Nurse Debbie Creaser leads an award-winning team that helps people with psychotic illness leave remote locked rehab units and live independently in the community of their home city
Imagine you’ve been diagnosed with a serious mental health problem. You feel isolated, confused and terrified about your future. It’s suggested inpatient care is the best option to help you recover safely. This is in a locked rehab unit miles away from your home. Days turn into months then years.
Sadly, this is the reality for people in many parts of the UK. It was also the case for those from Sheffield until nurse Debbie Creaser and her colleagues suggested a different way.
“I was working as a deputy manager on an inpatient rehab and recovery ward when I was asked to find out how many people from Sheffield had been placed in locked rehab units outside the city,” she recalls. “There was a sense that it was increasing but we had no idea of the numbers. It turned out to be 50 people, some of whom were up to three hours’ drive away from their families.”
Identifying unmet need
The realisation prompted discussions at senior level, with the clinical commissioning group devolving some of its budget to Sheffield Health and Social Care NHS Foundation Trust. They recognised that nursing staff are often the experts in identifying unmet need and leaders of change in mental health care provision.
Debbie got a new job as a case manager, responsible for taking a more proactive approach to caring for those in locked rehab units outside the city and enabling their return to Sheffield.
“I talked to them about where they wanted to live, what they enjoyed and what support they needed. We created bespoke care pathways and quite quickly helped them to come back, either to their own homes, their parents’ homes, supported accommodation or inpatient services.”
We wanted to think outside the box and deliver care in a completely different way
Encouraged by the results of the approach, a further proportion of the budget got devolved and the Community Enhancing Recovery Team (CERT) was born. Five years on it has 60 members of staff, including 11 nurses. Debbie is now the team manager.
“We wanted to do something different,” she says. “We could have built a locked rehab unit in Sheffield, or commissioned one to treat people locally. But we wanted to be more ambitious, to think outside the box and deliver care in a completely different way.”
It means frequent visits to those in locked rehab units outside the city, building relationships and developing holistic care packages to help them live in the community.
The team works in partnership with South Yorkshire Housing Association to find appropriate accommodation, which the person is helped to move in to, and can keep following discharge from the CERT.
The team provides up to six hours’ support a day, which reduces over time until the person feels ready to be self-sufficient, and discharged to the community mental health team or GP. People can be in the care of CERT for anything between six months and four years.
“It’s about thinking of rehabilitation in a different way,” says Debbie. “For too long hospitals have been working to solve all people’s problems. But recovery can continue in the community. It’s a journey. We help service users get ready for discharge from hospital, then support them to continue their rehab in a much less restrictive, false environment.
“People are in their own homes where they want to be. They have a much better quality of life. We support them to develop the skills they need to live independently, be that building their social networks, cooking a meal or changing a lightbulb. The impact this is having is huge.”
It’s so rewarding to play a part in helping to so significantly transform people’s lives
As well as transforming people’s lives, the CERT approach has enabled a dramatic reduction in the use of locked rehab units outside the city.
More than 50 people have returned to Sheffield, with most living independently in their own homes. The number of out-of-area treatment bed nights has been almost entirely eradicated and there has been a significant reduction in emergency department attendances and hospital admissions.
The reduction in out-of-city expenditure now funds the team, which has delivered considerable additional savings.
“I’m immensely proud of what we’ve achieved,” says Debbie. “It can be challenging to take positive risks at times, but the difference we’re making and the hope we hold for the people we care for is incredible.
“We invest a lot of time in our team and that pays off. So we have protected time for reflective practice and quality improvement, which I think is vital. And we work as a whole team. We don’t make clinical decisions or service improvement decisions unilaterally. Everybody is involved.”
One of those who’s vital to the daily running of the team is RCN member Steph Barker. As assistant team manager she’s responsible for making sure the staff, many of whom have lived experience of mental health issues, are well supported. She believes that nurses, working collaboratively as part of the multidisciplinary team, are crucial to the service’s ongoing success.
“Our nurses have such rich knowledge of their service users,” she says. “I can feel absolutely confident that their decisions are robust and in the best interests of the people in our care. Their compassion and commitment is really striking. It’s so rewarding to play a part in helping to so significantly transform people’s lives.”