Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro The South Cardiff and Vale Crisis Resolution And Home Treatment Team Jayne Bell Team Leader

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro

Where we are Based in the Hamadryad Centre, co- located with the South West CMHT Approximately geographically central to our sector (traffic allowing!) Cover from Llantwit Major to the west, to Llanrumney to the east

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro Who we are We are a multi-disciplinary team of 2 psychiatrists One part time psychologist One senior social worker Ten community psychiatric nurses Five community support workers One team leader

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro What we do Offer a genuine alternative to hospital admission through the provision of home treatment. Including the core functions of: Providing a rapid response Acting as the gatekeeper to hospital beds Providing a prominent role in facilitating early discharge

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro CRHTT ASSESSMENT MH IN-PATIENT UNIT CRHTT will assess for leave/early discharge CMHT (Known Client) Must be seen by care Coordinator/RMO Other CMHT staff the same day LIAISON PSYCHIATRY Client must be Assessed by care Co-ordinator/ RMO/Liaison Psychiatry Staff SELF REFERRAL ONLY if identified As part of current Care plan and Previously agreed With CRHTT DAY HOSPITAL Must be seen by Care Coordinator RMO or other day Hospital staff the Same day GENERAL IN- PATIENT WARD Client must be assessed By Psychiatrist prior To referral to CRHTT A&E Client assessed by MH Triage Nurse And CRHTT Staff Grade Psychiatrist CARER REFERRAL ONLY if identified As part of current Care plan and agreed With CRHTT POISONS UNIT Client assessed by Liaison Nurse POLICE Client assessed by Police Surgeon Prior to referral to CRHTT GP/HV/OTHER AGENCY CMHT initiates The referral In Hours Referrals

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro CRHTT ASSESSMENT GP Must have assessed a client prior to referral to CRHTT WEEKEND CPN Assessed by Weekend CPN or Joint assessment With CRHTT CARER REFERRAL ONLY if previously identified as part Of current care Plan with CRHTT A&E/POISONS UNIT Must have a medical Assessment prior to Referral to CRHTT MH IN-PATIENT UNIT CRHTT will assess prior To leave or early discharge POLICE Must be assessed by the POLICE SURGEON Prior to referral to CRHTT EMERGENCY DUTY TEAM Joint assessment with CRHTT SELF REFERRAL ONLY if previously identified As part of current care Plan with CRHTT Out of Hours Referrals

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro South CRHT Assessments for Admission Avoidance Oct 06 – Sept 07 CRHT SUPPORT IN PATIENT ADMISSION MHA ADMISSION RETURN TO REFERRER Total No. of assessments 851

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro Why we do it Evidence and support for the impact that CRHT services are having Beneficial for service users and carers, and the service as a whole Service users and carers generally prefer home-based treatment CRHT services are as effective both clinically and socially as inpatient care.

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro How we do it Open 24 hours a day, 7 days a week Minimum of 4 staff on a day shift, one at night. 3 shifts within 24 hours Provide intensive contact for up to 6 weeks Support people in the least restrictive environment as close to home as possible Offer early discharge support for those who need a stay in hospital

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro CRISIS HOUSE Philosophy:- Short-term accommodation for adult clients with severe and enduring mental illness who are experiencing acute mental health crisis Avoid stigmatisation of hospital admission Safe, comfortable and supportive environment Staffed 24 hours by support workers, supported by the CRHTs

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro Crisis House cont’d Service aims:- least restrictive environment with the minimum of disruption to their lives. The Crisis House will only be accessed via the CRHTT who will act as “Gatekeeper” to the service. Provide intensive support to clients in the Crisis House as an alternative to inpatient care.

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro Crisis House cont’d To provide practical and emotional support to individuals who are experiencing an acute psychiatric crisis. Be actively involved in “care planning” to facilitate a return to the individuals home.

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro CRISIS RECOVERY UNIT Philosophy:- assessment, therapeutic intervention and support, in a safe environment provide a flexible and responsive assessment and treatment service. The service supports clients of both South and North Cardiff Crisis Resolution Teams, providing a more intensive and consistent therapy that may not be available in a community based setting.

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro CRU cont’d The service provides respite for both Service Users and Carers, reducing tension and de-escalating difficult social situations. In some circumstances it will enable carers to return to work, if necessary. 7 day service.

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro CRU cont’d Service Aims:- A range of treatments and activities provided Service Users will collaborate in the development of individually designed treatment programmes. These programmes will provide balance of therapeutic interventions, recreational activities and “time out” in a non- pressurised setting.

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro Sector alignment for Admission Avoidance Assessments

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro Client Feedback “I liked that someone cared enough to listen to my feelings and problems. The staff appeared to show their concerns at my situation, and I felt their advice was specific to me and not necessarily the stock answer.” “I would have preferred to have seen the same person on each occasion rather than many different people.” “I have learned to monitor my state of mental health by looking out for ‘relapse indicators’, monitoring sleep patterns and social interaction patterns with my family and friends.”

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro Carer Feedback “It enabled us to support our son at home as we felt assured we could phone if his condition worsened.”

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro References The Department of Health The NSF for Mental Health – five years on. London: DOH; 2004 Northern Centre for Mental Health More than the sum of all parts. Improving the whole system with crisis resolution and home treatment Durham: The Northern Centre for Mental Health; 2003

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro References Department of Health The Mental Health Policy Implementation Guide London: DOH; 2001 Sainsbury Centre for Mental Health Crisis Resolution London: The Sainsbury Centre for Mental Health 2001 Welsh Assembly Government Policy Implementation Guidance on the Implementation of CRHT in Wales 2005

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro Websites All Wales Crisis Resolution Home Treatment Network GOFAL Cymru for information on The Crisis House