This case study forms part of the What Good Looks Like report on people with a learning disability and autistic people. This co-produced report was commissioned from the Building the Right Support Advisory Group, as part of the wider action plan developed by the Building the Right Support Delivery Board. It has been supported by Partners in Care and Health.
Introduction
The Rapid Intervention Team (RIT) and React Teams work together to provide a county-wide specialist health and social care service for people with a learning disability who are at risk of being arrested and/or being admitted to a mental health hospital. It is part of Somerset’s Transforming Care programme response.
The Somerset Foundation NHS Trust’s RIT is part of the Learning Disabilities Specialist Health Service and was established to minimise the risk of inappropriate hospital admissions and out of county hospital and community placements. RIT provide mental health, behavioural and low-level forensic community support, and provide a key working role for people with a learning disability who are detained under the mental health act.
Likewise, the React Team, provided through Realise, was commissioned by Somerset Council especially for this innovative service. It consists of social care staff who are very experienced and have a strong background in working with mental health difficulties and behaviour that challenges.
Both team’s work in collaboration to provide community-based assessment and treatment, and direct care and support when required, to enable people to remain in their own homes whenever possible. They are very flexible, and as such are always prepared to be called out at short notice when agreed via Somerset’s ‘blue light’ process which is led by Somerset’s clinical commissioning group.
For people that do require an admission to hospital, the team’s will provide in-reach and discharge planning support.
In addition, the teams may also support people within a registered bungalow in Taunton, which can serve as an alternative to hospital when it’s safe and appropriate to do so.
The challenge
The main barriers that had to be overcome were as follows:
- issues with tenancies for those who are not detained under the Mental Health Act (MHA), but who may lack the mental capacity to consent to care and treatment arrangements, and where there is no community Deprivation of Liberty Safeguards in place.
- using one provider means that if that provider doesn’t have sufficient staff, the organisation may need to get assistance from an agency or refuse the offer. Therefore, going forward, Somerset will commission with a number of providers to avoid this from happening.
What makes it good?
Finding alternatives to acute admission to mental health wards is crucial, not least because of the high cost of inpatient care. Instead, this service is:
- cost-effective
- successful with demonstrable outcomes (14 people have avoided hospital admission in the last year)
- safe
- evidence based
- outcome focused
- flexible – clients join a pathway that is tailored to their needs.
- responsive – able to access tailored help whether through in-reach work in inpatient settings or community. Provides support to families and providers as well as the individual. Can give respite to family and provide learning/support rather than admit to hospital
- the referral/triage process for accessing these services is a multi-agency approach which works really well and reduces bureaucracy.
Supporting human rights
In the management of those experiencing mental distress, where it may warrant detention under the MHA, there is a tension between protecting the rights of individual patients and safeguarding public safety. This bungalow offers an alternative to detention under the MHA act.
Reducing the stigma of a hospital admission
There is significant evidence and research regarding the stigma around hospital admission. This can be associated with feelings of fear, anger, prejudice, and even exclusion. The attitudes of professionals and factors related to the workplace culture in health can help to perpetuate stereotypes and interfere with the quality of care. Stigma has undesirable consequences in patients with mental disorders.
The approach helps by supporting assessments of people with “challenging reputations.” It helps in supporting in-reach work and where placements break down and offers time and space for an individual to recover from crisis and be reassessed for the right care and support when calm.
It enables teams to focus on quality care planning and understanding hidden needs. Moreover, it ensures they have the right personnel in place who all work well together in a responsive and enthusiastic way. Somerset is also developing Crimson Hill, which provides another crisis service, which consists of accommodation-based crisis provision. This will be a single person / self-contained residential service for six to eight week stays. This will help to prevent crisis and can also be utilised for hospital step down.
Lessons learned
An evaluation of these services is taking place, focussing on where referrals are coming from, and the outcomes achieved. It is hoped that this will create an evidence base to help with any expansion of the service in the future.