Solidarity in a Crisis (SiaC) is a Certitude project providing a peer led out of hours crisis support line and one-to-one peer support across Lambeth and Southwark. The model was launched in April 2012 as part of the Lambeth Living Well Network in Lambeth with the aim to develop and grow community resilience through peer support. A key component is that people with lived experience of mental health support needs, family and carers play an active role in supporting recovery; as well as engaging and working closely with the network of providers both statutory and third sector.
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Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
Solidarity in a Crisis (SiaC) is a Certitude project providing a peer led out of hours crisis support line and one-to-one peer support across Lambeth and Southwark. The model was launched in April 2012 as part of the Lambeth Living Well Network in Lambeth with the aim to develop and grow community resilience through peer support. A key component is that people with lived experience of mental health support needs, family and carers play an active role in supporting recovery; as well as engaging and working closely with the network of providers both statutory and third sector.
Co-designed and co-delivered by people with lived experience and carers, Solidarity in a Crisis has evolved organically and is currently providing a wide range of activities with the aim to support individuals in crisis by way of sharing empathy through similar lived experience and an opportunity to engage with like-minded people. Our activities include: • Out of Hours telephone line • Community Peer Support • Exploring Beliefs (Paranoia support group) • Peer Support at The Sanctuary (65 Effra Road) Our Aims • To reduce isolation during out of hours by providing support that is respectful and non-judgemental • To support people using the empathy and knowledge gained through lived experience • To support the person in distress before they reach crisis point and help guide them towards appropriate professional support when necessary • To reduce reliance in A&E and other health services by offering and sharing information and community resources to help build connections and self-resilience The Team • Out of Hours Crisis Line: 9 peer supporters working from home in the evenings • Community Peer Support: 4 peer supporters based at our office at railton road, Brixton. This team meet with people face to face in the community to provide emotional support • Peer Lead • Project Manager The team actively engage in a wide range of activities to promote the service and raise awareness of mental health across the two boroughs.
What makes your service stand out from others? Please provide an example of this.
Solidarity in a Crisis developed from the idea that crisis support in Lambeth is usually provided by statutory services and too little is provided by the voluntary sector or local people. It also emerged out of a conviction that by creating genuine partnerships between the voluntary sector and service users and carers, this would result in provision of more effective, relevant and person-centred services. Therefore, co-production has been paramount in the design and implementation of this crisis out-of-hours services. Solidarity in a Crisis stands out as being one of the view crisis support services that is delivered by people with lived experience.
The service also demonstrates great partnership between people with lived experience, the voluntary sector and statutory services. For example, the service has demonstrated how peer support can be integrated with formal statutory crisis services, incorporating peer support as a key component in individuals’ recovery. From November 2015, the team has been working closely with Psychiatric Liaison Teams in Kings College and the Nurses on SLaM’s mental health Support line. SiaC’s work with both teams marks a different way of providing statutory crisis service. It is a great shift in supporting individuals in a crisis by embedding peer support as a valuable resource to staying well, empowering people through lived experience. The feedback from Kieran Quirke one of the Psychiatric Liaison Nurses was as follow: “It is refreshing in that it’s possible to offer people something very different to the usual services available…….Solidarity appears to be able to offer an informal fast, responsive and positive emotional support to people and are filling a much needed gap in service provision.”
How do you ensure an effective, safe, compassionate and sustainable workforce?
Working as a peer supporter within the team has provided a space for people to acquire new skills, develop their self esteem despite what stage they are in their recovery. The team is diverse and it is made up of a mixture of people who are just getting back into work after a numbers of years, individuals who are not able to work full time due to their mental health or carers who are not able to work due to their caring role. Individuals work with SiaC for a number of reasons whether it is a stepping stone to getting into full time work, developing new skills or as a way of maintaining wellbeing by contributing to the recovery of others. There is a robust training program and development plan for the team. This includes a 3 part module on the values of peer support, boundaries, basic counselling skills, empathy. Other training opportunities include mental health first aid, Applied Suicide Skills Intervention Training, managing benefits whilst working, Safeguarding of Adults at Risk, Mental Capacity Act etc.
The team also have a personal development plan and in their one to ones with their line manager are supported to develop within the role whilst also looking at long term goals. Within the last 6 years 8 Peer supporters have moved on to acquire full time positions as teachers, Occupational therapist, bus driver, support workers, employment advisors etc. Within their role peer supporters have been encouraged to work on areas of personal development by completing certification in counselling, improve presentation skills by speaking in conferences and seminars, engaging in further education at masters level.
Within the service we are always aiming to grow peer support and we hold at least 2 recruitments in a year. We aim to retain staff to stay well by having wellbeing plans which allows the individual and their line manager to understand signs they might becoming unwell and what they and their manager can do to help. To help people to stay well within their role, they also have 6 weekly one to ones with their line manager as well as a group clinical supervision (reflective practice group) facilitated by a clinical psychologist. These spaces are for individuals to address issues of personal and professional development. Staff are able to discuss issues related to their development at work, their wellbeing and discuss any difficulties they are experiencing with the people they are supporting. Other ways that staff are supported with wellbeing include yearly staff outing, the organisation also runs wellbeing at work sessions for staff. Furthermore, within the organisation staff can access GP Advice Line, Virtual Doctor, 24/7 Counselling Service and legal helpline. Whilst retaining staff we also ensure that staff are supported to move on in their role.
Who is in your team?
The Team (Peer supporters are employed on a zero hour contract) • Out of Hours Crisis Line team: 9 peer supporters working from home in the evenings, paid on an on call and hourly rate. • Community Peer Support team: 4 peer supporters based at our office at railton road, Brixton. This team meet with people face to face in the community to provide emotional support. This team is paid at an hourly rate. • Peer Lead – the peer lead is employed on a part time basis working 22.5 hours a week on a pro rata salary. • Project Manager- the project manager is employed full time working 37.5 hours a week.
How do you work with the wider system?
Solidarity in a Crisis is part of the Living Well Collaborative which is made up of organisations from health and social care (GPs, the wider NHS, the local authority and community based health services) and voluntary sectors. Peer supporters are also involved in the Collaborative in co-designing new services and reviewing existing provision. Collectively our work is focused on supporting people in Lambeth to live well with their mental health. One of the partnership work we have engaged in through the collaborative is the Evening Sanctuary. The Sanctuary is an out of-hours support service in a non-clinical space, targeted at Lambeth residents over 18 years of age who live with a mental health condition. The Sanctuary is staffed by Mosaic Support Workers, Peer Supporters from Solidarity in a Crisis and Mosaic Clubhouse Members. The Sanctuary offers a comfortable and welcoming environment; people to listen; information and signposting service, and a range of snacks and refreshments. The service is open Wednesday-Sunday from 6pm-2am. A peer supporter from Solidarity in a Crisis currently provides support at the Sanctuary 2 days a week. On Thursday evenings at Mosaic Clubhouse we also hold our ‘Exploring Beliefs’ group, a peer led group which can be accessed by people who attend the Evening Sanctuary. Led by peer supporters, this support group meets to connect, befriend, discuss and share experiences of paranoia and fearful beliefs.
The group brings together people from a wide range of backgrounds and age groups (over 18 years only) to share lived experience in a non-judgemental, empathic and safe environment. Our Community Peer Support team also work with the Accident & Emergency Psychiatric Liaison Teams from Kings College and other statutory and voluntary crisis services. Teams can refer individuals that present to A&E if identified that the person could benefit from peer support. The peer support team will liaise with the referrer and the person referred and provide support over the phone and/or in person in a public place. We also work closely with the Nurses on South London and Maudsley’s 24hour Mental Health Support Line. Our work with the Nurses allows both teams to provide the widest range of options to help when people are in a crisis. The team who work on the out of hours crisis line check in and liaise with the nurses at the start of their shift. Peer supporters refer to the nurses where callers need more of a clinical input and the nurses refer callers to SiaC where they feel that the individual could benefit more from peer support. The team also share information regarding people who are being supported by both teams. The Nurses also attend SiaC’s team meetings and we have attended their away days.
Do you use co-production approaches?
The design and development of the service has always been built upon and maintained through co-production. The service was co-designed by the previous manager of the service and director of mental health within Certitude as well as two service user/carer independent consultants. A number of service user led focus groups were facilitated by the service user/carer independent consultants to gather information about people’s needs and perceptions of crisis support. Peer support quickly emerged as the most valued component of the service. Based on the feedback from the service user focus group, the vision for Solidarity in a Crisis was therefore to provide a service that was genuine, transparent and empathetic to the needs of the community using the knowledge of those with similar journeys within the mental health system. Since, peer support has been instrumental as a way of intervening and helping individuals work through crisis.
A year on after the service was launched, two focus groups were ran with the peer Supporters in Solidarity in a Crisis to get feedback on the project’s journey so far. As part of this meeting, challenges were identified. This included ‘not having access to information on previous callers – so you know what has been said before, as we only recorded names and contact details in the beginning’. They also spoke about the challenge of being alert at all times; anxiousness around late night and early morning shifts. The challenge of managing when someone shares something personal that chimes with own experience. All of these challenges were addressed by having a comprehensive database where individuals can access and follow up conversations with callers.
Individuals were also encouraged to access peer support through their colleagues who work on crisis line. Other support systems include regular one to one with the project manager/coordinator and clinical group supervision with Dr. Adrian Webster who has supported the team since it became operational. Furthermore, the views of the service users are always taken into account. For example, Solidarity in a Crisis was initially established as a weekend project as it was felt that this is the time when most people are likely to experience isolation. However, from the demands of the service, Solidarity now runs 7 days a week with extended opening hours Co-production is still maintained through the delivery of the service by people who use services as well as carers. We are also working with a clinical psychology student from Royal Holloway University to evaluate the service based on feedback from the people we have supported from 2016-2017.
Do you share your work with others?
We share our work through the steering committees that we sit on by informing others about the work that we do around peer support and using it to help shape the way peer support is delivered within other organisations. For example, we are currently sitting on a steering group for Centre 70 a counselling and advice organisation who are looking to implement a peer support element to their advice and counselling service. We have been able to share learning from the development and implementation of our service, advice on our model of peer support and values and how this can be implemented within the new service. Furthermore, another way that we share work is through presentations and workshops at conferences and seminars around the way that we help staff to maintain wellbeing at work. For example, for World mental health day, we delivered a workshop at Catford Civic Centre to residents and professionals in the Lewisham borough informing them about the way that we help staff to manage their wellbeing within Solidarity in a Crisis, one of our peer supporters also shared his recovery story and how the way he is supported at work enables him to look after his mental health. We also informed people about practical tips to look after their mental health at work.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
On the crisis line two questions are asked, one is around the usefulness of the service in dealing with their distress, the other is about examining the impact on the service in minimising people’s reliance on A&E, therefore callers are asked if they didn’t call whether they would have gone to A&E. For the community peer support service, individuals complete an evaluation form at the end of the support. Across both services about 80% of respondents complete a feedback form. The feedback is used for service development and also to look at the effectiveness of the service on reducing people’s distress. Furthermore, on the community peer support evaluation form, we ask individuals how they feel the service can be improved, some of the feedback we had initially was about extending the amount of sessions that people receive, since we have been flexible and provided individuals with more sessions when they need it. Overall, 97% of respondent said that they found the support useful in dealing with their distress.
Has your service been evaluated (by peer or academic review)?
We are currently working with a clinical psychology student from Royal Holloway University to evaluate the service based on feedback from the people we have supported from 2016-2017.
How will you ensure that your service continues to deliver good mental health care?
We believe that by supporting peer supporters in an effective way and providing them with development and training opportunities as well as resources to maintain good mental health will help them to deliver good support. Furthermore, we believe that the feedback from the people that we are supporting is really important in providing good mental health care, therefore we hope through ongoing evaluation and acting on the feedback from the people we are supporting, this will help us to deliver good mental health care. Also, we want to continue to work with commissioners and community groups to understand what the priorities are in the boroughs that we work in, what the demands are and what people feel is important. Working closely with our commissioners is really important and we have evidenced this in a number of ways including attendance at the Collaborative’s monthly breakfast meetings and feeding back to the commissioners and other professionals and service users on our performance as well as challenges. Furthermore, in our 6th year we have continued to secure funding by working closely with commissioners and the general public as well as professionals and demonstrating impact. In the last six years, we have implemented a robust system in order to continue to maintain the delivery of the service; the service has demonstrated its resilience through management changes within the services as well as wider changes within Certitude as an organisation. We have demonstrated our flexibility and robustness by continuing to deliver a good level of support. This is also helped by having a standardised way of working and training the team.
What aspects of your service would you share with people who want to learn from you?
We have shared learning with various organisations and people with a general interest in peer support. We have been able to talk about the values of peer support that we work within including mutuality, solidarity, respect, hope, empathy, asset based, equally shared power etc. We have also shared learning around training and ongoing support. We have been able to share learning around challenges some of which include engagement with statutory services and some of the challenges around supporting peer supporters with wellbeing. We have been able to feedback to others about how we dealt with those challenges by building trust with statutory services and raising the profile of the service through attendance at key meetings and events in the borough and scheduling on going meetings with teams to remind them of our service offer. Furthermore, we have been able to help staff cope better with their mental health through regular one to ones and clinical supervision, and also devising a wellbeing plan when they first start and reviewing this when things change with people’s mental health.
How many people do you see?
From January-December 2017, we received 300 referrals and supported 298 people. Furthermore, we dealt with 1,775 calls
How do people access the service?
For our out of hours crisis line, people access the service on a self-referral basis; we also receive referrals from professionals on behalf of individuals. This includes referrals from GPS, Psychologists, Nurses, Support workers, Social worker, housing officers etc For people who find it difficult to access services, we actively promote the services in a wide variety of settings to talk to people, this includes statutory organisations like inpatient wards, community mental health teams, GP surgeries as well as public places including libraries, local shops, cafes, festivals as this enables us to reach people who would not identify with mental health services. Furthermore, with our A&E work as well as work with other professionals we often encourage professionals to give us the details of the individuals with their consent instead of the individual being given our number to call.
We recognise that people are sometimes apprehensive about seeking help and assessing services, so we often try to make the first contact in order to engage with individuals. Individuals can call us during our open hours 7 days a week and are supported on the same day. For our Community Peer support team, individuals are referred for face to face support by a health professional and referrals are sent to a secure email, this is accessed Monday-Friday. Individuals are contacted upon receiving the referral on the day between 12-12am. The referrals are managed by the manager and a staff member who will assess the referral, contact the individual to check in and determine whether they want to be seen straight away and which one of the team members might be the best match. The team also meets one day a week to discuss referrals that have not yet been allocated to someone and decide who will be the best peer supporter to support the individual. We would usually meet with people on the same day of referral or within two days unless the person being supported specifies a later date.
How long do people wait to start receiving care?
For the crisis line, individuals are supported within 24 hours; we would support them during our opening hours 7 days a week. If it is a face to face support and the referral is made between Monday-Friday between 9am-6pm, individuals are contacted on the same day to check in with them and to determine whether they want to be seen straight away and which one of the team members might be the best match. We would usually meet with people on the same day of referral or within two days unless the person being supported specifies a later date.
How do you ensure you provide timely access?
For the crisis line, individuals are supported within 24 hours; we would support them during our opening hours 7 days a week. For any calls or messages left outside of our opening hours, we would follow these up when we are open. For the Community Peer Support service, if the referrals are made between Monday-Friday between 9am-6pm, individuals are contacted on the same day. Any referrals made on Saturday or Sunday are picked up on Monday. We would usually meet with people on the same day of referral or within two days unless the person being supported specifies a later date. We have not found a need to prioritise referrals as yet as our current staffing levels and capacity allows us to support people over the phone and face to face in a timely manner. With both teams, there is always 2 peer supporters working per shift, on the crisis line, it allows the call to go to the other caller and in a situation where both are on the phone we can call as soon as one person is off the phone. Furthermore, the community team also has 2 people on shift, if one person is in the community, one person is still able to support or the manager is around to attend to new referrals.
How do you identify the needs of a person using the service ?
Anyone who identifies as experiencing a mental health crisis or any level of distress can access our service. During the first call or contact with the individual we ask them questions around physical disabilities, education and employment, mental health diagnosis, learning difficulties/disabilities, ethnicity, care coordination and next of kin. These questions help understand their physical, psychological and social needs in order to identify what other services individuals may need in order to help them maintain wellbeing in the long term, it also helps identifies risk and protective factors around people’s wellbeing and also we ask about suicidality in order to devise safety plans for individuals if needed.
How do you meet the needs of people using the service and how could you improve on this?
We meet the needs of the people who use the service by ensuring that the listening support we offer is non -udgemental, care, empathetic and communicate this back to the person being supported. This is sometimes done by peer supporters sharing their experience. We also ensure that we support individuals in a timely manner as we understand that individuals need services that are responsive at a time of crisis. This is particularly effective as people that we support often stress the importance of feeling understood and listened to during their distress and identify this to be very important when they are at a low point. People often talk about how they have not always felt understood and some of our peer supporters often talk about how they wish they knew about a service like SiaC or had peer support when they were experiencing distress and how useful this would have been for them.
We also actively seek to build our knowledge of services and build relationships with other organisations in order to support people to access various sources of support and help transition from our service to services that can support them more in the long term. With the individual’s consent, we often liaise directly with the services we are referring people to and work with the lead person to discuss what the individual finds helpful when they are being supported. We also find at times that individuals find it difficult to articulate to professionals about what is going on for them and we would help the individual to express this to the professionals where appropriate. With the Community Peer support team when we stop meeting people in the community we would often have a number of follow up support over the phone in order to not end the service abruptly. The individual agrees with the peer supporter the frequency of the call and how they would like to phase it out. Individuals are also reassured that they can contact the service for support again whenever they need it. Furthermore, we often get feedback from the people that we support about the usefulness of the service and identify ways that we could improve on meeting the needs of the people we are supporting. We have identified that we could meet the needs of a diverse range of people more by being visible to people who are not known to services and are hesitant to seek help for emotional distress. We would like to have more visibility in the community and support people in the community more who would not have necessarily heard about the service from a mental health professional.
What support do you offer families and carers? (where family/carers are not the service users)
We offer listening support to carers and some of our peer supporters are also carers. We offer carers information about services and resources in their borough that are available to them and can support them. Some of the useful information that we have provided for carers included respite services for their loved ones as well as holiday schemes for them and their loved ones to go on together. We also attend carer’s events including SLaM’s carers listening event to inform carers about the service and the emotional support available to them.
Hours the service operates *
Monday-Friday 12pm-12am
Population details
Brief description of population
The service can be used by anyone who is over 18 across Lambeth, Southwark and Lewisham experiencing emotional distress
Size of population and localities covered:
Residents living in Lambeth, Southwark and Lewisham
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
CCGs in Lambeth, Southwark and Lewisham
Provided by (e.g. name of NHS trust) or your organisation: *
