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 hear the voices of those with lived experience and of front-line staff as part of understanding 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.

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

This project is important to our Facilitator, Catherine, who has lived experience of mental health care and recovery in the community. Catherine would like more people have the option of receiving care in the community and for more information to be available about alternative options to hospital in a crisis. She looks forward to reporting back on future engagement as the project evolves over the coming months and on project outcomes in early 2025. In her other role, Catherine works as a Partnership Officer for Environment Platform Wales, an organisation that seeks to bridge gaps between environmental research and policy in Wales.

The Shared Lives Team

When Shared Lives South East Wales decided to engage with IMPACT, they were welcoming of the chance for a fresh pair of eyes to come into the organisation. Shared Lives S.E. Wales wants to showcase the work the organisation is carrying out and raise awareness of the project amongst the general public, statutory organisations and the third sector. They are keen to enable the IMPACT Facilitator to explore any area of the service and have committed to providing information, co-ordinating visits and enabling co-production. They would like to see qualitative evidence of the difference it is making to individuals, their families and wider communities and to be able to utilise the evidence base for expansion and improvements. The team is open to receiving constructive feedback and ideas that would help with the development and growth of the service.

Shared Lives S.E. Wales envisage a number of as part of understanding the range community alternatives to hospital in a mental health crisis. This including 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. The team at Shared Lives think a centre like IMPACT is important due to the fact that it is being driven by the implementation of a range of evidence as opposed to conducting research. Whilst an academic researcher can look at data, systems and processes, the IMPACT Facilitator can share practical suggestions of what works elsewhere and of how to implement the evidence gathered to improve the service locally whilst contributing to wider learning. IMPACT is recognised at a Welsh government level so evidence holds weight when Shared Lives are approaching commissioners and presenting business cases.

Shared Lives South East Wales Team