Sequoia – Therapeutic Community – Highly Commended #MHAwards19

The Sequoia offers a weekly day programme for those with long standing and disabling emotional difficulties, mainly with a diagnosis of Borderline Personality Disorder but not exclusively. Community members are expected to attend from 10 am to 3 pm (5 hours per day) for 3 days per week (Monday, Tuesday and Thursday). Maintaining attendance is an important part of the programme with Therapeutic Community (TC) members committing to 80% attendance and making sure they ring in if they are not able to come. This is because of the way in which the Community functions, it is important that individuals can rely on other Community members being there to aid consistency in group work. Remarkably, the attendance threshold was originally set at 60% attendance and this was voted on by members of the TC to be raised to 80%, showing just how committed the service users really are to this programme.

Co-Production

  • From start: Yes
  • During process: Yes
  • In evaluation: Yes

Evaluation

  • Peer: Yes
  • Academic: Yes
  • PP Collaborative: Yes

Find out more

 

 

Please tell us why your service makes a difference

The Sequoia offers a weekly day programme for those with long standing and disabling emotional difficulties, mainly with a diagnosis of Borderline Personality Disorder but not exclusively. Community members are expected to attend from 10 am to 3 pm (5 hours per day) for 3 days per week (Monday, Tuesday and Thursday). Maintaining attendance is an important part of the programme with Therapeutic Community (TC) members committing to 80% attendance and making sure they ring in if they are not able to come. This is because of the way in which the Community functions, it is important that individuals can rely on other Community members being there to aid consistency in group work. Remarkably, the attendance threshold was originally set at 60% attendance and this was voted on by members of the TC to be raised to 80%, showing just how committed the service users really are to this programme. Each service user is entitled to ‘holidays’ (13 days + Bank Holidays) to ensure equality/diversity. Members manage their own diaries and their own leave.

 

What We Did

The Problem:  In July 1996, major changes were proposed to the Mental Health Act (1983) following the Lin and Megan Russell case. Both were beaten to death during a robbery by Michael Stones who was subsequently diagnosed with a Personality Disorder (PD). The changes brought a new focus to Personality Disorders and how they should be treated, driven by the NICE guidelines and paper ‘Personality Disorder no longer a Diagnosis for Exclusion’.

The Mental Health Act 2007 enacted changes to the way in which people were detained and treated under the Act. Locally, this was also when Dr Wojciech Gierynski (who has a special interest in PD) and Suzanne Brown (NAViGO Senior Operational Lead for Acute) who were wanting to work with this group of services users formulated a group of staff and trained in delivering Dialectical Behavioural Therapy (DBT). This team at the time was called the Personality Disorder Partnership. Over time delivering DBT alongside their already full time posts posed some inconsistency in the service that was offered.

The overriding approach and therapy within the current TC programme is governed by consistency, trust and the development of relationships, a huge contrast and improvement in how we work with this complex disorder now in comparison historically.

What became apparent was that individuals with a Personality Disorder diagnosis were getting stuck in the system with staff struggling to know how best they could be managed. To manage the risk we found that often there were extremely long inpatient stays and out of area expensive placements which actually conversely often has a detrimental effect on people with this type of illness. In fact, this key group of service users (6 people) were found to account for most repeat admissions within NAViGO with subsequent high bed day ratings (1045 days from April 16-April 17 equating to £418k).

Suzanne and Wojciech visited a number of different settings around the country to understand what was currently available for people with PD. Following a visit to the Cawley Centre in London, the whole concept and principles of the therapeutic community way of working appeared to be an innovative way to work with such complexities. Curiosity and an eagerness to learn about the model, the whole ‘new team’ enrolled on the ‘Living Learning Experience’ to experience how it actually feels to fully participate in a  TC and to truly try and understand how a TC functions in reality.

Feeling energised and excited about a new way of working it was at this point that NAViGO signed up to The Community of Communities, a Royal College of Psychiatry scheme that provides core standards for TCs. The C of C operates in a similar way to the AIMS programme, in that it undertakes peer reviews of services to encourage best practice.

The Sequoia Therapeutic Community opened at NAViGO’s Harrison House site in September 2015.

 

The Solution:

The Sequoia offers a weekly day programme for those with long standing and disabling emotional difficulties, mainly with a diagnosis of Borderline Personality Disorder but not exclusively. Community members are expected to attend from 10 am to 3 pm (5 hours per day) for 3 days per week (Monday, Tuesday, & Thursday).

The model used for The Sequoia is based on the work undertaken by William Tuke (who founded The Retreat in York  William Tuke). Tuke philosophised that people needed to be given meaningful support and valued roles / jobs in order to be released from the asylums of the time. The Sequoia offers an intensive 24 month psychotherapy programme where learning can come from understanding one another, and supporting each other in the process of change and mutual recovery. Therapy comes from whole-hearted participation in the whole programme. Sequoia also offers a 24 months “leaver’s programme” after the community members reach the end of the two year period in the main programme.

 

A)    The Team:

A small but dedicated team of five staff oversee the Community, currently three Social Workers, one of whom is also the Senior Operational Lead for Acute Services, a Health Care Worker and a part time Consultant Psychiatrist. A volunteer who was a community member and successfully completed the two year programme now offers her much valued support as an ‘Expert by Experience’, role that simply cannot be undertaken by a staff member therefore extremely valued within our community. There is also funding for a part time Psychologist but at this time the TC members feel this is not needed and democracy is crucial for our programme to work and to be successful.

 

B)    Referral Process:

We have made the referral process simple as we don’t want paper work and form filling to block entries into our programme. To make a referral, colleagues need to email both Suzanne Brown and Wojciech Gierynski with brief details about the individual, which must include their name and NHS number and why the referrer thinks the individual needs the TC. There are no forms to fill out as the team will then look into the case history and invite the service user in for a discussion, saving additional stress around form filling.

Community members can be anyone who has a complex history, is emotionally unstable and is chaotic in presentation. It may be that other services are struggling to manage these individuals.
When the service user has undergone assessment and wants to engage in our programme, a staff member is allocated to   act as Care Coordinator for them to offer a consistent approach – PD service users tend to be chaotic across all services so this model reduces strain on colleagues and improves the experience for service users. Despite having a named care co-ordinator we have a ‘whole systems approach’ to patient care. In essence this means that ALL staff know EVERY member so in the absence of CCO (leave / sickness) the member is always consistently supported.  To minimise ‘drop out’, all potential new service users go through a starter process which includes 6 x 2 hour sessions, consisting of a Mentalisation Based Therapy introduction and meeting the community. Sessions include staff and 2 community members so that when a new service user commits fully there is a degree of familiarity. This is also an opportunity to explain rules and standards and give the new service user the opportunity to understand how the programme works.

Over the four years of the programme running it has become apparent that this client group often have tremendous difficulties with endings which is often interpreted as rejection stemming from early life experiences. To avoid repeating cycles of chaos and crisis the members who chose to have ongoing support remain under CPA and ‘drop in’ after group times or access telephone support from staff who have a true understanding and formulation of their earlier lives and help them from repeating patterns of self-destructive behaviours.

There is an exclusion criteria for substances misuse but people are directed into dual diagnosis services and then supported to revisit Sequoia once this is no longer an issue.

 

How Does Sequoia Work?

Service users (Members) spend a substantial amount of time together as a Community including cooking, eating together whilst supporting each other to face their own personal challenges.

 

There are a range of therapies employed by the Community which include:

·      Mentalisation Based Therapy (MBT)

·      Dialectical Behaviour Therapy (DBT)

·      Laughter Yoga

·      Cognitive Analytical Therapy (CAT) – Suzannes CAT role is psychoanalytical which is helpful on the  initial formulation and underpins the problematic procedures which continually play out during their time in the programme

·      Art group

 

The Sequoia strives to work towards the Core Values identified by the Community of Communities (regulatory body at the Royal College of Psychiatrists) – the common shared values which underline all aspects of the work are:-

 

·      Promoting developing healthy attachment

·      Offering safe and supportive environment for containment of emotional distress

·      Respecting and valuing everyone’s individuality

·      Developing communication skills to learn to understand each other

·      Establishing supportive relationships with others

·      Encouraging full participation to influence one’s environment

·      Finding a balance in accepting that positive and negative experiences are necessary for healthy   development of individuals

·      Taking responsibility for self and the Group

The main goals of treatment for each Community member:-

 

·      To be able to regulate emotions through the discovery of alternative skilful behaviours

·      To be able to form and sustain meaningful relationships

·      To be able to manage dissociative symptoms, if present

·      To have gained confidence and to be able to find purpose in life determined by themselves

·      To have gained awareness of their own identity.

·      To be able to live more independently than prior to commencement of the Sequoia with less reliance on mental health services.

Democracy is the concept that underpins everything at The Sequoia; the team strive to create a family atmosphere so that each individual who is part of the Community takes responsibility for their own actions, gets involved and helps to make decisions as a collective Group. It is about respecting each other and in turn giving each person a voice. This helps to build confidence based on the attachment theory. Everyone has a view, and is encouraged to make decisions on, for example, menus/cooking, cleaning, rules and even voting people in or out of programme.

Healthy attachment is a developmental requirement for everyone and should be seen as a basic human right. The ability to form relationships with others is formed when we are children and unfortunately it is extremely common for people with a PD diagnosis to be victims of abuse when younger or to lack the relevant role models to learn how to develop relationships properly.

Due to the complexity, it is prerequisite that individuals referred to Sequoia TC are on the Care Programme Approach (CPA). When a member is deemed to need an inpatient admission, it has to be noted however, that this is a rare occasion, the member is not allowed to come to group. This decision was made collectively to encourage the member to remain in group, discuss and work through their problems. However, during any inpatient admission, staff members visit them and attend the doctor’s reviews to encourage a speedy return to the programme and discharge off the inpatient unit. Family support meetings are available to all members on a weekly basis to help educate, enable and extend family networks around supporting TC members in the home environment and beyond the length of the programme.

 

The Ethos:

Therapeutic Communities are structured, psychologically informed environments. They are places where the social relationships, structure of the day and different activities are all deliberately designed to help people’s health and well-being.

 

In TCs people with various longstanding emotional problems spend time and engage in therapy together in an organised and structured way, without drugs or self-damaging behaviour, so that a new life in outside society is made possible. Each member plays a crucial part in their own and others development and therapy. Members are often brutally open and honest in how they see and perceive how others are behaving. Each crisis and chaotic situation provides a valuable opportunity for self and others to learn new interpersonal skills rather than continue to use self-destructive behaviours such as anger, aggression, self-harming and avoidance. Each crisis situation allows staff to reinforce DBT skills and Mentalisation is always at the heart in all interpersonal transactions. The clue is in the title. TCs function as communities, with all members expected to commit to their values and standards. This is a key element of the programme in that people must accept responsibility for their own actions and behaviours in order to be allowed to join the Group. In a nutshell, it is designed to mimic a family environment where certain expectations are placed on Community members in order to build their social relationships and improve their overall health and well-being.

The Sequoia operates very much along these lines with TC members ‘gelling’ and living with family values but expected to have transparency; being challenging i.e., ‘what do you do in a disagreement’; making positive relationships/attachments and beginning to learn how to control emotions to decrease self-harming/self-defeating behaviours.

 

A Day in the Life of…The programmes/structure within the TC are decided upon by the Group in a totally democratic way, a typical weekly example of this would be:-

Monday

·      ‘Check In’

·      Community Meeting including Business part

·      Lunch with staff also cooking etc…

·      Dialectical Behaviour Therapy (DBT) Skills teaching

·      ‘Check Out’

 

Tuesday

·      Members Only Meeting (without staff) / Staff Supervision Meeting

·      Cooking Lunch

·      Small MBT Analytical Therapy Groups (community split into two smaller groups)

·      Lunch

·      Mentalisation Based Therapy (MBT) teaching

·      ‘Check Out’

 

Thursday

·      ‘Check In’

·      Large Therapy Group

·      Lunch

·      Art Group / Alternatively other electives

·      ‘Check Out’’

 

Friday

·      The Leavers Programme

‘Check In’, which is the first thing to occur every morning, involves each person in the Group speaking about their feelings in advance of the session. The community member speaking holds on to a NAViGO brain (promotional stress reliever) which encourages the rest of the Group to listen carefully during that time.

Weekly Community and Business meetings are Chaired and minuted by Service Users. Members manage their own rules and revisit boundaries on a monthly basis.

 

Wider Active Support:

 The sheer nature of the service itself and the privacy afforded to service users, makes it difficult for NAViGO to have active partners actually within The Sequoia per se. However, we work very closely with the Royal College of Psychiatrists and the Community of Communities to always ensure our service is second to none and fully aligned with best practice.

Other ‘partners’/stakeholders who help us to drive the service forward/maintain the equilibrium for service users are:-

·      Royal College of Psychiatrists CCQI – Community of Communities

·      Acute Adult (internal partner)

·       Community Services

·      Children’s services

·      PIP (Benefits Agency)

·      Care- Coordinators

 

We do however, work very closely with our own crisis team and encourage when possible each member to turn to group rather than contact emergency services.

Co-Production

 The whole service revolves around inclusivity and is managed using democracy trying to ensure inclusion and empowerment. For example:-

·      The members decided on a ‘Strikes’ system – e.g. if a member’s attendance drops below 80% then they receive a ‘Strike’; if they partake in alcohol or substances they receive a ‘Strike’ or suspension from the programme; challenging behaviour in the Community (or externally) has the same result. Once a TC member reaches 3 Strikes, the rest of the Community call a meeting (which includes the person involved) and enquire if the programme is working for them, making suggestions on how they might change behaviours/manage conflict.

·      If anyone from the TC presents in Crisis Service the night before a session then this is always discussed in the Community the following day to manage and promote responsibility and empowerment.

·      The Community excludes anti-social behaviour and people doing it are confronted by the rest of the Community.

·      The Community choose and prepare their own menus; sharing and eating this in a family atmosphere

·      The attendance policy was 60% but over time it has been increased to 80% and is set by the Community members themselves.

·      The Community sets its own boundaries and rules; collectively ensuring adherence.

What makes your service stand out from others? 

Outcomes:

The outcomes we have seen from implementing this service have been wide spread with positive changes being seen in:-

·      Service user outcomes/experience

·      Patient safety

·      Staff morale/less burn out

·      Cost savings

·      Reduction in out of area placements

·      Massively reduced readmission and presentations to crisis

Some good examples are:-

·      The Friends and Family Score for Sequoia is 93.7%

·      50% of service users open to Sequoia have an improved outcome measured on the PROM

·      82.4% of service users open to Sequoia rated their care as excellent or very good (the remainder rated care as fair)

·      Staff sickness rates have reduced not only within Sequoia but also within Acute Adult Inpatient units due a more relaxed environment helping with work related stress

·      Monthly audits on attendance show 80% which is remarkable for people with such complex needs

Since inception, the TC Group has almost doubled in size. Originally starting with 9 service users, there are now 16 currently. There is a waiting list of service users willing to start the next available starter’s programme to join the community.

The service user comments and case study below demonstrate the excellent outcomes/impact the service has had on service users lives:-

“Cannot thank the team enough, not only did they support me but my family were able to access support and guidance for themselves to help understand my needs”

“Since joining the TC I have met other people who have BPD which helps me feel that I’m not so alone. The TC helps me learn new ways of thinking and take control of our emotions.
Cannot thank the team enough, not only did they support me but my family were able to access support and guidance for themselves to help understand my needs.”

“You are the best thing since sliced bread.”

“Since coming to therapeutic Community, I feel I’m able to cope with family situations. I’m looking forward to the future.”

“I have seen big changes in myself and in others and I am now slowly being able to share some of my problems.”

Case Study:

Jane* is a current active member of the TC. Jane has been a prolific user of NAViGO services over the last decade and is an extremely hard case to manage as she refuses to engage with mainstream services to the extent that she has never had a care co-ordinator.

Jane has made numerous attempts at taking her own life (46 instances of self-harm and suicidal attempts recorded in the notes between 2007 and 2015). She also had 7 admissions over 9 years prior to joining Sequoia TC and her last stay within the acute lodges led to a seven month admission.

Last month Jane’s attendance at the TC was 100%. She attended all sessions and has shown remarkable progress since joining the TC.

*(Name has been changed to protect service user anonymity) See full report from the Kings Fund on the following link; Sequoia feature in kingsfund.org.uk 2019-03/outcomes-mental-health-services

 

 

How do you ensure an effective, safe, compassionate and sustainable workforce?

A small but dedicated team of five staff oversee the Community, currently three Social Workers, one of whom is also the Senior Operational Lead for Acute Services, a Health Care Worker and a part time Consultant Psychiatrist. A volunteer who was a community member and successfully completed the two year programme now offers her much valued support as an ‘Expert by Experience’, role that simply cannot be undertaken by a staff member therefore extremely valued within our community. There is also funding for a part time Psychologist but at this time the TC members feel this is not needed and democracy is crucial for our programme to work and to be successful.

Supervision:

There are two types of supervision in Sequoia TC:

1.       Group supervision – aimed at exploring the day-to-day functioning of the community programme, emotional struggles of the individual members, interactions between the community members and between members and staff.

2.       The staff dynamics supervision (otherwise known as the sensitivity group) – enabling staff to reflect on the relationship between them and the impact these have on their work. This group also allows reflecting on the Sequoia’s relationship with NAViGO as the whole organisation.

Both types of supervision are covered in our fortnightly supervision meeting with an experienced external supervisor (Dr Chris Holman). Also, both types of supervision constitute staff daily meetings following the whole community meetings – i.e., after every community meeting and daily check-outs all staff members meet together to briefly share their observations and reflections on the issues discussed, which also  allows to share thoughts about staff own feelings and mutual issues if any arise.

Staff WellBeing;

NAViGO have a strong ethos of staff support and wellbeing initiatives. The Director of Acute Services chairs the organisations Staff Wellbeing group.

NAViGO Staff Benefits/Staff Wellbeing

 

Who is in your team? Band/gradeNumberWhole-time equivalent
Consultant Psychiatrist10.5
Senior Operational manager/Cat Therapist/Social Worker8a11
Senior practitioners622
Nursing Assistant310.8

 

How do you work with the wider system?

The sheer nature of the service itself and the privacy afforded to service users, makes it difficult for NAViGO to have active partners actually within The Sequoia per se. However, we work very closely with the Royal College of Psychiatrists and the Community of Communities to always ensure our service is second to none and fully aligned with best practice.

Other ‘partners’/stakeholders who help us to drive the service forward/maintain the equilibrium for service users are:-

·      Royal College of Psychiatrists CCQI – Community of Communities

·      Acute Adult (internal partner)

·       Community Services

·      Children’s services

·      PIP (Benefits Agency)

·      Care- Coordinators

We do however, work very closely with our own crisis team and encourage when possible each member to turn to the group rather than contact emergency services.

Do you use co-production approaches? 

The whole ethos of co-production is encompassed in the way therapeutic communities work and is the main function of Sequoia.

Democracy is the concept that underpins everything at The Sequoia; the team strive to create a family atmosphere so that each individual who is part of the Community takes responsibility for their own actions, gets involved and helps to make decisions as a collective Group. It is about respecting each other and in turn giving each person a voice. This helps to build confidence based on the attachment theory. Everyone has a view, and is encouraged to make decisions on, for example, menus/cooking, cleaning, rules and even voting people in or out of programme.

An example of co-production involving staff is a current NAViGO service which supports staff, service users and carers to experience sailing – NAViGATE. Sequoia members are currently engaging in this which upskills them in sailing with access to qualification and progression to 1stMate status. Sequoia members both staff and service users regularly tweet about this experience:

Sequoia members also  do environmental checks on the inpatient areas, sit on interview panels setting their own questions, are members of the NAViGO choir and are encouraged to join  the membership and apply to be on the membership board

Do you share your work with others? If so, please tell us how.

 Internally

Morale has improved within the whole Acute staff Group. Being part of The Sequoia is a two way learning process; working with 16 complex individuals in one area at one time is a big learning curve. However, removing often chaotic PD service users from the main general in-patient units has brought about a much calmer environment, aiding faster recovery for others and in tandem giving the PD patients the bespoke care/support needed. Staff working within The Sequoia share their knowledge and experience with colleagues when working on the wards.

With the permission of the TC, a Laughter Yoga demonstration was given at the 2016 AGM and service users took part in two open days which included baking and raffles.

Community Members together with staff took part in the Annual AIMS Conference at the RCPsych, London delivering the workshop presenting our model and also co-facilitating the dispute about the stigma of the diagnosis of Personality Disorder in psychiatry.

Externally: With the permission of the Group, we have had many visitors to The Sequoia including:-

·      The Royal College of Psychiatrists

·      Positive Practice in Mental Health Collaborative

·      The Care Quality Commission

·      The Community of Communities       CCQI Royal College of Psychiatrists

·      Commissioners from other areas

·      Starwards

We regularly have trainee psychiatrists and nurses spending time with the community to understand individuals with PD better and learn our model of work.

Our commitment to sharing our practice is evidenced by the number of national awards NAViGO has won. Whilst we are always delighted to be recognised, our main driver for applying for award nominations is to ensure that a service which we know works, is disseminated to other health organisations.

 

What outcome measures are collected, how do you use them and how do they demonstrate improvement?

The Sequoia is very closely monitored by our Performance Team to ensure the cost of operation is covered (and surpassed) by the savings made in keeping service users well. Recent analysis of data from SystmOne demonstrates this clearly:

Over the four years since the launch of the Therapeutic Community, 17 service users were identified as having admissions both before and after their Sequoia referral.

For this cohort of service users, in the year before the referral there were 1327 peer review used, averaging 78 bed days per service user.

In the year after the referral, there were 215.54 bed days used, averaging 12.62 bed days per service user.

The bed days saved in the first year of a Sequoia referral: 1327-215.54-1111.46 x £400 (bed day cost) = £444,584

The table below illustrates the reduction in admissions and associated bed days used pre and post Sequoia referral and the accompanying decrease in costs:

Number of service usersAverage bed day per service user  Average cost per

stay

Year before Sequoia1778.06£530,808
1st Year after Sequoia referral1712.68£86,224
2nd Year after Sequoia referral117.82£34,408
3rd Year after Sequoia referral77.46£20,888
4th year after Sequoia referral59.01£18,020

 

 Evaluation (Peer or Academic):

As part of the Community of Communities initiative, Sequoia received a Peer Review on 20th September 2016  with a recommendation that we should apply for full accreditation status. The following years review highlighted one area for improvement which was the leavers programme. The reason for this was the simple fact that no one had actually left at that point and transferred over to the leavers programme.  We had an Accreditation Review on 5th March 2019 (awaiting the RCPsych accreditation decision) which should be received by July 2019. This works on the same principle as AIMS reviews undertaken for Acute Inpatient services in that Sequoia has been assessed against a set of core values by other mental health professionals. Results of the initial review were outstanding with the Royal College of Psychiatrists saying they were ‘blown away’ and advising The Sequoia to apply for accreditation after only one year of operation as it already currently meets all type 1 standards and a good percentage of type 2 standards.

The full report can be seen upon request.

NAViGO are expecting a CQC Inspection  in the next few months, PIR submissions  have been submitted.

Outcomes:

The outcomes we have seen from implementing this service have been wide spread with positive changes being seen in:-

·      Service user outcomes/experience

·      Patient safety

·      Staff morale/less burn out

·      Cost savings

·      Reduction in out of area placements

·      Massively reduced readmission and presentations to crisis

Some good examples are:-

·      The Friends and Family Score for Sequoia is 93.7%

·      50% of service users open to Sequoia have an improved outcome measured on the PROM

·      82.4% of service users open to Sequoia rated their care as excellent or very good (the remainder rated care as fair)

·      Staff sickness rates have reduced not only within Sequoia but also within Acute Adult Inpatient units due a more relaxed environment helping with work related stress

·      Monthly audits on attendance show 80% which is remarkable for people with such complex needs

 

How will you ensure that your service continues to deliver good mental health care?
Sustainability:

Whilst the Therapeutic Community is not a new concept, originating in the mid to late forties when the British Army used this model to treat their soldiers after PTSD front line fighting. NAViGO believe it is A GOLD STANDARD SERVICE. Other mental health organisations have closed their TC’s due to cuts in funding swallowing up running costs. This is where NAViGO ‘stands apart from the crowd’; being a social enterprise we can preserve our additional services by working smarter to preserve funds and ensuring sustainability. Since this programme started four years ago we have not placed one single service user out of area in rehab services who offer specialist PD services.

In terms of key staff leaving post, NAViGO has an internal development model which cross-cuts our Acute Service, with employees being given the opportunity to train around working within the TC ensuring an ever present full staff contingent.

What aspects of your service would you share with people who want to learn from you?
Sharing Externally: With the permission of the Group, we have had many visitors to The Sequoia including:-

·      The Royal College of Psychiatrists

·      Positive Practice in Mental Health Collaborative

·      The Care Quality Commission

·      The Community of Communities       CCQI Royal College of Psychiatrists

·      Commissioners from other areas

·      Starwards

 

We regularly have trainee psychiatrists and nurses spending time with the community to understand individuals with PD better and learn our model of work.

Challenges:

People with PD tend to use self-defeating behaviours to dull the distress caused by powerful feelings or impulses, commonly reporting a range of related difficulties, making treatment challenging:

 

·      Sudden and extreme swings in mood and feeling states

·      Impulsiveness – act without thinking

·      Frequent feelings of emptiness and boredom

·      Difficulty with a sense of self – who you are, what are you like

·      Difficulty with relationships, with a pattern of intense attachments to people which keep breaking down

·      Occasional episodes of loss of contact with reality or other experiences which might be seen as psychotic

·      Lack of confidence and self-esteem which shows through in difficulties managing your day-to-day life.

We reduced the possibility of ‘splitting’ between staff and the members by undertaking the role of care coordinator within our service. This ensures complete consistency of the expectations of services and the service that is given to the members.

When the TC was first set up it did not have a full and detailed business case attached to it prior to implementation. Initially this put a drain on the Adult Acute budget in funding the new service. However, the successful outcomes have meant the ROI realised from keeping people out of crisis services/bringing back from out of area placements has more than covered the original outlay (see Sustainability Section below).

It was difficult in the first year of service for Senior Management (SMT) to fully appreciate the impact due to the ‘closed shop’ nature of the Community. Whilst the privacy aspect of Sequoia is what empowers the service users to trust and support each other, the ‘double edged sword’ is that whilst the ethos protects service users, SMT viewed the TC as a ‘secret service’. This could not have been done any differently if the service was to operate as it should but the very first  excellent Accreditation Review from RCP swiftly allayed any fears as to whether the idea was a good one or not.

 

How many people do you see?
 From 1st June 2018 to 31st May 2019, there has been 30 referrals to Sequoia, 24 have been to community and 6 have been to day care.

Group attendance described in main body of submission

How do people access the service?
“We have made the referral process simple as we don’t want paper work and form filling to block entries into our programme. To make a referral, colleagues need to email both Suzanne Brown and Wojciech Gierynski with brief details about the individual, which must include their name and NHS number and why the referrer thinks the individual needs the TC. There are no forms to fill out as the team will then look into the case history and invite the service user in for a discussion, saving additional stress around form filling.
How do you ensure you provide timely access?
“We have made the referral process simple as we don’t want paper work and form filling to block entries into our programme. To make a referral, colleagues need to email both Suzanne Brown and Wojciech Gierynski with brief details about the individual, which must include their name and NHS number and why the referrer thinks the individual needs the TC. There are no forms to fill out as the team will then look into the case history and invite the service user in for a discussion, saving additional stress around form filling.”

 

What is your service doing to identify mental health inequalities that exist in your local area?
Crisis and home treatment teams are based within our Access Team and work closely local substance misuse services who offer sessions at Harrison House which we reciprocate at substance misuse services. People with substance misuse problems  present in high numbers to crisis and are highlighted in the   Mental Health Needs Assessment for N E Lincs  NEL MH Needs Assessment

Access to NAViGO’s Tukes Project which supports people back into employment and education. Tukes web page

 

Hours the service operates: 10 am to 3 pm (5 hours per day) for 3 days per week (Monday, Tuesday and Thursday). Plus Starters and Leavers groups.

 

Size of population and localities covered:

North East Lincolnshire is a small unitary authority covering an area of 192km2 with a population of around 160,000. The majority of the resident population (around 94.2%) live in the urban towns of Grimsby and Cleethorpes with the remainder living in the smaller town of Immingham, or in surrounding rural villages.

 

 

Commissioned by (e.g. name of local authority, CCG, NHS England)

North East Lincolnshire Clinical Commissioning Group (NELCCG) and NHS England (Rharian Fields)

Provided by (e.g. name of NHS trust):

NAViGO CIC – NAViGO is a not for profit social enterprise formed in 2011 under the Right to Request Agenda with a staff team of around 600 people. The whole of mental health services in N E Lincolnshire transferred out of the NHS yet is still the preferred provider to the NHS delivering both statutory and a range of innovative additional services in N E Lincolnshire. Becoming a social enterprise has allowed the organisation the autonomy to develop innovative projects. Any surplus made by working smarter is re-invested to improve services for local people.

 

 

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