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 is 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.
If you are experiencing a mental health crisis, please call 111 (option 2) for immediate support. You can also use the hub of hope to see services available in your area
Pre-project Evidence
The evidence review key points are:
- There is a link between a community approach to recovery and improved quality of life in mental health crisis care.
- Informal networks, family and community have been identified as important protective factors to hospital admission in a mental health crisis.
- 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.
- 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.
- Crisis Resolution and Home Treatment Teams face challenges with providing a rapid response and managing safety and risks.
- There is a lack of support and planning in the high-risk period after hospital discharge.
- ‘Revolving door’ re-admissions account for a large number of hospital admissions for mental health crisis.
- There is a lack of representation of people with lived experience and professionals in the evidence with few studies focusing on race and ethnicity.
Facilitator Engagement
The IMPACT Facilitator project in South East Wales is seeking to understand routes to mental health crisis support in the community. This involves engaging with staff, families and people in receipt of support to understand risks, barriers and opportunities from different perspectives. IMPACT Facilitator, Catherine has lived experience of mental health care and recovery in the community; she also works as Partnership Officer for Environment Platform Wales, an organisation that seeks to bridge gaps between environmental research and policy in Wales.
Project Host Organisation
Shared Lives South East Wales are keen to enable the IMPACT Facilitator to explore any area of their service and have committed to providing information, co-ordinating visits and enabling co-production. They would like to understand and utilise the evidence base to support expansion and improvements.
Shared Lives South East Wales envisage a number of potential challenges as part of understanding the range community alternatives to hospital in a mental health crisis. This includes a lack of understanding and awareness of the Shared Lives scheme amongst individuals, their families and mental health professionals and the ability to successfully match individuals with carers in the community.

Project Updates
Discussions are underway with professionals and family members from a range of organisations including Shared Lives, Platfform, Adferiad Recovry, Suicide Crisis, Second Step, MIND, local universities and the NHS.
Support Utilisation
Suggestions for ways in which support can best be utilised include:
- Person-centred approach with case-by-case consideration, rather than generalised exclusion policies
- Dynamic risk assessment using Wales Applied Risk Research Network (WARRN) framework to contextualise identified risks and where these are no longer relevant
- Develop and maintain close working relationships with other organisations to ensure various needs can be and ensure appropriate referrals are made.
- Flexibility and adaptability of service to meet service users’ needs, for example, option of telephone or face-to-face appointments, scheduled around service users’ commitments with upskilling available for staff for specific needs.
- Offer over-the-phone and appointment-based options to increase accessibility to people who don’t want to be recognised in a ‘crisis’ waiting room in their professional capacity. Consider anonymising the facility.
- Integration of health and social care budgets to provide continuity of care across different time-scales to meet varied needs.
Barriers to accessing support
To date, some of the barriers identified are:
- Homelessness / no fixed abode
- High risk (risk to individual, staff and other individuals who use services)
- Episode of psychosis / severe acute mental health issues
- Accessibility of premises
- Perceived stigma, for example of being seen walking into a drop-in crisis centre.
- Opening hours.
- Risk perceived as too high based on UK mental health triage system/exclusion policies such as drug and alcohol dependency.
Additional Resources
Meet 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.
