Lighthouse Recovery Support is a specialist service for people with a diagnosis of personality disorder (PD) in Brighton & Hove aged 18 and over, aiming to support those who wish to improve their coping skills with severe and longstanding difficulties associated with PD. Opened in May 2013 Lighthouse is so far commissioned for 60 members and it is open 7 days a week.
What We Did
Lighthouse Recovery Support is a specialist service for people with a diagnosis of personality disorder (PD) in Brighton & Hove aged 18 and over, aiming to support those who wish to improve their coping skills with severe and longstanding difficulties associated with PD. Opened in May 2013 Lighthouse is so far commissioned for 60 members and it is open 7 days a week. Those referred to the Centre often require more input than the treatment mainstream services (Wellbeing and ATS) can offer, and often present with frequent visits to emergency services. In accordance with NICE guidance, great care is taken to encourage participation and co-creation at each phase of a service user’s (“member’s”) engagement.
Lighthouse is a multi-agency service, with Sussex Partnership closely collaborating with Sussex Oakleaf and MIND. The membership is seen as the 4th agency, with a representation on the Partnership Board.
This partnership offers many opportunities for innovative and creative ways of working to meet the needs of members, their loved ones and carers in a holistic and person-centred way.
The Lighthouse treatment pathway is in three phases:
– Phase 1: Attachment to Lighthouse. Taking individual attachment styles into account, staff support members to develop a secure attachment to the service (rather than individual workers) in order to provide a solid platform for challenging their difficulties
– Phase 2: Skills development. Members are encouraged to develop skills in emotion regulation as well as interpersonal, self-care and leisure skills though group work, through participation in the community and with the support from peers. Feedback and discussion is offered in key work sessions. Clinical groups at this phase include STEPPS and STAIRWAYS.
– Phase 3: In the third phase, members progress through peer support training, vocational assessment and activities or, if indicated, receive psychotherapy. Currently this is provided by the clinical staff in Schema Therapy Groups. If individual therapy work is appropriate, the person is referred to the local Assessment and Treatment Service and Lighthouse can complement individual work by providing a “safe space” for members to gain support after distressing therapy sessions. Taking PD specific difficulties and the high risk of relapse into account, there is no formal discharge from Lighthouse. Members can retain their membership as long as they meet the inclusion criteria. As they progress, great care is taken to increase self-efficacy, independence and participation in the wider community and to reduce the need for support. In this way service users become peer and community supporters, who help to make the service effective and increase its capacity.
Crisis prevention and relapse session are available to members in all phases.
In addition to direct work with members, the role of Lighthouse crucially also encompasses support, consultation and training for other services in Brighton and Hove, who wish to meet the needs of their users, who experience difficulties related to a Personality Disorder Diagnosis.
One key aim of Lighthouse is to reduce the members’ use of emergency services, especially the number of acute admissions, and for those who are admitted to see their length of stay reduced to under 72 hours unless clinically contraindicated. This is being monitored regularly in addition to clinical and functional outcomes to ensure effectiveness.
What members say:
‘Without this service I would be dead or at home with the curtains shut.”
“…since I started coming to Lighthouse regularly I have noticed that it’s easier with my three kids. They seem happier.”
“… I can now say to my wife what I need in a kind way and she understands me much better.”
What colleagues say:”
The trainers from Lighthouse were very accessible, great communicators, dynamic and inspirational!”
What carers say:
“I have noticed a large reduction in my daughter’s risk taking behaviour.”
Wider Active Support
*Joint risk and crisis planning with partner services, e.g Caburn ward, Sussex police or Sussex Ambulance Service
*Provision of training and consultation across the city (e.g Brighton Housing Trust, GPs).
*We work closely with numerous Trust teams, Third Sector and other services across Brighton and Hove.
*Monthly carers support group
*Joint key working sessions with members and their loved ones with consent of our members
*Sign posting to carer’s centre and other resources
* Regular Friends and Family Days
Service Users are an integral part of the planning and running of the service. They participate in staff recruitment and training, Committee meetings, and at Lighthouse Board level.
Looking Back/Challenges Faced
We initially began with Tiers more clearly defined within the service. We have learned that all referrals should be assessed and signposted on the same basis, and that great care should be taken to ensure that people’s needs are considered at all levels of complexity. We have also learned the importance of integrating new members of staff into the culture and in good a clear induction for everybody.
- Effective joint working between organisations
• Effective multiagency risk management
• Managing expectations, as the current service is not able to provide as service for the whole PD population in Brighton & Hove.
- Quick recruitment and good induction programme, good support from senior managers
• A flat hierarchy allows a high degree of self- organisation and allows all members of staff to be actively engaged in service development and leadership.
. There are plenty of opportunities for staff and Members to get to know each other very well, so our members are less likely to be severly disrupted if there are staff changes.
The team evaluates the service on an ongoing basis. Quarterly reports are shared with the commissioners.
Yearly clinical evaluation shows an improvement in clinical outcomes, such as symptom strength and functional measurements as well as a reduction in the use of crisis services and length of stay in hospital.
Non clinical evaluation shows that community participation, participation in education and volunteering are increasing.
- For individual Members: Members of staff assist with risk management and formulation across primary and secondary services
• Regular open mornings take place for interested colleagues
• Training sessions are available for stakeholders on request
• The team leader attends operational meetings and service development meetings, where information can be shared
. Lighthouse regularly hosts visitors from both local and other teams. For example, we recently hosted a group of clinicians from Norway. Lighthouse activities are also regularly presented at conferences and other teaching and training events.
Is there any other information you would like to add?
We also have a commitment to training the next generation of clinicians, so provide placements for trainees and interns.