New services, new roles and new teams in Rehabilitation and Recovery

Posted by Devon Partnership Trust in Mental health, News on 25th January, 2023

Along with eating disorders and personality disorders, recovery and rehabilitation is one of the three clinical areas identified as priorities in the Community Mental Health Framework (CMHF), which we are implementing across the county.

The model of care proposes a comprehensive service to support those with complex psychosis. At its heart is an ambitious drive to deliver a high quality, consistent service that meets people’s individual recovery and rehabilitation needs more fully, evidence-led, but tailored to meet the differing needs of Devon’s localities and individuals. A huge amount of work has already taken place and some of the key successes so far include:

• An entire new rehabilitation service created in North Devon including intensive inpatient rehabilitation and a community rehabilitation service.
• Ocean View ward has been repurposed as a rehabilitation and recovery ward, creating eight new beds for North Devon and providing improved support for those with rehabilitation needs.
• An intensive rehabilitation service has been added to the existing intensive inpatient provision in Exeter, creating a model that can be replicated in South and West Devon once their workforce is established. This has created place-based rehabilitation provision across Devon where none existed before, bringing expert rehabilitation care and support to the places people live.
• Training has enhanced the skills of teams to develop improved ways of working with patients, their families and carers. New learning modules include:
  - Principles of Recovery and Rehabilitation
  - Substance Misuse and Dual Diagnosis
  - Improving Physical Health for patients with Severe Mental Illness
  - Key Principles for Influencing Contact with patients, carers and families
• The CMHF has provided the opportunity to further develop multi-disciplinary roles that support career progression, inward investment of talent into Devon, and enhance retention. These roles include Specialist Mental Health Prescribing Pharmacists, Advanced Occupational Therapists, Physical Activity Coordinators and Peer Support Workers.
• The CMHF funding included one clinician per locality for the delivery of Cognitive Behavioural Therapy for psychosis (CBTp). These posts have been successfully recruited to as ‘recruit to train’ clinicians who are embedded within each team and co-aligned short-term to Early Intervention teams for support and development.

In Plymouth, Livewell Southwest (LSW) has combined its Community Recovery Team and Assertive Outreach Service into one Specialist Outreach Recovery Team (SORT). This new team provides a comprehensive service to support those with complex psychosis and as part of that has developed closer ways of working with the recovery inpatient units, Greenfields and Syrena.

 This includes:

• SORT is invited to the first CPA reviews on admissions, and if the patient is likely to require SORT on discharge, full assessment can be scheduled to avoid discharge delays
• Fortnightly attendance in the inpatient units to discuss discharges, progress of care plans and actions for SORT to support community plans
• SORT multi-disciplinary team routinely monitors progress of relevant recovery inpatients and feeds back any actions
• Inreach work continues to maintain therapeutic relationships and continue with individual pieces of work when and where appropriate 
• SORT Occupational Therapists (OTs) have stepped in if a unit OT is unavailable to complete assessments in the units and in individual homes to identify, support and plan needs prior to discharge, again, preventing delays
• SORT has been successful in recruiting into various CMHF roles, including Occupational Therapy Assistants, who will support the current Occupational Therapists in the group development and recovery through activity programme.

Elizabeth Fox, SORT Team Manager, said: “Bringing together the expertise of the two teams into one means we can identify and support those people who need our help in a much more streamlined and timely way. It is so much better for the person as the same team is with them on their recovery journey, and more rewarding for colleagues who see that whole journey.”

Ocean View Deputy Ward Manager Jon Hill said: “These changes have been brilliant and we can better meet the needs of individuals with severe mental health problems and help them recover in a way we just weren’t able to do before”.

For more information, please visit the Rehabilitation and Recovery page on the DPT website, or contact SORT in Plymouth at Livewell.sort@nhs.net

If you have any questions about CMHF, please email dpt.cmhf@nhs.net