DH@T is an out of hours' crisis service for people from BAME groups. It has been funded by the Lottery since 2013. DH@T is on its second grant from the Lottery which is for 2018-2021. DH@T is open Tuesday and Thursday nights 6pm-12am and is based on the flagship service of LSLCS, Dial House crisis service which has been open out of hours since 1999. DH@T is a compassionate, confidential, effective and respectful service staffed by people from BAME communities. The model is a culturally specific service – a BAME service delivered by people from BAME groups – and a bridge to Dial House, through the staff who work in both services
Webpage for service (if available): www.lslcs.org.uk
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
DH@T is an out of hours’ crisis service for people from BAME groups. It has been funded by the Lottery since 2013. DH@T is on its second grant from the Lottery which is for 2018-2021. DH@T is open Tuesday and Thursday nights 6pm-12am and is based on the flagship service of LSLCS, Dial House crisis service which has been open out of hours since 1999. DH@T is a compassionate, confidential, effective and respectful service staffed by people from BAME communities. The model is a culturally specific service – a BAME service delivered by people from BAME groups – and a bridge to Dial House, through the staff who work in both services. It is widely recognised that the Delivering Race Equality agenda (2010) has not improved access to mental health services by people from particular BAME groups or their experience of services. Black men in particular remain over represented in psychiatric units and the criminal justice system, but are reluctant to engage with community based mental health services. This is the cycle DH@T aims to interrupt.
What makes your service stand out from others?
DH@T is a survivor led service (as are all the services of LSLCS). Staff are from BAME groups and have their own experiences of mental health problems. DH@T (along with the other services of LSLCS) provides a non- medical, non-diagnostic response to mental distress which is an alternative to psychiatric hospital admission, A&E, police contact and custody and other statutory services. As a person centred, survivor led, voluntary sector service, led by BAME staff, DH@T is unique and accessible to people who do not trust or use mental health services due to the stigma of mental health in some BAME communities, language barriers and the cultural insensitivity of services. DH@T has a proven track record since 2013 of delivering an effective, compassionate service to people who are marginalised and often facing multiple disadvantage (i.e. LGBT asylum seekers living in poverty).
How do you ensure an effective, safe, compassionate and sustainable workforce?
LSLCS employs high calibre staff. DH@T must be from BAME groups with direct experience of mental health problems and extensive experience of supporting BAME people with mental health problems. This must include having supported people at risk of suicide and self harm and who are survivors of trauma. Staff also need to have an understanding of the philosophy and practical applications of the Person Centred Approach. Staff are provided with a comprehensive induction and on-going training within LSLCS, on, for example working with trauma, supporting refugees and asylum seekers and domestic violence and abuse. Staff receive monthly supervision, attend a monthly reflective practice group, are supported to attend external training and events to support professional development and have a wellbeing budget to be spent on counselling, external supervision or complementary therapies. DH@T also supports volunteers, in order to develop their next generation of BAME support workers and has trained visitors in group work facilitation to enable them to work alongside staff in the delivery of the Black men’s group, Unique Minds.
Who is in your team?
LSLCS uses the NJC salary scale. All staff work across the services of LSLCS as part of the model, so these hours are not exclusively delivery DH@T Manager, P01-02, Points 34-38 – 33 hours per week Senior Crisis Support Worker, SO1 points 32-34 – 25.5 hours per week 3 Crisis Support Workers, Scale 6 point 26-SO1 point 29 – 27-28.5 hours per week Bank Staff used to cover staff absence, planned and unplanned.
How do you work with the wider system?
LSLCS undertakes robust and comprehensive monitoring and evaluation of DH@T to identify the needs of our visitors, including the inequalities they face. This is fed into work within Leeds. For example, during 2016-17 the local mental health trust, Leeds and York Partnership Foundation Trust (LYPFT) undertook research with charity Touchstone (our partner in delivering DH@T) on increasing access to mental health services to people from BAME groups. Data from DH@T was used to inform this work. DH@T staff are involved at this strategic level in Leeds in improving mental health services to people from BAME groups. LSLCS have also held public learning events in Leeds to disseminate our learning of what works and does not work in supporting BAME people in crisis. This included a large event after the first 3 years of DH@T and being a national delivery partner for the Jo Cox Loneliness Commission spotlight month on loneliness in refugee and asylum seeker communities. This event in Leeds attracted media attention, with keynote speaker Rachel Reeves MP, Co-Chair of the Loneliness Commission. DH@T staff are also involved in other strategic and operational groups – i.e. the Refugee and Asylum Seeker network within Leeds. LSLCS also has a Deaf and LGBT project and works extensively with visitors and callers who are marginalised and often experiencing multiple disadvantage. In addition to this, during the current Lottery grant period, DH@T are developing training to deliver externally with the desired outcome of Leeds based mental health staff becoming more aware of the impact of racism, structural oppression and discrimination in causing mental health crisis. During 2017, DH@T staff delivered a national webinar for the Collaborating Centre for Mental Health and the Royal College of Psychiatrists. This was part of their work on increasing access to mental health services by people from BAME groups. DH@T was presented as an example of excellent and innovative practice
Do you use co-production approaches?
LSLCS is a survivor led organisation – all DH@T staff are from BAME groups with lived experience of mental health problems. DH@T visitors are involved in the development of the service in the following ways: • Interviewing staff for posts • Sitting on DH@T Steering Group, alongside professionals • Delivering the Black men’s group, Unique Minds and BAME women’s group, Sisterhood • Facilitating activities and taking a leadership role at the monthly social event • Speaking at learning and other public events and to other professionals about DH@T • Taking part in focus groups, to feed back their experience of DH@T to the Chair of LSLCS Board of Trustees. • Involvement in extensive monitoring and evaluation of DH@T to ensure it is meeting their needs and delivering the outcomes it is funded to provide.
Do you share your work with others? If so, please tell us how.
LSLCS was used in the 2017 Leeds Crisis Care Concordat report in improving access to mental health services by people from BAME groups. LSLCS have also held public learning events in Leeds to disseminate our learning of what works and does not work in supporting BAME people in crisis. This included a large event after the first 3 years of DH@T and being a national delivery partner for the Jo Cox Loneliness Commission spotlight month on loneliness in refugee and asylum seeker communities. This event in Leeds attracted media attention, with keynote speaker Rachel Reeves MP, Co -Chair of the Loneliness Commission. During 2017, DH@T staff delivered a national webinar for the Collaborating Centre for Mental Health and the Royal College of Psychiatrists. This was part of their work on increasing access to mental health services by people from BAME groups. DH@T was presented as an example of excellent and innovative practice
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
The outcomes DH@T is funded to provide are as follows: Outcome: The mental wellbeing of people from BME groups in crisis will be improved. People using the service will report: • Improved coping strategies & being more able to resolve or better manage crisis • Feeling less lonely & isolated • Improved confidence and having plans and aspirations for their future. Outcome: The service will prevent escalation of problems and deliver cost savings to the health economy. People using the service will report: • Reduced self harm • Reduced use of crisis and emergency services • Reduced use of drugs and alcohol • Reduced contact with the Criminal Justice System. Outcome: People using the service will be more empowered and included in their local community and take on leadership roles. People using the service will report: • Benefits of the peer support offered at DH@T • Improved connection and relationships within their local communities. • Increased involvement in community activities, including employment, voluntary work and education • Benefits from undertaking the Peer Mentor roles and other involvement opportunities at Dial House @ Touchstone Project will also demonstrate: • Increased understanding in the Leeds mental health system of racism, oppression and poverty being root causes of mental health crisis in BME communities Evidence is collected through the following mechanisms: • Getting feedback from visitors at monthly social event • Postcards completed by visitors every 10 visits • Quarterly questionnaires • Reviews with regular visitors (face to face meetings to get more in depth feedback) • Focus Groups • Learning events DH@T demonstrates the outcomes it is funded to provide
Has your service been evaluated (by peer or academic review)?
In 2018, LSCLS had a Social Return on Investment analysis undertaken of its Dial House, Dial House @Touchstone, Group Work and Connect Helpline services. This concluded that for every £1 invested in LSLCS, society gets £7.50-£12.50 back. This social return includes the cost savings of suicide prevention and keeping people out of psychiatric hospital, A+E, the criminal justice system and other statutory services.
How will you ensure that your service continues to deliver good mental health care?
Due to the success of DH@T in its first funding grant of 2013-18, the Lottery provided an additional 3 years of funding for 2018-21. On-going work with commissioners and the wider mental health community in Leeds will ensure that DH@T is seen as an essential part of the crisis and urgent care pathway. We are confident that the NHS will pick up funding for DH@T at the en do the current grant cycle..
What aspects of your service would you share with people who want to learn from you?
Learning from delivering at BAME crisis service included: People value a BAME only environment staffed by people from BAME groups. The importance of confidentiality and trust – development of 6 sessions model where visitors work with the same team member for the first few visits to build trust with the service. The use of language – mental health terminology is stigmatizing and off putting. Using terms like “stress” instead of “mental health” makes the service more accessible. Needing to work around the shame of mental health in BME communities DH@T is a livelier service than Dial House – Less emphasis on a quiet place of sanctuary, More emphasis on communal activity, shared meal, people seeking community. People from BAME groups tend to understate their crisis – had to adapt Dial House referral model as BAME people were not meeting the crisis threshold due to understating their distress. People from BAME groups less willing to disclose feeling suicidal, self harm, or being survivors of sexual abuse/sexual violence. Importance of faith and spirituality as defining aspects of people’s lives and identities. Reduction in loneliness and isolation – Lottery target where we have most over achieved and had the biggest impact.
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 many people do you see?
In the last complete year of data collection, 72 people made 725 visitors to DH@T
How do people access the service?
DH@T staff continuously undertake a comprehensive programme of outreach to promote DH@T. Regular monitoring of DH@T stats enables us to target groups not being reached. For example, outreach to the Eastern European community by a Romanian team member supported access by this under represented group. Visitors self refer to DH@T by phone or by turning up at the door. DH@T is deliberately situated in the heart of the most diverse part of Leeds, to support accessibility. Our partnership with Touchstone combines our expertise in delivering crisis services and their experience and knowledge in supporting people form BAME groups. The service is delivered from their building to trade on their reputation and trustworthiness. An early learning point from DH@T was that word of mouth was how people from BAME groups would develop trust in DH@T and be willing to visit. We discovered that traditional printed publicity material was of limited value. The top way that visitors first come to Dial House, our flagship crisis service, is via the statutory NHS crisis team, followed by other parts of the secondary mental health system. The top way that people are signposted to DH@T is friends/family, followed by third sector services supporting refugees and asylum seekers and GPs. This further demonstrates the lack of engagement by BAME people with statutory mental health services.
How long do people wait to start receiving care?
there are no waiting lists – people phone Dial House @ Touchstone (and Dial House, the Connect Helpline and Teen Connect) on the night that they want support
How do you ensure you provide timely access?
As outlined above, we provide an instant access crisis service 7 nights of the week through Dial House and DH@T
What is your service doing to identify mental health inequalities that exist in your local area?
LSLCS undertakes robust and comprehensive monitoring and evaluation of DH@T to identify the needs of our visitors, including the inequalities they face. This is fed into work within Leeds. For example, during 2016-17 the local mental health trust, Leeds and York Partnership Foundation Trust (LYPFT) undertook research with charity Touchstone (our partner in delivering DH@T) on increasing access to mental health services to people from BAME groups. Data from DH@T was used to inform this report. DH@T staff are involved at this strategic level in Leeds in improving mental health services to people from BAME groups. LSLCS have also held public learning events in Leeds to disseminate our learning of what works and does not work in supporting BAME people in crisis. This included a large event after the first 3 years of DH@T and being a national delivery partner for the Jo Cox Loneliness Commission spotlight month on loneliness in refugee and asylum seeker communities. This event in Leeds attracted media attention, with keynote speaker Rachel Reeves MP, Co-Chair of the Loneliness Commission. DH@T staff are also involved in other strategic and operational groups – i.e. the Refugee and Asylum Seeker network within Leeds. LSLCS also as a Deaf and LGBT project and works extensively with visitors and callers who are marginalised and often experiencing multiple disadvantage. In addition to this, during the current Lottery grant period, DH@T are developing training to deliver externally with the desired outcome of Leeds based mental health staff becoming more aware of the impact of racism, structural oppression and discrimination in causing mental health crisis.
What inequalities have you identified regarding access to, and receipt and experience of, mental health care?
The Report of Leeds Crisis Care Concordat (Jan 2017) identified that people from BME groups are not using community mental health services before they are at crisis point and are admitted to hospital: Adults identified as Black or Black British are more likely to be admitted to psychiatric hospital than the white British population. This included people of mixed Black/white heritage being 130% more likely to be admitted and people who were Asian or Asian British being 60% more likely to be admitted. The reasons for this are complex and include: Stigma around mental illness, lack of cultural awareness of services, language and cultural barriers and negative experience of services. This is the cycle DH@T interrupts. This cycle of exclusion is evidenced elsewhere, including in the Mind Report Commissioning Excellence for Black and Minority Ethnic Groups (2013) People from BAME groups come into contact with mental health services later and when in crisis. A&E is often the first point of contact and the police are more likely to be involved in admissions and readmissions. This report recommends commissioning crisis houses and sanctuaries. In 2018, in order to reapply for Lottery funding, LSLCS consulted with people who have visited DH@T and 80 additional people from BAME groups with mental health problems, who overwhelmingly stated that the DH@T service is desperately needed. As well as the above research based evidence, we have witnessed the lived experience of our visitors with regard to (for example) Black men being sectioned for long periods of time, being over medicated and given labels such as ‘schizophrenia.’
What is your service doing to address and advance equality?
The very purpose of DH@T is to address and advance equality. DH@T provides a culturally sensitive and accessible service staffed by people who are themselves from BAME groups with lived experience of mental distress. In addition to the provision of a compassionate, respectful, empowering, survivor led crisis service; DH@T (as outlined above) is involved at a strategic level in Leeds in disseminating our learning from DH@T in order to improve the experiences of people from BAME groups in mental health services. As outlined above, DH@T staff have developed a training course about supporting BAME people in mental health crisis, which has been delivered to LSLCS staff. This will be rolled out to staff outside LSLCS working within the mental health system, in order to raise awareness of the impact of racism, structural oppression and discrimination on mental health and people’s willingness to seek support. As well as the DH@T night service; we have a Black Men’s Group, Unique Minds, led by a Black male staff member and visitors. We also received funding from national Mind to deliver a BAME women’s group to raise self- esteem and provide women with a safe, non- judgemental space to discuss mental health issues which are often stigmatised within BAME communities
How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?
We meet new visitors for 2 hours on their first visit which enables them to tell us their story. We recognise the social, emotional, practical and spiritual needs of our visitors. We also respect that for some visitors (i.e. asylum seekers) their practical needs are overwhelming and need to be supported before they can undertake therapeutic work
How do you meet the needs of people using the service and how could you improve on this?
DH@T is delivered by staff from BAME groups with lived experience of mental health problems. The service is compassionate, respectful, kind and culturally sensitive. It is also in the voluntary sector, without statutory power, which makes it less threatening and more accessible. Staff understand the barriers people from BAME groups face in accessing services. For example, the central importance of trust and fear of confidentiality being breached. LSLCS has a survivor led, person centred ethos which supports empowerment. We have adapted the service to meet the needs articulated by visitors. For example, loneliness and isolation are high presenting issues at DH@T are many visitors are seeking a place of belonging, especially people from other countries who are displaced from family and community. Some visitors also find the traditional LSLCS practice of one to one support inaccessible and would prefer a more communal approach. To meet this need; once a month, the usual service of DH@T is replaced with a themed social night with a meal. Themes have included languages and celebrating Black History month.
What support do you offer families and carers? (where family/carers are not the service users)
A key outcome of DH@T is supporting people who use the service to be more engaged with the local community and, also, linked in to other mental health services, where appropriate. Our aim is to build trust with visitors, which enables us to refer them to other services to meet their needs. We refer extensively to Touchstone, our partner in the delivery of DH@T as well as to counselling, housing, advocacy and mental health services. DH@T has a proven track record of supporting visitors to engage with other mental health services. It also has an outstanding record in supporting visitors into paid work, voluntary work and education. This is partly through the provision of role models, through the BAME staff who work in DH@T. A visitor is training to be a counsellor, having articulated that it was DH@T staff who inspired her to do this, as, until she met them, she had never known any Black people in counselling roles.
Hours the service operates
Dial House @ Touchstone (DH@T) is part of Leeds Survivor Led Crisis Service (LSLCS) and is open 6pm-12am on Tuesday and Thursday nights. LSLCS also has another crisis house, Dial House, open 6pm-2am Monday, Wednesday and Friday-Sunday, the Connect Helpline, open every night of the year, a programme of group work, the Leeds Suicide Bereavement Service (with Leeds Mind) and the Wellbean Crisis Café (with Touchstone).
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England):
Funded by Lottery, Reaching Communities
Provided by (e.g. name of NHS trust) or your organisation: Leeds Survivor Led Crisis Service
Population details
Brief description of population (e.g. urban, age, socioeconomic status):
DH@T is an out of hours’ crisis service for people from Black, Asian and other Minority Ethnic (BAME) groups. It serves the population of Leeds. The most common profile of people visiting DH@T is men and women aged 35-44. Most visitors to DH@T come from the high deprivation postcodes of Leeds. DH@T supports people from all over the world, including refugees and asylum seekers. The most common ethnic backgrounds of visitors are Black Caribbean, Pakistani, white Irish and Iranian, which reflects the BAME population of Leeds.
Size of population and localities covered: Leeds has a population of approx. 800,000. Around 22% of this population is people from BAME groups. DH@T supports anyone with a Leeds postcode, or people living in WF3, WF10, BD4 and BD11
