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The Core Study

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Item 19

Helping with social and practical problems

Target

The CRT helps service users with the following life domains: 

a) Basic living needs (e.g. ensuring access to food, heating and helping with immediately required cleaning or repairs).

b) Benefits and debts (e.g. ensuring access to essential benefits/sources of income + assistance with urgent debt management). 

c) Urgent legal and social problems (e.g. assistance with urgent criminal justice matters; threats to current employment; threats to housing tenure).

Why this is important

Social stresses and a difficult living environment contribute to many mental health crises. Resolving these problems may help achieve a prompt recovery and timely CRT support may help prevent further problems, like losing employment or a housing tenancy. Practical support is highly valued by service users and was identified in our survey by CRT managers as an area CRT teams would like to offer more intensive help with than they currently do.

In the video below, Danni Lamb, the CORE Study's Deputy Programme Manager, describes what teams who scored highly on this item did to help support services user with any social or practical problems. Service users and carers also talk about how to approach these issues, and the importance of making sure they are adequately addressed.  

Ways of doing this well

Considering all contributing factors of crisis (Holistic Approach) 

Greenwich HTT have two Support, Time and Recovery (STR) workers seconded to the CRT from a social care team who work with service users experiencing a range of social and practical problems. Read their case study below:

Adopting this holistic approach will involve screening for social and practical problems, and will also mean that the CRT takes a range of different strategies depending on the specific needs of the service user.

Having the resources to proactively assist the service user

In order to successfully carry out this kind of work CRT staff members must have access to appropriate resources, which may include petty cash and/or an emergency credit card. This should be used proactively with service users, with the expectation that this is identified as a central part of the CRT remit. A former service user who works with the CORE study has identified this proactive approach as central to resolving practical and social problems:

Working with other agencies

Local advocacy services may be able to offer support around specific matters such as legal or financial issues. The following links may help locate those services:

Examples of good practice

In our fidelity review survey of 75 crisis teams in 2014, the following teams achieved excellent model fidelity, and can be contacted for advice about how they achieved this:

  • Witshire North Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
  • South Gloucester CRT, Avon & Wiltshire Mental Health Partnership NHS Trust
  • Greenwich CRT, Oxleas NHS Foundation Trust
  • North Somerset Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
  • Wyre Forest, Bromsgrove and Redditch HTT, Worcestershire Health and Care NHS Trust
  • West Gwent CRHTT, NHS Wales
  • Northamptonshire South CRHTT, Northamptonshire Healthcare NHS Foundation Trust
  • West Suffolk HTT, Norfolk & Suffolk NHS Foundation Trust
  • South Gwent CRHTT, NHS Wales
  • Northamptonshire North (Kettering) CRHTT, Northamptonshire Healthcare NHS Foundation Trust
  • Gateshead CRT, Northumberland, Tyne and Wear NHS Foundation Trust
  • South Powys HTT, NHS Wales
  • Newham Psychiatric Acute Community Team, East London NHS Foundation Trust
  • South Tyneside Initial Response Team, Northumberland, Tyne and Wear NHS Foundation Trust
  • Bromley HTT, Oxleas NHS Foundation Trust
  • Barking, Dagenham, Havering HTT, North East London NHS Foundation Trust
  • North West Hertfordshire CAT, Hertfordshire Partnership University NHS Foundation Trust
  • Redbridge HTT, North East London NHS Foundation Trust
  • Hastings CRT, Sussex Partnership NHS Foundation Trust
  • Adur, Arundle & Worthing CRHTT, Sussex Partnership NHS Foundation Trust
  • West Berkshire CRHTT, Berkshire Healthcare NHS Foundation Trust
  • Swale and Medway CRHTT, Kent and Medway NHS and Social Care Partnership Trust
  • Hounslow HTT, West London Mental Health NHS Trust
  • Brighton & Hove CRHTT, Sussex Partnership NHS Foundation Trust
  • North West Sussex (Crawley) CRT, Sussex Partnership NHS Foundation Trust
  • Surrey East (Redhill) HTT, Surrey and Borders Partnership NHS Foundation Trust
  • Sandwell CRHTT, Black Country Partnership NHS Foundation Trust
  • Mendip CRHTT, Somerset Partnership NHS Foundation Trust 
  • Teignbridge CRHTT, Devon Partnership NHS Trust
  • North Devon CRHTT, Devon Partnership NHS Trust
  • East and Mid Devon CRHTT, Devon Partnership NHS Trust
  • Taunton and Bridgewater CRHTT, Somerset Partnership NHS Foundation Trust 
  • Chichester CRHTT, Sussex Partnership NHS Foundation Trust
  • Wandsworth CHTT, South West London and St George's
  • South East Hertfordshire (Ware) CATT, Hertfordshire Partnership University NHS Foundation Trust
  • North Camden CRT, Camden & Islington NHS Foundation Trust
  • Chertsey HTT, Surrey and Borders Partnership NHS Foundation Trust

Relevant reading

National Audit Office: Survey of Service Users (2008)

Practical help can be instrumental in the care and recovery of service users. A number of service users reported occasions where practical help allowed them to maintain or resume normal life, avoiding the need for inpatient admission or helping them fit back after hospitalisation and cope with the challenges of everyday life. As part of CRHT teams' role in avoiding admissions and facilitating discharge, this practical process of doing 'whatever needs to be done to help that person survive in the community' is an important part of the care they provide. (p.8)

McGlynn (2006) CRHT: A Practical Guide

To survive in the community a person needs money, food, shelter and utility supplies. CRHT teams must address these issues at the beginning of their involvement with the person in crisis. Sometimes they have to buy food, charge an electricity key, lend a person some money or arrange accommodation on the first day. On subsequent days they may have to organise benefits, arrange emergency house repairs, help clean up, take the person for blood tests or to a GP appointment - whatever needs to be done to help that person survive in the community. (p.18)

Chisholm & Ford (2004) Transforming Mental Health Care 

Learning points:

  • CRTs start with getting some basics sorted out - food, money and alleviating distress. This enables initial engagement.
  • Over time CRTs undertake a broader range of psychological interventions and social supports. They also work with families.
  • A positive aspect of CR is the amount of face-to-face support received, which may be more than someone would receive in a hospital setting. (p. 55)

National Audit Office (2008) CRHT: The Service User and Carer Experience

'Practical help can be instrumental in the care and recovery of service users. A number of service users reported occasions where practical help allowed them to maintain or resume normal life, avoiding the need for inpatient admission or helping them fit back after hospitalisation and cope with the challenges of everyday life. As part of CRHT teams' role in avoiding admissions and facilitating discharge,14 this practical process of doing 'whatever needs to be done to help that person survive in the community'15 is an important part of the care they provide.' (p.8)