Woman having conversation with mental health professional

Mental health crisis: How a new approach to care could help the NHS

In England, it’s predicted that up to 10 million people will need either new or additional mental health support as a result of the pandemic. This forecasting, carried out by the Centre of Mental Health, paints a pretty bleak picture for both patients and the professionals looking after them.

Indeed, within the 10 million, which equates to almost one in five people, there are groups identified as being more at risk than others; people with existing mental health conditions, the bereaved, those affected by unemployment, patients and their families, and NHS workers themselves.

The pandemic has resulted in a worst-case scenario for mental health, with demand increasing but capacity decreasing due to social distancing practices. It’s a situation that will only get worse as lockdown measures continue, suggests Katy Baigrie, Clinical and Forensic Psychologist and Psychology Lead for the housing association Home Group.

She said: “Lockdown has meant that the usual support provided to individuals with mental health difficulties has been significantly reduced or changed. Prior to lockdown, mental health services were already significantly stretched.

“A prolonged lockdown is likely to have a significant impact on people’s mental health. Lack of social and physical contact from others, specifically those we care about, has been shown to have a longer-term impact on mental health.

“Deprivation of this kind can lead to symptoms of depression, anxiety and loneliness. This is likely to be more severe for those living with a mental health problem or who live alone, such as the elderly. More people are also working from home, further limiting contact with others and access to different environments.”

So, what are the solutions to help alleviate some of the additional pressures being placed on NHS services?

As a housing association, Home Group might not be the first name you consider when it comes to providing mental health support for people in crisis.

The social enterprise is one of the UK’s largest providers of housing, health and care, supporting some 115,000 customers across 55,000 properties in England and Scotland - including around 15,000 people with mental and physical health issues.

Home Group have invested heavily in recent years to recruit colleagues with clinical expertise in order to better shape and implement its care model, including ensuring the support it provides is psychologically informed.

Katy explains: “The concept of Psychologically Informed Environments advocates a particular approach to the development, delivery and evaluation of services. This approach is one that focuses on understanding the thoughts, emotions and, most importantly, the past experiences of people in the way it operates.

“In Home Group, working in a psychologically informed way is one of the fundamental principles of our LIFE support practice model. It is central to how we support our customers in that we seek to understand what has happened in their lives up to that point in order to develop how we support them most effectively.

“Mental health services have historically been based on a medical model where diagnosis is the focal point. Working psychologically helps avoid the stigmatisation and labelling that can arise from a diagnosis driven approach and looks at what has happened rather than what is wrong with individuals.

“Our customers have often experienced trauma and many other difficulties in their lives. Having support teams that understand the impact of trauma, are empathic and supportive of customers regarding such experiences, helps prevents re-traumatisation and leads to much better outcomes for all.”

Home Group’s approach is designed to support the NHS and tackle common issues shared across most mental health trusts, such as capacity, out of area placements and bed flow.

This starts on the frontline with services that offer support without the need for a physical location – something that has proven ideally suited to life during a pandemic.

One initiative in Southampton is looking to prevent those lacking in digital skills from falling through support gaps and deals with a range of mental health needs, including financial stress, social isolation, signposting to food banks, claiming benefits and housing needs.

This support model acts as a triage for those who need low level help to prevent their mental health deteriorating and who, if left unsupported, would ultimately end up entering the NHS system with more severe and longer-term issues.

At the other end of the scale are those in crisis who either need additional support to prevent them going into hospital, or those on acute mental health wards who need to step down to a supported environment as they’re not ready to return to independent living.

Beech Range, a mental health step down service providing homes and care for up to eight people over a 12-week period, was piloted by Greater Manchester Mental Health Trust (GMMH) to help reduce the need for out of area placements (OAPs).

OAPs occur when patients are moved out of a trust’s geographical area, usually due to a lack of available beds, and includes the use of expensive private health care providers.

Zoe, a former customer at Beech Range, was sectioned, lost her children and struggled with the isolation caused by being away from her family, until she was discharged into the service.

She said: “The separation; it proper affected me. I was on my own, isolated and it made me ill.

“They’re great [at Beech Range]. Everyone has got one-to-one support and that extra reassurance and support you get; you know when you’re on your own it could be scary getting out of here, but it wasn’t for me.

“They are the only ones who helped me sort my storage out, sort my dog out, sort out where I need to live. They have been a godsend – I don’t know what I would have done without them.”

Breaking the cycle of mental health is an important part of the work Home Group are doing at Beech Range. Zoe now has her children back and is living independently in her own home.

As well as improving bed flow and patient outcomes, figures produced by GMMH show that Beech Range has the potential to achieve an annual saving of £1.27m for the NHS in Greater Manchester, compared to the independent sector’s average nightly bed rates, and £738,000 compared to GMMH’s own nightly average.

With this pioneering service proving its value to both commissioners and customers, Home Group are now expanding the model further, both in Greater Manchester and across England, in order to support bed flow in the NHS and reduce the reliance on out of area placements.

Just as with fighting Covid-19, NHS capacity will be at the heart of the mental health challenge, but with innovative solutions across all levels of care there is an opportunity to ease that pressure, and possibly even think beyond the pandemic, about how services and organisations can better work together in the future.

NHE March/April 2024

NHE March/April 2024

A window into the past, present and future of healthcare leadership.

- Steve Gulati, University of Birmingham 

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