The BAT Project in North Wales

Staff from the Ablett Unit in Rhyl with voluntary sector agencies including Vale of Clwyd Mind, Unllais,
Therapy Dogs Nationwide and Twix the dog.

I recently found out about a new partnership project in North Wales called BAT - Bringing Agencies Together. It's all about supporting people who have been in contact with mental health services, specifically hospital, and bridging that gap between leaving the ward and returning to the community.

The BAT Project has been running in the two neighbouring counties of Conwy and Denbighshire for just over a year now. It is a massive geographical area to cover, taking in the sandy beaches of the North Wales coast from Llandudno across to Prestatyn, and sweeping south across parts of the Snowdonia National Park, east into the Clwydian Hills and right down to Llangollen. On its southern edge Denbighshire borders Powys, so we can definitely count the locals there as our near neighbours! 

Hannah Luhde-Thompson (4th from left in photo) is the Improvement and Partnerships Development Officer at Unllais, the mental health development, involvement, information and training agency covering North Wales (our sister agency in the North!) She told me more about the initiative:

Service users at the Ablett Unit at Glan Clwyd Hospital in Rhyl are being supported in their recovery and return to the community thanks to an innovative multi-agency group. The Bringing Agencies Together (BAT) project supports patients in identifying activities and groups which can help them in the transition back into their local community and continue to promote their health and wellbeing. We formed the BAT group (patients in the unit chose the name) in early 2016 and it has been a very successful, multi agency partnership. 

The project is a collaboration between the Betsi Cadwaladr University Health Board staff (including Ablett based Occupational Therapists, Clinical Psychologist, and Home Treatment and ward staff), the North Wales mental health development agency Unllais, and Vale of Clwyd Mind, service user and carer representatives, as well as a range of community groups and charities from throughout Conwy and Denbighshire. The occupational therapists from the unit lead the group, but the service user & carer rep on the group played a big part in pulling it all together. 

The BAT group organises community groups to facilitate therapeutic sessions jointly with staff as part of the patient therapeutic programme. These include shared reading delivered by the library service, taster sessions run by the Women’s Centre in Rhyl, massage sessions run by the Red Cross, therapy dog sessions supported by the Therapy Dogs Nationwide and courses run by Llandrillo College to commence in May of this year.

The project group also held two open events in July and November of last year to support patients once discharged back into the community. The project welcomed Conwy and Denbighshire based groups, clubs and organisations to the unit to showcase activities available to service users and their carers out in the community.

More than 24 groups, including Conwy Community Wellbeing Team, Men’s sheds, and Denbighshire Walking For Health, attended the event to provide information on how to sign up to their activities.

The aim was to showcase community activities to service users, as well as their families and carers. It has been really helpful, enabling people to continue pursuits which support their health and wellbeing. The two events were true networking and celebration events and have connected many people in the unit to groups in the community. I frequently hear from third sector colleagues who attended the events that they have since linked with people when they go home! 

Feedback following the open events:

'Everyone was really friendly and approachable.'

'I think all the organisers and volunteers have done an excellent job today.'

'Excellent day, really inclusive and positive. In line with the Social Services & Wellbeing (Wales) Act, partnership working and integration,' - someone from the Community Mental Health Team.

'Wonderful event bringing services together. Promoting wellbeing.'

We were really keen that people were aware of the things available AND they could meet a friendly face from the organisation and understand what to expect if approaching the organisation when they got home.

In Powys Mandy Pearce works as a Reablement Worker with Mid Powys Mind to help support people in transition from hospital back to the community. Mandy also works very closely with the statutory provider of health services, in this case, Powys Teaching Health Board, and other third sector groups.  We would love to hear what you think about initiatives like these in the comments box below.

North Powys Crisis Resolution Home Treatment Team

I first wrote about the introduction of a Crisis Resolution Home Treatment Team for North Powys (Montgomeryshire) in February 2013 (Home Treatment Team for the North) when Mike Shone unveiled the plans for the new team. Earlier this month I met with the team’s manager, Graham Batha, and asked him for an update about the service.

Tell us a bit about your background

I am a registered mental health nurse, and have been registered in this profession for approximately 10 years. I trained at the University of Central Lancashire, and then worked in Preston in an acute inpatient setting before moving to the Preston home treatment team. I later went on to work within the Wrexham home treatment team before moving to this post as the team manager for the Crisis Resolution Home Treatment Team in April 2013. My professional interests include service user involvement in the development of services, and professional education for students.

Tell us more about the service

The CRHT in North Powys opened in May 2013. To date we have received 419 referrals into the team, and our service is open 7 days a week, from 9am to 9pm Monday to Friday, and 11am to 7pm at weekends and Bank Holidays. The objective of the team is to provide an equal alternative to inpatient care, and to facilitate early discharge from hospital when it is safe to do so.

What staff roles do you have on the team?

The team consists of one team manager, one team secretary, one health care support worker and six registered nurses. The team is also having an additional 3 members of staff in the future. The team is also supported by a dedicated Consultant Psychiatrist.

Who can refer people for the CRHT service?

The Community Mental Health Team can refer people into our service, during the hours of 9am to 5pm. Out of hours, the CRHT does accept referrals from ShropDoc, which is the out of hours GP service.

Can people of all ages be referred?

We look after people aged 18 or over with a functional* illness.

What happens if someone experiences a crisis outside of your usual hours?

It can be useful to write a contingency plan with your care coordinator (if you have one), which can be used to highlight what needs to happen in an emergency. I would suggest that you contact your on call GP or in an emergency attend your local Accident and Emergency Department.

What is the nature of the service provided by a Crisis Resolution Home Treatment Team?

The CRHT is a short term but intensive service. The team visits service users on a frequent basis, up to twice a day, providing the same service as you would receive in hospital. When someone is referred into the CRHT team, the team will arrange an assessment as soon as possible. The team will then develop a care and treatment plan with that person, with the aim of supporting and aiding recovery. 

How do you promote a person’s recovery?

Twice a week, the whole team meets in a confidential environment to discuss each person that the CRHT is caring for. This allows the team to do its very best for the people we care for, and to support recovery in a timely manner. People who have used our service have been positive about their experience with us. The team does share the entire CRHT caseload, and people who do use our service can see all members of the team.

As a relatively new service in North Powys, how has the CRHT impacted on provision of mental health services generally?

The CRHT has had huge benefits in supporting those who really don’t want to go into hospital, and would rather stay at home. The team does, however, understand that sometimes hospital is necessary, and the CRHT will try to facilitate an early discharge with our support at the earliest opportunity when it is safe to do so.

Are there any specific needs that can be well-addressed by the CRHT?

The CRHT can help with practical issues such as housing etc, and will do all they can to ensure carers are supported.

Do you refer people on to other services?

When someone has recovered in the CRHT, their care is either referred on to additional mental health services or another appropriate service, or their care is handed back to the GP. In all cases the CRHT writes to the GP to ensure that the GP is aware of our intervention and any changes we may have made to the person’s care or treatment.

What are the challenges for a CRHT in a large rural area like North Powys?

The distance of travel that is required within this area is a challenge for the team, but it does not cause us too many problems once you become familiar with the area.

What are the most rewarding aspects of the work you do?

For me it is rewarding to see people recover at home, within a familiar setting, as opposed to a hospital setting. I feel that you are able to work with people more creatively and independently at home, as hospital can sometimes be restrictive.

How would you like to see mental health services developing in North Powys in the next few years?

From the view of the CRHT we would like to help and support more people to recover at home. We understand that hospital admissions will always be needed at times, but if we can reduce the stress of going into hospital for the client and their family, this may limit the amount of time it takes to recover.

Many thanks to Graham for the update. If you have any queries relating to the Crisis Resolution Home Treatment Team in North Powys, you can comment below.

*This term is defined online on an NHS jargon-busting website: "A term for any mental illness in which there is no evidence of organic disturbance (as there is with dementia) even though physical performance is impaired". 

Home Treatment Team for the North

About 20 months ago I supported the charity Powys Mental Health Alliance to edit the organisation’s summer 2011 newsletter. On page 10 there is a really interesting article by Gethin Evans about the new Home Treatment and Crisis Resolution team he was leading on at the time in South Powys. You can read it here.

The definition of a Crisis Home Resolution Team, according to a Sainsburys Centre for Mental Health report in 2006, is as follows:
A CRHT team is a team of mental health professionals which can respond to psychiatric emergencies and crises quickly and in the person’s home.  The team is able to support, treat and manage the person at home (and support their carers) until the crisis is resolved and the person is offered on-going care.

Gethin is employed by Aneurin Bevan Health Board – which provides mental health services in Brecknock & Radnor. Home Treatment Teams have been available for many years in other parts of England and Wales, with the first teams in Wales being established in December 2002.

But what of North Powys, which until now has had to struggle on with no such service? Yesterday I met with Mike Shone, who is the Project Lead for the new Home Treatment Team in the North. He works for Betsi Cadwaldr Health Board, which provides mental health services here in the North (Montgomeryshire).

Mike told me all about the plans for the new Home Treatment Team – which are already well under way.  The new posts for the 10-strong team have been advertised, new premises are being sought, and Mike hopes that the team will be in place to start work the week commencing 6 May.  The new service is regarded as an alternative approach to hospital admission for people experiencing mental distress, but also as “in-reach” into hospital so that patients can be discharged earlier.

The only difference with this team is that it will be called a Home Treatment Team, not a Crisis Home Resolution Team. Mike explained that Crisis Resolution teams were trialled in other areas of North Wales such as Wrexham, but when reviewed not found to be particularly effective. Referrals could be from anywhere, and many were from GPs. However, in reality people were often not appropriately referred, and much CHRT time was spent assessing people who in all likelihood would not have been facing hospital admission anyway. Following the review the teams became known purely as Home Treatment Teams, and only took referrals from Community Mental Health Teams. (In other words, people referred had already been diagnosed with a mental health condition and were keen to receive further specialist support). You can read more about how Crisis Resolution works alongside Home Treatment in the Sainsburys report (see below). What do you think about this? Clearly those people already registered with a CMHT and in crisis will be eligible to take up the services of the new HTT. But not others. Where does that leave those who are not with the CMHT when a crisis unfolds which could potentially lead to a hospital admission?

An information event about the new HTT is planned for Monday 8 April, 1.30 - 4.30pm at The Elephant & Castle in Newtown. There is an open invitation to those individuals using services, carers and staff to attend and find out more. Read more and book a place here.

You can download and read Crisis Resolution and Home Treatment – a Practical Guide, by the Sainsbury Centre for Mental Health, here.