Bridge House Detoxification Unit – Maidstone – KMPT

Bridge House is a 9 bedded Inpatient Detoxification Unit located in a beautiful converted oast house, set in tranquil gardens on the outskirts of Maidstone, overlooking the farmlands of the Medway Valley, close to major transports links. At Bridge House we offer high quality medically assisted detoxification for client’s dependant on alcohol, opiates, stimulants, sedatives and/or other prescribe drugs, aged 18 upwards. Our aim is to provide a safe, comfortable detoxification regime that allows maximum engagement with, and benefit from, the psychotherapeutic programme available. We offer holistic care with a focus on co-production with our clients and a strong emphasis on harm reduction and relapse prevention.

Co-Production

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

Evaluation

  • Peer: No
  • Academic: Yes
  • PP Collaborative: Yes

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Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.

Bridge House is a 9 bedded Inpatient Detoxification Unit located in a beautiful converted oast house, set in tranquil gardens on the outskirts of Maidstone, overlooking the farmlands of the Medway Valley, close to major transports links. At Bridge House we offer high quality medically assisted detoxification for client’s dependant on alcohol, opiates, stimulants, sedatives and/or other prescribe drugs, aged 18 upwards. Our aim is to provide a safe, comfortable detoxification regime that allows maximum engagement with, and benefit from, the psychotherapeutic programme available. We offer holistic care with a focus on co-production with our clients and a strong emphasis on harm reduction and relapse prevention. Bridge House incorporates a variety of treatment modalities and psychosocial interventions to ensure the best outcome for each individual client. We have an excellent completion rate (96% 2016/17), extremely high client satisfaction and long-lasting input from ex clients and carers. We strongly uphold client efficacy, dignity and individual rights. Clients are treated with respect and supported through the challenging journey towards recovery. Bridge House remembers that each client is a person as well as a drug/alcohol misuser and encourages the continuation and development of personal interests as part of building individual recovery capital and reintegration into their own community. Bridge House Mission Statement. • ‘We will provide excellent, individualised care for every client requiring inpatient detoxification. We will provide treatment for a range of clients, including the most complex, by thorough, clinically safe services delivered with kindness and respect. We know that we can provide this as we have a highly qualified, skilled and committed staff group with an excellent track record in terms of client feedback and completed treatment episodes.’

 

What makes your service stand out from others? Please provide an example of this.

We are very proud of the services we provide at Bridge House for our clients, the whole team is 100% committed to delivering the highest quality care they can. Here are just a few pf our compliments that we have received in recent weeks: • ‘You have all been the best people I have met in a long time; thank you from the bottom of my heart’ • ‘Thank you for support and help…I wish you all the best….my recovery is because of you’ • ‘ I will never be able to put into words my gratitude towards Bridge House’ • ‘You are literally saving peoples lives, thank you so much, you are all wonderful’ • ‘ Thank you all for my wonderful care, the food was amazing too’

 

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

At Bridge House we employ staff who are in recovery themselves, we utilise volunteers who are in recovery and we have a regular ex user who comes back and talk to our clients about their own journeys of relapse and recovery. Bridge House also has a volunteer, who is the partner of a former client of the unit. She attends Bridge House bi-weekly and co-facilitates a group with a particular focus on the perspective of a loved one of a drinker. She explains that her motivation for volunteering her time and sharing her lived experience is her way of thanking Bridge House for caring for her partner and being a vital part of his recovery Qualifications include: • Membership of Royal College of Psychiatrists and Specialist Registration with the GMC • DGDip’s Addictive Behaviour, Counselling, Academic Practice • BACP Counselling and NVQ Healthcare • Acupuncture Professional GMC/NMC registration is mandatory. Social work support is available locally via KMPT.

 

Who is in your team?

1 WTE Detox Manager: Band 7 1 WTE Ward Manager: Band 7 0.8 WTE Band 6 Deputy Ward Manager 4 WTE Band 5 Qualified Nurses 8 WTE Band 2 Healthcare Assistants (some with lived experience) 1 Chef 1 Band 3 Administration assistant 1 Cleaner

 

How do you work with the wider system?

At Bridge House we are co dependant on third sector agencies who provide the Community Drug and Alcohol services, these include ‘Turning Point’ , The Forward Trust and CGL. We also work with the local Community Mental Health Teams and substance misuse services AA (Alcohol Anonymous) , NA (Narcotics Anonymous) and CA (Cocaine Anonymous). Clients admitted to our Unit also have access to faith communities if they wish, facilitated through KMPTs chaplaincy services. All clients leave Bridge House with a personal seven day post-discharge Recovery Planner, facilitated by volunteers in recovery. This includes precise appointment details, community groups, mutual aid meetings and other individual recovery capital activities such as leisure pursuits and family visits.

 

Do you use co-production approaches? If so, please illustrate how you involve individuals, families and carers to drive improvement and deliver services?

KMPT Service User Involvement Strategy ‘The purpose of service user involvement is primarily to improve the service users’ experience of services and to make those services more responsive to local needs.’ KMPT is deeply committed to involving both service users and carers in the design, development and delivery of services. KMPT has a formal service user strategy, (Service User Involvement: Strategy for the Involvement of Service Users in the Work of the Trust) which is available via the Trust Intranet or the Freedom of Information Office. At Bridge house we employ staff who are in recovery themselves, we utilise volunteers who are in recovery and we have a regular ex user who comes back and talk to our clients about their own journeys of relapse and recovery. Bridge House also has a volunteer, who is the partner of a former client of the unit. She attends Bridge House bi-weekly and co-facilitates a group with a particular focus on the perspective of a loved one of a drinker. She explains that her motivation for volunteering her time and sharing her lived experience is her way of thanking Bridge House for caring for her partner and being a vital part of his recovery Bridge House recognises the fundamental importance of carers’ involvement in the recovery process. Bridge House is carefully laid out to welcome both service users and carers. The reception and main area contains reading material and compliments which highlights the positive atmosphere at Bridge house and shows the feeling of gratitude from so many ex-service users. This provides a warm and caring ambience which reassures carers that their loved ones will be cared for. We are also taking part in the National initiative ‘Triangle of care’ whereby we work in partnership with both clients and their relatives.

 

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

Complimentary Treatments; In recent months Bridge House has developed such innovations such as offering an Auricular Acupuncture treatment service to its clients as a complementary therapy alongside the detoxification programme. Auricular Acupuncture has been used for many years in conjunction with detoxification, with benefits such as reduction in cravings, alleviation of withdrawal symptoms and the reduction of stress. The feedback has been very positive with clients being helped with problems such as withdrawals symptoms, stress, pain and insomnia. Comments include: “The session really helped with my anxiety and has helped me to be more relaxed around the other clients on the ward. The magnets are a great help with my nervousness during the day”. “For some reason, I seem to handle my back pain better. I don’t know whether it’s my mind, but the needles, and the magnets especially, are a fab help”. “The session is just a great way to help me relax for a bit during a hectic day where my minds all over the place”. Also at Bridge House and by way of promoting holistic sleeping practice, we purchased 9 MP3 players, one for every client’s bedroom. These are pre-loaded with music composed to include Delta Waves which are beneficial in both helping people get to sleep and to stay asleep and which allows a person to wake up feeling refreshed and rejuvenated.

 

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

Preadmission assessment and motivational work undertaken by Bridge House staff supports the client prior to admission and as well as providing information for the client and their family and starts to build a therapeutic alliance. Motivational techniques address pre-admission ambivalence resulting in low non attendance rates. (2016/17 being 0%) Medically Assisted Detoxification is consultant led; medications offered include Chlordiazepoxide, Oxazepam, Methadone, Buprenorphine, Lofexidine and Pabrinex for Wernickes prevention (NICE CG’s 100 and 52) Detoxification is symptoms-led, nurse monitored, titrated against validated withdrawal scales (e.g. SOWS, CIWA-A). Each day is structured to maximise treatment opportunities with flexibility to best meet clients needs. Psychotherapeutic activities are balanced with leisure, providing space to process group/reading material. Bridge House believes that a structured day is critical to successful treatment outcomes by engagement in therapeutic activities, normalising sleeping and waking routines and minimising boredom, which leads to craving and disengagement.

 

Detoxification at Bridge House is supported by a full range of adjunctive, supportive interventions to maximise completions (currently 96%) including: • Group work including; Relapse prevention, Psycho-education, Harm reduction. • Recovery focused groups run by highly experienced staff with accredited qualifications in addictive behaviour, counselling and/or group therapy. • Approaches include CBT, 12-step and Interpersonal Therapy. • Introduction to the fellowships of Alcoholics Anonymous, Cocaine Anonymous and Narcotics Anonymous • Mutual Aid (AA, NA, CA fellowships) • Individual psychosocial interventions/counselling • Peer led activities • Non-mandatory chaplains group (linking to other faith communities) • Foundations of recovery (includes concepts of group working in ‘The Johari Window’ and topic based groups looking at the maladaptive, ingrained patterns of thoughts and behaviours that maintain addiction). • Structured therapeutic day includes community meetings, accompanied walks and relaxation • Social/occupational activities (pool tournaments, quizzes etc) We recognise that nutrition is also very important and as such all our food is freshly prepared daily on site by our very talented chef.

 

Has your service been evaluated (by peer or academic review)?

Bridge House was assessed by the Care Quality Commission (CQC) in January 2017 and was rated as ‘Outstanding’.

 

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

Within our Specialist Care Group we have worked closely with our financial accountant colleagues and with stakeholders within Kent and Medway and stakeholders outside of Kent, by tendering for and being awarded ‘preferred provider’ status for medically assisted detoxification services. We currently provide our service to not only Kent clients but also to CGL in East and West Sussex, Pier Point Project in Bexley, Turning Point Oxford, Buckinghamshire, CGL in East London, Essex and Bromley. Bridge House has had a challenging two years and this has impacted on the ability to meet its ‘break even’ income target. The team have reviewed how to ensure the income is regularly at a level to meet both this target and contribute to the required 4% Cost Improvement Plan savings. Bridge house enjoys an excellent reputation. The services delivered are of an exceptionally high quality providing services to the most vulnerable people in our community and as such we are committed to ensuring its financial viability and securing its future. This is demonstrated by the most recent CQC review which rated the service as ‘outstanding’. Our plans to address the increase in the target income are; 1. Increase our bed price days by between 1%-4% 2. Accepting Privately Funded patients at an increased rate per bed day 3. Offering our services to Surrey residents

 

What aspects of your service would you share with people who want to learn from you?

The detox service provided at Bridge House is not part of KMPTs Mental Health ‘block’ contract commissioning arrangements nor is it commissioned by NHSE; it is a service hosted by KMPT, where bed days are bought by third sector substance misuse community service providers such as Turning Point, The Forward Trust and CGL on a spot purchase basis. This kind of commissioning arrangement leads to financial insecurity for Bridge House and as third sector providers’ budgets are reduced year on year, the financial viability and future of Bridge House becomes more and more uncertain. Many other ‘NHS’ detox units have closed in recent years putting an increased pressure on A&E departments and Acute Medical Wards.

 

How many people do you see?

Bridge House is a 9 bedded unit. Average length of stay is 13 days. We aim to be 85% – 95% occupied at all times, however this is dependent on referrals.

 

How do people access the service?

Beds are purchased on a spot basis by community substance misuse providers, which are a mix of third sector, local authority and NHS providers. All referrals are screened by the Detox Manager.

 

How long do people wait to start receiving care?

Approximate wait to receive care from point of referral is 2 weeks.

 

How do you ensure you provide timely access?

Referrals are screened and triaged by the Unit Manager. Urgent referrals are prioritised.

 

What is your service doing to identify mental health inequalities that exist in your local area?

A mandatory requirement of the service is to collect minimum data set information and this is analysed by our Management Information team. All referrals are accepted, providing they meet the eligibility criteria of requiring detoxification.

 

What inequalities have you identified regarding access to, and receipt and experience of, mental health care?

We have recognised that the Asian community tend to present less than others.

 

What is your service doing to address and advance equality?

The Detox Manager works with other organisations to raise awareness of substance misuse and treatments available within Bridge House and the community.

 

How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?

All referrals are screened by the Detox Manager and medically by the Consultant Psychiatrist.

 

How do you meet the needs of people using the service and how could you improve on this?

The Care Group has a NICE Gap Analysis Group, where guidelines relating to detox and substance misuse have been used to self-assess and improvements made. A Comprehensive Assessment of Need is completed; assessment at the point of admission, including risk, forms the basis of a personalised, recovery orientated, holistic care plan. A individual Risk Assessment is completed; including self-harm, injecting/drug use behaviours, harm to others, physical frailty, sexual practices, safeguarding, financial vulnerability Relapse prevention offered: Acamprosate, Naltrexone and Disulfiram prescribing and client and referrer consent. Psychotherapeutic Input includes Detoxification occurs as part of a package of intervention (NICE CG115). Structured Psychosocial Intervention: • Daily community meeting • Peer-led recovery planning • Group work and Mutual Aid • Individual counselling Wellbeing Interventions: • Non-mandatory chaplains group (linking to other faith communities) • Well-being • Relaxation • Acupuncture Discharge Planning and Aftercare Liaison includes: • Early relationship building with Aftercare provider/Rehab 7 day peer-led, multi-agency discharge planning

 

What support do you offer families and carers? (where family/carers are not the service users)

Bridge House recognises the fundamental importance of carers’ involvement in the recovery process. Bridge House is carefully laid out to welcome both service users and carers. The reception and main area contains reading material and compliments which highlights the positive atmosphere at Bridge house and shows the feeling of gratitude from so many ex-service users. This provides a warm and caring ambience which reassures carers that their loved ones will be cared for. We are also taking part in the National initiative ‘Triangle of care’ whereby we work in partnership with both clients and their relatives

 

Further information

We are very proud of the services we provide at Bridge House for our clients, the whole team is 100% committed to delivering the highest quality care they can. Here are just a few pf our compliments that we have received in recent weeks: • ‘You have all been the best people I have met in a long time; thank you from the bottom of my heart’ • ‘Thank you for support and help…I wish you all the best….my recovery is because of you’ • ‘ I will never by able to put into words my gratitude towards Bridge House’ • ‘You are literally saving peoples lives, thank you so much, you are all wonderful’ • ‘ Thank you all for my wonderful care, the food was amazing too’

https://www.kmpt.nhs.uk/services/bridge-house-at-fant-oast-inpatient-detox-unit/7187

Population details 

Brief description of population (e.g. urban, age, socioeconomic status):

Adult clients, 18 years +

Size of population and localities covered: 

Localities: Kent, Medway, West Sussex, East Sussex, Oxfordshire, London, Buckinghamshire. North Essex

Commissioner and providers

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

Spot purchase arrangement by community substance misuse providers.

Provided by (e.g. name of NHS trust) or your organisation: *

Kent and Medway NHS and Social Care Partnership Trust

 

 

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