The Urgent Help Service in Sussex is an intensive crisis intervention and home treatment team providing an alternative to inpatient admissions through community support and risk assessment, reduction and management. The overall aim of the team is to contribute to existing packages of care for children and young people who are presenting with acute mental health needs, which place them at significant risk of harm to themselves and/or others. They deliver a 4-hour crisis response, a 2-week extended assessment and crisis support, and home treatment.
The Urgent Help Service in Sussex is an intensive crisis intervention and home treatment team providing an alternative to inpatient admissions through community support and risk assessment, reduction and management. The overall aim of the team is to contribute to existing packages of care for children and young people who are presenting with acute mental health needs, which place them at significant risk of harm to themselves and/or others. They deliver a 4-hour crisis response, a 2-week extended assessment and crisis support, and home treatment. By adding to existing packages of care, the service can provide up to 3-5 contacts per week for 2-12 weeks. The goal of the intervention is to maximise coping strategies of the child or young person, and their support network. The service aims to include solution and task focused work, family work, motivational interviewing, and graded exposure.
The Urgent Help Service covers all of Sussex, including Brighton and Hove. All practitioners in the service also work in the duty team, which operates on a daily basis to support and manage new crisis referrals while also adding care into existing cases which need extra support that day. Referrals to the service are made by Health professionals – predominantly Community CAMHS practitioners and A&E mental health liaison teams.
The service operates 9 am to 8 pm weekdays and had a small duty team working from 10am-6pm on weekends and bank Holidays. The service also operates locally based home treatment services in each locality of East Sussex, West Sussex, Brighton, and Hove. Each team has a team leader who reports to the service manager/matron. Two practitioners a day work the ‘duty shift’ which run from 12pm to 8pm weekdays and 10am to 6pm at weekends. The duty shift covers the whole of Sussex.
The service provides three care pathways:
- Intensive home treatment as a viable alternative to inpatient admission providing up to daily contact
- Extended assessment and care planning pathway to prevent re presentation in emergency departments, provide comprehensive risk assessment and planning and to ensure timely access to appropriate mental health support in a crisis
- Admission and out of area support pathway (coordinate all admissions, expedite discharge, keep in touch with out of area beds).
Working with inpatient care
The service links closely with young people whilst they are receiving care as an inpatient. They provide in-reach during admission, as well as working to bring discharge forward through community support. To manage out of area admissions they have a weekly task force to review cases, clarify goals, contact families and liaise with out of area providers. The team attends reviews and conducts regular visits if location allows. The aim is to facilitate transfer to home treatment or to a bed placed more locally if needed. They work with both young people in the community and with those who have been admitted; their goal is to make the admission as short as possible.
What makes this service an example of positive practice?
We work hard to keep young people out of hospital and connected with everyday coping mechanisms. We are extremely flexible in our approach and can see young people in a variety of settings where they feel most comfortable (café, school, home, park). We can text, phone or see young people face to face. We have individualised packages of care for each young person and almost always involve families or carers in some positive way. We speed up admissions in the hope that young people do not get too dependent on, or deskilled by, the hospital environment. Our service has experienced a decrease in out of area admissions from 2860 bed days between April 2015 and March 2016, to 1176 bed days between April and December 2016.
|Commissioning||CCG and NHS England|
|Providers||Sussex Partnership NHS|
|Workforce (WTE)||1 consultant psychiatry, 0.3 clinical psychologist (band 8a), 3.0 (band 7) Team Leaders, 7.6 Band 6 mental health practitioners – tend to be either Nurse, Social worker or Occupational therapist), 0.5 matron (band 8) and 1 team secretary (band 3)|
|Population size||All ages – 1,827,880, under 18 – 361,171 (Office of National Statistics 2016 mid-year population estimates for East, West and Mid Sussex and Brighton and Hove)|
|Caseload||Receive around 50 referrals a month, 60% receive an initial assessment, consultation and signposting, and 40% assessment and home treatment. The average time on caseload is 39 days.|
|In-reach, inpatient and residential|
|Access and advice – consultation lines, triage and signposting||Crisis|
|Biopsychosocial assessment||Intensive interventions|| |