While the impact of Covid-19 on mental health is still to be fully understood, we are seeing the pressure that’s being placed on NHS services when it comes to bed capacity.
A report last year by the Centre for Mental Health forecasted that 8.5 million adults and 1.5 million children will need some kind of mental health support as a result of the pandemic.
With a problem of this size, relieving pressure on NHS frontline services and providing appropriate support to people with a range of mental health requirements is something every Trust is trying to solve.
One way is to manage issues directly on the hospital ward. This is the approach Tees, Esk and Wear Valleys NHS Foundation Trust has taken to help tackle the impact of delayed discharges.
“The Mental Health Discharge funding that was made available in early 2021 enabled us to think creatively about how we could build on existing good practice to maximise the support we were able to give to people,” explains Mike Brierley, Director of Commissioning Strategy and Delivery at County Durham CCG.
“There were a number of needs. Delays in discharge from hospital due to accommodation issues, which had been reducing but it was clear further work was identified to make existing accommodation safe, needing support to manage in the community. We had also an increase in demand for specialist crisis services from people whose crisis could have been prevented had alternative strategies been in place.”
The Trust now work closely with the national integrated housing and care provider Home Group, who themselves have a wide range of mental health services on offer – from community-based support to crisis prevention.
But it’s their discharge service offer that attracted them; streamlining the process for those people in hospital awaiting suitable accommodation.
The project began life as a discharge and crisis prevention service in Durham (commissioned through Durham County Council) and Darlington, before being replicated in Teesside across four acute wards within Roseberry Park Hospital in Middlesbrough.
Here, Home Group offers housing support for patients, both in a ward-based setting and, following discharge, in the community. Support can be practical or emotional and is wide ranging, such as how to deal with a long-term tenancy, financial management skills, employment and training, and help related to domestic abuse or anti-social behaviour.
With the offer having now expanded further again to the rehabilitation ward at Lustrum Vale, Home Group’s team forms part of the discharge planning process. At the point of admission, patients receive an initial assessment to identify specific areas of need and work collaboratively throughout to create their support plan.
Mike Brierley added: “The project was driven by a national initiative to better support discharges for people in mental health hospitals, so we were hoping to impact positively on the KPIs associated with that, in particular to reduce length of stay for inpatients.
“This service has built on current best practice to reduce length of stay by proactively identifying accommodation related factors and achieving alternative or more rapid solutions. This has included a range of interventions from fixing/procuring white goods to facilitating supported tenancies which otherwise might not have happened.
“For those supported through the hospital discharge element of the service, generally people have felt better able to manage their mental/physical health and better able to connect with others as a result of the community based follow on interventions in place post discharge.
“Success in securing or maintaining appropriate accommodation post discharge has been critical.”
Indeed, since it was commissioned in 2021, 152 patients have been accepted into the discharge service at Teesside with 117 (77%) supported back into the community. In the first nine months, the average duration of stay has been reduced by a total of 73 days per person.
Although not included in these figures, one patient with complex housing needs had been on the ward for almost two years but was discharged within three weeks of accessing Home Group’s support.
Christina Clark, Bed Manager at Tees, Esk and Wear Valleys NHS Foundation Trust, explains how the service has directly impacted the workload of staff and the wellbeing of patients.
“The involvement of Home Group coordinators provides individualised support to patients, both during their admission and into the community.
“This has a real and positive impact on the quality of the service and reduces the distress that can otherwise be experienced when patients are faced with accommodation difficulties, or other housing related problems, at a time when they are already struggling to cope.”
Rachael Byrne, Executive Director of New Models of Care at Home Group, said: “Our Home group hospital discharge service can ensure customers get quick access to housing related support and improve patient flow within the wards. We aim to reduce pressures on NHS staff, prevent symptoms re-escalating and help patients access safe, appropriate housing, and sustain their tenancies.
“Additionally, our support staff work not only on the housing side but also with social care, so are able to bring that rounded support across housing, health and care.”
Bed blocking and delayed discharge aren’t new challenges, nor are they issues exclusive to Covid-19, but the innovative integration of housing and support services directly within the NHS means issues that once took months to solve can now take weeks.
This is a model that we could see replicated far and wide as the impact of the pandemic on the nation’s mental health continues.
To learn more about Home Group’s approach to mental health care and the services they offer, click here https://www.youtube.com/watch?v=Jx0MEA-q_bc