Lean on me

Readjusting to life in the community after a stay in a mental health hospital can be difficult, but a project is providing support to make the transition as smooth as possible for people from Black, Asian and other minority ethnic backgrounds. Paul Brewer reports:  

Coming home from a stay in a mental health hospital to a cold house with no milk in the fridge and little idea of where to start rebuilding your life can be a shock and a challenge. It certainly was for Coral Hines – but it was an experience that she is now using to help others.

“It [coming home] was tough for me and I wanted to make sure other people don’t go through the same experience,” says Hines, a founder member of Canerows, a service user-led group working to improve the experiences of people from Black, Asian and other minority ethnic (BAME) backgrounds in the local mental health system.

Canerows – until recently Canerows and Plaits – operates under the umbrella of Sound Minds, a user-led mental health arts project in Wandsworth, South London. Hines’ experience has led to the development of a community support service in Wandsworth to help people adjust to life back in the community after a period spent in hospital. The service is staffed by people with lived experience of mental ill health, who are well positioned to give advice and support.

The service sees peer-to-peer contact take place for up to six weeks following discharge from hospital. “We played it by ear on the length of contact – but most people are happy with the six weeks,” says Hines. Peers can advise on anything that the person wants help with, but it can be just talking through their feelings and how they deal with being back in the community and resuming their lives.

Developed from existing services
The service was developed from an existing Ward Visiting Service run by Canerows, which first started as a pilot in 2008, and, after a positive early evaluation (Reynolds, 2010), was awarded further funding from Comic Relief to extend the service to four wards.

Here, visitors work in pairs visiting each ward once a week. They sit with, listen and talk to people from the perspective of someone who has been in that situation. Visitors also organise occasional social, craft and music activities on the wards – even bringing in a line dance instructor on one occasion. Visitors take a simple survey tool to note patients’ concerns and suggestions. Results are compiled into reports that are then discussed at meetings between managers and the project worker.

“Your wound is helping their wound,” says Devon Marston, chair of Canerows. “The idea of love and compassion is fundamental… someone to talk to, someone to hold your hand… encouragement… Those are the things that matter.”

Many who met with ward visitors when they were in hospital later ask if they too can train as visitors, affirming the value of the service. “They want to help others and put something back,” says project worker Rima Williams.

With the ward visits service working well, attention was turned to designing a community support service for those being discharged. Canerows consulted with their extensive network of service users, including ward visitors and their beneficiaries. Conversations were also held with experts in the field, including those running similar services, and a literature review took place.

As a result, the group decided to focus on people already known to them through the ward visits, offering them peer support immediately following discharge. To reduce the geographical spread and the number of staff with whom they would have to liaise, the service was restricted to Wandsworth residents from one acute admission ward at Springfield Hospital in Tooting.

To succeed, co-production initiatives involving small groups like Canerows and large NHS institutions such as South West London and St Georges Mental Health NHS Trust (SWLSTG) which runs Springfield Hospital, require some adjustments on both sides. The SWLSTG ward team, including the consultant psychiatrist, were receptive to the project, as were general management, perhaps because the ward visiting service was already well established.

Nevertheless, there were many issues to work through including communications, operational policy, confidentiality and procedures to minimise the risk to all concerned.
Documents were drafted, redrafted and travelled slowly back and forth. But finally in April 2013 Hines’ long-held ambition became a reality.

The community service recruited peer support workers already operating as ward visitors. By integrating the two services, peer supporters and potential beneficiaries can establish a relationship and agree their plans for meeting up before discharge takes place. This approach also eases communication with hospital staff and offers continuity to people leaving hospital.

Williams acts as a central liaison point for Canerows, reviewing risk factors with Sound Minds’ chief executive and discussing risk management with peer support workers as necessary. Ward visits currently take place early in the week in the hope that arrangements for community support can be finalised before the weekend.

The hospital’s occupational therapists (OTs) agreed to be the communication point for the ward. They suggest people who might benefit from the service and ensure that the clinical teams are informed and in agreement. Although Canerows has a BAME focus, peer supporters work with anyone who wants the service, regardless of background.

There are no preconceptions about what form the contact in the community should take. Between April and October 2013, peer activities included playing tennis, going to a café, helping to get voluntary work, sharing experiences on moving house, linking up with a drop-in facility run by Canerows, help with shopping, chatting at home and sharing an interest in art and music.

Training and supervision
As the community peer support workers are already experienced ward visitors, they have already completed an accredited Open College Network Level Two Ward Visiting course devised by Canerows and Sound Minds, followed by a month of supervised ward visits. Before working in the community they attend further training on procedures and protocol, record-keeping and safeguarding. The NHS provides training on personal safety. All community peer support workers receive individual and fortnightly group supervision through Sound Minds.

Learning so far
A review of the community service after six months reported positive feedback but suggested that improved communication with the ward would increase the flow of new contacts. It was noted that the role of the OT as the single point of contact worked well and her experience and enthusiasm were invaluable. But when she took sabbatical leave fewer potential contacts were recommended. Other ward staff were often busy with their clinical responsibilities, and shift working impacts on continuity.

Hospital admissions are usually brief, exacerbating problems in identifying potential beneficiaries. Sometimes people are discharged before contact can be made, making follow-on peer support more difficult to arrange. Meanwhile, some people wanted the service when in hospital, but changed their minds once they left the ward.

Support from the community mental health teams has been mixed, although one care co-ordinator was particularly helpful, arranging a joint visit to someone’s home, which shows what can be done.

New funding from London Catalyst will enable Canerows to expand its team and increase the number of ward visits. Integrating the team further into the life of the ward will help them to keep up with the fast-changing ward population and meet potential beneficiaries. Canerows also plans to communicate more regularly and proactively with community teams. Following a review of training needs, Canerows and Sound Minds will develop further accredited training for community peer support workers.

Conclusions
Canerows has always been characterised by the passion and energy of its members who devise their own ways of supporting their peers. This informal, organic approach is part of a spectrum of peer support schemes now operating. Different aims and approaches grow from different roots; peer support can have corporate origins in the NHS or large charities but also may evolve locally, perhaps from a single individual or a concerned group of service users, as in this case.

The mutuality and creative, evolutionary approach of Canerows is fed by the commitment and long friendships within the core team. This is hard for statutory services and larger, more corporate third sector organisations to replicate. Canerows’ members, beneficiaries and many stakeholders believe it should be treasured.

References: Reynolds D (2010) Human kindness, compassion and love: the hospital ward visiting scheme designed and delivered by Canerows and Plaits. Mental Health and Social Inclusion 14 (3) 6–9.
Thanks to: beneficiaries and stakeholders who participated in the recent review, South West London and St. Georges Mental Health NHS Trust, Comic Relief and Patience Seebohm.
About the author: Paul Brewer is CEO of Sound Minds