Coral Lodge. RDaSH. Locked Recovery Service for Adult Males with Enduring Mental Illness. Adult Mental Health Services

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1 Coral Lodge Locked Recovery Service for Adult Males with Enduring Mental Illness RDaSH Adult Mental Health Services

2 Coral Lodge Rated as outstanding in a recent quality review Our Mission: For people leaving our services to to be equipped with the skills, knowledge and confidence to manage their symptoms and not go through life defined or restricted by their illness.

3 Coral Lodge Locked Recovery Service for Adult Males with Enduring Mental Illness Coral Lodge locked rehabilitation and recovery unit provides a specialist assessment, treatment and rehabilitation service for adult males with enduring mental health issues detained under the Mental Health Act and is based in Doncaster, South Yorkshire. The unit has 16 beds, six of which are available to all commissioners in the United Kingdom. The remaining beds are commissioned by clinical commissioning groups (CCGs) in North Lincolnshire and Doncaster. We also have contracts with Sheffield Health & Social Care NHS Foundation Trust and East Midlands CCGs. Our team of over 35 highly trained practitioners have the right mix of skills to provide a safe, effective combination of assessments, treatment and therapy packages to people whose needs cannot be met by mainstream adult mental health services, and we specialise in the care of people with more complex mental health problems. Our recovery-focused, person-centred approach is evidence based and assists patients to achieve their full potential by placing them at the heart of the support and care they receive. We encourage personal development and work with individuals, their carers and support networks to maximise rehabilitation and improve their chances of maintaining an independent life.

4 Coral Lodge is sited in the attractive Tickhill Road site and is ideally placed for social interaction such as shopping and using public transport. It has its own secure garden where patients are able to exercise, and gardens, including flower beds and a vegetable patch, that patients can help cultivate. Our male-only accommodation is bright and modern with single en-suite rooms. It provides safe, secure care in a non-institutional home-like environment that is the least restrictive as possible. It is designed to protect patients from avoidable harm, but allow them the environment and freedom to take therapeutic risks. One hundred percent of our patients report they feel safe on our ward. Patients can relax in two lounge areas; work out in the gym or spend time in the e-café, which allows patients to access s, the internet and on-line training opportunities. In addition there are two self-catering assessment kitchens, where patients are supported to provide healthy and nutritious meals for themselves. Coral Lodge also has a variety of therapy rooms, tranquillity and dedicated visitor rooms. All service users benefit from a diverse and stimulating range of therapeutic activities, as well as a holistic approach to their health and wellbeing, including diet, exercise, substance misuse and medicines management. This is a really nice place with lovely open spaces

5 Our approach At Coral Lodge, we work in partnership with our patients to foster a culture of dignity, compassion, positive human rights and equality, where everyone feels valued, respected and has choices. Our Strengths Model of care focuses on recovery, promotes social inclusion and aims to combat stigma. All patients work towards a return to independent living and we recognise that the therapeutic relationships developed between patients and direct care staff are key in facilitating positive change To ensure the best possible treatment choices for the patient, we provide a multi-disciplinary team (MDT) approach to the assessment, treatment and rehabilitation of our patients. Our MDT have a breadth of expertise and experience in adult mental health care. They are our greatest asset, and when asked what they like about Coral Lodge, our patients always put our staff at the top of the list. They are highly trained professionals who deliver flexible packages of care, which are tailored to commissioner s needs. In return, we ensure they feel valued by providing them with ongoing training, supervision and support. Those around me and looking after me are well supported I am treated with compassion, dignity and respect

6 My care is regularly reviewed to see when I should be moving on patient quote We use the Care Programme Approach (CPA) which provides the framework for care co-ordination and resource allocation within mental health services and is an effective, efficient and transparent process. Our MDT comprises: The modern matron who has responsibility for the management of the service and is accountable to the assistant director for the Adult Mental Health Inpatient Services Medical staff, comprising a consultant psychiatrist and a speciality doctor Nursing staff, comprising qualified mental health personnel and a balance of health care support workers Occupational therapy staff An art therapist A psychology team comprising a senior clinical psychologist and an assistant psychologist Pharmacy staff Voiceability who provide an advocacy service (group and individual sessions) for all patients. Our MDT is actively involved in both delivering and supporting services, which include: Counselling/therapy (individual and group) Recreational activities such as therapeutic diversion interventions including engaging in creative work, hobbies and special interests Life skills training incorporating psycho-education on topics relating to activities of daily living, such as interpersonal communication, relationships, coping with stigma and stress management Health promotion and activities including diet, weight management, exercise, substance misuse and smoking cessation Occupational therapy assessment and treatment. We work with patients to enable them to manage their recovery by understanding their illness, learning how to control or improve their symptoms, and promoting independent living skills. We promote a transitional care pathway, and every patient is assessed when they first arrive at Coral Lodge. We work with them (and their family or carer where appropriate) to put in place an activity programme to address their identified needs. Patients are supported to focus on the four areas identified in the HoNOS 4 Factor Model: Personal well-being Emotional well-being Social well-being Severe disturbance. Each individual has a plan, which is reviewed and amended in partnership with them throughout their stay to ensure it reflects their current needs, and is designed to provide a balance of therapeutic and recreational activities. All patients have access to independent advocacy. All patients at Coral Lodge work towards a return to independent living (with robust support packages). Their progress is regularly reviewed to ensure they don t spend any unnecessary time in our facilities.

7 Psychological treatment Coral Lodge has a clinical psychologist and an assistant psychologist who offer individual therapy and group work. They regularly attend multidisciplinary meetings on the ward, and contribute toward the understanding of complex individuals and the development of evidence-based approaches for managing challenging clinical issues. Individual therapy Clinical psychology offers intervention for a range of problems, including managing low mood, anxiety and voices with cognitive behavioural therapy (CBT), as well as longer term work on emotional and identity issues, using a more integrative approach such as cognitive analytic therapy (CAT), and other interventions tailored to the needs of the individual. Psychology open group We run a weekly open group for all Coral Lodge patients, where we discuss a different topic at each session. The emphasis is on improving understanding of the issues concerned and developing more effective ways of coping with difficulties. The informal setting of the group encourages patients who do not regularly engage with psychology to make some initial steps towards doing so. Although the group is open to all, some basic ground rules are in place to encourage attendees to focus on the topic and treat each other with respect. I like having my say and being listened to

8 Therapeutic activities Each patient participates in a minimum 25 hours of meaningful activity each week. We customise groups and activities around the needs and choice of patients in our care, and everyone is encouraged to participate at their own pace. Four main themes inform our programme of groups and activities: Recovery Healthy lifestyles Physical wellbeing Creative expression. We work in partnership with referrers, community colleagues, voluntary and independent sector services to deliver an integrated care pathway, with the overall aim of supporting patients to live well and safely in the community Group activities such as fishing, cycling and golf are run by our reablement workers to take them out of the confines of Coral Lodge. Coral Lodge also benefits from the neighbouring Walled Garden, which operates as a garden centre, and is part of the Trust s Flourish Enterprises a developing social enterprise which enables patients to access meaningful work experience. I am supported to live safely in the community

9 Case studies Joe s story Joe came to Coral Lodge in August In 2005, he began a series of admissions to mental health services suffering from psychotic symptoms related to alcohol or cannabis use, and received a paranoid schizophrenia diagnosis in He had studied in further education and was employed in a permanent job until his symptoms increased to an unmanageable level. When he arrived at Coral Lodge, he had been in inpatient mental health care since On admission to Coral Lodge, Joe engaged well with the multidisciplinary team (MDT), who helped him to identify a set of clear personal objectives for his period of rehabilitation and recovery. Treating Joe with a full holistic care package, the team helped him with his Wellness Recovery Action Planning (WRAP) and provided support to assist him in managing his anxiety. Joe said: It was a relief to get to Coral Lodge because I felt it was the right time for me. He attended Alcoholics Anonymous sessions to help him remain in control of his previous issues with alcohol, and worked with nursing staff to manage an additional diagnosis of diabetes. I get the right treatment and medication for my condition Joe received practical support to improve his cooking skills, as well as advice on budgeting to help him manage his money and make the most of his finances. He was fully concordant with his medication and progressed to independently medicating in preparation for discharge. Joe said: I felt I had a good interaction with the MDT and felt I was listened to. After spending eight months at Coral Lodge, he demonstrated his new budgeting skills to great effect when he furnished his flat ready to be discharged in March Joe now has a clear plan for the future. He is aware of his own limitations and recognises the need for support if necessary. He is engaging well with one of the Trust s community mental health team. He recognises the value of the time he spent in rehabilitation and recovery and said: I m glad I came to Coral Lodge instead of going straight back to my flat because I think I would only have lasted a few weeks. To improve his fitness and address his weight gain, Joe is participating in a boot camp in the short term and thanks to support from the Coral Lodge physiotherapy team, he will continue with longer term gym use near to his home. I am helped to keep in touch with my family and friends Joe is now enjoying a good life, being very much part of the community. He regularly spends time with his family, and is working hard to improve relationships; he s also getting more involved in the family business and is considering a return to his studies. He has also found a new hobby - stand-up comedy. After trying his hand at an amateur night he proved to be a great success and has been invited back to perform further sets in the future. Names have been changed and stock images used to protect identities.

10 Case studies Len s story Len came to Coral Lodge in Autumn 2011 as a step down from a low secure unit, which was situated a long way from his home. He had experienced several psychotic episodes in his youth and had a long history of contact with mental health services. Due to his borderline learning difficulties, he had struggled to live independently. Len had a history of alcohol abuse and aggression to members of his family. Following a violent attack on his mother six years ago, he was placed on a section 37/41 of the Mental Health Act and admitted to a secure inpatient unit. As a result, his whole family broke all contact with him due to fear of further attacks. When he first arrived at Coral Lodge, Len appeared uncooperative and angered easily if things did not go his way. He expressed paranoid ideas and made threats to harm himself and others. He was possessive towards his favourite staff members, becoming angry and jealous when they worked with someone else. The Coral Lodge multi-disciplinary team put in place a package of care for Len and psychological treatment revealed he d had a troubled early life, in which violence was normalised. He had not experienced any significant relationships in his personal life, which explained his strong attachments to support staff. Len agreed he had difficulty managing his anger, and worked to identify his triggers and coping strategies, including how he dealt with relationships. The team worked closely to ensure a consistent approach to Len s difficulties with relationships and managing anger to develop a more realistic understanding of the risks he posed. Len was kept busy with a full programme of activities during his stay at Coral Lodge. He gradually gained more independence shopping, budgeting independently and was able to gradually increase his unescorted leave. After eight months at Coral Lodge, Len was discharged to an open rehabilitation ward. Names have been changed and stock images used to protect identities.

11 Our Performance At Coral Lodge we are committed to minimising the length of stay in a restrictive environment. Discharge planning is done at an early stage, using a transitional care pathway approach, which aims to move patients through the recovery model in an expected 18 months in line with their individual needs. We are proud of our performance and the average length of stay for patients at Coral Lodge is nine months. Discharge profile Coral Lodge 2013/2014 Discharges 5% 5% 5% 10% 40% 35% Community Open Rehab Low Secure Medium Secure Supported Living Slow Stream Rehab Commissioning arrangements At Coral Lodge we offer a high quality service - aiming to achieve the best possible outcomes in the most efficient and effective manner. Our competitive tariff covers our whole package of care, and there are no hidden costs. We have effective and efficient governance arrangements in place and adhere to all regulatory and legislative requirements, including those of the Mental Health Act, Mental Capacity Act and Multi-Agency Public Protection Arrangements (MAPPA). We respond appropriately to the diversity of everyone admitted to Coral Lodge, paying attention to each of the Equality Act protected characteristics. We have appropriate safeguarding policies and procedures in place in consideration of children and vulnerable adults.

12 Referrals Making a referral to Coral Lodge Within one week of receiving your referral at Coral Lodge we will arrange for a member of the multi-disciplinary team to contact you to arrange a date to begin the assessment. Assessment We ensure the skill mix of the assessing team reflects the emerging clinical profile, and in the case of patients whose first language is not English, we will make arrangements for an interpreter to be present We offer the patient the opportunity to have a carer or advocate present at their assessment Our assessments are face to face with the patient using the FACE risk assessment/management tool, HoNOS 4 Factor Model. The BAME Recovery Star will be used if this is indicated by the patient s cultural needs We review the referrer s case notes and assessment, and the assessors will speak to the key staff involved in the patient s care On the basis of this assessment, a report is written by the assessors and the outcome is discussed with the multi-disciplinary panel at the referral meeting A copy of this report is sent to the referrer If it is appropriate to transfer or admit the patient to our service: If a bed is available at Coral Lodge we will make arrangements to transfer the patient as soon as is practically possible, based on their needs and legal status i.e. requirement for Ministry of Justice approval If a bed is not available at Coral Lodge, we will place the patient on our waiting list, or discuss the possibility of a suitable alternative placement with you If the patient is not appropriate for admission a comprehensive assessment will be sent to the referrer with reasons why not they were not felt to appropriate for our service. I am supported to make choices in my daily life when I need more help its there for me, I get support in our most appropriate setting

13 Who can refer? We welcome referrals from: Clinical commissioning groups Medium/Low secure care, within the NHS and independent sector Acute admissions and psychiatric intensive care units (PICUs) etc. Any other appropriate source. Patient criteria Male only Aged between 18 and 65 Are detained under a section of the Mental Health Act 1983 Do not present a grave or immediate risk to others, but can present with immediate risk to self There are significant risks in relation to mental disorder or short-term risk/ symptoms regarding stabilisation Do not have a primary diagnosis of personality disorder Patients who require support with managing: Aggression Where to send your referral Please address your referral to: Susan Halder, Modern Matron, Coral Lodge, Rotherham Doncaster and South Humber NHS Foundation Trust, Catherine s Close, Tickhill Road, Doncaster DN4 8QN Tel (01302) ; fax ; susan. halder@rdash.nhs.uk Other useful information to include: Recent psychiatric reports Recent psychological reports Latest risk assessment Absconding How to refer Challenging behaviour Referrals are accepted in writing, by fax or by . Any enquiries prior to referral can be made to Ward Manager Jane Curtis. Coral Lodge Locked Recovery Service for Adult Males with Enduring Mental Illness

14 About Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH). Coral Lodge is managed by RDaSH. RDaSH provides a range of mental health, learning disability, substance misuse and community services across Rotherham, Doncaster, North and North-East Lincolnshire and in Manchester. The Trust s headquarters ar based at: Woodfield House, Tickhill Road Hospital, Weston Road, Balby, Doncaster, DN4 8QN. Our Vision Leading the way with care. Our Mission Promoting health and quality of life for the people and communities we serve. Our Values Derived from work undertaken with service users, carers and other stakeholders, our values describe how we will act while delivering the mission, in providing services that are: Passionate Reliable Caring and safe Empowering and supportive of staff Open, transparent and valued Progressive. Website: Follow us: rdash.nhs

15 How to find us By car From A1 junction 36 - Exit A1 at junction 36, then at the roundabout bear right and take the third exit onto the A630/ Warmsworth Road and proceed towards Doncaster - Turn right at A60/Sanford Road and follow A60 - Continue to follow A60 (Tickhill Road), follow signposts for St Catherine s - Turn left into St Catherine s. From M18 junction 3 Sat nav - Exit M18 at junction 3, then at the roundabout take the exit signposted A6182/Doncaster - At the first roundabout, take the first exit signposted Carr Hill Industrial Estate - At the exit roundabout, take the third exit signposted Carr Hill Industrial Estate - At traffic lights, turn left onto dual carriageway - Branch left and merge onto the A60, signposted Worksop - Continue to follow A60 (Tickhill Road), following signposts for St Catherine s - Turn left into St Catherine s Our post code is DN4 8QN Car parking There is free parking for visitors (some restriction apply). By bus The site is on a regular bus route served by the numbers 19, 20 and 22 from Doncaster town centre. Bus service information is available from Traveline on (01709) By train The station is located in Doncaster town centre, approximately two miles from the St Catherine s site. Travel information is available at the following website:

16 Coral Lodge Catherine s Close Tickhill Road Site Weston Road Doncaster DN4 8QN Telephone (01302) fax