As the Mental Health Taskforce launches its strategy, Oxleas Foundation Trust describes how its Crisis Home Treatment Teams are all about putting the patients’ views back into practice.
A home treatment team (HTT) in London tasked with helping keep people with mental health crises out of hospital, says its success is due to patients constantly helping them improve their care.
The Bromley HTT, providing care 24/7 with a team of 14, has around 20 patients on its books at any one time and can see around 1200 patients a year.
The team’s dynamism has been recognised nationally: they were one of the pilot sites for the new Royal College of Psychiatrist’s HTT accreditation system, and they have pioneered self-evaluative research in collaboration with the Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, resulting in peer-reviewed scientific papers and conference presentations on their work.
They use a state-of-the-art live technology “outcomes measurement” system so professionals can see “real time” severity of patients’ mental health, monitor these changes with time, and use them to both aid clinical decision making and get a better understand of what is working well (and less well).
Service users often say they have had improved mood and less depression, managed to get back into employment, taken the children to school for example or managed their finances.
Consultant Psychiatrist and Associate Clinical Director at Oxleas NHS Foundation Trust Dr Derek Tracy, who has a specialist advisory role with the Care Quality Commission (CQC) on crisis services, said his team’s success is due, not to the number of patients seen, but to a constant open and inquisitive culture of actively seeking feedback and learning from their service users every day.
“There isn’t a lot of good research out there about the impact of HTTs, and most such work has just looked at ‘numbers and throughput’, though we know that they keep people at home where the majority of people prefer to be.”
“We don’t have the overheads that hospitals have so we are more cost effective, but more importantly we are a crucial cog in the system facilitating and advocating for patients moving through all services, whether NHS or other agencies.”
“It is, however, critical to move beyond ‘numbers’ get a measure of what ‘good’ crisis care is. One of the reasons I believe we’ve got such a good service is because we’ve been very dynamic in going out to people and asking them about the care we provide to learn what works, and how we can improve. The team is always keen to reflect on what it means and feels like to be our patient during difficult times.”
The team, which includes doctors, nurses and psychological therapists, take referrals from other services, self-referrals and third parties and provide an intensive community alternative to hospital. They provide choice in where care is delivered and reduce the length of inpatient stay with a step down care approach. It is thought they reduce the number of admissions and lengths of stay by around 30 per cent.
A psychiatric nurse or other member of the team visits most service users daily for up to an average of 40 minutes but Dr Tracy says it is how that makes the patient feel and not the time they stay that makes the difference.
“Our teams bring speed and calm in a crisis“, he said. “We are used to dealing with people when they feel at their worst or most vulnerable, and working with them during these life crises in a non-judgemental and compassionate way. People can find us at any time of day, we’re accessible and always able to come out.”
Home Crisis Teams were mandated by Government in the NHS Plan 2000 and there were 363 teams and full national coverage by 2006.
“The most important thing is to remain curious about how we can continue to learn, and what we can improve. Healthcare is always an inexact and imperfect art, but that shouldn’t stop us asking those tough questions about what works, and importantly, why and in whom” said Dr Tracy. This may mean them explaining which therapies worked best and which less so or discussing the visit arrangements.
“There may be some things we can’t change, for example, our 24/7 role means that we have to work on a shift system; but what we can do is think about how that feels for patients, and actively address this with them.
“Whilst many people are pleased to be seen at home, others can feel unsafe with this and want the security of a ward, or have family and friends who have such concerns, so it’s about finding out about these issues and using them thoughtfully in our approach.”
Dr Geraldine Strathdee, NHS England’s National Clinical Director for Mental Health, said: “The Oxleas service shows Home Treatment working really well and as a model demonstrates how, by involving patients in care, it is possible to consistently refine care.”