Our Urgent Help Service is a comprehensive viable alternative to inpatient care. We provide assessment and care for young people in mental health crisis at risk of admission. This consists of emergency assessments 365 days a year. Following assessment young people may be put on one of our 3 care pathways.
What We Did
Our Urgent Help Service is a comprehensive viable alternative to inpatient care. We provide assessment and care for young people in mental health crisis at risk of admission. This consists of emergency assessments 365 days a year. Following assessment young people may be put on one of our 3 care pathways (1. intensive home treatment – up to daily contact with young people and families who are in crisis – aim to maintain safety at home and crisis resolution work, 2. Enhanced assessments – a 2-week intensive supercharged care coordination package where risk and risk management is established along with deciding what next for young person. 3 – admission pathway – includes gatekeeping and bed searching and then regular liaison with all hospitals that young people from our area are in (including out of area beds). We work to expedite discharge from hospital through excellent liaison and offering intensive home treatment.
Some examples: We regularly join Mental health Act assessments and offer an expert CAMHS view. We offer an intensive care package which can prevent a detention under the act. If a young person is seen in A&E with a mental health difficulty we can offer them a home visit the next day. This would involve working with families and the young person to manage risk but also to help the young person to continue with as many positive aspects of their life as possible (hobbies, school, contact with friends)
Below is a case study:
Ryan is a 17 year old man who was referred to Tier 3 CAMHS for a Choice appointment by the Paediatric Liaison Mental Health Team who had assessed him following a small medication overdose. Whilst awaiting the Choice appointment he engaged in an escalating pattern of deliberate self-harm and para-suicidal behaviour including threats to jump in front of a train, and one incident of drinking after-shave which led to his admission to a paediatric ward. He was referred to UHS from the Paediatric Liaison Mental Health Team as he was presenting as highly distressed, stating suicidal intent and requesting admission to psychiatric hospital.
Ryan and his parents were assessed within four hours of referral on the paediatric ward. This was a thorough assessment of his presenting mental health needs, risks and social and family circumstances. The assessment identified that Ryan had complex needs that were primarily mediated by social factors, including significant substance misuse and mental health difficulties within key family members. He did not wish to return home and did not feel able to guarantee his safety if required to do so. With the agreement of his family, Children’s Social Care was contacted and an emergency placement was provided within 24 hours. It was agreed that Ryan would be placed on the Extended Assessment Pathway to provide on-going monitoring of his mental state and risk within the community.
While on the Extended Assessment Pathway Ryan was contacted daily by phone and received six face to face sessions over the two week period. The intervention consisted of solution-focused therapy, psychoeducational work and support around emotional regulation. This enabled Ryan to achieve a greater degree of stability and safety before returning home to his family. At the end of the assessment phase with UHS he was discharged to the care of Tier 3 CAMHS who offered a period of treatment with interpersonal psychotherapy and medical review with a psychiatrist.
The Extended Assessment Pathway provided Ryan with an alternative to acute hospital admission. This was achieved by intensive support over a two-week period that provided containment and reassurance to Ryan, family and the systems within health and social care. Adoption of the care coordination role by UHS facilitated a greater level of inter-agency working which was central to the successful management of this case.
Wider Active Support
We work with a variety of agencies including: Local CAMHS teams, Social Services, education, Police, Street Triage, AMPHs, Paediatric care staff. We often go into schools with families and young people following a crisis. the aim is to help the school to understand what has happened and to work out how the young person can be safe at school.
We work with social services very frequently. very often a young person has social care needs and mental health needs. (see case study detailed above)
All our young people under home treatment within the UHS are asked to complete a HONOSCA questionnaire on starting and finishing treatment with us. The aim of this is to seek the perspective of young people on whether UHS has helped, and, if so, in what areas. Staff also complete a CGAS questionnaire with young people receiving home treatment.
Where appropriate we ask young people to complete our friends and family questionnaire. When we are interviewing for new staff we invite service users to be part of the interview panel. The UHS team has regular away days where all of the team members contribute to ideas for service improvement and development.
Looking Back/Challenges Faced
I would have asked for more staff so that our hours could be extended and so we were able to offer more visits to young people and their families.
We cannot always get to every referral on the day that it is made – this is due to the high demand for our service. We are currently working with commissioners to look at expanding our service. We always provide consultation and safety management advice to all cases that we cannot see. We will then follow this up with a face to face visit as soon as it viable
We have a clear aim, philosophy and mission statement which has been jointly developed by the whole team. Our quarterly away days ensure that our values and ethos remain aligned.
Admissions to out of area acute beds and length of stay in these beds have decreased. We feel that the UHS has had an integral role in this
We have presented our service at a conference within Sussex Partnership. We have hosted visits from colleagues from other services looking to develop their service model, and are also part of the QNIC networking group.