This is the 1st of 5 blogs related to some organisational development work that we are doing to help sustain and develop our adult wellbeing programme, through funding kindly provided by the Arts Council. We thought that it would be helpful to share some of our learning with you, and share our thoughts on what this might mean for our future programme.
Back in November, we went to a ‘Reach Out Recovery Partners ‘Joined Up Thinking Event’. Reach Out is a West Midlands initiative formed to change secure mental health services for the better. The programme is led by a partnership between Birmingham and Solihull Mental Health NHS Foundation Trust, South Staffordshire and Shropshire Healthcare NHS Foundation Trust and St Andrew’s Healthcare.
The idea of Reach Out is to improve community networks, provision and resources to enable people to spend less time in secure mental health hospitals, and to be cared for better in their local communities, where they will be able to live safely and well whilst accessing meaningful activity supporting their reintegration.
Whilst there is an overwhelming consensus between partners that people are staying in hospital for too long due to lack of community provision to support them in their own area, there are also big financial implications for making this change. In the old way of doing things, the NHS paid for mental health inpatient care from a central budget. Now, in the new care model, providers like Reach Out hold this budget. They also have to use this budget to pay for all its service users who are out of area. The solution is to bring these ‘out of area’ service users home and save that money. However, to bring people back home, there needs to be hospital places to accommodate them, and these places will only be able to be provided by discharging people quicker. The idea is that, if people don’t stay in hospitals for as long, then that money can be used to invest in better community services.
The project has just come to the end of its first year pilot and we were invited along to contribute to discussions about the future, as well as to learning about the successes and challenges faced.
Some of the important aspects for service users in their recovery include: appropriate accommodation; community services; having carer/family support; access to peer support; activities providing a meaningful use of time; employment and having a directory of services.
Agreed principles include: a need for flexibility; positive partnerships; support for transitions; having recovery at the centre; and peer support/ co-production. From our perspective, this sounds extremely positive as it makes sense that the best people to design any service are those that are going to use it, and those who have experienced the best and worst of the old system. It was also fantastic to hear that there is a service users and family, friends and carers involvement strategy, set up to ensure these views and listened to and acted on in co-production of services, but also to help with demonstrating the impact of the work.
What was apparent during the day was that there is also a significant change in the language being used. The term ‘treatment’ is now replaced with ‘recovery’; ‘rehabilitation’ is now referred to as ‘experience’ and ‘reintegration’ becomes a patient’s ‘journey’. It was really powerful listening to service user reasons given for this change of language, as it is often easy to underestimate the impact that a particular word can have. For example, the term treatment implies something clinical with expectations of success, whereas recovery is an experience meaningful to the service user. Rehabilitation might fix the mechanics, but what about the heart and soul? Rehabilitation infers that the person was previously an alien and can feel like a ‘parachute’ and ‘boot in the back’, whereas ‘journey’ reflects a more gradual process, informed by the person’s own life and wishes.
We were really interested to hear about the introduction of Reach Peer Support Worker roles into the project, and these roles are part of patients care plans in preparation for discharge.
Much of the first year of Reach Out has been about putting systems in place and supporting this cultural shift. It’s been about recruiting these peer support workers, about communication and improved data sharing, with a big focus on slowly supporting patients in their journey back into the community. Also, in this first year, new funding for wraparound care has been identified, called FIRST. FIRST is funding for anything that may support a service user, with examples given including sheds, hobby items or practical things.
In year 2, there will be increased involvement of service users and carers, plus increased staff engagement, as well as an attempt to develop one shared process. There is also an ambition to support 3 BME project workers, for advocacy, personal development and peer support. Of relevance to our work, there will also be individual placement support and a systematic review of each out of area patient, to support transition and removal of any barriers for discharge.
Certainly, Quench may be able to play a role in supporting the FIRST scheme and patient transition, where patients may have a musical interest. Here, our creative music making activities can support meaningful activities addressing the 5 Ways to Welbeing whilst also enabling participants to connect with others through shared interests and experiences.
The breakout workshop session on ‘Transition and Living Well in the Community’ was an interesting discussion of the barriers that prevent people from accessing community provision. As well as Quench Arts, the sub group included Reach Out staff, occupational therapists, social workers and service users. A big area for discussion was the inflexibility of secure care when patients are in transition and how community services are often not in the area of where the patient is currently staying (hospital) therefore scheduling and transport barriers are high. Whilst these costs and practicalities are high, where it is possible, Quench Arts have certainly found this to have a huge positive impact through the wellbeing projects that we run.
We are looking forward to becoming more involved with the Reach Out Recovery partnerships and in exploring how our work can be offered as part of personalised budgets in the future. We will provide an update on this later in 2019.