NE Lincolnshire Crisis, Liaison and Home Treatment for children and young people

A crisis, liaison and home treatment service for young people has significantly reduced hospital admissions through providing immediate and intensive care that is tailored to their needs. Treatment and support can be provided at their home, or other locations as required, with care plans drawn up with each person and their carers. Support also draws on the expertise of other agencies and services young people may be in contact with.

“The crisis team became my lifeline when things were overwhelming for me, especially during holiday times when they would actually ring me in order to try and prevent any crisis and readmission. This helped me and made me feel less alone.” Harry, 19.

A mental health team providing 24/7 intensive treatment and support for young people experiencing extreme distress and mental health crisis has been helping them recover at home, instead of being admitted to hospital.

The crisis liaison and home treatment team in Grimsby is part of the Young Minds Matter (YMM) service at Lincolnshire Partnership NHS Foundation Trust and employs social workers alongside mental health nurses, with additional support from clinical psychologists, a psychiatrist and a peer support worker.

Funded through North East Lincolnshire CCG, the team launched in August 2013 after an 18-month period in which 18 young people needed to stay in hospital, including well away from home at times when there weren’t enough beds available locally.

Since then just two new young people have needed admission to hospital, thanks to tailored care adapted to the specific needs of each young patient.

This successful team is available around the clock, 365 days a year, by operating extended hours and a direct out-of-hours on-call service so that young people can feel supported at any time.

Staff work closely with colleagues at A&E and police, ensuring those who need help can be referred as quickly as possible. They also provide training and support for other professionals, including school nurses and teachers, which allows young people to be offered help much sooner, helping to prevent them reaching crisis point.

The team received 223 referrals in the year to April 2018, with face-to-face assessments carried out within an hour in 70 per cent of calls.

Depending on the needs of young patients, follow-up care can be provided via specialist mental health services or wider community services, including through the crisis team on a non-emergency basis. Those who need intensive, emergency care can receive treatment and support at home or other suitable locations. The follow up is handled, as far as possible, by the same worker who first took the referral, which improves the help on offer and reduces confusion and anxiety for young people and their families and carers.

Support can range from phone calls to check on wellbeing, to talking therapies, expert support for those with eating disorders and specialist therapies such as Eye Movement Desensitisation and Reprocessing (EMDR) – aimed at helping someone feel less distressed from memories of previous trauma.

Harry, 19, was initially referred to children and young people’s mental health services in 2012 because of concerns about his eating habits. He received treatment through the community team, but needed to be admitted to hospital in 2013 when he was losing more weight and feeling overwhelmed.

Having made some progress during treatment he left hospital with a package of care put in place to support him.

“My psychologist, dietician, deputy head of my school and my parents all rallied together to come up with a care plan that helped me leave the hospital,” he said. “Every single aspect of my day-to-day life was going to be completely supported by one of their teams. But despite their help, it was still a hellish experience.

“Because of all the guilt I was feeling, I lost all my gained weight plus more, my harmful coping behaviour was more dangerous than ever and it was the lowest point of my life.”

A new therapist introduced Harry to the crisis, liaison and home treatment team to help him to get more intensive specialist support.

“My therapist Laura and the rest of the team supported me with various different therapies, and connections with my school, my college, and dietician in order to make sure I was fully supported during my struggle to recovery.

“The crisis team became my lifeline when things were overwhelming for me, especially during holiday times when they would actually ring me in order to try and prevent any crisis and readmission. This helped me and made me feel less alone.”

That support ensured Harry did not need a readmission to hospital. Instead, he began to use his experiences for peer support and became a member of the Patient Participation Group.

He added: “Had I not worked with them, I don’t think I would’ve been out of hospital to take my GCSEs, finish school, go to college, go to university, pass my driving test, have a long-term relationship, make new friends, be comfortable in public places, or even get through another day.”

Consultant Clinical Psychologist and service manager Tracey Urquhart said: “In 2013 we had a big challenge; to design a service which was evidence-based and provided good quality care which fit the needs of our young people.

“The success we have had is all because of the staff; they are committed to providing the highest standard of care to the young people and their families whilst achieving value for taxpayers. It is a tribute to their flexibility, hard work, resilience and care that they continue to innovate and provide outstanding quality despite the usual pressures.”