Innovation and new initiatives case-studies: Rotherham Crisis Resolution and Home Treatment Service and Portsmouth Central Point

Anybody can find themselves in a mental health crisis – from people with an existing and severe mental illness to those who have never previously experienced mental ill-health.

Social factors can contribute to a sudden deterioration in a person’s mental health – for example relationship breakdown, redundancy, debt, housing problems – and for many people a hospital psychiatric ward is not the best place to get the help they need so that they can recover as quickly as possible.

Cedar House, a large detached house in Rotherham, offers an innovative and effective alternative to hospital admission. Four crisis beds are available to people who are experiencing a mental health crisis for up to seven nights. While staying at Cedar House they can benefit from 24-hour emotional and practical support to help them get back on their feet.

It is a great example of Rethink working in partnership – with Rotherham Metropolitan Borough Council and Doncaster and South Humber Healthcare NHS Trust – with Rethink providing the accommodation-based aspect of the crisis service.

A multi-agency team based in the house offers a flexible service that really makes a difference to people with mental health problems. People using the service and carers were involved in designing the service, which complements the statutory crisis resolution and home treatment team that was already working 24 hours a day.

The team combines community mental health workers alongside consultant, specialist, registrar and staff grade psychiatrists, specialists in clinical nursing, social workers and mental health nurses. They can respond to a crisis within two hours, will offer treatment at home wherever possible and where not possible, they offer beds in Cedar House.

“The attic and basement house our crisis and home treatment staff while the middle two floors are accommodation. There are four bedrooms and a standard kitchen, so people can carry on with their daily living tasks,” said service manager Philippa Smith.

The crisis resolution and home treatment team assesses individuals and can refer people to the Rethink accommodation service for up to seven nights. They also provide all out-of-hours assessments. On admission, Rethink puts together a recovery plan with the person, looking at what they want to achieve and how we can support them.

“We see people from both ends of the spectrum – those with severe and enduring mental health problems who have used services for many years (those with schizophrenia or bipolar disorders, for example) to people whose mental health has deteriorated slightly for any number of reasons. These could be relationship breakdown or problems with neighbours.

“These people are not so unwell that they need admission to a psychiatric ward, but they need increased help to get them over what’s going on,” said Philippa.

For some of the people who come to the service this will be their first involvement with mental health services. Many have taken overdoses impulsively, gone to hospital, been deemed medically fit and then assessed by the crisis team. They’ll stay for few days, be discharged and will then possibly have no further involvement with mental health services.

The service was set up when the National Service Framework recommended that commissioners provide an alternative to hospital. The team has comfortably met its original target of 3,400 hospital bed days saved and more than 700 people were assessed by the service in the six months to September 2004.
 
“The feedback that we get is very positive. Especially from people who’ve been involved with services for many years – people who’ve had to go on a ward because there’s been no alternative,” says Philippa.
The service was a national finalist for the NHS Live award for Innovation and Improvement at the Health and Social Care Awards in 2005.

Portsmouth is home to one of Rethink’s most innovative services, which has grown out of the needs of the community and is a prime example of what can be achieved when several agencies combine experience and work together with the same goal.

Central Point is a modern building that houses an impressive day centre offering a wide range of services for homeless and inappropriately housed people – many of whom have, or are at risk of developing, mental health problems.

“We are part of the safer Portsmouth partnership – involving the drug action team, anti-social behaviour unit, and other statutory and voluntary agencies. People come in off the street or are directed by the police and hostels. We also help those who are sleeping in squats or on sofas,” said service manager Stuart McDowell.

“We have 11 staff, a couple of bank workers and a team of about five volunteers.
About 30 people access the service every day during the week.”

The centre has a safe, welcoming feel with its sofas and fish tank, where people can relax and socialise in a secure environment. Staff direct them to hostels and give information about where they can access the help they need. Much of what is done at Central Point is respite for people who are sleeping rough.

Stuart says Central Point is a key part of homelessness services in Portsmouth. This is evidenced by the fact that each new police recruit in Portsmouth has a two week induction at the service.

People attending the centre benefit from weekly visits by an alcohol and substance abuse service, a mental health practitioner and a GP, for those who aren’t registered with a practice. Around a third of those using the centre have mental health problems, and many of them have substance and alcohol misuse issues as well.

“People who rough sleep are more at risk of developing mental health problems than usual, so the work we do is around prevention as well – avoiding mental health decline,” said Stuart.

There are also hot meals every day for 50p, showers, laundry facilities and space for people sleeping rough to store belongings. Central Point is also a Big Issue distribution office for Portsmouth, Southampton, Chichester and the Isle of Wight.

“A typical case study of someone we’ve helped is a man who was rough sleeping and begging. We linked into him through our outreach workers who got him coming in to the centre. He started selling the Big Issue, then we gave him a rent deposit and he moved into accommodation. He kept selling the Big Issue and is now fairly stable.”

Its rent deposit scheme has links with approximately 15 local landlords. It pays them a deposit so people can move into a property and then take on the rental payments. The cost of providing this is far less than the equivalent cost of housing people in hostels.

The service was commissioned mainly by Portsmouth City Council but also receives funding from the Drug Action Team for outreach work and the Drug Implementation Programme.