Lara Sonola and Shamim Rahman, members of DH System Oversight, Planning and Legislation team, recently completed a connecting placement at East London NHS Foundation Trust. Lara and Shamim have kindly shared their experience here.
During our two d
ay visit, I had the chance to hear about City and Hackney’s preventative work to provide support to young people at risk of developing psychosis. Called ‘HEADS Up’ it is a new programme that has been set up to provide 18-35 years old with emotional and practical support provided by a support worker, as well as access to psychological therapies. The team leader shared the story of setting up the programme during a pilot the previous year with a visiting team from another mental health trust, and explained how they had built up their caseload by engaging with local GPs, attending community events and local colleges.
Their aim to help younger people evolved out of the EQUIP (Early Intervention in Psychosis) service, one of the specialist community mental health teams based in City and Hackney’s mental health service. We observed their weekly clinical meeting attended by the full multi-disciplinary team (MDT), including nurses, social workers, clinical psychologists and psychiatrists. I was struck by how closely the various professions worked together, we had the chance to see genuine integration between health and social care to provide a holistic view of the clients on their caseload.
We sat around a projector, showing RAG ratings, while each care co-ordinator summarised their clients history, legal status, relevant housing or benefit needs, to ascertain where they needed additional MDT input and collectively reached a view on next steps. Throughout the meeting, it was clear that an important part of their role involved assessing and managing risks, while working within the strict framework of the Mental Health Act.
Individuals are referred to EQUIP on experiencing their first symptoms of psychosis; they are assessed for eight weeks, and those deemed suitable are allocated a care co-ordinator, who develops a care plan with them which includes medication, if appropriate, access to individual or family therapy sessions, advice with housing and benefits and other community resources. As EQUIP is an early intervention service, clients receive intensive support with weekly visits, for up to three years while in community and through any inpatient admissions. After that point, they are discharged to another service, for example the recovery team or back to their GP with access to enhanced primary care (EPC) provided by mental health workers.
I was lucky enough to get taken on a home visit by a Social Worker/Care Coordinator I was shadowing – a visit she specifically arranged on that day so I could have a taste of this important aspect of their job. We visited a lady who had been placed in Supported Housing, which consists of self-contained flats, communal spaces, and support staff during normal working hours. This type of housing helps service users with their recovery, supports their wellbeing, and helps them develop skills to live independently. The flat she lived in was clean, spacious and looked very much like a loved home. It had not always been this way – I was told she had been reluctant to engage previously and refused to clean or tidy her flat.
The Care Coordinator had worked hard to build up a trusting relationship over time, to the point where she was able to talk very openly with the lady about her mental health condition, her sexual health, and any other concerns she had during our visit. Unusually for many in this situation, the lady had family support: her sisters would visit regularly and help her with shopping and cleaning, and the Care Coordinator also maintained contact with them.
At the time of my visit, there was a chance that the service user would be moved to private, shared accommodation as the Supported Housing was being turned into a higher need centre, one for which this lady did not qualify. Understandably, this was a cause of great anxiety for the service user. The Care Coordinator assured her she was on the case, and would not rest until the lady was allowed to stay or some alternative, similar accommodation found. I was impressed by the level of dedication shown not just to the mental health condition of a service user, but all the contributors such as housing, family support, and social circumstances. It is this holistic approach to mental health support by City and Hackney Community Mental Health that ensures their treatment programme is so successful.
Clients are discharged from mental health services such as the EQUIP, after 3 years or earlier if they no longer need intensive support, and are in the recovery phase of their treatment. At this stage, individuals still have an allocated support worker or care co-ordinator, but the focus shifts towards recovery and signposting them to relevant services in the local community. One example was City & Hackney’s new Recovery College, on the day we visited a team member came to the meeting to publicise an upcoming launch event and distribute flyers on their autumn programme with courses to help individuals become experts in their own self-care and wellbeing. On a home visit with one of the care-co-ordinators later in the day, we mentioned the College as a possible opportunity to investigate, which was positively received by the client.
The visit ended with an opportunity to sit-in on a psychologist’s session with a service user who was in the latter stages of the Recovery phase. As with all patient contact throughout our visit, the service user’s consent was sought before I was allowed to join the appointment. I introduced myself to him outside the room and he appeared at ease to have me there. A young man in his late 20s, he’d successfully finished his course of treatment and now required support to transition back into his usual routine. He was very keen to start working again and his enthusiasm was heart-warming. It was fascinating to listen in as the psychologist drew out from the young man what kind of support he would need, and devised a plan of action. Collaboratively, they decided on fortnightly sessions to deal with the anxiety his was feeling.
I was particularly impressed with the way the different services (psychiatry, social work, psychology) offered by the Trust fit so seamlessly together to make sure no patient is left out in the cold once their “treatment” is deemed over. It was a positive note on which to end the placement; it left me feeling hopeful that the brilliant services provided by City and Hackney Community Mental Health were having a lasting impact on the community.
Want to know more about how Connecting can help you and your team? The Connecting team (Jane Ellis in London and Roy Axon and Sophie Collinson in Leeds) would be very happy to join in with team meetings – get in touch via the Connecting mailbox (connecting@dh.gsi.gov.uk)