Crisis House: improving outcomes and cutting long inpatient admissions

Published: 6th April 2023
In this blog, Look Ahead's Tower Hamlets Crisis House Contract Manager David Walls explains the value of the service model from both a customer outcome and cost perspective (originally published in Mental Health Today).

We all know that a clinical setting is needed when someone is in the midst of a mental health crisis. NHS clinicians are the right people to ensure we have the correct medication and treatment to begin recovery from a crisis. However, what then?

After these vital early stages of care, a person can be discharged from hospital, but would still need a range of support going forward. Some of this can still be provided on psychiatric wards, but these spaces are faced with immense demand and could use the breathing space. Community-based alternatives, however, can ease the pressure on NHS services, while facilitating quicker, and more resilient long-term recoveries.

This is where social care comes in.

Look Ahead, the care and support provider I work for runs a crisis service in partnership with Tower Hamlets Council and East London NHS Foundation Trust (ELFT). At the crisis house we collaborate with ELFT to ensure customers receive continued clinical input such as psychiatry during their stay. The Crisis House model offers an alternative to hospital admission for some people, and a step-down for others who no longer need the psychiatric ward. It provides people with a place to recover for up to three weeks before they go home, or respite for those who live independently but feel they need some intensive support to avoid a crisis.

Our support workers are given the time to provide the building blocks of sustainable and independent living to help avert future crises and aid longer term recovery.

We support people from all backgrounds and walks of life who have experienced a mental health crisis. Our customers might come to us with psychosis, depression, drug and alcohol dependence, PTSD, a trauma, or they may be a domestic abuse survivor.

At Crisis House, they can expect a warm welcome, and the calm and safety of a private room. With the option to enjoy communal spaces, and socialising on site. Promoting independence is at the heart of this set up, and we build on this off site too by giving customers the opportunity to come and go as they please.

During their stay, we do all we can to ensure they are prepared, better able to cope, and know where to go if they have a problem as they return home or move to lower acuity supported housing at the end of their time with us. This could include benefits applications, to managing appointments, to professional or educational development, and support with medication.

For commissioners, a joined up, offer of supported housing working in tandem with a specialist NHS home treatment team is a winning combination. It’s borne out by the changes we see time and again here at Crisis House. There were no unplanned discharges in the last three quarters of 2022/2023, and only three hospital admissions occurred in that time. Better, yet, when surveyed over 77% of customers said they would be extremely likely to recommend the service to another person. To me it’s clear as day that Crisis House is a place customers want to be, feel comfortable, and are progressing towards independence.

In addition to being a service model that works, the icing on the cake is the price. The current cost of an adult acute bed is roughly £432 per diem, a Crisis House bed meanwhile, costs only £186 per diem. When totalled up, this amounts to a saving of £1,722 per person to the NHS every week, freeing up vital resources for the health service to use.

Our support is free of charge, and longer stays are an option too for anyone facing housing issues.

The team includes specialist support workers and permanent night staff, for both quality and consistency of support. Our offer is also tailored to the individual’s needs, aspirations, and goals.

Crisis House staff sit down with a new customer early on and make a support plan with this in mind. The initial meeting is crucial to a person regaining their independence as we can identify what support to they would benefit most from.

There’s so much we can help with here. I remember the words of our former customer Sandra, with this in mind. “Crisis House helped me a lot,” she once told my colleague, “they’ve been helping me with moving into my new flat, helping me to get back to work, helping me with my mental health. Crisis House is very important to me. I would never forget them.”

With the financial and impact results we see in this model, the question commissioners should be asking themselves, is not whether they should set up a Crisis House service in their locality, but how quickly it can be set up.