The day hospital has been remodelled into an integrated service which is now part community based and delivered by services from Oxford Health NHS Foundation Trust and Oxfordshire Mind. This combined model: Enables clinical work to continue to be carried out at the Warneford ; Promotes a recovery focus which is part delivered in the community away from the hospital site and linking into other community services; Supports a person’s journey through recovery rather than the previous static day hospital service; Enables service users to easily access mainstream Wellbeing services at Oxfordshire Mind after they are discharged from the service.....
What We Did
The day hospitals are among some of the earliest forms of community and social psychiatry. The first day hospitals in Europe started in the 1940s reaching their peak in the 1970s with the development of the partial hospitalisation programme. These programmes were developed with the purpose of offering either a cost effective alternative to admission or an intermediate step down after inpatient stay. Day hospitals have subsequently evolved to the extent that the generic term ‘day hospital’ is almost impossible to define.
Adjoined to the City Adult Mental Health Team (AMHT) at the Warneford Hospital there is a day hospital provision for service users mainly from Oxford City and the South & Vale. The function of the Warneford day hospital was to provide an alternative to admission or a step down service after an inpatient stay. It allowed people to stay at home during an acute episode. The service however lacked social inclusion, a pathway of recovery and the approach was outdated despite running some therapeutic groups. The day hospital also provided medication monitoring for Olanzapine depots, post ECT treatment and Clozapine titration.
The day hospital has been remodelled into an integrated service which is now part community based and delivered by services from Oxford Health NHS Foundation Trust and Oxfordshire Mind.
This combined model:
• Enables clinical work to continue to be carried out at the Warneford
• Promotes a recovery focus which is part delivered in the community away from the hospital site and linking into other community services.
• Supports a person’s journey through recovery rather than the previous static day hospital service.
• Enables service users to easily access mainstream Wellbeing services at Oxfordshire Mind after they are discharged from the service.
• Ensures service users have options sessions with a Mind Wellbeing worker to provide information on available services in the community and plan support/goals.
• Provides ongoing support and resilience building interventions which helps to reduce the impact on AMHTs.
• Results in a reduction of clinician hours at the hospital site. The hours released will be transferred into the City AMHT.
• Provides a better quality of service, improves team working and learning across Oxford Health and Oxfordshire Mind.
• Works closely with families, friends and carers involved in the persons support.
In summary, the combined model provides a less institutionalised and recovery focused service which better meets the needs of service users, family, friends and carers.
Wider Active Support
The Oxfordshire Mental Health Partnership combines the mental health services from the Adult Directorate within Oxford Health NHS Foundation Trust, Elmore Community Services, Connection Support, Response, Restore and Oxfordshire Mind to deliver mental health services to adults aged 18-65 within Oxfordshire. The partnership is the coming together of six, specialist mental health organisations and each brings with it a specific area of expertise and resource. The aim of this partnership is to ensure that patients are offered assessment and/or treatment by the most appropriate service at the right time as well as ensuring people living with mental health illness, their families, friends and GPs access to high quality, accessible and timely care.
This mixed model initiative is a combined effort of both Oxford Health and Oxfordshire Mind and fits with the aim of the partnership. An Oxford Health clinician is based at the Mind Wellbeing hubs on the days the service operates from there to provide continuity of support and communication. The Wellbeing workers are equipped with knowledge of the partnership and community services and are able to provide information to service users helping them link in with appropriate services, organisations and community groups.
Oxfordshire Mind offers co-produced peer support groups focused on recovery, resilience, wellbeing and move on from services. The groups offer the opportunity to explore techniques to manage mental health, to problem solve, give and receive support with peers and share experiences. Oxfordshire Mind staff facilitate the groups alongside peer supporters and these groups include:
• 5 Ways to Wellbeing
• Managing conflict
• Building positive relationships
• Problem solving skills
• Stress and support
• Managing strong emotions
• Goal setting
Peer support groups also focus on self-expression and creativity and the groups have the opportunity to engage in activities and events such as art exhibitions, trips to museums, or musical performances. Between sessions service users are able to prepare lunch together.
‘Move on’ peer support groups take place fortnightly and monthly to support move on and build on skills developed in the weekly groups. They provide a check in for service users who need less intensive support. They are supplemented by one to one options sessions based on recovery planning, goal setting and problem solving. Service users may move on and use the wider Wellbeing service if this is identified as a support need through the one to one sessions.
Looking Back/Challenges Faced
The project is very much in its infancy and the mixed model has been running for just over a month. The service will be reviewed at the six month stage to look at lessons learnt and to improve practice, further developing and refining the model. The Warwick Edinburgh Mental Wellbeing Scale will be used to assess improvements in wellbeing and qualitative data will be sought from people using the service, their carers, family and friends and staff.
One of the challenges has been to reassure consultants and clinicians that risk is properly managed and standard operating procedure has been drawn up between Oxfordshire Mind and Oxford Health. Risk will be assessed at referral by Oxford Health and the risk information passed onto Oxfordshire Mind. By having a named Oxford Health member of staff who works across all locations five days a week to ensure continuity of care and establish good communication through agreed processes helps to manage risk jointly. Oxfordshire Mind Wellbeing workers have honorary contracts with Oxford Health and are able to access risk information on Care Notes.
The Oxford Health Partnership Manager developed the service with the City AMHT manager and Senior managers from Oxfordshire Mind. Now that the service is operational the Partnership Manager is now longer involved except in future reviews and front line staff and service managers are responsible for ensuring the continuity of the service. The service is backed by both senior managers and operational managers within the partnership. The service has supported a change in culture and further developed our positive partnership working with a strong focus on recovery which has been welcomed by all staff in the partnership including those who work within the mixed model service.
Evaluation (Peer or Academic)
Evaluation will be qualitative using feedback from people who have used the service to develop it further. Surveys and interviews may be used to gather feedback.
Outcomes will be demonstrated when the service is reviewed. Admission rates of those people using the service will be analysed including gathering qualitative feedback. A recovery focused service which is part embedded in the community compared to the previous institutionalised model can only improve outcomes for those using it.
Good practice is shared across the partnership through key meetings such as the Partnership Senior Management Team meeting, though the Partnership comms work stream and with the CCG in a regular report demonstrating positive partnership work. Other Trusts and CCGs have expressed interest in visiting our service to learn about our partnership and the work we do. Initiates such as the mixed model Better Alternatives to Hospital Admission Project will be shared with other visiting groups.