An innovative recovery and rehabilitation service for adults with complex mental health needs

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1 An innovative recovery and rehabilitation service for adults with complex mental health needs Nelson House Gosport A partnership approach to mental health rehabilitation and recovery

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3 Nelson House Introduction Care UK and Sussex Partnership NHS Foundation Trust are leading the way in the delivery of mental health recovery and rehabilitation services. Nelson House is a modern, purpose-built mental health hospital that is specifically designed to support both male and female service users on their recovery journey. Our multidisciplinary approach brings together a team that includes a psychiatrist, psychologist, occupational therapist, social worker, nurses and recovery support workers, to deliver a programme of care specific to the needs of each individual service user. The purpose-built hospital provides accommodation for up to individuals. The bedrooms are private, en-suite and completed to a very high standard. The hospital also has therapy and treatment areas, a communal bistro, kitchens and safe, private grounds. The unique environment at Nelson House enables recovery focused services for both groups and individuals. Service users also have the potential to step down their intensity of care and move to a rehabilitation bungalow at our sister unit in Horsham. The self-contained accommodation at Crawley Road provides flexible levels of rehabilitation, which support service users to progress towards discharge into the community Our service philosophy is central to how we work in partnership with our service users. The philosophy, designed in conjunction with our service users, underpins our model of care, objectives, policies, recruitment, training and how we monitor outcomes. The environment and model of care complement each other, offering service users the best possible opportunity to lead fulfilling lives back in their communities. Nelson House provides a fresh new approach to supporting service users on their recovery journey. Recovery and Rehabilitation Partnership The Recovery and Rehabilitation Partnership is a joint venture between Care UK and Sussex Partnership NHS Foundation Trust. As leaders in their respective fields they have combined their expertise to create a service that will transform the lives of people living with mental health problems.

4 We welcome referrals from a broad range of services The personalised care we provide supports service users to reach their goals and navigate their recovery journey. We accept referrals from medium and low secure forensic services, acute wards, out-of-area services, rehabilitation services or from the community Service user profile Men and women Aged + Have a primary mental health diagnosis Informal or detained under MHA Severe, complex and enduring mental health issues which might include treatment resistant conditions May have challenging behaviour, substance misuse and learning disabilities May be difficult to engage / motivate May have a history of disengagement and nonadherence with traditional services Recovery pathway: one and two stage process bed central unit Nelson House Recovery and Rehabilitation Unit According to service user need Flexible care environment: service users can move between the bungalows and the enhanced rehabilitation unit Crawley Road - individual bungalows Discharge to the community In the community: provision of ongoing attendance at recovery programme hosted by the Nelson House mental health hospital

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6 Our multidisciplinary team approach We are immensely proud of the multidisciplinary team we have in place to support service users on their recovery journey. Our multidisciplinary team consists of: A consultant psychiatrist, specialising in the recovery focused treatment of service users with severe and enduring mental illness and performs the role of responsible clinician under the Mental Health Act. A clinical psychologist, using a range of psychometric measures to develop a person-focused treatment plan. Interventions can include: schemafocused therapy, cognitive skills training, psychoeducation and cognitive-behavioural therapy. A recovery and rehabilitation lead, promoting the ethos of recovery within the service, empowering service users, carers and staff, working collaboratively by sharing knowledge and clinical expertise through learning and development. Registered mental health nurses working in the care teams, supporting service users on their recovery journey, providing : individualised care as per recovery plans. An occupational therapist, providing bespoke programmes to maximise activity and social interaction and importantly, develop links into the local community. A social worker, working with the whole person, counterbalancing a clinical model of care, building social competence to aid recovery and reintegration back in the community. Recovery support workers (RSWs) working with service users and the clinical teams to deliver the recovery plans. They support service users integrating into the community, acting as an advocate, listening and engaging with them to support their recovery.

7 Nelson House Developing and delivering care plans in partnership Our service users develop their care plan in partnership with their named nurse. Our care plans use the following principles:. Unique Care plans personalised to the specific needs, aspirations, challenges and goals of each service user. Evidence based Each MDT discipline uses recognised, evidence based interventions. Multidisciplinary. Milestones Each MDT discipline contributes meaningfully to the care plan and delivers the care plan working in partnership with each other Clear, personal and measurable goals are agreed that guide service users towards recovery Activities designed to support recovery and independence Activities at Nelson House are structured according to the specific needs of our service users. We provide them with opportunities to build or maintain skills, such as helping regain their identity and improving confidence, concentration and motivation. Example of activities run by the unit Shopping Improving personal care Taste of the world Cooking Budgeting Mindfulness Employment in the unit. Outcomes. Challenging Recovery Star outcomes are used to monitor and benchmark progress Taking positive and informed risks is fundamental to our recovery approach Example of activities in the community College courses such as art, gardening, cookery Wellbeing groups Hearing voices groups Employment

8 A flexible recovery environment Nelson House provides opportunities for individuals to pursue their own recovery journey in a structured and safe environment. This modern, purpose built hospital provides accommodation for up to individuals. Enhanced recovery and rehabilitation The en-suite rooms are clustered around a central, communal area which includes a bistro-style dining space, communal lounges, nursing office and meeting rooms. The unit also has an inviting central garden with tables and chairs, which we actively encourage service users to spend time in. Admission to the enhanced rehabilitation unit offers services users the potential for a hybrid approach to their care:. The unit is suitable for individuals who require intensive support with an increased staffing ratio. The structured environment gives service users more confidence and a sense of safety. Individuals accepted to this unit are likely to be detained under the Mental Health Act, or informal service users who require greater support.. As a service user progresses on their recovery pathway in Nelson House, they have the option to step down to an individual bungalow at our sister unit - Crawley Road - which provides a less restrictive care setting. Opportunity for greater independence Our sister unit s bungalows provide service users with the opportunity to explore and be independent within a safe and therapeutic structure. The bungalows provide service users with the opportunity to explore and be independent within a safe and therapeutic structure. This opportunity to gain greater independence is not readily available at other mental health institutions. Each bungalow has its own front door, a symbolic feature as service users develop their own independence to then move on to supported accommodation or independent living. Each has a lounge and kitchenette, separate bedroom and bathroom. Access to the shared living, kitchen, and -hour psychiatric care is also available. This facility is suitable for individuals who have progressed along their recovery pathway and have some independent living skills.

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10 Our service philosophy We recognise that recovery means something different to each service user in Nelson House. Our service philosophy, designed in partnership with our service users, provides us with guiding principles - you could describe it as a compass - to shape what we do as a team at Nelson House. Our service philosophy provides us with a set of behaviours that our team demonstrates, ensuring that our service users receive the experiences they describe as important to them. The service philosophy describes five domains that flow through everything that happens in our day-today work: Outcomes Mission Behaviour Experience Beliefs Our service philosophy applies to all professions, regardless of discipline and includes ancillary staff. Recovery Advisory Panel (RAP) Service user involvement is key to ensuring we live our service philosophy. The Recovery Advisory Panel (RAP) is a group of current and past service users from across our services. The members are paid and meet regularly to work on initiatives such as: Policy development and review Data collection Sharing experience with other service users, Quality audits Staff training Health and safety committee RAP helps our service users gain confidence, build their self-esteem and learn new skills. RAP helps us by ensuring our services meet service user needs and offers a critical eye as we continually shape our care delivery. I wanted to become part of the Recovery Advisory Panel to help with understanding recovery from a service user s point of view. It helps me to get motivated in doing something, and travelling to meetings, getting to know new people and being involved in new projects is good for me. Annie, service user RAP is so important because it involves service users who can better explain how each service affects them and their wellbeing. The vibes about the panel are very good and positive and I think things can only get better. Alan, service user

11 Nelson House Service Philosophy Behaviour Experience We approach things with an open mind We enable everyone to be heard Beliefs I am not judged My opinion is heard We respect differences We encourage and support choice We take time Everyone can achieve Mission Everything we do promotes recovery Everyone is unique I can be myself No decisions about me are made without me People always have time for me We see the whole person We inspire people to have hope for the future Everyone s journey is different People see beyond my symptoms I feel inspired to achieve more We recognise that individuals will achieve at their own pace I am able to achieve at my own pace Outcomes Be healthy Stay safe Enjoy and achieve Make a positive contribution Achieve economic wellbeing

12 We A differentiated, multidisciplinary service leads to positive outcomes We focus on maximising an individual s ability to improve the quality of their life, moving beyond their illness to a greater level of independence. Our success in discharging service users to less restrictive, lower cost settings of care:.% of service users discharged to family Supporting our service users to manage their own recovery:.% of service users have a recovery plan that relates to physical wellbeing and/ or health promotion.% Our services rooted in local communities: of service users involved in paid employment.% of service users discharged to less dependent living (e.g. shared house) % of services have a service user meeting where the service user facilitates the meeting and is responsible for creating minutes and actions % of service users involved in education.% of service users discharged to independent living % of service users have direct involvement in creating their recovery plans*.% of service users involved in voluntary work.% service users discharged to other services % of recovery plans have long and short term measurable goals with actions We are proud of the outcomes our service users achieve We report each service user s performance on the Mental Health Provider s Forum. 0 measure service user progress using the Recovery Star. * This number represents all Care UK units, some which have a significantly high level of acuity, presenting challenges for services and service users to be wholly involved in their recovery plan. Reporting period: August 0 - August 0

13 Nelson House Mental Health service users in education April 0 - March Number of SU engaged in education Mental Health service users in employment April 0 - March Apr Apr May May Jun Jun Jul Jul Aug Aug Sep Sep Oct Oct Number of SU engaged in paid work Number of SU in voluntary work Nov Nov Dec Dec Jan Jan Feb Feb Via a survey conducted in March 0, our service users told us that they were encouraged and supported to be ambitious about setting goals that would lead to recovery. Mar Mar Number of plans that show service users involvement Recovery plans Aug 0 Jan 0 Discharge plans Recovery star Number of plans that show clear goals for service users and progress against plan Aug 0 Jan 0 Clear goals Shows progress Our service users like our services. In 0/0 our customer satisfaction rate was %.

14 Patient story After just seven months, Sara has turned her life around and is preparing to move in to an independent living environment. Sara has been known to Mental Health Services since December 0 and has been diagnosed with schizophrenia and displays traits of personality disorder. Sara has a complicated history stemming from negative childhood experiences. She began taking illicit substances and drinking alcohol as a teenager. This had a significant detrimental impact on her mental health resulting in a withdrawal from education and isolation from her family. Sara sought solace in environments that posed a risk to her and those around her. As a result she became involved with a peer group that had a further negative impact on her and her life choices which culminated in a prison sentence. Sara was admitted to Nelson House in March 0 under Section of the Mental Health Act. Upon admission it was evident that Sara found the transition and approach to Recovery difficult. During this time Sara pushed boundaries and was reluctant to engage with staff, falling into her historical patterns of behaviour. The multidisciplinary team found creative ways to work therapeutically with Sara and she gradually became more involved with her recovery. She has developed insight into her behaviours and has shown willingness and openness in working on her difficulties through engagement in her individualised occupational therapy and psychology programmes. Over time Sara has become a pivotal member of the groups and activities that are run within Nelson House, growing in confidence and ability. She has shown consideration and concern for others and often assists other service users if they find a task difficult. Sara has taken the lead within some groups often guiding a discussion appropriately. Sara has shown a talent for cake making and has prepared items for groups as well as for meetings that have been held within Nelson House. Sara continues to make positive strides towards achieving her goal of returning to education and independent living. Sara said: There is a big difference between the support I receive in Nelson House and the other services I have used. I feel that staff here are more dedicated in what they do and they have more time for you. Nelson House does not feel like a hospital and I feel like I am treated like a human being. In the previous hospitals I relapsed on a regular basis as I saw no point in making any effort in my recovery. Although at times I take a step back I always receive support and staff help get me back on track with no judgement. I have recognised that my biggest difficulty is with poor impulse control and this is something I am starting to work on. I am looking forward to going into independent living and I feel this is now more achievable. Sara (not her real name) was admitted to RRP s Nelson House, Gosport, Hampshire under the Mental Health Act.

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16 Recovery and Rehabilitation Partnership The Recovery and Rehabilitation Partnership, a joint venture between Care UK and Sussex Partnership NHS Foundation Trust, runs two independent hospitals. Independent hospitals. Nelson House Rowner Road, Gosport, Hampshire PO 0EW 0 referrals-nelsonhouse@recoveryandrehabilitation.co.uk. Crawley Road Horsham, West Sussex RH HN 00 0 referrals-crawleyroad@recoveryandrehabilitation.co.uk A M A A M A M A A M A M A A A A A A A M A A A A0 A A A A A A Nelson House Rowner Road Gosport Hampshire PO 0EW 0 referrals-nelsonhouse@recoveryandrehabilitation.co.uk careuk.com/nelson-house HC Jul. (0) MHMKTNELSOBRO Oct. (0)