Effective Services for people
in mental health crisis
The Respite and Wellbeing House
Swindon 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
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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 Model
These are community-based crisis services that offer residential support
and include:
Clinical crisis houses
They provide residential services with staff onsite through the night and
have a high level of clinical staff involved in providing onsite care.
Specialist crisis houses
These services share similar features to Clinical crisis houses but are
aimed at specific groups such as women and people with early psychosis.
Crisis team beds
These services provide a small number of beds aimed at short stays and
are fully integrated with CRHT teams.
Non-clinical alternatives
Mainly 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?
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 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
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)
The Respite and Wellbeing House
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.
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
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
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.
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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
Don’t wait for it
to become a crisis!
One way to respite with
Five Ways to Wellbeing