisis House Input Regular one to one support. Developing trust around disclosure on mental health. Regular one to one support. Developing trust around disclosure on mental health. Support and information around use of leisure/employment. Support and information around use of leisure/employment. Support and information around use of Drug and Alcohol services. Support and information around use of Drug and Alcohol services. One to one support for relative with provision of carers information pack. One to one support for relative with provision of carers information pack. Provision of a leaving pack for client. Provision of a leaving pack for client. Close liaison with CRHTT Close liaison with CRHTT Leading innovation and quality in mental health services

16. Benefits of Crisis House Stay Liaison between his divorced parents on his behalf Liaison between his divorced parents on his behalf Time out for all concerned Time out for all concerned Ability to spend 10 days away from his drug taking circle (identified by client) Ability to spend 10 days away from his drug taking circle (identified by client) Close monitoring of his mental health – option to start on a low dose of anti-psychotic in a monitored environment. Close monitoring of his mental health – option to start on a low dose of anti-psychotic in a monitored environment. Leading innovation and quality in mental health services

17. Outcome Client had 10 day spell of 24 hour monitoring without need for admission. Client had 10 day spell of 24 hour monitoring without need for admission. Team had ability to make a working diagnosis Team had ability to make a working diagnosis Family had the opportunity to talk about their concerns for their son, be supported and receive guidance on how to cope Family had the opportunity to talk about their concerns for their son, be supported and receive guidance on how to cope Leading innovation and quality in mental health services

18. Statistical Information 254 referral accepted since opening. 254 referral accepted since opening. 88% Hospital avoidance. 88% Hospital avoidance. Incremental increase in referral quarter on quarter. Incremental increase in referral quarter on quarter. 83% of service users previously admitted to hospital had experienced longer stays than at the crisis house. 83% of service users previously admitted to hospital had experienced longer stays than at the crisis house. Leading innovation and quality in mental health services

19. Learning and Service Development Commissioners need to consider the configuration of services to meet local need e.g. staffing levels, medicines regime/arrangements for clinical input. Commissioners need to consider the configuration of services to meet local need e.g. staffing levels, medicines regime/arrangements for clinical input. Geography/demography of service area needs to be considered. Geography/demography of service area needs to be considered. Collaborative approach needs a maintenance component. Collaborative approach needs a maintenance component. Leading innovation and quality in mental health services

20. Conclusions Crisis House provision can assist in hospital avoidance. Crisis House provision can assist in hospital avoidance. Provides a viable alternative to hospital. Provides a viable alternative to hospital. Promotes choice for service users and professionals Promotes choice for service users and professionals A service more in line with the wishes of service users and carers. A service more in line with the wishes of service users and carers. Leading innovation and quality in mental health services

21. Thank you. Any Questions? Leading innovation and quality in mental health services

22. For information on the Community Crisis House and Report please contact – Alexandra McMillan 01656 647722 alexandramcmillan@gofalcymru.org.uk Leading innovation and quality in mental health services