Cardiff and Vale Community Crisis House Jayne Bell – Team Leader South Cardiff/Vale CCRHTT Richard...

Cardiff and Vale Community Crisis Cardiff and Vale Community Crisis HouseHouse

Jayne Bell – Team Leader Jayne Bell – Team Leader

South Cardiff/Vale CCRHTTSouth Cardiff/Vale CCRHTT

Richard Bundy – Service Manager Richard Bundy – Service Manager

Gofal CymruGofal Cymru

Leading innovation and quality in mental health services

IntroductionIntroduction

Briefing on Gofal CymruBriefing on Gofal Cymru Briefing on Community Crisis HouseBriefing on Community Crisis House Briefing on Collaborative ApproachBriefing on Collaborative Approach Future development opportunitiesFuture development opportunities Q & A sessionQ & A session


The Work of GofalThe Work of Gofal

Celebrating18 years as a leading Mental Health Charity Celebrating18 years as a leading Mental Health Charity in Walesin Wales

Working across eleven local authority areas and Working across eleven local authority areas and employing in excess of 100 people.employing in excess of 100 people.

Providing a range of specialised services including -Providing a range of specialised services including - Employment schemes.Employment schemes. Tenancy Support.Tenancy Support. Supported Housing.Supported Housing. LobbyingLobbying Crisis HouseCrisis House


Aims of the Crisis HouseAims of the Crisis House People experiencing severe mental health difficulties should People experiencing severe mental health difficulties should

be supported in the least restrictive environment with the be supported in the least restrictive environment with the minimum of disruption to their lives. minimum of disruption to their lives.

To serve patients of the Crisis Resolution & Home Treatment To serve patients of the Crisis Resolution & Home Treatment Teams who act as ‘gatekeeper’ to the serviceTeams who act as ‘gatekeeper’ to the service

Provide intensive support to clients in the Crisis House as an Provide intensive support to clients in the Crisis House as an alternative to inpatient care in an un-institutionalized alternative to inpatient care in an un-institutionalized environment.environment.


Aims of the Crisis HouseAims of the Crisis House

To provide practical and emotional support to To provide practical and emotional support to individuals who are experiencing an acute individuals who are experiencing an acute psychiatric crisis.psychiatric crisis.

Avoid Hospital Admission.Avoid Hospital Admission. Promote service user choice.Promote service user choice. Be actively involved in provision of support to Be actively involved in provision of support to

facilitate a return to the individual’s home.facilitate a return to the individual’s home.


Criteria for AdmissionCriteria for Admission Accepted by one of the CRHTTAccepted by one of the CRHTT Need to considered as appropriate for hospital Need to considered as appropriate for hospital

admission.admission. Less likely to respond to those with mild anxiety Less likely to respond to those with mild anxiety

disorders, Primary diagnosis of alcohol substance disorders, Primary diagnosis of alcohol substance misuse, organic disorders.misuse, organic disorders.

No blanket rules – referral dependent upon No blanket rules – referral dependent upon assessment of CRHTT.assessment of CRHTT.


What the House ProvidesWhat the House Provides Twenty-four hour waking cover with high staff to resident Twenty-four hour waking cover with high staff to resident

ratio.ratio. Therapeutic/homely environment.Therapeutic/homely environment. Intensive social and emotional support/planning.Intensive social and emotional support/planning. Support with daily living skills.Support with daily living skills. Signposting to services.Signposting to services. Liaison with carers.Liaison with carers. Observation and liaison with CRHTT’s.Observation and liaison with CRHTT’s.


Reasons for ReferralReasons for Referral


Poor living conditions Risk cannot be managed by home visits alone Abusive relationship/something in the home is causing/exacerbating the crisis Self-neglect

Reasons for ReferralReasons for Referral

Carers needing respite from crisis Less stigmatizing than hospital Easier to maintain social networks Ability to carry out a fuller assessment of daily

living (ADLs)


Service User PerspectiveService User Perspective Significant number of service users with experience Significant number of service users with experience

of hospital admission.of hospital admission. 95% of service users rated the house good or 95% of service users rated the house good or

excellent in comparison to hospital. excellent in comparison to hospital. (89 % excellent)(89 % excellent)

99% felt they had good or excellent access to staff99% felt they had good or excellent access to staff 95% felt the benefit to their mental health was good 95% felt the benefit to their mental health was good

or excellent. (81% excellent) or excellent. (81% excellent)


Case Study-BCase Study-Background to Referral ackground to Referral 19 year old male19 year old male 11stst presentation to services presentation to services Difficult social systemDifficult social system History of substance misuse, of a binge natureHistory of substance misuse, of a binge nature Petty crimePetty crime


Case Study - AssessmentCase Study - Assessment Initially seen by SHO who identified ongoing risk of potential Initially seen by SHO who identified ongoing risk of potential

suicide.suicide. Seen on poisons unit after an attempted overdose, coupled Seen on poisons unit after an attempted overdose, coupled

with failed hanging attemptwith failed hanging attempt Lengthy assessment; uncommunicative, sullen, poor eye Lengthy assessment; uncommunicative, sullen, poor eye

contact, embarrassed contact, embarrassed Would not divulge thoughts/feelings “Let me go home”Would not divulge thoughts/feelings “Let me go home”


ConsiderationsConsiderations Mother’s feelings/observations/wishes. Scared to Mother’s feelings/observations/wishes. Scared to

have son home vs wishing to avoid a compulsory have son home vs wishing to avoid a compulsory admission.admission.

Client’s fear/pride etc. Preventing him being open Client’s fear/pride etc. Preventing him being open and honest.and honest.

The need to keep himself safe and to observe his The need to keep himself safe and to observe his mental health vs risk of labelling.mental health vs risk of labelling.


Crisis House StayCrisis House Stay

Visited twice daily by CRHT clinical staff.Visited twice daily by CRHT clinical staff. Reviewed by team Psychiatrist on 1Reviewed by team Psychiatrist on 1stst full day in house full day in house Prescribed only lorazepam and zopiclone PRN, given on the Prescribed only lorazepam and zopiclone PRN, given on the

twice daily visits when deemed necessary.twice daily visits when deemed necessary. Stay extended to 10 days to accommodate his mother’s Stay extended to 10 days to accommodate his mother’s

days off work.days off work.


Crisis House InputCrisis House Input Regular one to one support. Developing trust around Regular one to one support. Developing trust around

disclosure on mental health.disclosure on mental health. Support and information around use of leisure/employment.Support and information around use of leisure/employment. Support and information around use of Drug and Alcohol Support and information around use of Drug and Alcohol

services.services. One to one support for relative with provision of carers One to one support for relative with provision of carers

information pack.information pack. Provision of a leaving pack for client.Provision of a leaving pack for client. Close liaison with CRHTTClose liaison with CRHTT


Benefits of Crisis House StayBenefits of Crisis House Stay Liaison between his divorced parents on his behalfLiaison between his divorced parents on his behalf Time out for all concernedTime out for all concerned Ability to spend 10 days away from his drug taking Ability to spend 10 days away from his drug taking

circle (identified by client)circle (identified by client) Close monitoring of his mental health – option to Close monitoring of his mental health – option to

start on a low dose of anti-psychotic in a monitored start on a low dose of anti-psychotic in a monitored environment.environment.


OutcomeOutcome Client had 10 day spell of 24 hour monitoring Client had 10 day spell of 24 hour monitoring

without need for admission.without need for admission. Team had ability to make a working diagnosisTeam had ability to make a working diagnosis Family had the opportunity to talk about their Family had the opportunity to talk about their

concerns for their son, be supported and receive concerns for their son, be supported and receive guidance on how to copeguidance on how to cope


Statistical InformationStatistical Information 254 referral accepted since opening.254 referral accepted since opening. 88% Hospital avoidance.88% Hospital avoidance. Incremental increase in referral quarter on quarter.Incremental increase in referral quarter on quarter. 83% of service users previously admitted to 83% of service users previously admitted to

hospital had experienced longer stays than at the hospital had experienced longer stays than at the crisis house.crisis house.


Learning and Service DevelopmentLearning and Service Development Commissioners need to consider the configuration Commissioners need to consider the configuration

of services to meet local need of services to meet local need e.g. staffing levels, medicines e.g. staffing levels, medicines regime/arrangements for clinical input.regime/arrangements for clinical input.

Geography/demography of service area needs to Geography/demography of service area needs to be considered.be considered.

Collaborative approach needs a maintenance Collaborative approach needs a maintenance component.component.


ConclusionsConclusions Crisis House provision can assist in hospital Crisis House provision can assist in hospital

avoidance.avoidance. Provides a viable alternative to hospital.Provides a viable alternative to hospital. Promotes choice for service users and Promotes choice for service users and

professionalsprofessionals A service more in line with the wishes of service A service more in line with the wishes of service

users and carers.users and carers.


Thank you.Thank you.Any Questions?Any Questions?


For information on the Community Crisis House and For information on the Community Crisis House and Report please contact –Report please contact –

Alexandra McMillanAlexandra McMillan01656 64772201656 647722

[email protected]@gofalcymru.org.uk


Cardiff and Vale Community Crisis House Jayne Bell – Team Leader South Cardiff/Vale CCRHTT Richard...

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