There is a decreasing trend in fire incidents and injuries as result of successful fire safety and prevention activity. However, the rate at which this figure is reducing has slowed down it is thought because of a small group of people known by fire services as ‘people at increased risk of fire’ (PaIRoFs). The journey started in 2007 when I met with a community safety manager from Greater Manchester Fire and Rescue Service because they had a feeling that people with mental health conditions were more likely to die in fires than others ie PaIRoFs. We compared the fire deaths between 201-2007 with Trust records and found that 37% of those who died in fires were known to mental health services in Manchester. As a result of this we agreed a formal partnership and a jointly funded post between GMFRS and what was Manchester Mental Health and Social Care Trust (Now Greater Manchester Mental Health NHS Foundation Trust (GMMH)). We recruited occupational therapist for 2 years consider help the fire service to think beyond the environmental cause of fire and look at the interrelationships between the person, the things they do day-to-day (occupation) and their physical and social environment with regard to fire risk and safety.
Co-Production
From start: Yes
During process: Yes
In evaluation: No
Evaluation
Peer: No
Academic: Yes
PP Collaborative: Yes
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David Marsden - Head of Occupational Therapy Greater Manchester Mental Health NHS FT
There is a decreasing trend in fire incidents and injuries as result of successful fire safety and prevention activity. However, the rate at which this figure is reducing has slowed down it is thought because of a small group of people known by fire services as ‘people at increased risk of fire’ (PaIRoFs). The journey started in 2007 when I met with a community safety manager from Greater Manchester Fire and Rescue Service because they had a feeling that people with mental health conditions were more likely to die in fires than others ie PaIRoFs. We compared the fire deaths between 201-2007 with Trust records and found that 37% of those who died in fires were known to mental health services in Manchester.
As a result of this we felt we had to act and agreed a formal partnership and a jointly funded post between GMFRS and what was Manchester Mental Health and Social Care Trust (Now Greater Manchester Mental Health NHS Foundation Trust (GMMH)). We recruited occupational therapist for 2 years consider help the fire service to think beyond the environmental cause of fire and look at the interrelationships between the person, the things they do day-to-day (occupation) and their physical and social environment with regard to fire risk and safety.
In 2011, the University of Salford were commissioned to independently evaluate the pilot project. It was noted by the author that the project was a ‘successful collaboration’ and that the ‘investment to save potential for this specialist partnership are clearly measured’. GMMH and GMFRS decided that a sustainable approach was required to maintain these outcomes and that any future approach should acknowledge that in general physical and mental health issues contributed to fire risk, not mental health issues alone. Rather than one occupational therapist bridging the organisations we moved to training all occupational therapists in the Trust to carry out specialist occupational assessments in collaboration with the fire service staff. This was cemented in our partnership agreement.
At this point GMFRS took the positive step of recruiting a health and social care coordinator to foster similar partnerships across Greater Manchester. This happened to be Paula Breeze who was the occupational therapist employed in the pilot.
In 2015 Paula and I published guidance for other health and social care providers. The aim was to spread good practice to help reduce injury and death from fire in PaIRoF groups. Key objectives included: setting up sustainable partnerships, collaboration in assessments and interventions and skill sharing.
One component of this guidance was an example of how, in Manchester, we strengthened the partnership through the use of occupational therapy role emerging placements. A key focus of the fire and rescue service currently is delivering safe and well checks which are an expansion of the old safety checks or home fire risk assessments you may be familiar with. So when fire and rescue staff go to people homes they now ask about health and wellbeing and signpost where necessary. This is clearly more holistic and requires a person centred approach to engage individuals who may have a health condition or disability. Occupational therapists are best placed to assist the fire and rescue service in achieving this aim. In our experience fire and rescue service staff have responded well to our description of fire risk in terms of occupational therapy models. For example, looking at the person, their occupations and the environment and the interrelationship between these. Fire services don’t traditionally employ occupational therapists so role emerging placements has been an ideal way to support the fire and rescue service aims whilst exposing them to the added value of the profession. The University profile is inevitably raised and community relationships are improved. With the direction of travel clearly focused on collaboration there are clearly ways health/social care, fire and rescue services and Universities can support each others aims.
With the aim of sustaining our efforts nationally and spreading partnership work across the UK I recently developed a plan in collaboration with and with the support of Linda Hindle, Lead Allied Health Professional and National Engagement Lead for Police and Fire Services, the Chief Fire Officers Association, NHS England and the College of Occupational Therapists. Going forward there’s an aspiration to collaborate further and carry out research. An element of the plan is to promote the uptake of role emerging placements across the UK. There are a number of Universities supporting role student placements into fire and rescues service in the UK. We are aware of Greater Manchester, Nottinghamshire, Dundee and Aberdeen. Feedback from fire and rescue staff and students has so far been extremely positive. As a result I have started contacting Universities via Health Education England and I’ve received a number of enthusiastic responses, from those who are starting to offer role emerging placement in the fire and rescues service and those who are interested in this area.
GMMH and GMFRS work with Allied Health Professionals and other staff at the centre of the design and delivery, continue working together, now in partnership with Universities, continuously to reduce the risk of fire for their service users. The two organisations have committed to share best practice nationally and have started to locate all the learning on a web page and host further best practice sharing sessions using online platforms.
Case examples
Case 1 – Background information
The client (known as Mrs X to protect her identity) was referred to Manchester Mental Health and Social Care Trust (MMHSCT) by Greater Manchester Fire and Rescue Service (GMFRS) following a call out to a cooking related fire incident.
Mrs X had left a pan of food unattended on the hob. She had been drinking alcohol, put some food on to cook and had then fallen asleep in the lounge. A neighbour heard the alarm and called the fire brigade. They entered the house and found Mrs X suffering from the effects of smoke inhalation. An ambulance arrived and Mrs X was given oxygen therapy and taken to the local hospital for treatment. The incident resulted in smoke damage to the kitchen. Due to the number of factors involved in causing the fire an occupational therapist was allocated by MMHSCT.
The fire service were able to inform the occupational therapist that they had been called out to similar incidents at this address 9 times over the last two years and they were very concerned that a more serious fire may occur.
The case study demonstrates the use of the unique Occupational Therapy perspective to summarise the issues concerning fire risk and to describe it within the context of Mrs X’s mental health, lifestyle, daily occupations, social and physical environment. A joint visit was coordinated so that the occupational therapist could meet Mrs X with her care coordinator
Sources of information
Reports from fire service, discussions with Mrs X and with her care coordinator.
Home Fire Risk Assessment findings
Person
Mrs X is a 76 year old female who has a diagnosis of depression.
Occupation
Since the death of her husband two years ago Mrs X has experienced a deterioration in her quality of life, loss of confidence and role as a wife. She has become isolated and has limited motivation to engage in meaningful occupations. Mrs X now spends most afternoons drinking alcohol which reduces her energy levels and concentration. She falls more frequently which results in back pain and restricted mobility. This further perpetuates her low mood, social isolation and dependence on alcohol. Mrs X is a heavy smoker which increases her risk of fire when she smokes in bed or on the sofa whilst consuming alcohol.
Mrs X carries out most activities of daily living independently although she is easily distracted and experiences memory loss when she drinks alcohol, this has resulted in several fires.
Environment
Mrs X lives alone in a semi detached house that she bought with her late husband. Despite feeling isolated she loves her home and does not want to consider sheltered accommodation even though this has been suggested to her. Neighbours are available for support and Mrs X has some telephone contact from Age Concern and friends.
Fire and Mental Health Liaison Officer Intervention
Following the initial introduction Mrs X was agreeable to a further 6 visits. The following risks were identified and risk management strategies agreed.
Risk Identified Action
Repeated fire incidents due to food left unattended Provision of a cooking timer that automatically turns cooker off after set amount of time
Additional smoke alarms fitted in kitchen and lounge
Add fire incidents to Mrs X clinical records
Smoking in bed whilst intoxicated. Risk of burns/fire Provision of fire retardant bedding
Smoking on sofa whilst intoxicated. Risk of burns/fire Provision of fire retardant sofa throw
Alcohol dependence, low mood and loss of interest in meaningful occupations Carry out occupational therapy assessment to establish interests and barriers to achieving a balanced daily routine
Support Mrs X to engage with community alcohol team
Outcome
At the end of the six weeks the smoke alarms, fire retardant equipment and cooking timer had been fitted/delivered. Mrs X had started to identify alternative occupations to drinking alcohol and had started attending an art class once a week which she reported she enjoyed. Mrs X was considering making contact with the community alcohol team although she identified that her alcohol consumption had reduced because she was feeling more positive and had other things to focus on.
The fire safety recommendations were handed over to Mrs X’s care coordinator who then took over responsibility for supporting Mrs X to minimise the risk of fire.
The occupational therapist adopted a person centred approach to understanding Mrs X’s needs and aspirations and considered the interactions between the person, occupations and the environment which was increasing the risk of fire and from fire. Therefore, in collaboration the occupational therapist and Mrs X were able to agree a plan which successfully reduced fire related risks and improved Mrs X’s quality of lice and occupational participation.
Case 2 – Background information
The client (who will be known as Miss B to protect her identity) was referred to the Occupational Therapist by the rehabilitation unit where she was a resident following a fire incident whereby Miss B had discarded a cigarette in a waste paper bin. The materials in the bin started to smoulder and this had set the smoke alarms off.
Miss B is a 57 year old woman who was living in hospital rehabilitation accommodation and was due to be re-housed to live in 24 hour supported accommodation. She has a long history of a depressive illness with psychotic features. Miss B experiences command hallucinations which tell her to set fires when experiencing a phase of illness. Miss B has a history of deliberate fire setting and the following incidents have been documented in her clinical notes:
• 2009 – Small fire in waste paper basket as a result of discarded cigarette
• 2006 – Set fire to her bed whilst in a rehabilitation unit resulting in arrest
• 2006 – Set fire to her flat resulting in police caution and eviction
• 2004 – Set fire to flat resulting in eviction
• 2003 – Set fire to curtains whilst in hospital
• 2003 – Left a chip pan on with the intention of causing a fire (this did not occur)
Introduction
This case study demonstrates the use of the unique Occupational Therapy perspective to summarise the issues concerning fire risk and to describe it within the context of Miss B’s mental health, lifestyle, daily occupations, social and physical environment. It illustrates the importance and benefit of partnership working to assess and manage fire risk in complex cases.
Sources of information
Conversation with client, occupational therapy assessment, care coordinator, electronic clinical notes. A joint visit was carried out by the occupational therapist and the Fire Prevention Liaison Officer (FPLO) from Greater Manchester Fire and Rescue Service prior to Miss B moving into her new accommodation.
Analysis of findings
Person
Miss B is a 57 year old woman who at the time of the report was waiting to move into a new flat where she would have access to 24 hour staff support. Her mental health condition is managed by medication and can fluctuate in presentation and how it impacts upon her function.
Miss B’s fire setting risk increases during times of stress and frustration. When her mental health deteriorates some of the relapse indicators are:
• Increased consumption of alcohol
• Isolation and withdrawal from usual activities
• Increased thoughts of self-harm, harm to others or fire setting
Occupation
Miss B engages in community activities and enjoys going to cafes and spending time with her son and partner. She is able to cook for herself although she requires prompting to maintain a balanced diet. It was identified that she would require support from the occupational therapist to practice cooking skills with her new cooker once she has moved into her new flat as she has not cooked for some time. This would increase safety as well as independence.
Miss B is a heavy smoker and she smokes in her lounge and bedroom.
Miss B reports that when she moves she would like to consider voluntary work as she has limited access to meaningful occupation. An increase in structured activity reduces the amount of opportunity for rumination and negative thinking.
Environment
Miss B was about to move from hospital accommodation into a self-contained flat where she has access to staff 24 hours a day. Miss B would have her own kitchen and bathroom facilities.
A discussion took place with care staff, occupational therapist, the FPLO and Miss B’s care coordinator regarding how best to manage the risk within the new environment. The following fire element of the clinical risk management plan was developed.
Interventions
Person
It was identified that it is essential that Miss B has access to staff support during times of stress so that she is able to discuss her feelings and any thoughts of fire setting that she may have.
It was agreed that her flat would be situated on the ground floor next to the staff office.
Miss B will have an allocated key worker who she can talk and who can support her to manage her feelings.
Environment
• General advice was given to the manager to ensure that the building’s risk assessment is up to date.
• It was also recommended that the manager re-visits the evacuation policy and procedure with all staff so that each individual tenant’s needs are included in the evacuation plan
• It was recommended that all recycling bins were removed from communal stair well
• Miss B’s front door should have a self-closing door bracket and a fire retardant letter box
• Ensure all storage cupboards that are accessible to tenants are kept locked
• 2 additional smoke alarms would be fitted in Miss B’s lounge and bedroom
• A fire retardant bed pack and sofa throw would be provided
• The manager agreed to purchase fire retardant curtains for the flat
Occupation
• If Miss B feels agitated or stressed staff will encourage her to participate in activities that she identifies as relaxing. For example listening to music, watching tv, having a bath, painting, swimming.
• If Miss B is experiencing any thoughts of fire setting she has agreed to give her lighter to a member of staff.
• Further occupational therapy assessment to increase occupational participation
• Cooking practice to improve confidence, skills and safety in cooking meals independently using new cooker in a new environment
Wider Active Support
We have worked with a range of partners to ensure safety is improved for people at increased risk of harm from fire in Greater Manchester. Most of the detail is in the ‘What we did section’ but these are the key areas and partnerships:
1.GMFRS: GMMH have a formal partnership with GMFRS to work together at the front line to assess for risk jointly, to run safety campaigns, to investigate fire deaths, to deliver reciprocal training, to share information safely to reduce the risk of harm from fire and to use each others estates where appropriate.
2.GMMH occupational therapists: deliver the joint fire safety interventions with GMMH. All occupational therapists are trained to incorporate fire safety into their routine occupational assessments.
3.University of Salford: GMMH work with the University of Salford to supervise and place students into fire and rescue services to promote the leaning experience of students and to improve the person centred and wellbeing focus of the fire and rescue service.
4. Network of interest: GMMH hosts a network to share best practice across the UK and sometimes beyond.
5. AQuA (advancing Quality Alliance) AQuA works with GMMH to deliver webinars to our network of interest to share best practice across the UK in terms of fire safety partnerships.
6. National bodies: The College of Occupational of Occupational Therapists, Chief Fire officers Association, Public Health England and NHS England are supporting the plan to promote a sustainable approach to the communication of best practice, an information repository, placement in fire services, social media for Allied Health Professions regarding fire safety.
7. Service users: were involved originally in the planning and delivery of mental health training to the fire and rescue services.
8. Library services: provide an evidence scan and updates routinely in the area of fire risk, health and social care.
Co-Production
Service users: were involved originally in the planning and delivery of mental health training to the fire and rescue services.
Looking Back/Challenges Faced
I would have completed the NHS Sustainability tool at the start of the partnership. After the joint funded pilot, the partnership developed organically and has succeeded by willing collaborators and shared goals rather than a well-funded business case. There are economic evaluation emerging which demonstrates the invest to save potential of thsityrp of partnership and the added value of occupational therapy.
Sustainability
With the aim of sustaining our efforts nationally and spreading partnership work across the UK I recently developed a plan in collaboration with and with the support of the Lead Allied Health Professional and National Engagement Lead for Police and Fire Services at Public Health England, the Chief Fire Officers Association, NHS England and the College of Occupational Therapists. The plan includes developing a national network, national repository for information and a webinar series to share best practice/collaborate. Going forward there’s an aspiration to collaborate further and carry out research.
Locally, strategic leads are needed in each health and social care organisations and each fire and rescue service to ensure partnerships are developed, monitored and maintained. This is based on the national guidance authored by GMMH and GMFRS in 2016.
An economic evaluation was carried out by the College of Occupational Therapists in 2016.
The local partnership is monitored quarterly by GMMH and GMFRS.
Outcomes
The partnership work has achieved the following outcomes:
-reduced the risk of harm from fire for service users and the people who live with them
-extended the reach of the fire and rescue service in terms of using health/social care staff to spot fire risks and reduce them
-extend the reach of the health/social care services in terms of fire and rescue service personnel considering well-being of residents and signposting to services (especially public health priorities)
The outcomes above are referenced in the pilot evaluation and economic evaluation.
Sharing
We share:
-through the temporary repository for best practice: https://www.gmmh.nhs.uk/fire-safety-advice which will be hosted by the Chief Fire officers Association in the future.
-Through our webinar series
-Multiple conference presentations at the National Occupational Therapy Conference and Chief Fire officers Association
-Articles in the Health Service Journal, Mental Health Today, Occupational Therapy news
