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 prescribed or non-prescribed 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.
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 prescribed or non-prescribed 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% 2017/18), 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?
Bridge House is one of only 5 national detoxification units hosted by an NHS Trust in England. Bridge House employs, as part of its multi-professional team, people with lived experience. Currently, the unit has a Healthcare Worker in recovery and a volunteer chef, also in recovery. In addition to this, Bridge House has a partner of an ex-drinker who facilitates a monthly group with current patients, to highlight the challenges experienced by loved ones of a person with substance misuse issues. Bridge House featured in the prestigious 2019 Parliamentary Review. The Parliamentary Review is a publication that features commentary from the Prime Minister, other cabinet ministers, and eminent journalists. Its aim is to promote best practice in health and bridge the gap between industry and politics.
How do you ensure an effective, safe, compassionate and sustainable workforce?
All staff who join the team receive a local induction as well as a Trust induction. Staff are encouraged during their appraisal to identify pertinent training opportunities as part of their continued professional development, and are supported by the unit manager to achieve their goals. Reflective Practice sessions take place monthly for all staff, facilitated by the unit manager. Daily community meetings take place for all staff and clients. Six weekly supervision also takes place for every member of staff. They also have Trust-wide staff MOT days. Staff are encouraged to attend to receive their health check. The employees with lived experience are of course afforded all of the same training and support as other members of the team.
Who is in your team?
1 Consultant Psychiatrist 1 GP (1 day a week) 2 Band 7 Nurses 5 Staff Nurses 7 Support Workers 1 administrator 2 Housekeepers 1 Chef
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?
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 monthly 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.
Bridge House are always keen to learn from others and to share with others good practice that they provide. They share all their initiatives via KMPTs ‘Peak of the week’ and ‘Quality News Letter’ publications that are feely available to patients, carers/relative and staff colleagues. They are also available via the Trust website. (Examples attached) In addition to this, the work that Bridge House do in caring for their patients on Bridge House has been published in this year’s prestigious Parliamentary review. The Parliamentary Review is a publication that features commentary from the prime minister, other cabinet members and eminent journalists. Enclosed within it, are a series of profiles from organisations that have a story to tell. The aim is to promote best practice and bridge the gap between industry and politics. Bridge House ensure the voice of the patients, their loved ones and their relatives are heard and their opinions and wishes really matter and are valued. Staff are asked to reflect on their practice, whether it be clinical or non-clinical and examine whether or not they could do something differently, which would be more beneficial for the patients and their families. Daily meetings are held on Bridge House to allow space for ideas and suggestions to me made.
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 (2017/18 being 0%). Medically Assisted Detoxification at Bridge House 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 at Bridge House 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) Bridge House also recognise that physical health and nutrition is also very important and as such all their food is freshly prepared daily on site by their very talented chef. Bridge House also collects a wide range of feedback by asking patients to complete the Trust-wide PREM (which has the FFT questions within it), and the Bridge House Satisfaction Survey. Patients are asked on discharge to complete these measures.
The Care Group Quality Team support Bridge House to analyse the data and present it in clinical reports with action plans for improvement. You Said, We Did posters are also displayed, to show our patients the changes we have made as a result of their feedback. Community meetings take place daily, providing an opportunity for patients to put their views across and receive updates from staff. A suggestion box is also on display on the ward at all times. Recent qualitative feedback as follows: Ø‘’You helped save my life.’’ Ø‘’The staff are outstanding. Very compassionate in every way.’’ Ø‘’Joe’s groups are fantastic.’’ Ø‘’Their enthusiasm and faith in me.’’ Ø‘’I could not have been better looked after.’’ Ø‘’The caring attitude of the staff is second to none.’’ Ø‘’They have genuine concern for everyone’s welfare.’’ Ø‘’Excellent advice given about my recovery.’’ Ø‘’A peaceful, tranquil environment.’’ Ø‘’The staff always had time for me, day and night.’’ Ø‘’They took time to explain treatments to me.’’ Ø‘’They make you feel at home the minute you walk through the door.’’
Has your service been evaluated (by peer or academic review)?
Bridge House received a CQC rating of ‘Outstanding’ when it was inspected in January 2017 and commented in their report “Staff interacted with patients and their approach was kind, respectful and professional at all times. Staff continually interacted in a positive and proactive way. The atmosphere was really welcoming, friendly and warm. Staff were particularly enthusiastic, dedicated and motivated by their work”. Bridge House retained their Outstanding rating following the November 2018 KMPT CQC inspection. And, as previously mentioned, the services delivered from Bridge House were published in this year’s Parliamentary Review,
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, Hampshire, Buckinghamshire, CGL in East London, Essex and Bromley. 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’. We have recently started accepting referrals from clients who are self-funded.
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. In order to ensure its future, we have worked hard to increase our preferred provider status with other agencies across the UK and also have extended our service to self-funding clients.
Additional Questions
The following questions are an opportunity for you to provide further details on how you implement positive practice in your service delivery and how you ensure your service is advancing access and equalities. Answers to these questions will not influence how your PPiMH awards application is assessed, however any responses received may contribute to the potential inclusion of your service/team as a positive practice example within published guidance developed by NCCMH and NHS England.
How long do people wait to start receiving care?
Bridge House have approximately 18 admissions per month (on average, 216 admissions a year) with the average length of stay being 9 days.
How do you ensure you provide timely access?
All referrals to Bridge House are screened by the unit manager and Consultant Psychiatrist. Priority is given to those with the highest risk factors as well as self-motivation to make a positive change in their life. We aim to admit all those referred within 2 weeks.
What is your service doing to identify mental health inequalities that exist in your local area?
Our colleagues at Bridge House have recently been in discussions with the Community Diversity and Inclusion Placements Officer at Kent Police College, with the aim of offering placements at Bridge House to trainee Police Officers. The aim of the Placements is to give an understanding to Officers of how to communicate and care for those with alcohol and drug issues as well as a better understanding of issues relating to mental health . It is hoped that these placements will improve police’s communication skills, knowledge and performance, resulting in greater awareness and insight into mental health issues and detox services which will benefit the Officers, Bridge House, KMPT and Kent Police as a whole. Providing an opportunity for organisations and communities to contribute to the training of Kent Police Officers, will strengthen working relationships and enhance better understanding and appreciation of demands and requirements of each service as well as the positive aspects of the understanding roles that staff undertake.
Two examples of the proposed placements as follows: • The Student Officer Community Placement is scheduled during the induction stage of the Police Officer training and will last for two days – on the student’s return to Kent Police Training School they will present back to their colleagues what they have learnt whilst on placement, and will also complete an assignment. • Another placement, for Student Officers, will be completed after 9 months service, and this will last for four days. On the fifth day they will present what they have learnt to their colleagues and tutors. Bridge House are currently working with the Placements Officer on the necessary procedures and protocols, with the aim of starting the placements in the coming months.
What inequalities have you identified regarding access to, and receipt and experience of, mental health care?
Strong family ties, with the larger community keeping an eye on the activities of its young members, combined with the strict anti-alcohol and anti-drugs rules within Islamic law, are credited with keeping Asian youth relatively drug free. But a sea change is taking place with the erosion of traditional ties, the growing influence of Western culture, a larger proportion of young men and the greater availability of drugs. We share this information with trainee Police officers that are placed on Bridge House with the intention that, when Police officers go into local schools to talk about crime prevention and issues relating to drugs, i.e. county-lines, that they will be aware of these influences affecting young Asian people.
What is your service doing to address and advance equality?
Strong family ties, with the larger community keeping an eye on the activities of its young members, combined with the strict anti-alcohol and anti-drugs rules within Islamic law, are credited with keeping Asian youth relatively drug free. But a sea change is taking place with the erosion of traditional ties, the growing influence of Western culture, a larger proportion of young men and the greater availability of drugs. We share this information with trainee Police officers that are placed on Bridge House with the intention that, when Police officers go into local schools to talk about crime prevention and issues relating to drugs, i.e. county-lines, that they will be aware of these influences affecting young Asian people.
How do you identify the needs of a person using the service ?
All referrals are received via a referral form which specifically details the current drug/alcohol use stating quantities and frequency. The referrer also details the history of drug and alcohol abuse, as well as any previous attempts to withdraw, noting any complications previously experienced.
How do you meet the needs of people using the service and how could you improve on this?
Bridge House has an Operational Policy: ‘The Management of Facilitated Withdrawal from Alcohol, Opiates and Other Drugs’ based on NICE Guidance, and is reviewed annually. 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 (2017/18 being 0%). Medically Assisted Detoxification at Bridge House 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 at Bridge House 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.
What support do you offer families and carers? (where family/carers are not the service users)
Bridge House are committed to the Triangle of Care Principles. They have a Carer Champion on the unit and have completed their self-assessment for the ToC standards. The Trust have recently achieved their second gold star of accreditation for this initiative. Bridge House have a welcome pack for patients and their loved ones, detailing what to expect during the unit stay, giving contact details of the unit, visiting times, and signposting to other support services. Leaflets for other carer support groups are also available on the unit. The NHS National Friends and Family Test cards are also given to patients to complete, and feedback received is overwhelmingly positive.
Further information
Is there anything else you want to share about what makes you an example of positive practice?
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. In the last Patient Satisfaction Survey (exit survey that patients fill out when they leave the unit): • 98% of patients either ‘agreed’ or ‘strongly agreed’ with the statements relating to the staff at Bridge House, referring to how welcoming they were, how they planned and provided care so well, and how efficient they were. • 92% of patients either ‘agreed’ or ‘strongly agreed’ with the statements relating to the choice and quality of food, and the size of food portions. • 91% of patients either ‘agreed’ or ‘strongly agreed’ with the statements relating to the facilities at Bridge House. • 91% of patients either ‘agreed’ or ‘strongly agreed’ with the statements relating to their treatment and care planning at Bridge House. Additionally, some very positive qualitative comments were received. Highlights as follows: Ø‘Just to say a massive thank you to all staff for saving my life’. Ø‘Just to say thank you for having me and making everything an unforgettable experience!’ Ø‘My love to all your wonderful employees’. Ø‘Just a big thank you to all the staff at Bridge House, you are all fantastic’. Ø‘Would highly recommend to anyone and can honestly say it has saved my life and changed my attitude that there is hope’.
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): Bridge House is not directly commissioned by any statutory organisations. Beds are predominantly purchased on a spot purchase agreement by community substance misuse service providers (via local authorities). However we also accept referrals from NHS Trusts and self-funded placements.
Provided by (e.g. name of NHS trust) or your organisation: Kent and Medway NHS and Social Care Partnership Trust
Population details
Brief description of population (e.g. urban, age, socioeconomic status): Bridge House is a 9 bedded detoxification unit in Kent. Kent and Medway have a combined population of approximately 1.8 million people. However, Bridge House will accept referrals from anywhere in the country. Given this broad catchment area, the socioeconomic status is equally diverse.
Size of population and localities covered: Bridge House is a 9 bedded detoxification unit in Kent. Kent and Medway have a combined population of approximately 1.8 million people. However, Bridge House will accept referrals from anywhere in the country. Given this broad catchment area, the socioeconomic status is equally diverse.
