Agenda item

Ms Jane Hainstock, Head of Joint Commissioning at North West London Integrated Care Board (NWL ICB) – Hillingdon, advised that The Retreat (the mental health crisis recovery house) had opened in August 2022.  Following a benchmarking exercise in 2020/2021 against best practice across the country, it was recognised that related mental health services need to be interlinked through initiatives such as the Cove Café, crisis house, street triage and hospital at home.  A pilot for the crisis recovery house had been initiated in early 2022 by Comfort Care Services in conjunction with the North West London Integrated Care Board (NWL ICB), Central and North West London NHS Foundation Trust (CNWL) and the Council. 

The Board was advised that the aim of the crisis house was to avoid A&E attendance before someone’s mental health escalated into crisis.  The system would continue to be tested and action would be needed to educate possible guests and their families about the availability and purpose of the crisis house.  Over time, the number of suitable referrals being made had increased and the length of stay had changed accordingly. 

Feedback from guests that had used the service had been generally positive but it was clear that further work was needed to promote the service amongst possible service users, expand the access route into the service and to raise awareness of the service amongst professionals.  The referral process had already been streamlined but further improvements could still be made.  Consideration was also being given to having tours of the crisis house for possible service users before they needed to use the service and a video had been produced to view the house virtually. 

The Co-Chairman advised that she and Ms Hainstock had opened the crisis house and that the initiative had been borne out of great partnership working.  The house was a warm and calm place to be where service users were referred to as ‘guests’, not patients.  Since opening, the service had been developing and learning and had subsequently made adjustments to the male/female staff split. 

Mr Richard Ellis, Joint Lead Borough Director at North West London Integrated Care System (NWL ICS), commended this innovative project and queried why there had only been male guests staying at the house even though there had been a roughly equal number of male and female referrals.  It was recognised that only a proportion of referrals would be accepted.  He questioned what support was available for those who were rejected and whether, in future, the threshold for acceptance could be lowered.

Ms Pamela De La Fosse, Central and North West London NHS Foundation Trust, advised that, since the report had been written, further data had become available which showed a more even gender split.  To accommodate, genders could be separated on different floors of the house and staff would need to assess the current gender divide when deciding whether or not to accept a referral. 

Ms Hainstock noted that crisis houses had been opened in Northampton and Kingston and that they had been at 63% occupancy at the end of year 1.  It was clear that there would be a need for ongoing communication with professionals around the existence of the crisis house, its purpose and how it operated.  The model operating in Hillingdon had been marketed and bought by Surrey. 

The Board was advised that, although there had been a large number of enquiries, these were not all resulting in the submission of a referral form.  A number of “inappropriate” referrals had been made where the individual may have already been beyond the threshold for acceptance into the house.  As such, consideration was being given to what point in the crisis pathway it would be ok to intervene with a referral.  It would be important to talk to people who might use the service in future about the crisis house whilst they were feeling well as it was unlikely that they would want to go once they were unwell if they’d not been there before. 

Mr Spencer queried what success looked like.  Ms Hainstock advised that a business case had been submitted in relation to the expected delivery over the course of the year-long pilot.  It was anticipated that success would reduce the number of attendances at A&E and the number of inpatient stays.  Feedback from guests had been that it had made a difference to them and professionals had been surprised that it had worked for their patients. 

Ms De La Fosse advised that Comfort Care Services would often be able to decide whether or not to accept a referral within one hour of receipt.  Agreement would then be needed as to when the guest would be able to move in, which could be the same day. 

The Co-Chairman queried whether there was a shared understanding of risk with the Cove Café.  She asked that she have a conversation with Ms Vanessa Odlin, Managing Director for Hillingdon and Mental Health Services, Goodall Division at CNWL, and Ms Sandra Taylor, the Council’s Executive Director of Adult Services and Health, about what the service had learnt since opening. 

Ms Odlin thanked all partners for helping to get the crisis house project off the ground.

RESOLVED:  That the report be noted.