The need for investment in alternatives to hospital admission is identified in the national service framework for mental health.
1The framework advocates that when clients cannot be looked after at home, care should be provided as close as possible to the individual's local community and in the least restrictive environment possible.
This sort of care has already been set up in Leeds where a hostel on a housing estate is relieving pressure on acute beds.
The six-bed Octavia House hostel, managed within the voluntary sector by Community Links on behalf of Leeds health authority, opened in June 1998 with the following aims:
reducing the need for hospital admission;
enabling patients to leave an acute admission ward at the earliest opportunity;
providing positive rehabilitation in a local, noninstitutional setting;
returning residents to the community within a short period of time.
It is staffed by seven mental health support workers, an activity and catering instructor and a manager, and provides 24-hour care. Clients can stay up to eight months, but the average length of stay is 20 weeks.
Between June 1998 and March 2001 the hostel achieved:
an 18.2 per cent cut in hospital admission rates;
a reduction in the hospital daily bed occupancy of 6.6 per cent;
very high user satisfaction rates;
a cost of£80 per bed day compared to£139 in hospital.
2The primary focus is to provide intensive rehabilitation in a non-institutional setting. This is partly achieved through sharing communal tasks including the cooking, gardening and cleaning. The activity and catering instructor has responsibility for assessing domestic skills and overseeing the catering. But the residents do most of the cooking with staff support.
Common problems among clients are poor coping mechanisms, poor self-care and repeated admission to hospital. A significant number have been diagnosed with schizophrenia.
Octavia House is used exclusively by the south Leeds area of Leeds Community and Mental Health trust.Many new developments commissioned in the voluntary sector encounter scepticism from frontline statutory staff, particularly if they do not employ professionally qualified staff. Significant effort was made, particularly during the first 12 months, to demonstrate the value of the service.
Links to primary care and the local community have been important in supporting the residents and re-engaging them with their local community.
Feedback from the consultant psychiatrists on the value of the service has been very positive, as has user feedback. All residents are asked to complete a questionnaire when they leave and 92 per cent have been very satisfied.
Several lessons have emerged, as Leeds rolls out similar services to other primary care group areas.
One of the beds was designated to provide short periods of respite care for clients being supported in their own homes by the Community and Mental Health trust. The demand for this service has far outstripped supply, and the HA agreed this year to 'convert' a further nonrespite bed.
The use of the hostel by the consultant psychiatrists to provide assessments within an observed but non-institutional environment has proved valuable.
Without the hostel, clients might have to be admitted to hospital for assessment, which can be a traumatic experience.
The ability to work with residents who self-injure is significant. And the ability to access appropriate accommodation, where necessary, and assist in formulating a care package before discharge from Octavia House has been essential to ensure the desired throughput.
Community Links currently supports over 300 clients with mental health problems in Leeds in a range of accommodation, including supported housing, hostels, nursing and residential care homes.
Its links with both statutory and non-statutory services have proved invaluable in helping residents move on to more appropriate accommodation.
The ability to work actively with families and carers has also reaped benefits. The informal, noninstitutional nature of the hostel appears to encourage carers who might be more reluctant to become involved in other settings. Families often seek support from hostel staff and are actively involved in future care planning. Octavia House has contributed to enabling residents to move successfully into less supported accommodation or enabled them to maintain themselves within the community and avoid hospital admissions.