The recent CQC report on the quality of specialist mental health care in England highlighted challenges facing mental health services, including high demand and bed shortages. It was a good reminder of the ambitions of the five year forward view for mental health - for people to have easy access to high quality care close to home.

Bradford faced the same challenges with a large number of people presenting at A&E, inpatient wards over-occupancy and regularly having to place people out of area – Bradford’s mental health crisis service was under severe strain.

"The change to a 24-hour service meant our intensive home treatment team (IHT) needed to increase in capacity to provide what we’d call ‘hospital at home’ so we could visit someone three or four times a day if required."

Now over two years later, following a redesign of services and the launch of the First Response service in February 2015, no adult has been sent out of area for an acute admission. The striking turnaround involved a rethink of how we had historically responded to mental health crisis care. We couldn’t have achieved this without working in partnership to operate the service with the local authority, police and voluntary sector agencies.

24 hour self-referral

The First Response service gives a single point of phone access; this self-referral route offers telephone triage and assessment, where people in crisis can ring for help. Staff assess individuals and signpost to the right service, often avoiding hospital admission or A&E attendance. Call numbers clearly show there was a need for the service; we’re now getting an average of 6,000 calls per month.

The change to a 24-hour service meant our intensive home treatment team (IHT) needed to increase in capacity to provide what we’d call ‘hospital at home’ so we could visit someone three or four times a day if required. The evidence is very clear - people make better recoveries and have better outcomes in their own homes, rather than by being brought into hospital, so we avoid hospital admission wherever possible.

Timely discharge and care at home

Three homely and welcoming safer spaces for adults and young people to go to in emotional distress, give a realistic alternative to hospital admission and are run in collaboration with the voluntary sector. Resulting in a significant reduction in A&E attendances since the acute care system was transformed.

We’ve reduced our length of hospital stays and average occupancies through a whole system approach. Our IHT works with a multi-disciplinary team to support people to be discharged in a timely manner and to be cared for at home. As soon as a person is admitted, we agree a discharge plan and flag any key issues that might prevent this. For example if there are issues with housing, we link in with the council’s specialist housing social worker, who is co-located within the First Response team.

Supporting people to remain independent is a key factor in to treating people at home. The IHT recognised this, restructuring the skillset of the team to include occupational therapists, social workers, community mental health nurses, support workers and psychologists, to assist people to stay at home with the right support.

Preventing housing issues causing delayed discharge

Many people in acute care have housing issues such as being homeless, losing their homes on admission, or being turned down for housing for a variety of reasons ranging from complex needs, behaviour, family breakdown or debt.

Housing can be a cause of delayed discharge from hospital so we’ve been working with the council’s housing specialist social worker to improve easy access to housing for these vulnerable people, either on the wards or in the community.

The housing specialist attends weekly discharge planning meetings and supports our community and ward staff, patients and families to begin resolving any housing issues as soon as they’re admitted. Also some people with severe mental illness have limited capacity to make decisions and live independently so the quality of supported accommodation for these people has been improved in the district so they can avoid residential care.

It’s fantastic that since the launch of the First Response service, people in the community experiencing an acute mental health crisis are no longer being sent miles away. People are being cared for closer to home, often in their own homes, with the support of the care team they know and with their loved ones around them, which could be for many people the key to their wellbeing.

Success stories

*Khalid accessed the First Response service and was referred to the Sanctuary safer space, at Mind in Bradford. He credits the service with making a real difference to his mental wellbeing.

Khalid said: “When I was going through my mental health crisis, Mind helped me accept my mental health issue. I could ring up First Response and come down to the Sanctuary in my own time. It was a safe environment."

"The people were accepting and didn’t judge me. I was able to speak about my worries, fears and problems. From coming down to speak about my different mental health issues I’ve been able to accept them and it’s given me hope for the future, that yes, I might live with a mental health issue but I don’t need to let that hold me back.”

* Name has been changed to protect identity.

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