IPSA works with people who are currently living in residential or nursing placements who are funded by the Local Authority, people who are registered with a Lambeth GP, who are receiving treatment within the rehabilitation wards in SLaM, or are placed out of borough due to their complex mental health needs. The underlying principles are to ensure that people have more personalised opportunities to be supported in the community, at home where possible with tailored packages of support to meet their needs. This will reduce the reliance on hospital and ‘institutional’ types of care. A key principle is to facilitate as much independence as possible, recognising that people have skills and assets to support their own recovery.
Co-Production
From start: No
During process: Yes
In evaluation: No
Evaluation
Peer: Yes
Academic: No
PP Collaborative: Yes
Find out more
Liz Durrant - Director of Mental Health, Certitude
IPSA works with people who are currently living in residential or nursing placements who are funded by the Local Authority, people who are registered with a Lambeth GP, who are receiving treatment within the rehabilitation wards in SLaM, or are placed out of borough due to their complex mental health needs. The underlying principles are to ensure that people have more personalised opportunities to be supported in the community, at home where possible with tailored packages of support to meet their needs. This will reduce the reliance on hospital and ‘institutional’ types of care. A key principle is to facilitate as much independence as possible, recognising that people have skills and assets to support their own recovery.
The service consists of an Alliance Rehabilitation Team (ART); an integrated team of voluntary sector staff, social workers, nurses, occupational therapists, consultant psychiatrists to intensively support people in their homes who would have previously entered hospital. There are then a number of housing options from high support through to support for people living in their own homes provided by Certitude and low support provided by Themes reach.
Certitude provide a community recovery service which is used as an alternative to hospital admission, as well as a step down from rehab wards. People stay for 6-9 months and work on their agreed goals to enable them to continue growing in independence. This service has led a key role in reducing the need for rehabilitation inpatient services and 1 ward was closed due to no longer being needed. Also within the IPSA pathway are 9 self-contained studio flats which are staffed 24/7 where people are supported over a 18 month period to continue to develop their skills and prepare them to move onto their own flat in the community. These flats are in the heart of Brixton, above our creative hub and community resource centre. Art groups, exhibitions and community events take place in the space.
The most recent addition to the IPSA is the 12 bedded female only supported living service, this service has enabled women who were in residential services to step down into the community with a tailored package of support that works closely with their individual needs and focuses on female orientated activity schedules, that look at improving health and well-being. This is done through workshops including Yoga, chair exercises, confidence building and pamper sessions.
Wider Support
IPSA is an alliance between a number of partner organisations:- Thames Reach, Certitude, South London and Maudsley NHS Foundation Trust (SLaM), Lambeth Clinical Commissioning Group (CCG) and Lambeth Council, and is unique in the alliance approach to delivering mental health support across the whole system with the intention to enable recovery, reduce restrictive practices and support and develop wellbeing.
A big part of the success of the services is the collaborative work that has taken place across partners within the alliance. The great relationship that we have today hasn’t come without its challenges, and it is important to recognise the challenges that occurred during the development of the IPSA, and to ensure that we has partners remain reflective and the outcomes that we want to achieve are all agreed. It was vitally important that the partners had the same values and drive to make this alliance a success and more importantly ensuring that the people we support are at the centre in the driving force, to ensure positive change is occurring for the lives of people within Lambeth
Co-Production
It is inspirational to see the team’s working with the people that are in the services, and how the focus is on their strengths and their future progressions. The people that are supported are included in all aspects of the service delivery, including getting involved in their support notes, writing their support plans and one client even oversees the rota at their own request! The people that live at the services take a lead role during recruitment of new staff, by writing their own questions to chairing the interview meetings
Looking Back/Challenges Overcome
The big challenge that occurred between the alliances was changing the mind set of what recovery looked liked. In addition to this it was moving from the old deficit way of working, which included a big culture change. In addition to the culture change was the understanding that the Alliance needed to embrace the risks that may be presented, with moving away from locked wards and high supported services where the risks are minimised, to giving people more independence and choice and letting them take positive risks within the community.
Sustainability
IPSA is a system approach to supporting people. The whole system works with people from the most restrictive environment through to having floating support in their own flat. People continue to be supported by the ART throughout their journey and the alliance between all the different parts of the system works together so the person is known. Each part of the system spends time getting to know their person and their strengths prior to them moving from one part of the system to another.
There is an emphasis on what the person wants to achieve and the entire ethos of the system is asset based and a belief that people can achieve great things when given the choice, hope and control.
Evaluation (Peer or Academic)
The Lambeth living well collaborative worked with people who used services to define the outcomes for the service and this is what IPSA is measure against by the alliance:
1. Reducing the use of residential placements by 50% and instead supporting people to access accommodation where people can do more for themselves
2. Increasing other outcomes that are important to people, including:
• Increasing the numbers of people who are in employment or voluntary work/ education or training
• Increasing peoples’ positive connections in the local community
• To support people to improve their physical health care.
3. Delivering savings in year one and 23% (c£2.8m) on the original budget from year two of the programme. The premise is that by developing more community options, this not only supports better outcomes, but is more efficient.
Outcomes
In year one we identified community alternatives to inpatient admission which has led to a reduction of 60% admission rates to inpatient rehabilitation wards in Lambeth. For those people who continue to require inpatient rehabilitation admission, we have provided outreach from the ART to support people to identify housing needs more quickly, develop friendships and community connections, and to support people with personal budgets to help them in their recovery. We have supported 65 people in rehabilitation and residential care placements to move to alternative accommodation or back home with support.
We have reduced the entrance rate to residential care by 67% and have increased the numbers of discharges from residential care by 30%
We have worked with people and made them feel like part of the team and used their assets to develop their independence. People have been able to form an identify again and feel a part of their community. We have supported people to access voluntary work and training and encouraged peer support within the services. We have worked with families and help build relationships that were strained, recently a family member stated in ‘The Future of people powered by health’ conference:
‘I never thought my son would come out of hospital, the service gave him the opportunity to move into the community. The staff at the Turrets helped him get his dignity back and now he is living in his own flat and volunteering at a garden centre. I no longer worry about his mental health but instead I worry about what next girlfriend he is getting. I feel like I can now worry about things that normal mums should worry about, I feel like his mum again’.
Sharing
The Lambeth Living well alliance approach has been shared at conferences and promotional videos explaining the service are being developed. The alliance is also forming part of a research project about alliance models in health and social care
Is there any other information you would like to add?
I have spent my career working in NHS mental health services and have met so many people that services have not known what to do to support the person in their recovery. Across the country there are many people who have been in rehabilitation wards, placements and forensic wards for years and to be frank, the health service has given up or forgotten about them.
Coming to Certitude and meeting colleagues in IPSA I have been blown away by the commitment to hope, to believing in people’s potential and to working in partnership. I have met a number of people who had been in hospital for years (13 for one person!) who are now living in the community, working, playing football and living a life full of meaning. I have been humbled and inspired by everyone I have met and truly feel this collaborative is something special.
