We are open from 6pm to 11pm 365 days a year in York and 6pm – 12am, 365 days a year, in Devon. We are a service for people who are in crisis, or near crisis who have nowhere else to turn to and really do need someone to catch them by providing a warm and welcoming place to come when their mental health is at its worst. Face-to-face support from our specialist workforce is available within 20 minutes of attendance, if not immediately, and people can begin to receive the support they need. We also have telephone support on site manned by our telephone support workers, providing additional staffing in the service to support crisis, without delay. We have a pathway and interface in place with Police and Ambulance services along with the amazing Community Mental Health Teams.
Highly Commended - #MHAwards19
From start: No
During process: Yes
In evaluation: No
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Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
These projects aims to develop ‘Safe Haven’ services across York and Devon to provide a place of safety and access to multi-agency support, out of hours, for those at risk of experiencing mental health crisis. Working in partnership with Tees Esk and Wear Valley Trust (TEWV) has been fantastic, the support we have received in developing and growing the service is amazing. The team at TEWV really believe in what we are doing. That support really makes a difference in delivering crisis services. The Haven came to life after a group of service users and TEWV and decided that York needed an out of hour’s crisis support service. MHM have been so lucky to have been successful in securing this innovative and valuable service. Following the success of the York Haven, Devon Partnership Trust consulted with services users in their area, which led to the development of the Moorings The OHH services offer a welcoming, safe, supportive, comfortable and non-clinical environment that promotes independence and opportunities for recovery. It is somewhere people can go to gain support, when they would usually have attended A&E or called their GP.
The Haven and Moorings is a supportive alternative that is already proving to work through delivering positive outcomes and de-escalation for those in crisis. This is achieved through offering a sense of sanctuary after the individual has had an initial assessment. Our skilled workforce will work with the individual to deal with and understand their situation, but also signpost onto and draw on the significant local resource and professionals if necessary, for example: drug and alcohol workers, advocacy, learning and employment opportunities and other suitable support available in the wider community outside of mental health services. The OOH services focus on wrapping support and the community around each individual to ensure the right interventions are delivered at the right time, by the right experts. The OHH services: • Acts as a key Interface with NHS services ensuring that where a user would benefit from a referral, this is completed in a timely and seamless way. This helps to ensure that the more severe crises are supported quickly and seamlessly meaning that no one is left behind. At MHM we use a ‘trauma aware approach’ to gain an understanding of not only an individual’s history of trauma, but also any risks that their thoughts and feelings may pose. All support and approaches are used to work alongside the individual to ensure they feel supported and valued. • Provides opportunities for support outside traditional support options; through sharing experiences, self-help groups, mentoring and befriending and importantly, providing the skills and confidence to problem solve and build on service users own strengths and assets. • Provides support that respects individual rights and allows support to occur in a relaxed comfortable and informal environment. Where required and it is appropriate to do so, a person will be signposted to a care professional who will facilitate a structured mental health assessment. • Delivers care in partnership with statutory and third sector organisations in order to provide an integrated approach to Crisis Management, whilst providing interventions that seek to build on personal confidence and ability to solve problems and manage health and wellbeing whilst working closely with families and wider social networks in supporting the whole person.
What makes your service stand out from others? Please provide an example of this.
We are open from 6pm to 11pm 365 days a year in York and 6pm – 12am, 365 days a year, in Devon. We are a service for people who are in crisis, or near crisis who have nowhere else to turn to and really do need someone to catch them by providing a warm and welcoming place to come when their mental health is at its worst. Face-to-face support from our specialist workforce is available within 20 minutes of attendance, if not immediately, and people can begin to receive the support they need. We also have telephone support on site manned by our telephone support workers, providing additional staffing in the service to support crisis, without delay. We have a pathway and interface in place with Police and Ambulance services along with the amazing Community Mental Health Teams. We know that our support has saved lives, because our service users have told us so. This is incredibly powerful feedback to receive and shows the impact that this service is already making to people’s lives. We also know that the work we have done is relieving the stress on Hospital and A&E staff, easing access into both physical and mental health support across York & Selby and Devon. For Service Users, knowing that people are waiting for them is such a relief, you can see a weight lift off their shoulders when they walk through the door. No two days are the same and we have done everything from calming a crisis to de-escalating suicidal ideation. When the service closes at 11/12pm, we ensure that any individuals who have attended that night are safe, comfortable and placed where they need to be, whether that is back at home or in a place of safety. Either way we complete a follow up call the next day at a time arranged with the individual to ensure they remain safe and sound. Wrapped all around this service is our 24/7 Support Matters service, which is another valuable tool to ensure that people are supported in their own living room. In addition to delivering wellbeing calls following in individual crisis, Support Matters can be contacted by those accessing the Haven 24 hours every single day, helping to ensure that individuals stay well, and access they support they need.
How do you ensure an effective, safe, compassionate and sustainable workforce?
MHM take the development of their staff very seriously. Each contract has its own unique needs but no other is like The Haven or The Moorings. These services are different in regards to having health and social care blending in a community based setting. Having these two sets of skills working together in a potentially acute setting ensures we have an incredible skill mix within our team, experienced and able to deal with any situation. All MHM staff are experienced in working with people with mental health issues and regardless of their need we will be waiting to support them. The simple answer is we are a non-referral based service, a non-clinical provision that expects people and welcomes them in. The service can be faceless if the person so wishes. We can and do support anyone that is in need of something even when they are not sure what that is. There is no waiting times and no exclusion criteria unless they are violent or threatening. We are an alternative to A&E, prison cells and more importantly suicide. We refuse to accept that all options have been explored and we believe in people and the value they add to our community and our lives. The Moorings and Havens have supported people known to services, carers, veterans, serving police and paramedics, young people, and our older generation. Everyone working together to live!!!!! We leave no stone unturned we have managed to get people back to work, overturn sanctions on benefits, support individuals to find housing, reduce domestic violence, help people get off drugs, and incredibly saved over 36 lives, (that we know about), helped people go back to the family home, get people off the streets, reduce self-harm, and build resilience. In continually assessing the risks involved with this, and are supported in the service by experienced and qualified staff.
Our mandatory training modules, completed within the first 6 – 8 weeks of staff’s employment, cover key topics including: Risk Assessment; Professional Boundaries; Conflict Resolution; and Incident Management. All mandatory training is refreshed on a 2 yearly basis. Training modules align with our robust policy & procedure framework, which has been developed directly in line with legislative, regulatory & best practice standards (e.g. CQC regulations & all relevant NICE guidelines). One of the most effective ways to prevent abuse from occurring (and/or worsening) is to ensure our staff recognise the indicators of abuse & neglect and know what to do if a concern is raised. All staff complete MHM’s Safeguarding Adults and Safeguarding Children modules within the first 6 – 8 weeks of employment and again at least every two years. Additionally, MHM staff attend local Safeguarding Board training relevant to their service. Staff development and support – Training plans provide opportunities for staff to consolidate their training by receiving dedicated time and access to appropriate callers/cases to practice recovery interventions and promoting reflective practice, ensuring all staff are competent to provide a high standard of recovery advice/support. Our approach to performance management is made up of: • Appraisal: a formal approach to performance management, delivered through an annual cycle, which enables the objectives, behaviours and personal development aims of an individual to be set out, reviewed and assessed. • Personal Development Plans (PDPs): all staff members have an up-to-date PDP in place at all times, developed and reviewed as part of the annual Appraisal and Interim Appraisal review.
The purpose of this plan is to identify the development needs of the staff member which need to be addressed in order to achieve their Appraisal objectives. • 1:1: a less formal and more frequent review of performance (at least every 6 weeks, led by line manager) which also provides an opportunity to discuss current work priorities, encourage progress and identify possible problems. • Caseload Quality Monitoring: regular discussion (led by Practice Lead/ Locality Manager) which supports the continual development of our staff and enables the organisation to ensure services are being delivered safely, effectively and in line with both MHM policy and procedure and contractual requirements. There is a wealth of evidence demonstrating clear links between good employment practices and business outcomes. We create an environment where staff are valued, rewarded, appropriately trained and developed, regularly appraised and properly managed. We always put the development of our staff first, which has a positive impact on the people who use our services and their families. This also creates a system where we always have individuals in post who are ready to step up when the opportunity arrives (either planned or unplanned). We also see the impact of this approach in the calibre of applicants who wish to work for MHM. This is how we continue to attract and retain high quality staff who are consistently high performing, highly motivated and flexible. Without fantastic staff we cannot deliver fantastic services to the people we serve. We have an employee of the season scheme which staff can be nominated for, by going above and beyond their job roles and duties. Staff receive regular feedback and compliments from clients and callers which is fed-back through supervisions and documented.
Who is in your team?
To safely staff The Haven and ensure that the required skill mix is always available, we have: We have a minimum of 3 people on shift at all times, one of which is always a Qualified mental health professional. Responsibilities of the qualified staff role include: • Lead point of contact for day to day delivery of the service. • Work closely with partners to develop the service and Operational Policy. • Support the team, staff and volunteers to deliver the service safely professionally and effectively at all times. • Where necessary carry out routine 1:1 interactions of half hourly duration’s with people or carers using services. 2 x Recovery Workers with lived experience of mental ill health, whose responsibilities include: • Where necessary carry out routine 1:1 interactions of half hourly duration’s with people or carers using services. • Engage with service users during throughout their interaction with the service enabling a clam and supportive environment. • Support the qualified staff members in delivery of the service as directed including both service user support and administrative duties. Peers talking to people about their journey giving hope when people thought there was none.
How do you work with the wider system?
Since the launch of The Haven and Moorings contract we have worked closely with experts by experience within the service with engagement moulding and shaping the way in which the service develops. We have taken pride in standing shoulder to shoulder with these experts to ensure we stay on task and deliver the dream they had when building and fighting for this service. There is no bigger pride in a service coming to life, built by the experts for the experts. We are an advocate of working in partnership to achieve the best outcomes for people and this shows, whilst working closely with TEWV and DPT to make this service come to life, and within those partnerships defining clear roles and responsibilities ensuring each organisation can play to its individual strengths. We work alongside a number of different agencies in the Haven/Moorings to ensure we can deliver an integrated service. Collaborating in this way not only avoids duplication and improves the user experience, but it also enables greater good practice sharing and the exchange of expertise, ensuring that projects culminate in a whole that is greater than the sum of its parts. MHM work closely with Psych Liaison and the Police to get people to our services to avoid long waits and unnecessary arrests. So before people are checked into A&E they are asked have you been to the Haven or Moorings and if not they are directed to us. The police pick people up and bring them to us rather than the station. We also get linked to victims of crime so we can support straight away.
We currently work alongside a number of Community Mental Health teams. Communication is a key aspect of ensuring that the service users continues to receive the most appropriate support. Whilst ensuring we can get the right support for service users and we can only do this if we have the right support pathways in place. We also attend monthly stakeholder meetings and events that promote and grow relationships. Thereby providing all those working with the service users the most up to date information. We actively promote the service through face-to-face networking as well as social media and web, highlighting the potential benefits for service users, families and carers. We have ensured that all promotional material has been co-produced with the experts by experience who created this service model, and made it a reality, as well as those who have accessed crisis support in The Haven since we launched. Information on what is being delivered is available online, in service and in the premises of local service providers, ensuring there is no duplication of support, unless it was agreed due to it increasing access and service availability for York and Devon residents. This focused work with partners is further enhanced by the involvement of successful ‘graduates’ of the service, who have successfully moved into a stage of recovery where they are happy and comfortable to work with the team to share their stories and encourage their peers to follow their example. In addition we attend local networking events and forum, including those hosted at in The Haven. We have built a database of networking contacts who are able to provide opportunities such as health awareness sessions e.g. smoking cessation; training and volunteering/ employment opportunities. Raising awareness of mental health and other needs is delivered alongside all networking activities, with leaflets and self-help guides made available to those in need, or seeking information
Do you use co-production approaches?
Co-production forms the very foundation of our services. MHM pride ourselves on delivering excellent services and we cannot do that without the involvement of key stakeholders. MHM have used co-production since we started this contract from working on developing messaged and marketing materials, to a joint service launch at York and Devon. We have stood shoulder to shoulder with our peers, experts by experience and commissioners throughout the launch and the service implementation, and this has laid solid foundations from which we will continue to build on and embrace in the future for the ongoing success of this service.
A further example of co-production can be found in the development of MHM’s own recovery tool, My Future Matters (MFM). MHM worked with existing and past Service Users to co-design / develop, test and implement MFM. This person-centred, recovery focused planning tool is a system which achieves positive outcomes for Service Users, and we are immensely proud of what we have developed. MFM is a tool which is proven to support individuals to achieve independence and was developed alongside our Service Users. This allows us to deliver the highest quality support, and is an example of how what we learn from listening to those who access our services, and how this shapes our services and interventions for every individual. We understand that the needs of individual Users change as they achieve their outcomes and MFM helps Service Users find hope, meaning, personal responsibility and self-identity by allowing individuals to build a new sense of self, purpose and discover their own resourcefulness. We know that taking such a comprehensive approach to recovery takes more time, but it gives the people a sense of being valued and ensuring that the people we are working with and supporting know that their opinion count. Its co-production and peer development in its truest form, which delivers sustainable outcomes for our service users The benefit from co-production is that we are closer to what people with mental health issues want and need, delivering the service which supports their individual recovery and not a one size fits all approach.
Do you share your work with others? If so, please tell us how.
Before we deliver on any contract, MHM cast a ‘spiders web’ over the locality to familiarise ourselves with the area. We also complete a roadshow to enable us to deliver and manage expectations and work in true partnership across the area. This means that we map and gap all local service provision and engage with providers to learn about what they do, before then sharing information about our service, support and pathways to join together knowledge and networks. We use our attendance at local provider forums to share best practice and to ensure the needs of service users are met and to ensure they are receiving the best possible support. Seeing the success of The Haven and Moorings, we know that these out of hour’s services will be opening around the country and MHM are really delivering some amazing outcomes and we must ensure that lessons are learnt and that the services are as successful as ours to help people to get the support they need when they need it most. We will publish the findings from the university on our own website and ask commissioners to do the same, to help us continue to celebrate the success of the service.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
MHM have their reporting system that shows the recovery outcomes of all individuals using the service. We also have feedback forms within the service that allows the service users to be open and honest in a confidential way to express their views. MHM have also followed up calls to all service users to ask how their visits to The Haven impacted on how they are feeling. • Some went on to say that the haven had stopped a visit to the hospital, which was a normal outcome. • Others had mentioned that by coming to the haven they didn’t not need additional support from primary or secondary care. One Commissioner told us that, I have been working alongside Mental Health Matters for the last 4.5 months in the mobilisation of the Moorings in Devon. This is the first time I have worked so closely in partnership with a third sector organisation and I can honestly say it has been an invaluable experience throughout which I have learnt so much. All the staff I have come across have been warm, engaging and professional. Nothing seems too much trouble for anyone and there is always a solution to problems encountered. When there have been more serious concerns expressed, this has been escalated and actioned extremely quickly within the organisation, ensuring patient safety is always at the core and learning from experiences alongside reflection and support has been evident.
The geographical distance between our headquarters has not been an obstacle in any way – people outside Devon communicating in a timely way when required via email, phone and skype. The local team members, as well as more senior management have embedded themselves within the local communities and the Moorings is being talked about in a very positive way amongst many forums. Most importantly, the uninvited feedback from people who have accessed the service has been glowing – people obviously finding the staff incredibly supportive. This is also apparent in the demand that has already been placed on the service – episodes of access being extremely high in volume for the first 6 weeks of operation. Again, this appears to have been embraced by the staff team and has not hindered them in any way. I look forward to further working with Mental Health Matters and hopeful spread of our partnership across Devon! Emma Tucker, Operational Transformation Manager Devon Partnership Trust ‘MHM have proven themselves to be a committed and dynamic partner who have proactively engaged with the Trust at every step to deliver an innovative and high quality service at the Haven. As a partner they have shown a willingness to go the extra mile and have not shied away from being a critical friend when necessary. In particular communication and accessibility has been exceptional. With regard to delivery they have embraced challenging targets and from the outset have focused on achieving the projects goals and objectives as opposed to working to change them. This has been particularly impressive in light of the innovative nature of the project, a limited mobilisation period and a soft launch process that identified a series of issues that had to be quickly overcome.’ John Hay TEWV Commissioning Team Planning and Business Development Manager
Has your service been evaluated (by peer or academic review)?
MHM are in the process of having the service independently reviewed by St John’s University. This will enable MHM to share the hard and soft outcomes that have been achieved whilst delivering the services.
How will you ensure that your service continues to deliver good mental health care?
MHM attend a monthly stakeholder forum that supports the evaluation of the service. We also attend a monthly connect meeting that looks at the progress of the contract and any complaints or compliments. We also provide service users, families and carers, and professionals ongoing opportunities (both formally and informally) to provide feedback on our service delivery and how this can be strengthened and/or adapted. This approach in in addition to the follow up calls our team complete with each individual after receiving a service from MHM allowing us to reflect and review our practice in a constant cycle of improvement. MHM have also had unannounced visits at the OOH Services from commissioners and CQC even though they are not registered and key stakeholders, which has supported the assurance of the quality of service we provide
What aspects of your service would you share with people who want to learn from you?
We would celebrate the success of the services and look at what worked and what didn’t. Whilst protecting our own key success drivers, we see it as our responsibility to share learning if, as we expect, these types of service become commonplace throughout the country. MHM love delivering The Haven and The Moorings and we pride ourselves on delivering great quality outcome based services.
How many people do you see?
MHM progressed with a soft launch in October 2017 in York and on the 1st of April 2019 in Devon although this was not a soft launch. Each delivery model was a request by the commissioners and agreed by MHM to ensure that we gave the community exactly what they needed. The full service has delivered across our OOH services: May 2018 – May 2019 York • 1570 Visits to the service • 236 calls to the service • 36 Lives saved Devon • 288 Visits to the service (only open 8 weeks) • 321 calls to the service • 6 Lives saved
How do people access the service?
MHM run a walk in service for people in distress, which is a viable alternative to the GP Practice or the local hospital. We know that we cannot support everyone and inevitably we will need some specialist support but we work together to give the best care and support possible to our service users. Access is promoted to the Haven and Moorings via A&E and Community Mental Health Teams along with GP and IAPT services. We work with Fire and Rescue and the Street Triage teams to get people to a place of safety. Additionally we have a number of people accessing that hear about our service through our website, via marketing materials in local services or word of mouth, and simply by walking off the street to seek support. There is always a warm smile, a cup of tea and some support available. We also know that not everyone will just come to a new service, and may wish to speak to us about what we do, so we have set up a phone line service that allows people to contact us before they come along. It’s amazing how many people come to The OHH Services after they have chatted to our staff team, stating that we provide a “safe and inviting space”.
How long do people wait to start receiving care?
We aim to see everyone that comes through the door immediately, but at the very least we will offer a drink and a comfortable place to sit whilst they wait to see a trained staff member, who may be supporting another individual. We have books and self-help materials available to read whilst they wait, along with a PC that can support learning and take their mind off things. We know that, for example, people can wait two hours to be seen in a hospital setting or four hours to be seen by the community crisis team. MHM can support people straight away and if people need additional support we can seek it, whilst they are sat in a safe and supportive warm environment. Please don’t visualise a waiting room, this everything but, it’s a warm and inviting space with lots to do.
How do you ensure you provide timely access?
The service is open 6-11pm in York and 6pm to midnight in Devon every day including Christmas and bank holidays. We do a low level triage, as people walk in that ensures we catch those in distress quickly enabling us to start de-escalating the crisis they may be in. We always ensure that there is a minimum of 3 staff on at any one time. Buts that’s not all, if people cannot get to us we have a 24/7 support service that people can make direct contact with and support can be given. So everyone gets support when they need it.
What is your service doing to identify mental health inequalities that exist in your local area?
MHM collect as much data as possible to understand the demographics of those that use the service. This enables us to work on promoting the service to those hard to reach groups and areas in the city. MHM are not shy in knocking on doors to understand the communities’ needs and working at ways to meet the needs of those communities that may have issues in accessing the service we provide
What inequalities have you identified regarding access to, and receipt and experience of, mental health care?
MHM have had a wide and varied mix of people using the service but recently noted that Carers were stating they had real support needs but were not really sure where to go. I advised that I would ask my team to do a piece of work around services available to carers to see how we could cater for the needs of the carers in the city of York and Devon. In Devon there is a large cohort of homeless and substance miss use MHM ensure they are linked up to those services to ensure we are delivering a one stop service provision
What is your service doing to address and advance equality?
MHM take great care in ensuring our services are available to people that made need support. Great care is taken to understand the population and how we need to staff are services and have a varied mix of people who deliver the services. We keep a close eye on people accessing the service and go into the community where we feel we are not targeting hard to reach groups. We are based next door to a university in York and in two GP practices in Devon and a St Johns ambulance head quarter, so we are in the heart of the communities.
How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?
MHM have developed a comprehensive assessment, safety and recovery action planning toolkit called My Future Matters (MFM), which puts the Service User (SU) at the heart of the process. MFM was developed alongside SUs and is utilised to great effect by all MHM social care services. Initial assessments cover wide ranging barriers to recovery, including housing/mental health/physical health/wellbeing, where Staff/SUs agree levels of support required as well measures around managing risk. Staff/SUs then co-design a Recovery Action Plan and Safety Plan. These are delivered at the SU’s pace whilst providing encouragement/support/appraisal. Staff continuously promote independence and SUs are encouraged to continue their recovery journey independently of staff as soon as they feel able to do so.
What support do you offer families and carers? (where family/carers are not the service users)
All families and carers have access to the Haven and Moorings to support their loved ones, or to have their own needs looked after. Additionally, all families and carers have access to our 24/7 support matters helpline, and can benefit from our substantial networking/ signposting service, ensuring they also get the support they need, when they need it.
Have you implemented any of the mental health care pathways developed by the NCCMH (on behalf of NHS England)?
Emergency Mental Health Care
If you have implemented any of the above, what were the benefits and challenges?
Reduction of A/E attendances
Is there anything else you want to share about what makes you an example of positive practice?
Because we are a driving force in client delivery we are molding and shaping services to reach more people and we are working hand in hand with experts by experience
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): Tees, Esk and Wear Valley NHS Foundation Trust Devon Partnership Trust
Provided by (e.g. name of NHS trust) or your organisation: Tees, Esk and Wear Valley NHS Foundation Trust Devon Partnership Trust
Brief description of population (e.g. urban, age, socioeconomic status): •The Haven @ 30 Clarence Street offers out of hours mental health support to anyone aged 16 or over in York and Selby. • The Moorings @ Barnstable offers out of hours mental health support to anyone aged 16 or over in Devon • The Moorings @ Torquay offers out of hours mental health support to anyone aged 16 or over in Devon. • The Moorings @ Exeter offers out of hours mental health support to anyone aged 16 or over in Devon. • Haven @ Coventry and Warwickshire out of hours mental health support to anyone aged 16 or over – Opening Soon
Size of population and localities covered: Size of population and localities covered: 215,000- York 470,000- Across Devon
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