Supporting people with serious mental illness to live well out of hospital

Overview

In partnership with the Oxfordshire Mental Health Partnership, the Response Littlemore Campus reduced out of area placements in Oxfordshire to its lowest ever level.

What the organisation faced

NHS and voluntary sector providers in Oxfordshire faced growing numbers of adult out of area placements and delays in hospital discharge. 

What the organisation did

In 2015, the Oxfordshire Mental Health Partnership established the Response Littlemore Campus as part of a plan to tackle this issue.

The campus is an intensive supported housing service for people with complex mental health challenges. It is part of an innovative joint proposal by the partnership in response to a tender opportunity for support services for adults with significant mental health needs. 

The campus is part of a broader supported housing offer for people with serious mental illness, provided by Response and Oxfordshire Mind. A full pathway of support is available, ranging from 24/7 intensive support, through to unstaffed houses with visiting support for those closest to living independently.  Oxford Health NHS FT is the lead contractor and subcontracts to Response and other voluntary sector partners individually for the components they provide. The campus aims to provide patients with assertive support and accommodation that will actively aide their recovery towards greater independence and to reduce out of area placements by freeing up inpatient beds. 

The campus provides support and accommodation to people with the highest needs, and as a result of a social care assessment or and are under Section 117 of the Mental Health Act.  It is based around a former hospital building gifted to Response by Oxford Health NHS Trust in the early 1980s, as well as another building rented from the hospital trust and a street of houses owned by a housing association. All of these are based on hospital grounds. 

The wider service is intended for people who are actively using secondary mental health care, and Response’s provision is focused on those with significant need on leaving inpatient care.

The layout of the campus is similar to that of a traditional small housing development, replicating a community as much as possible to support residents to live independently. Placements are for two-to-five years, but some people stay longer if needed. Establishing strong working relationships with local authority housing teams has been important for the success of the approach.

An embedded clinical team comprises nurses and a social worker, as well as access to the consultant psychiatrist, occupational therapists and psychologists of the local adult mental health team. The joint team provides assertive outreach on the campus, using a shared caseload approach to support proactive joint support, care planning and risk planning. There are also close links with primary care and the local police. This means that the service can manage people with the most complex needs in the community. 

As part of the approach, staff visit mental health wards to understand patients’ estimated discharge dates, assess their needs and put a post-discharge care plan in place, increasing the efficiency of the discharge process. Once patients move to the campus, the Response team develops goals with patients and work alongside them to re-engage with the community; explore training and work opportunities; develop confidence, self-esteem and sense of belonging; manage medications and help them develop independent living skills. 

In addition to the campus there is a range of further supported housing provision, providing a pathway of support for people to ensure all level of needs and intensity is catered for with the ultimate aim of independent living.  Response provides this service to over 200 individuals and Oxfordshire Mind supports a further 90 individuals across a range of staffed and unstaffed properties, which are a mix of shared homes and self-contained accommodation, depending on the needs and preference of the person.  The two organisations work collaboratively in partnership to place people in the most appropriate service.

Alongside the housing offer, other partnership members provide floating support; a wellbeing service; safe havens; crisis support; benefits advice and a training, volunteering and coaching service, which empowers people to keep or gain paid employment. 

The partnership contract is overseen by a management group comprising voluntary sector chief executives and very senior managers at the trust , while a partnership senior management team work collaboratively on operations. A combined on-campus multidisciplinary team meeting involving Response and trust staff takes place every week, supported by staff touchpoint meetings during the week. Service leaders work to create a sense of professional curiosity in staff teams, encouraging them to think proactively about residents’ needs.

Results and benefits

As a result of the partnership’s work, including but not limited to Response’s’ intensive supported accommodation approach, out of area placements in Oxfordshire are at a low level, and only around 2 per cent people discharged are readmitted within 90 days. 

Response Oxfordshire chief executive Nicola Leavesley says: “We've had some amazing outcomes. A lot of people who live with us have spent decades of their lives in and out of hospitals and actually, they're living pretty independently with us.”

Key benefits and outcomes

• Long-term low levels of adult out of area placements.
• Low readmission rates of around 2 per cent within 90 days of discharge.
• More efficient discharges from inpatients.

Overcoming obstacles

The service relies on maintaining good working partnerships at all levels, which requires effort particularly when staff leave and new people join the team. Partnership members use different IT systems, meaning effective communication between teams is crucial for providing effective, well-coordinated care. It has also been important to ensure that the partnership’s leaders are aligned in terms of how much risk they are happy for the voluntary sector to hold.

Response sometimes cannot support patients with mobility needs, many of whom are older, because its properties tend to be in old buildings that may not meet modern accessibility requirements. It is exploring the possibility of developing accessible flats on some nearby land. The other group that Response is sometimes unable to support is people with very severe substance misuse issues who are unwilling to engage with support services, since the campus is an open environment and may impact on others’ recovery. 

Takeaway tips

• Spend time on establishing and maintaining strong working relationships between teams and stakeholders.
• Ensure all partners are in clear agreement about the approach to managing risk in the community.
• Be clear about who the service can and can’t help.
• Think innovatively across sectoral boundaries to tackle longstanding problems.