Haven was developed as a result of the Crisis Care Concordat following the work to establish the First Response service, and the Sanctuary (a night time crisis service based at Mind in Bradford). Haven has been funded via NHS England for A&E diversion on the basis of 2 years non-recurrent funding, with a view to identifying savings in other acute services, which will allow it to become a sustainable service in the longer term. Haven is a partnership between The Cellar Trust as an established local mental health charity, the NHS Bradford District Foundation Care Trust (BDFCT) and the local authority (BMDC).
What We Did
Haven was developed as a result of the Crisis Care Concordat following the work to establish the First Response service, and the Sanctuary (a night time crisis service based at Mind in Bradford). Haven has been funded via NHS England for A&E diversion on the basis of 2 years non-recurrent funding, with a view to identifying savings in other acute services, which will allow it to become a sustainable service in the longer term. Haven is a partnership between The Cellar Trust as an established local mental health charity, the NHS Bradford District Foundation Care Trust (BDFCT) and the local authority (BMDC). It is being established to provide an alternative to A&E for people who are in mental distress and need support. We have put an emphasis on peer support from people with lived expertise and our aim is to support people in distress and work with them to develop their plans to stay well and cope better with distress in the future. The Haven is a person centred, non-clinical setting where there is someone to talk to without the fear of in-depth assessment, excessive notes, being detained or medicated
The aims of the service are:
• To build community resilience
• Work as part of a wider strategy across Bradford to build individual and community resilience so that individuals are supported and empowered to develop the skills they need, and access relevant
• Support at an early stage, before their health deteriorates to the point of crisis.
• Reduce the number of individuals inappropriately attending A&E because they are in mental distress and do not feel there is an alternative
• Provide a community based, non-clinical setting to deliver a more accessible and welcoming environment for individuals in distress.
• Reduce the resource burden in A&E, and potentially other such services such as Yorkshire Ambulance Service and the police.
• Reduce the amount of time that individuals spend in A&E if they inappropriately attend due to a mental health problem, and do not have physical health needs which need immediate attention.
• Contribute to a wider strategy across West Yorkshire, working towards a suicide reduction approach.
• Develop an innovative and effective new model for delivery which can be, over time, implemented across West Yorkshire.
• Establish a model which is based on a strong partnership between VCS and statutory services.
• To work in lines with the NHS 5 year plans and the Sustainability and Transformation Plans STPs)
Haven – The core team for Haven is made up of Cellar Trust staff, the Manager works for BDCFT. There will also be a Shift Coordinator and/or Duty Social Worker from the BDCFT/BMDC Intensive Home Treatment Team who will operate on site during all Haven opening hours. Shift Coordinators work on a rota basis and will be available to the team as a senior mental health professional where additional advice or support is needed. They will also triage individuals if they arrive at Haven without the standard referral.
A standard shift will include 1 Senior Support worker (Team Leader) and 2 Support Workers including at least 1 Peer Support Worker.
The service operates 10am to 6pm every day
The aims of the Haven are to –
• Offer additional support to those feeling in crisis where they feel presenting at A&E may not be the right way to access support, post discharge from hospital or for anyone experiencing a mental health crisis. Haven operates 10am to 6pm every day and is available to all residents within Bradford, Airedale, Wharfedale and Craven.
• Haven is a person centred, non-clinical setting where there is someone to talk to without the fear of in-depth assessment, excessive notes, being detained and medicated.
• Haven will primarily be staffed by The Cellar Trust, but with additional staff on site from BDFCT and BMDC staff.
• Haven will work with/support individuals, and if appropriate, their families/carers to do an initial assessment. They will then work with them to de-escalate the level of mental distress, discuss what is going on for the individual concerned, and work with them to plan what they need to do to stay well.
• A wellness and safety plan will be developed for use with individuals. Wellness and safety plans will be followed up to ensure that actions are put in place.
The Sanctuary –
This is our flagship, award winning crisis service. The Sanctuary provides a calm, safe space for adults experiencing mental distress. It is often used as an alternative to hospital admission. The Sanctuary is operated by Mind in Bradford, in partnership with ‘Sharing Voices’ and ‘First Response’. This service is open 365 days a year from 7pm-1am.
The First Response service is operated by Bradford District Care NHS Foundation Trust and offers support 24 hours a day, seven days a week to people of all ages living in Bradford, Airedale, Wharfedale or Craven experiencing a mental health crisis.
The Sanctuary aims to support people in order to help them resolve or better manage their personal crisis. We work around the four key elements of effective emotional support:
• Listening with empathy
• Treating visitors with warmth, kindness and respect
• Ensuring visitors do not feel judged or assessed
• Providing a calm and non-clinical environment
Monthly meetings with the Steering Groups – which consists of Voluntary Services staff, BMDC Staff, Peer Support Workers, NHS staff. Action plans are developed form each meeting to review current service needs and the service delivery is continuously evolving to meet the local demands of the population we serve.
Monthly Frequent attenders meeting for A&E services – this helps identify alternative ways to reduce attendance where no medical issues have been identified.
Local advertising has been used to promote the services, including local radio, local television, advertising banners, use of social media.
• Mark Trewin – BMDC
• Debra Gilderdale – BDFCT
• Kim Shutler-Jones – The Cellar Trust
- Steering Group meetings – a joined approach to manage the Safer Space Initiative
• Monthly meetings, which includes Peer Support Workers, staff , CCG members
Service user feedback actively sought through questionnaires following a visit:
Examples of feedback –
• What a motley crew of staff here! Yet together they have formed a perfect team with a huge range of complimenting strengths… …And great at advising, stepping in when necessary, always alongside each other delivering a consistent approach
• I love and appreciate the feeling within the Sanctuary. Very ease to open up in this environment among the very talent and hardworking staff
• You are all amazing. I have never felt judged can tell you anything. I feel so at home here and leave feeling so, so much better. Thank you. I hope this service is around for a long time because it was badly needed!
• Always felt safe, secure and heard. Never judged or looked down on. Always feel better/improved when I leave. Thank you for this place
• Should be more places like this. No clinical stuff
Looking Back/Challenges Overcome
Challenges that have been overcome for Haven, have been increasing the referral process and looking at how all the Safer Spaces work in unison. These issues have been overcome by combining the meetings on a monthly basis, and opening the referral criteria to allow the services to be accessed easier.
Developed a Perinatal pathway – to allow this population access the Haven
Raised the profile of the services through alternative clinical meetings with partnership trusts.
The service has been driven by the enthusiasm and hard work of key members of the team such as the CEO for the Cellar trust Kim, however a wider team has been involved and attending regular planning meetings. Attendees are from the different stakeholders allowing for a true depth of knowledge and shared responsibility for direction of the service. This joint working has informed a joint action plan and in turn has helped us develop policies and procedures for the service.
This process of joint working lends its self well to the option of different members of the wider team becoming more active in leadership while maintaining the positive direction the service is already on.
Evaluation (Peer or Academic)
The safer spaces are evaluated by service users via questionnaires to generate information on how effective a service has been provided. BDCFT review A&E attendance figures to highlight reductions in attendance due to service users attending the most appropriate services via the safer spaces. This information is collated by staff at the safer spaces and shared with A&E deliver board.
The First response service has utilised the Haven between the times of 10am-6pm to support 427 service users following the services establishment in August 2016. The Sanctuary in mind has been utilised by FRS between the times of 6pm-10pm to support 834 people over a 12-month period. Service user feedback from those attending the Sanctuary and Haven identifies that 80% reported that they would have gone to A&E if they had not been able to attend Sanctuary or the Haven. This is strong evidence of how the existence of the Sanctuary & Haven is keeping people from needing to go to A&E when they are in crisis. Service user feedback also identifies that 97% of attendees reported they were satisfied with the support received.
This is a joint venture and the Safer Spaces involves 3 initiatives that are available to both CAMHS and Adults. Information is regularly shared between the agencies through meetings, social media – twitter.
Our service has a twitter and Facebook account that is monitored and responded to daily by members of the team. New ideas and initiatives are promoted, while individual queries and concerns are responded to.