Community alternatives to hospital in a mental health crisis

Project Background

Shared Lives has a long history of providing bespoke care in the community to meet various support needs. Since 2019, Shared Lives in Caerphilly has been providing short-term mental health care placements in partnership with Aneurin Bevan University Health Board, enabling more people to access care in the community. Individuals can be placed with an experienced host who supports and includes them in family and community life, whilst receiving medical support from the Crisis Response and Home Treatment Team.

The aim of this Facilitator project was to understand experiences of community alternatives to mental health hospitals when someone is experiencing a crisis. Before this project started an evidence review was conducted by IMPACT. This reinforced the lack of representation in current evidence and the need to know more from a wider range of perspectives. Find out more about Shared Lives in the video.

Video: Shared Lives- Nikita’s story
Watch the ‘Shared Lives – Nikita’s story’ video on YouTube

Pre-Project Evidence

Key points from the evidence review are the following:

Link Between Community and Improved Care

There is a link between a community approach to recovery and improved quality of life in mental health crisis care.

Importance of Informal Networks

Informal networks, family and community have been identified as important protective factors to hospital admission in a mental health crisis.

Limited Data on Community-Based Services

There is limited data on community-based services due to the diversity and fragmentation of services. There is a need for more research into the effectiveness of different community-based models.

Barriers to Mental Health Care

There are many criteria for exclusion from community mental health care including compulsory detention (sectioning under the mental health act), risk of self-harm or suicide, addiction, violence and unstable housing or homelessness.

Challenges in Crisis Response

Crisis Resolution and Home Treatment Teams face challenges with providing a rapid response and managing safety and risks.

Post-Discharge Support Gaps

There is a lack of support and planning in the high-risk period after hospital discharge.

Revolving Door Admissions

‘Revolving door’ re-admissions account for a large number of hospital admissions for mental health crisis.

Lack of Diverse Representation

There is a lack of representation of people with lived experience and professionals in the evidence with few studies focusing on race and ethnicity.

Evidence Review (DOC, 285 KB)

Facilitator Engagement

The IMPACT Facilitator project in South East Wales sought to understand routes to mental health crisis support in the community. This involved engaging with staff and families to understand risks, barriers and opportunities from a range of perspectives.

Project Outputs

Find below links to the project summary and three information guides.

Summary report (pdf)
Information Guide 1: Navigating community care options in a mental health crisis. A guide for family and friends. (Word)
Information Guide 2: Managing Risks in Community Mental Health Crisis Projects, A guide for professionals. (Word)
Information Guide 3: Barriers to and opportunities for community crisis care. A guide for commissioners of services. (Word)
Community approaches to crisis care projects

Shared Lives South East Wales Team

Our Facilitator: Catherine Arnold

I joined IMPACT as someone with lived experience of mental health, knowledge of trauma and a drive to make a difference. Co-producing evidence based on people’s experiences of community-based care for bottom-up change is a great fit for me.

My work at Environment Platform Wales is to facilitate environmental research and networking across Welsh Universities. I formerly facilitated First Aid training for the British Red Cross and am currently working to establish an organisation to deliver Trauma-Informed First Aid training.

Facilitator Projects