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Creating a 24-hour mental health service

Developing a new home treatment service in Stamford, Lincolnshire

Why was the initiative launched?
How was the work handled?
24 hour telephone helpline.
Training and Staffing
Is the new service working?
Tips for success
For more information contact

Why was the initiative launched?

Rauceby Hospital was a large mental hospital in Sleaford, Lincolnshire, and closure was planned for the end of 1997. Questions about how mental health services would be provided for the rural populations of Stamford, Bourne and Market Deeping arose during planning for its closure. Geography was a real problem because Rauceby was about 30 miles away. Re-provision of acute mental health inpatient services could have been centred at Grantham, but that also was about 30 miles away. At the time another option explored by the Health Authority was to commission services from Peterborough, closer but over the county border in Cambridgeshire.

There were strong views, especially from GPs, that there must be ways to develop a local service that would meet the needs of the community. These views led to the agreement to create a home treatment service to complement the existing Community Mental Health Team based in Stamford. The challenge was to have the new service, the Stamford Resource Centre, in place by beginning of 1998.

How was the work handled?

A project team, led by Eddy Seymour, the general manager of mental health services, was appointed in 1995 to plan the new service. The lack of local experience in managing a community-based service encouraged the team to look at developments elsewhere. They visited other services and invited staff from services elsewhere to visit and pass on their experiences. All those involved were encouraged to see the work as an opportunity for their personal development. Each member was involved in two or three specific aspects of the work.

Gradually, during 1996, a model for a new nurse-led service was talking shape: the key elements would be:

The overall design was only the start. Policies and procedure to enable it to operate were required. The main challenge was to develop a model for the 24-hour crisis service that would work in a rural community and in which staff felt safe and supported. Groups of staff nurses did most of the work. For example, they established ways to assess risk and create treatment protocols. Completing the premises before the new service went live was helpful. The team had time to settle in before the service started. This space meant that the Home Treatment Service and the Community Mental Health Team were able to get to know one another.

Training and Staffing

It became evident that an extensive training programme would be required to equip a new group of staff to tackle the challenging roles. A Centre Manager was appointed in 1996 to bring the preparations together. Success required acceptance of a new model of care unfamiliar to many patients, carers and staff. The manager was able to recruit a team keen to work in the new and innovative service. This contrasted with other areas where staff were redeployed from the old institution at Rauceby to alternative inpatient facilities. Although none of the team had experience in home treatment they had a wealth of mental health experience.

Two other issues required attention. Out-of-hours junior psychiatric cover would be provided from Grantham Hospital which could be a problem. Creating working relationships between the Home Treatment Service (a 24-hour, 7 day service) and the Community Mental Health Team (a 9 to 5, Monday to Friday service) also proved challenging. Ways are being found to improve links by making sure that communications between to the two teams are effective.

Is the new service working?

As the model for the new service was taking shape research evidence demonstrated that 'where a home treatment model of care has been introduced it has - on average - reduced hospital admissions by two thirds'. (Dean and Gadd, BMJ 1990).

Experience from Stamford reaffirmed those estimates. Admission to hospital fell by 60% in the first year. The Centre opened as planned in February 1998 and is exceeding expectations. It has proved popular with staff and patients.

'.. nurse assessments have proven to be a great asset in the provision of continuity of care. It has also enhanced my own professional development'. (E grade nurse in the HTS )

'The staff at the centre offer professional, caring and friendly support for the many people who use the centre.' (service user)

The overall success of the new service has been acknowledged by the granting of Beacon Status in 1999.

The Home Treatment Crisis Service has a target response time of four hours but so far all (127 patients in the first year) have been seen within two hours. Teams of two nurses working with strict assessment protocols undertake the crisis visits. Only 32% of these referrals in 1998/99 led to inpatient admission. The remainder of patients were cared for by the Home Treatment Service (32%), transferred to the Community Mental Health Team (11%), referred for day care (13%) or discharged. The level of activity overall has matched expectations and remained broadly stable over the two years since the Centre opened (Table 1).

Table: Stamford Resource Centre: referrals and use telephone helpline
  1998 1999
  Jun Sep Dec March June Sep Dec
Calls to helpline 171 113 104 145 144 260 427
Crisis referrals to HTS/CMHT 22 25 37 43 28 33 25

The 24-hour telephone helpline is proving popular with patients, carers and health professionals. Psychiatric 'first aid' is provided, but an immediate response from the crisis team can be triggered if required. Anecdotal evidence from general practitioners suggests that the service is reducing demands on them. There has been a steady rise in its use (Table 1), although action to improve the accuracy of recording may mask the true rate of change.

The eight-bed inpatient unit is matching expectations with a significant reduction in inappropriate admissions. The majority of admissions fall within the Mental Health Act. Home treatment is designed as part of the care plan enabling earlier discharge. All inpatients attend the day hospital. The unit can provide accommodation for a mother suffering post natal mental health problems and her baby.

The day hospital operates for 12 hours each day and for seven days a week. It is proving popular with patients. In an absence of reliable local public transport, the Centre provides transport driven by centre staff known to patients.

The Centre has a user group that has already suggested ways of improving the service. It has raised funds for the purchase of equipment to benefit users of the service. Two staff nurses have set up a carer's group which is offering support, advice and information. The group sets its own agenda and invites different speakers to present topics of interest.

Tips for success

For more information contact

Nick Endley
Centre Manager
Stamford Resource Centre
South Lincolnshire Healthcare NHS Trust
St George's Avenue, Stamford
Lincolnshire PE9 1UN

Telephone 01780 757142 Fax 01780 757193

The following material is available:

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