Case study summary
A small team of Peer Support Workers employed by Reach Out – one of the healthcare partnerships established under the New Care Models in Tertiary Mental Health programme – use their own experience of secure adult care services to support patients in the West Midlands who are moving towards discharge and supported recovery in the community.
People’s confidence is low after discharge and it can be boosted by having support workers and peer mentors visiting them more often and linking them up to learning, work and leisure activities.
Reach Out service user
Reach Out secure care services model
There are around 560 people in the West Midlands with severe enduring mental health problems in medium or low secure care.
Reach Out is an equal partnership of NHS and independent sector providers which provides approximately 440 inpatient beds. Comprising Birmingham and Solihull Mental Health NHS Foundation Trust, St Andrew’s Healthcare and Midlands Partnership NHS FT, it is the biggest partnership in wave one of the adult New Care Models programme.
Mandy Jinks, New Care Models Programme Manager for Birmingham and Solihull Mental Health Foundation Trust, said: “The Reach Out partnership is clinically led with strong service user involvement. By being bold, innovative and transformational it has delivered positive outcomes and financial efficiencies.
“The approach taken by Reach Out includes investing in community outreach which enables the discharge of inpatients into a supported community setting. This frees up inpatient beds, allowing us to repatriate patients who have been sent to secure care settings outside our region. Bringing patients back into the area, closer to family, friends and carers, helps them to access that support more easily and speed up their recovery journey. We’ve also implemented a robust bed management process with greater coordination between wards across the region, which allows all three partners to utilise their bed capacity more effectively. In addition, we now run an offender personality disorder project within the programme.”
Under the New Care Models in Tertiary Mental Health programme, Reach Out became operational in April 2017, and secure care pathways have been redesigned to better suit the needs of adult secure patients. A focus on recovery involves supporting service users who are stepping down from secure care with their accommodation needs, community activities, social networks and offering employment advice. This is supported by a range of therapeutic interventions.
At end of October 2018 the Reach Out programme had repatriated 21 patients back into the West Midlands area. Savings made by the programme have allowed funds to be re-directed into additional schemes to further the overall aims of Reach Out. Improved data and data sharing among partner organisations has led to a better understanding of patients’ needs across the partnership.
Reach Out NCM figures show the secure care inpatient population reduced by 16 people between March 2017 (559) and October 2018 (543). There have been 22 fewer out-of-area patients since April 2017 and fewer delayed discharges (October 2018)
We’re continuing to manage our inpatient beds in co-ordination with our Reach Out partners, and we’re certainly using those beds more efficiently, which helps us minimise the number of people we send out of area.
Brian Jopling, Head of Integrated Care Partnerships at St Andrew’s Healthcare
Supporting service users into the community
One of the service developments undertaken by Reach Out has been the recruitment of former service users as Peer Support Workers. They use their experience of adult secure care to encourage and inspire current service users as they undertake their journey through stepped-down care into the community.
Community follow-up and liaison work is carried out through Reach Out’s FIRST service – an enhanced version of the existing forensic outreach service. Jo Probyn, who heads up the FIRST team for Midlands Partnership, commented: “The knowledge that former inpatients with lived experience of secure care have been employed by the Reach Out partnership as Peer Support Workers has proven highly motivating for a number of inpatients who have expressed an increased sense of hope they would be able to find meaningful employment on discharge. Equally motivating is the increased belief they will be able to use their own experience to support other people in their recovery journeys.”
For me, being in the community is the most exhilarating situation ever, getting my freedom back and managing things independently is the most precious achievement I ever got.
Reach Out service user
At present, four Peer Support Workers, formerly supported through secure care, provide information and advice about supported accommodation, to service users close to discharge. Being able to have frank and open conversations about the strengths and weaknesses of the accommodation and hear useful tips on how to survive in the community have made both service users decide to move into supported accommodation and continue their recovery in the community.
The role of Peer Support Worker was introduced at Reach Out in 2017. Each Peer Support Worker works four hours a week – adding up to 16 hours as a team. Recruitment is by interview with members of the partnership’s Forensic Intensive Recovery, Forensic Learning for Recovery and Human Resources teams. All four Peer Support Workers were previously volunteers for the Midlands Partnership NHS Foundation Trust and had expressed an interest in returning to paid employment. Their day-to-day duties can include:
- involvement in designing, planning and delivering the syllabus and course content at the Forensic Recovery College, which provides education to support recovery,
- supporting recruitment interview panels as service user representatives,
- representing the service users’ voice at Reach Out managerial meetings,
- setting up a weekly community drop-in group for newly discharged service users.
One Peer Support Worker said: “I’ve been a lot more involved, not just with patients, but in the background. I’ve enjoyed the meetings in Birmingham and away days. It’s good to be official!”
A fellow Peer Support Worker added: “Using my lived experience to reassure inpatients they can move on and learn from my lived experience is really helpful to us both. One patient leaps to mind – I spent time talking to him, one to one. Not only was he grateful and appreciative, he’s really involved with the forensic learning for recovery college as a co-trainer. This is a really good first step for him and will hopefully help him to stay well in the community when he is discharged. I will help support his transition and build healthy links with his local community.”