Fay Belham, aged 53, has experienced periods of depression throughout her life and plummeted into a severe postnatal depression after having twin boys in 2009. That’s when she became aware of the English mental health charity, Cambridgeshire, Peterborough and South Lincolnshire (CPSL) Mind, which she turned to for support and has continued to do so ever since.
CPSL Mind provides numerous services, including discharge buddy—short-term support to people discharged from crisis services that take place over a four- to six-week period—and the Sanctuary, where people can call or experience face-to-face support. There are two sanctuaries: one in Cambridge and one in Peterborough, and they’re open from 11 am to 5 pm by phone during the weekdays and daily between 6 pm and 1 am for in-person support.
The Sanctuary is described as a safe, warm, and welcoming environment for people experiencing an emotional or mental health crisis. Belham said it has encouraged her when she’s needed it most. “Rather than a clinical experience,” she said, “it provides a person-centred approach, meaning I can easily talk things through with someone who understands and can help me,”
The lived experience of people like Belham has been a driving force in the establishment of alternative services, like the Sanctuary, for people experiencing a mental health crisis and who would otherwise have to attend accident and emergency centres in hospitals. In England, the Healthcare Safety Investigation Branch estimates that 5% of all hospital emergency department attendances are primarily due to mental ill-health.
Bobby Pratap, deputy head of Mental Health at NHS England, told #CrisisTalk that “the big difference with the long-term mental health plan is the enhancement of community services.” “There are so many people who, up until now, have been presenting to hospital when clearly another service could meet their needs,” he said. The new plan aims to build new models of primary and community care.
One of those new models is the Sanctuary. It opened in Cambridge in 2016 as a pilot and served as a demonstration of the community-based services that the Long Term Mental Health Plan wanted to offer as an alternative to accident and emergency centres. It is a non-clinical, warm, and homely space where a person can feel safe and de-escalate over a two-hour period before returning home. In its early stage, the opening hours were from 6 pm to 1 am, but as more people learned of the service, there was an increasing demand for daytime contact, so a phone service opened which operates from 11 am until 5 pm.
Emma Welsh, Mental Health Crisis Care Concordat Manager at Cambridgeshire and Peterborough Clinical Commissioning Group, which funds the service, says access to the Sanctuary is through a referral from First Response Service (FRS), the phone service in this area of England which provides immediate access to mental health support. “A referral from this service means that the person can spend up to 2 hours at the Sanctuary in an environment conducive to recovery,” she says, “rather than being taken to A&E in a state of distress where the support available may not meet the person’s needs.”
Welsh, a clinician, points out that the service doesn’t have clinical staff because it’s not a clinical setting. Instead, the staffing model is made up of people with lived experience or people who simply want to make a difference in the lives of those with mental ill-health. Referrals to the service aren’t limited, but each visit is deemed a unique intervention which means that each visit to the sanctuary focuses on addressing the current issues that the person is experiencing. “This approach has pros and cons and can present a challenge for those who prefer to provide ongoing support for an individual,” she says.
Hannah Turner, Head of Services at CPSL Mind, the charitable organisation contracted to manage the Sanctuary, says the focus is on the person at that time they present. “It’s about keeping someone safe in that moment” she says. Staff immediately focus on de-escalation, helping the person in crisis complete a safety plan as part of the de-escalation process. That said, each intervention is tailored to a person’s individual needs. “We may create a safety plan with somebody at the moment that’s literally just for that night,” says Turner. “Where are you going when you leave here? When you wake up tomorrow, is Mum coming round to sit with you?” This type of plan is focused on the moment and helping the person get through the next 12-24 hours. “If we have a follow-up by phone with the person, we will do a full-blown safety plan, which tends to work better when the person has settled and is not so distressed,” she says.
“Our first concern is to ensure what we offer is appropriate for the person,” notes Turner. “Our de-escalation performance measure is 95%, and the team is proud to achieve or better that level of performance.”
After attending the Sanctuary, the person is offered a follow-up contact, either by the FRS or the Sanctuary Aftercare service. A report is provided back to the FRS, and a decision is made on whether there’s to be further follow-up. That may be a face-to-face interview, a home visit, or providing medication. Turner says the collaborative approach has a high level of success. “It’s very rare that a person who has been referred to the Sanctuary needs to attend A&E in the hospital.”
A second service is available in Peterborough, drawing on the learning from the Cambridge pilot. While it was thought that the transition of the service from one place to another would be a fairly simple replication, that has not been the case. Peterborough has bigger and more diverse populations, requiring a lot of groundwork to get people to access the service. Links with local community leaders and groups have been influential in getting people to talk about mental health and helping people to feel comfortable using the service.
Another learning is in relation to recruitment. Initially, it was estimated the Sanctuary would have two full-time staff on a shift, but this was an under-estimation as it quickly became clear that at least two to three additional full-time staff were needed. In addition, with staff working with highly distressed people, it can take its toll, so having the flexibility to move team members around to protect their own well-being was an important consideration.
Also challenging is who to prioritise for access to the service. Since people can re-visit the service, which is desirable because it relieves pressure on A&E, it also means that someone experiencing their first crisis might not be able to get access when needed because a person who has used the service previously may have already returned. This has led to a need for the team to collaborate further with other agencies so that those who need continued support for mental ill-health can be directed to services that can meet their ongoing needs.
Creating a partnership between the public NHS service and a charitable organisation such as CPSL Mind requires considerable collaboration and trust. Turner adds “It’s taken a good deal of relationship-building over at least two years,” she says.
“It takes time to be able to build trust to have those difficult conversations that come with shared responsibility in such a sensitive area as mental health,” says Turner. “Staff and leadership changes mean we must continuously work hard to maintain that relationship.”
Sue Murray, International Correspondent
A health promotion advocate in Australia dedicated to improving the health and well-being of all people. Throughout her career, she has focused on health for the community and has expertise in communications, education, and organisational development.
Sue currently leads the Zero Suicide Institute of Australia, which aims to support the healthcare system to understand and more effectively manage those who are vulnerable to suicide and suicidal behaviour.