Our partnership with Oxford Health NHS Foundation Trust has created three Mind worker posts to address the gap in services where people are either discharged from a stay in hospital or period of treatment. In addition, the service also supports those who may not have met the criteria for treatment at the assessment stage. There are two roles:
They provide a vital bridge into the community for service users who feel alone during a challenging and uncertain transition in their life. The aim is to help people live safe, purposeful and fulfilled lives in the community with a legacy of ongoing community support. Initial indications are a reduction in the need to access higher tier mental health services, including crisis support.
Working with people who are close to discharge the information and options workers operate in a client centred way, guided by the individual’s needs and hopes for the future. Their extensive knowledge of community based services across Buckinghamshire is used to signpost and encourage people to access services that benefit their recovery. Importantly, they often accompany the person on the first visit to build their confidence and reduce social anxiety.
The key areas of support the workers help with are social isolation (52%), welfare support services (26%), and sourcing volunteering opportunities and wellbeing education (21%).
This role works with people who are referred into the AMHT but don’t meet treatment criteria along with those people who are coming out of treatment. Regardless of the referral route individuals voluntarily access this group based support.
The recovery worker runs groups based both on five ways to wellbeing and service user demand. The information and options workers will also identify service gaps that the recovery worker may be able to address. Groups have included back to work support, movement and relaxation, walking and talking and yoga. Where necessary specialist expertise has been brought in. For example, housing and benefits clinics and mental health educational groups run in collaboration with the day hospital and the Recovery College.
The posts arose primarily from service user feedback and our service user council. Buckinghamshire Mind service users were experiencing a gap following discharge from day hospital or inpatient treatment. They told us there was only a short window during which they received support from services and little direction as to what was available in the community.
We put a business case and proposal to Oxford Health who agreed to pilot the partnership for one year. It went live in November 2016 and following the overwhelmingly positive response from service users, NHS staff and community partners the programme has subsequently been extended.
Feedback from a service user was that the project has been “a lifeline, which has made a huge difference and dramatically reduced my anxiety. Without this support to make the first step I would not have been able to move on in my recovery.” In addition, there is praise for the respectful person-centred support within the safety of hospital environment. Service users feel they have the best of both worlds.
From an agency point of view, this is a collaboration appreciated by both Oxford Health and community-based services. It frees up clinician time which would previously be spent trying to meet these needs but without the community knowledge to do it as effectively. There are a lot of very good community services that don’t have the time or funding to promote what they do, so having the Mind workers link people up is beneficial all round. In fact the first job of the worker was to help produce this online guide.
We have supported 285 service users since January 2017 of whom 92% have felt less socially isolated, 91% have reported a reduction in their anxiety and 89% felt an increase in confidence since receiving this support. We have also engaged and worked with over 116 local community organisations to promote good mental health.
Things we have learned or that you might find useful from our approach: