Women’s Mental Health Services Northampton, Birmingham, Essex
As a charity, St Andrew’s is committed to achieving positive outcomes for our patients and value for money for our commissioning partners. This means focusing on active rehabilitation, constantly working towards reducing length of stay and, where possible, facilitating people’s return to their home area.
To achieve this, St Andrew’s is proud to become the first mental healthcare provider to implement a Value Based Healthcare system across its organisation. This has seen the introduction of 15 clinically-led Integrated Practice Units (IPUs). The aim of these IPUs is to deliver more effective care by aligning resource and specialisms to patients with similar clinical needs.
The research below was conducted across our Women’s Mental Health Services. It looks at some of these outcome measures, including aggressive episodes, restraints, seclusions, self-harm, length of stay and discharge destinations with the aim of reviewing the effectiveness that specialised intervention, delivered at St Andrew’s, has on the women we care for. The data has the ultimate aim of improving care, helping more women to achieve sustainable recoveries and return home as quickly as possible.
St Andrew’s recognise the importance of the Care Closer to Home (CC2H) agenda and the impact that receiving care away from family and ‘home’ has on the women within our care. Our focus as an organisation is to improve the effectiveness of our clinical interventions, to deliver better outcomes for our patients, and help them to move to less restrictive services, closer to their home area, as quickly as possible.
In our Women’s Mental Health Services there are three individual IPUs consisting of women’s mental health medium secure, women’s mental health low and locked, and women’s dialectical behavioural therapy (DBT), specifically for personality disorder and comprehensive DBT provision. There is also an Essex and Birmingham IPU which focus on the needs of a ‘local’ patient group and which also contain women’s mental health and Psychiatric Intensive Care (PICU) services.
Last year our Women’s Mental Health Services discharged 184 patients with a ward average length of stay of 8 months. Over a 1/3rd returned home or to community accommodation closer to or within their home area.
We reviewed patients admitted to our Women’s Mental Health Services over a two year period. Patients were reviewed over 6 and 12 month periods within our inpatient mental health and personality disorder services. For Psychiatric Intensive Care Units (PICU) patients were reviewed over their first 8 weeks of inpatient stay, due to the length of stay being much shorter in these services.
The outcome measures we looked at included the number of:
We also looked at length of stay across these services and discharge destinations.
The outcomes are used to understand patient improvement and the effectiveness of our care. Information gathered on discharge destination helps us to see how well we were working with providers to support women to return home.
95 female patients, admitted between pre-determined dates across our women’s mental health services, were reviewed as part of this research.
8 patients were admitted direct from forensic/prison service, 58 were admitted from NHS mental health units, 5 were admitted from non-NHS mental health units, 11 were admitted from mental health units outside of England and 13 were admitted from community residence. All presented with severe and complex mental illnesses.
19 patients met the criteria across our medium secure wards. These wards included Sunley, our admissions ward, Stowe, our mental illness treatment and rehabilitation ward and Seacole, our personality disorder treatment and rehabilitation ward.
The results showed:
85.4% reduction in aggressive episodes
80.9% reduction in the use of seclusions
82.2% reduction in the use of restraints
59.7% reduction in self-harm incidents
15 months was the average length of stay.
80% of patients discharged to lower levels of security with over 3/4 moving closer to their home area. Most patients discharged to NHS mental health wards.
The emphasis at medium secure level is on stabilisation, which is encouraged through relational security, a personalised approach, Safewards, Reinforce Appropriate, Implode Disruptive (RAID®) and Positive Behavioural Support (PBS) techniques. Women are encouraged to transition to less restrictive environments, with greater emphasis on recovery and skill development for Borderline Personality Disorder (BPD) and psychosis, as quickly as possible.
19 patients also met the criteria across our low secure wards. These wards included Sinclair ward, our admission, treatment and rehabilitation ward in Northampton, Elgar ward, our specialist older female admission, treatment and rehabilitation ward in Northampton, Colne ward, our admissions, treatment and rehabilitation ward in Essex and Moor Green, our admissions, treatment and rehabilitation ward in Birmingham. All wards support females with mental illness/personality disorder presentations.
Due to the nature of a rehabilitation ward outcomes were measured over 12 months for this cohort of patients, with comparisons made between the first 3 months and months 10, 11 and 12 for these patients who had a LOS of over 12 months.
The results showed:
40.0% reduction in aggressive episodes
63.9% reduction in the use of seclusions
54.1% reduction in the use of restraints
59.2% reduction in self-harm instances
12 months was the average length of stay.
1/3rd of patients returned home (28%) or to community accommodation (72%) within their home area. Most patients discharged to their usual place of residence, NHS wards, non-NHS care homes and Local Authority residential accommodation.
Low secure offers women recovery-orientated services, aiding independent skill development and transition to community living. Women are encouraged through a comprehensive timetable of therapeutic, occupational and recreational sessions which complement individual interests and needs alongside their clinical treatment and rehabilitation. Positive risk-taking is encouraged at this stage, managed through a personalised approach between patient and the clinical team.
20 patients were reviewed across our Dialectical Behavioural Therapy (DBT) wards. These services have been specifically designed for women with Emotionally Unstable Personality Disorder (EUPD) or Borderline Personality Disorder (BPD). They consist of low secure Spencer South, and locked wards Spring Hill House and Hereward Wake, each offering specialist borderline personality disorder and Comprehensive DBT programmes.
Patients were recorded over their initial 12 months of stay on the DBT wards as they worked through the programme focusing on skills development and behavioural management.
The results showed:
94.0% reduction in aggressive episodes
97.0% reduction in the use of seclusions
95.9% reduction in the use of restraints
79.8% reduction in self-harm incidents
14 months was the average length of stay.
71% of patients returned home (13%) or to community accommodation (87%) closer to or within their home area. Most patients discharged to non-NHS run care homes, Non-NHS run hospitals, NHS mental health wards and Local Authority residential accommodation.
The strength of comprehensive DBT programmes are that they are evidenced-based, meaning that the treatment plan integrates clinical expertise with scientific evidence. In Spring Hill House the service offers a unique progressive environment which enables a complete risk-managed pathway of care, creating a sense of momentum and motivation of patients.
37 patients were reviewed across our PICU wards. These patients were admitted between the dates of January 2016 and March 2018. The female PICU wards consist of Bayley in Northampton and Frinton in Essex. Both offer 24 hour admission for rapid stabilisation and mental health assessment for patients who are acutely unwell, due to their mental illness.
The results showed:
66.7% reduction in aggressive episodes
52.9% reduction in the use of seclusions
74.5% reduction in the use of restraints
90.2% reduction in self-harm incidents
35 days was the average length of stay on our female PICU wards.
1/3rd returned home (11%) or to community accommodation (89%) closer to or within their home area. The majority of patients returned to an NHS acute mental health ward.
Procedural and physical security is important in PICUs, providing clinically safe and supportive environments for rapid stabilisation and mental health assessment.
St Andrew’s is committed to achieving positive outcomes for our patients and value for money for our commissioning partners. Working in partnership with the NHS we support the most complex, challenging patients.
The information presented here show that the experience and expert intervention used across our Women’s Mental Health Services are helping to deliver some outstanding outcomes for patients, helping them to progress and successfully discharge from hospital.
The introduction of a Value Based Healthcare system across the charity will emphasise this focus, continually improving clinical practices and interventions that meet the individualised needs of our patients.
Supporting the Care Closer to Home agenda, our Women’s Mental Health Services consistently work with local teams to facilitate the discharge of women. This is an important step to achieve a sustainable recovery and one we will continue to improve with our NHS and community partners.
To discuss our clinical methods within our Women’s Mental Health Services please contact the following people:
Mr Hugo Nel
Clinical Lead and Consultant Clinical Psychologist – Women’s Medium Secure Services
Dr Michelle Huggins
Clinical Lead and Chartered Clinical Psychologist – Women’s Low Secure and Rehabilitation Services
Dr Emily Fox
Clinical Lead and Consultant Clinical Psychologist – Dialectical Behavioural Therapy Services
Dr Mark Tarn
Clinical Lead and Consultant Forensic Psychiatrist – PICU