East Lancashire Community Restart is a social inclusion service and a non-clinical team, although the management of the Service is led by Registered Mental Health Nurses to provide a Clinical oversight. The role of the team is to reintegrate those who have mental health difficulties and are socially excluded into their local communities by supporting individuals into meaningful activity such as education, volunteering, employment and housing. The aim is to strengthen social networks and build resilience.
Highly Commended in Specialist Services Category #MHAwards18
From start: Yes
During process: Yes
In evaluation: No
PP Collaborative: Yes
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Gillian Halsall - Team Manager East Lancashire Community Restart
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
East Lancashire Community Restart is a social inclusion service and a non-clinical team, although the management of the Service is led by Registered Mental Health Nurses to provide a Clinical oversight. The role of the team is to reintegrate those who have mental health difficulties and are socially excluded into their local communities by supporting individuals into meaningful activity such as education, volunteering, employment and housing. The aim is to strengthen social networks and build resilience. The service is made up of a social inclusion team, an employment team, a housing team, a service user development team, community development workers, a carer support worker and a rural development officer.
The service has been operating for over ten years and has three bases in Lancashire (Blackburn, Rossendale and Burnley which is the main hub). Community Restart provide person centred care and allow people referred to the service to discuss their needs and how best they can be supported by exploring what difficulties they experience and what is important to them as individuals. The service has adapted since its inception to work with people presenting with an increased complexity relating to their mental health and social situations, as a result the teams have developed new Pathways with agencies specialising in working with Asylum seekers, working with hostels to cater to the needs of a transient population within the district and collaborating with local food banks. The national pressure on acute inpatient mental health beds has resulted in more individuals remaining in the Community, sometimes on Community Treatment Orders, this has increased referrals to community based services.
What makes your service stand out from others? Please provide an example of this.
Community Restart differs from other services as the focus is not based on clinical input. It is noted that social isolation has a detrimental effect on mental health, impairs quality of life, is associated with increased mortality and a potential suicide risk and the team work with individuals to increase social networks by supporting them to access meaningful activities which gives purpose. Alongside these interventions the team are able to assist with housing issues, employment issues and also empower service users to access interventions outside of standard mental health services (such as Wellness action plan course, setting up their own peer support groups) or groups/activities that already exist in the community Our service provides a bespoke and tailored service for individuals, for example, we currently support a service user to attend adult learning courses in BwD and this person needs one to one support due to her profound deafness to enable her to engage fully within mainstream Education. The support worker assigned to the individual has British Sign Language training and has a strong deaf culture awareness she also has been sensory impairment champion.
The Community Development Workers (CDW) are specific and specialist mental health workers recruited in 2005 to look at developing opportunities and Pathways for BAME populations to access services in mental health. The workers have a role to develop services both proactively and retrospectively once gaps in the community have been identified. The CDW’s have the capacity to develop their own projects and lead or take leads from local public health bodies or commissioning to deliver targeted pieces of work. These are otherwise not possible for clinical staff or staff with fixed job criteria. The CDW Team have the capacity to work in a flexible manner and be receptive to community requests in developing their work streams. The Team can also utilise community funding to develop requested services and can influence existing service development through their intervention and representation. The CDW Team has the capacity to provide and deliver training and development opportunities to staff and community individuals.
How do you ensure an effective, safe, compassionate and sustainable workforce?
All staff have access to regular supervision sessions, 1-1 and group supervisions where personal development, wellbeing at work and home, their health and safety, equality and diversity are discussed. This takes place on a monthly basis, a Personal Development Plan is drawn up from supervision sessions and is reviewed every 4 month this effectively identifies personal aspirations for development both short term and long term, areas of improvement and current job performance. Staff are also encouraged to consider their personal aims in their career and training is then identified for the individual to progress. There is a whole team meeting every quarter that brings together all staff from across the locality to review Governance processes, share best practice and give an opportunity for individuals to contribute to Service development and delivery.
To address Learning and Development needs there is a shared learning opportunity following each of the whole team meetings which aims to utilise external speakers providing information and allowing staff to network with other organisations and agencies. A recent example of this has been a presentation from the Behind the Mask project which works with women from diverse backgrounds and offering an insight into the projects related to this. The Service provides a team Away Day for all staff to attend, this is developed in conjunction with the Trusts Quality Academy, this aims to provide learning and development opportunities incorporating positive team building and future service development plans. At all times, staff are encouraged to reflect on challenges and positive practice in a supportive environment which promotes growth and resilience. Blackburn with Darwen Restart staff are able to access both Lancashire Care Foundation Trust and Blackburn with Darwen Council training opportunities therefore providing more openings for learning and development, staff are also encouraged to engage in external /3rd sector training where appropriate, for example Inspire provide training for Dual Diagnosis (drug and alcohol)
The team also has members of staff that have a lived experience of mental health issues, the skills and knowledge from these individuals are used to promote a culture of support and empathy to individual people using our service. Feedback we have received from a member of staff with lived experience has been that they feel engaged in their role through support from colleagues, “if I am going through a difficult time I feel supported and the team have shared values and ethics, I feel I am part of a valuable service, I am trusted to work autonomously, I feel trusted by my manager and team leader.”
Who is in your team?
The wider Restart Service, incorporating locality wide Restart Teams is under the management of a Service manager (Band 8A). 2 Deputy Service Managers (Band 7) support this work, one of whom is aligned to the Teams providing a service to East Lancashire, including Blackburn with Darwen. There are 3 team leaders (Band 6 or equivalent), one in each of the bases, 2 of the Team Leaders hold a Registered Mental Nurse qualification and the third is employed through the local Council. The teams in the Burnley and Hyndburn area consist of 8 Support, Time and Recovery (STR) workers (Band 3), 2 Housing Support workers (Band 3), 2 Employment Officers (Band 4) who are supported by an Employment STR worker, 2 Service User Development (SUDE) workers (Band 3) who work alongside the SUDE Team Leader (Band 6) and a rural development worker (Band 3). The team located in Blackburn with Darwen are employed by Blackburn Council and are line managed by the Lancashire Care Foundation Trust Deputy Service Manager through a partnership agreement. The team comprises of a Team Leader (Band 6 equivalent), 4 STR workers, 2 Community Development Workers (Band 6 equivalent) and a Carer support worker. All STR staff are a Band 3 equivalent.
How do you work with the wider system?
The Community Restart Team work with wider systems and services in the community by developing or steering service provision towards partnership with community and statutory agencies. This collaboration can include developing and delivering training, developing referral pathways, or working with wider services to… • Deliver Wellness Recovery Action Planning • Develop Volunteer induction packages and service policy relating to access and equality • Facilitate mental health first aid through public health and third sector organisations • Developing a pathway between community learning and mental health trough the Positive Minds Programme. • The team has a referral pathway through the refresh project • Attending representative bodies from the statutory, third sector and commissioning to update and identify new developments • Lead other projects to deliver mental health specialist services e.g. One Voice BAME enagagement.as expert Mental Health Leads. • Develop world mental health day activities and other community events in partnership with wider agencies. The Housing Team and Employment Team are incorporated into East Lancashire Restart Service. Both teams receive referrals from any mental health service across East Lancashire, such as Complex Care Treatment Teams and Primary Mental Health Teams.
In addition, the Housing Team receives referrals via their psychiatric in-patient units, thus supporting timely discharge with an intended reduction in delayed discharges. The Housing Team liaises with Local Authority Housing Options services and local housing providers to assist people who need to be re-housed or encounter difficulties with their tenancies due to problems with their mental health. Often, cases are further complicated by issues such as drug and alcohol use, domestic violence, major property disrepair, and threats of eviction. Support provided by the Housing Team includes: • Access to accommodation through providing: o Information on the service users medical needs which may help to dispel myths surrounding mental ill-health. o Applications for bond schemes, housing benefit, housing benefit being paid direct to landlord, other benefits which may help ensure a successful tenancy • Prevention of homelessness where there is risk to the service users tenancy • Seek accommodation for service users by helping to provide potential tenants where a landlord has a vacancy. The Employment Team supports individuals who wish to seek employment by supporting them to access mainstream provision to gain sustainable employment. The team also supports individuals who are in work by working with the employer and Human Resource Departments to help them retain employees affected by mental ill-health which impacts on their current employment. Support provided by the Employment Team: • Supporting the Employee at work related welfare meetings • Negotiating rehabilitation hours with support appraisals and feedback from employers • Supporting and negotiating a phased return to work • Providing advice and guidance to the employer and employee on mental health issues and strategies to enhance wellbeing in the workplace
Do you use co-production approaches?
The team uses co-productive approaches in all the activities they deliver in order to get a more meaningful insight into individual and community needs, families, carers, group representatives, and community individuals are identified through community engagement and one to one work. Individual meetings will take place to personally get to know representatives, community groups and individuals and to have meaningful conversation about the service need. e.g the focus group activity and one to one interviews taking place at part of One Voice’s Baiter Sehat (Better Health) with local Imams, women’s’ groups and those bereaved by suicide.
The Service User Development Team work with people who may represent service users, carers or the local community to set up and support groups and project which ultimately become assets within those communities. The work is driven by the wishes and needs of the individuals and their communities and not by the needs of the service. A good example of co-production is the Wellness Recovery Action Planning (WRAP) programme. The team refers to CDW’s who they feel would benefit from the WRAP programme these individuals are both service users and carers. The CDW’s deliver and empower the individuals to acknowledge, assess and improve their wellbeing. After completing the WRAP programme it also gives the attendees the opportunity to become co-facilitators and deliver. For example a junior doctor was referred into our service for volunteering that went through the above process and is currently co-facilitating and delivering the WRAP programme. The development and improvement with this individual has been immense.
Do you share your work with others?
The Team share work with others by Virtual information network: An email based distribution forum which lets members from the statutory, voluntary, faith and community sector and community individuals, know about events, activities, funding opportunities, training and development and local community findings. Team huddle give the opportunity to inform colleagues and support staff of new group and service opportunities available in the borough as well as current work streams that we are engaging with. We invite staff from other teams to join us in meetings to discuss how we work and engage with people, Staff who are new to mental health are invited to shadow our service to understand what support we can provide.
Professionals Network: A CDW led initiative bringing members of staff from all sectors face to face on a 6 weekly basis to discuss current project, joint working, future projects, activities, events and other work. the network informs members of potential partnerships and current work being done by the service. In addition the CDW’s represent on the following forums where they update their current work and projects. • Families Health and Wellbeing forum (Monthly) • Suicide Prevention Forum and Working group (Bi Monthly) • Asylum seeker multi agency forum (Bi Monthly) Posters based on the work of the SUDT have been exhibited at The College of Occupational Therapists national conference in 2015 and 2016. The team will be delivering a presentation at the Trust Quality Improvement Conference in May 2018. Work is also shared at local events eg – Accrington Health Mela and by attending local forums such as Rossendale Health and Wellbeing Forum, Burnleywood Network, Southwest Burnley Partnership and Lancashire Adult Network. Community Restart has a dedicated webpage on the Lancashire Care Trust Website, https://www.lancashirecare.nhs.uk/Community-Restart, this page contains information about the Service, a link to the Team Information Leaflet and contact details for each of the teams in the wider Service.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
In East Lancashire there has been significant growth in numbers across all spoke services and this has been most pronounced within the Burnley team which has resulted in the Spoke team working at capacity (1WTE = 26 Service Users. The total number of referrals to Community Restart across all spoke teams are set to exceed all previous years. Our BwD team have been gathering service user feedback in an innovative way in addition to the Standard feedback that our team already receives. Outcomes achieved through the BwD carers support element of the team continues to have a positive outcome within the local population and despite a Local Authority reduction in resources the number of people supported continues to be in high demand.
The Service User Development Team (SUDT/SUDE) has experienced a period of transition and a refocusing of both peer support and project development activities. Work has re focussed on a number of new projects which have been developed in all service locations. An example of some of the enterprises include: Burnley Football Club & collaboration with Minds Matter Service in promoting mental wellbeing and mental health in the Burnley community. Setting up and facilitating a local hoarders support group. Our Rural Development worker was nominated for 2 separate awards for assisting and organising a local community gardening project which continues to run successfully. Working in collaboration with Local residents, Community Payback, and local councils. The BwD Community Development workers have been involved with a number of projects including bidding for and gaining funding for a community garden, Developing and running a WRAP course and independent self sustaining support group. The employment team continues to achieve excellent outcomes and has also seen continued growth and has experienced a significant increase in referrals and as in Central Lancs, support is increasingly focused on complex in-work negotiations and/or employment retentions supporting people to stay in employment when experiencing mental ill health/distress.
Due to the ongoing and continued rise in referrals the Employment team has a current waiting list of 29 people. The team has worked effectively with local employers and this includes a major firm where one of the staff had worked in educating around mental health issues in the workplace which should have a potential impact on future employer retentions. All the employment teams pan Lancashire are now involved with a new initiative, contributing into a project which will offer employability support with specific LCFT jobs. The housing team have continued with high demand and work collaboratively with various housing providers, local councils and mental health services (both statutory and third sector) and successfully liaising with numerous partners to secure safe and appropriate accommodation. The team has further developed and strengthened their work with inpatient settings to enable the enhancement of capacity and flow of timely discharges. Their support has ensured that delayed discharges have been avoided through timely intervention by the team. This remains a priority for Housing referrals.
Has your service been evaluated (by peer or academic review)?
Lancashire Care Foundation Trust is audited on an annual basis by the Care Quality Commission, during the inspection completed in January 2017, Community Restart Services were evaluated against CQC standards and received the following feedback in the annual report. “Patients receiving social inclusion support from staff within the Restart teams were appreciative of the support they received to improve their mental well-being, get active and increase their confidence. A common theme from the patients about the restart team was that staff had been exceptionally helpful and supportive, much more than any other services patients had accessed.
The restart teams worked to ensure people’s holistic needs were met, promoted social inclusion and worked with hard to reach groups in innovative ways to promote mental well-being.” People who have engaged with the Service are encouraged to complete a Friends and Family Feedback form at the completion of the piece of work, in addition to this the team and individual members of staff regularly receive positive feedback and compliments from people who have used the Service. In the period April 2017 to April 2018 there were a total of 176 compliments received across the East Lancashire Restart Service, examples of these are as follows: • Without you and your team I was beginning to struggle, anything could have happened, I live alone and life is tough, thanks for helping me out! • I didn’t leave the house, didn’t socialise or maintain relationships, now all my relationships have improved • I am very grateful, very positive with the help I received • My support worker was very helpful and made me feel more secure • The Employment Officer was open and honest and very professional whilst having real constructive empathy with the employee he was supporting. This employee would have been unrepresented and unsupported in a really complex disciplinary hearing. His presence contributed to facilitating a fair and transparent process whilst having someone skilled at dealing with MH issues to guide the process
How will you ensure that your service continues to deliver good mental health care?
Through working with Blackburn with Darwen Public Health Commissioning the CDW’s are the expert lead for mental Health working with One Voice Blackburn. Over the last 5 years, the CDW’s have led the Public Health commissioned mental health and suicide insight work to look at what service criteria and needs analysis should take place in order for services to be commissioned appropriately. The engagement has been completed with various groups including those bereaved by suicide, women over the 50+ age group, women under the 49 age group, young people (Girls under 18), religious leaders, community leaders, older men, men of a working age, those using English as a second language, and young men (18-24).
In each category insight and focus group work has taken place with a report and specific recommendation for either more insight or work or programmes needing to be developed in order to meet the needs of the community. The CDW’s also works with Public Health as part of their Health and Wellbeing Stakeholder events to directly influence the BwD commissioning strategy using their working experience of Blackburn with Darwen to feedback on questions. We work in a Person-centred care approach that supports people who are referred to our service to develop their knowledge, skills and confidence they need to more effectively manage and make informed decisions about their own mental health. It is coordinated and tailored to the needs of the individual by using a Community Restart Initial Questionnaire (CRIQ). This ensures that people are always treated with dignity, compassion and respect. The CRIQ is revisited each time an appointment is completed with the individual and any changes as the person progresses are added to the persons plan.
Groups and projects supported by SUDT have sustainability and independence built into the plan. Some groups have been running for 10 years and the fact that this is done without funding or staff input from LCFT means that the groups will not be affected by changes in services. The team work with members and partner organisations to ensure that they have the skills and knowledge required to continue when SUDT step back their support, this might be skills around management committees and funding or assistance in obtaining funding for a paid position to take on work done by the team. The Service provides annual reports to Commissioning bodies detailing the number of referrals from each part of the service, providing examples of Best Practice and outlining the work that has been completed with local communities. This gives an opportunity for Commissioners to discuss with Managers how the Service can be shaped and developed in relation to current need and local/national drivers.
How do people access the service?
People can self-refer to Community Restart via their Gp or through a single point of access service and the referral is passed to Minds matter. If people are already supported by another mental health team within the Trust then their team can refer directly to Community Restart.
How long do people wait to start receiving care?
People referred to the Service will be contacted within 48 hours of referral (excluding weekend days) and service users will be offered an appointment within 7 days of that phone call
What is your service doing to identify mental health inequalities that exist in your local area?
Developing links with local councils and organisations working with asylum seekers and refugees in order to look at how opportunities for engagement can be developed for those communities. Working closely with local community forums made up of representatives from both third sector organisations and both local and county councils in order to ensure that the project we support and develop are in tune with the needs of local communities
What inequalities have you identified regarding access to, and receipt and experience of, mental health care?
Employment/Housing Opportunities/Depravation/Loneliness/Alcohol and Substance Misuse/Refugees/Asylum Seekers/Hidden Mental Health/Spirituality and Religion
What is your service doing to address and advance equality?
Attending Community events, providing education, working with local communities and organisations
How do you identify the needs of a person using the service ?
There are nursing staff within the team to offer advice and guidance as appropriate, assessments are holistic.
What support do you offer families and carers? (where family/carers are not the service users)
The Service has a Carer Support Worker based within the team, he supports carers and families by facilitating a Carer’s Group and 1-1 sessions in a confidential setting and making funding applications as appropriate.
In East Lancashire the registered population is evenly split between females (49.8%) and males (50.2%) and whilst almost a fifth (18%) of the population is aged 65 or over, 30% are aged 24 or under and 52% are aged between 25 and 64. Deprivation measures show that Burnley, Hyndburn and Pendle are amongst the most deprived districts in England, whilst Ribble Valley is one of the most affluent. Within Blackburn with Darwen the borough as a whole has a relatively young age profile. It has a higher than average proportion of young people (0-19) compared to the national figure and conversely, a smaller proportion of older people (65 and over). As a multicultural borough, the area is home to many people with diverse ethnicities and identities. Census 2011 suggested that within Blackburn with Darwen 66% of people identified themselves as White British, 28% as Asian / Asian British and 0.6% Black/African/Caribbean/Black British. Within the majority of non – white residents, most people identified themselves as either; Asian/Asian British: Indian (13%) or Asian/ Asian British: Pakistani (12%). However census data also shows that the borough is also home to people who identify as Bangladeshi, Chinese, African, Caribbean, Arab and people of multiple ethnicities.
Size of population and localities covered:
NHS East Lancashire CCG is made up of 57 GP practices, who care for around 378,849 patients (April 2017) making it the largest CCG in Lancashire. The majority live in the districts of Burnley (25%, 93,904), Hyndburn (20%, 75,954), Pendle (26%, 97,145), Ribble Valley (11%, 40,242) and Rossendale (18%, 67,305). The figures for Blackburn with Darwen show that the population was 148,500 (April 2016), making it the largest borough in Lancashire. The majority of the boroughs residents (in the region of 140, 000 people) live in the towns of Blackburn and Darwen with the remaining residents living in the rural villages and hamlets (Hoddlesden, Edgworth, Belmont, Chapel Town and Tockholes) that surround the two major urban centres
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
The East Lancashire Community Restart Team is commissioned by East Lancashire CCG, the team that covers Blackburn with Darwen is commissioned by Blackburn Borough Council but managed by Lancashire Care Foundation Trust through a partnership working agreement.
Provided by (e.g. name of NHS trust) or your organisation: *