The answer is not always hospital.
Providing community mental health services for people who have a forensic history is complex. As well as the needs of the individual, you must also safeguard the community, and bear in mind the burden on the taxpayer.
Many people get lost in the system or reoffend because the specific needs of their mental illness aren’t taken into consideration. At Bridge, we are committed to improving outcomes for these people through our specialist forensic mental health service, Tilt.
At Tilt, we have a strong track record of achieving astounding results. Reoffending rates are low – 1.46% pa over the last five years. Although the pandemic has seen a slight increase in the amount of time our clients spend with us, it is still low in comparison to other services – on average clients move on to less supported accommodation after 26 months.
We owe our success to a number of factors: our partnership with the NHS (Oxleas NHS FT), collaboration with other organisations, our rehabilitation and recovery-centred approach, and risk management experience.
What is the Tilt Project?
Our specialist male forensic mental health hostel opened in 2013. It was initially an 11-bed property called Project 106. In 2013 the service expanded and moved to new premises – an 18-bed hostel, renamed as the Tilt Project.
We provide support and treatment via assessment, recovery, and community integration. We have strong local links established over many years of working in collaboration with wraparound services to provide an integrated clinical and community pathway.
The Tilt project takes working age men from secure settings who have long term mental health issues and an offending history. They often have complex presentations alongside their forensic histories.
The service is recovery focussed, with the expectation that clients will work towards moving into less supported accommodation. Our philosophy is built on a culture of wellness and recovery.
Collaboration with other organisations
We have a strong track record of working collaboratively with other organisations to ensure that our clients receive the highest standards of care.
This is best evidenced at the Tilt project through the partnership between Bridge and Oxleas Community Forensic Team. This partnership has been in place for seventeen years and has been instrumental in delivering exceptional outcomes for the residents of the project.
Key to this success is strong leadership on both sides, good levels of communication between both teams and mutual trust coming from a proven track record.
We have a close working relationship with Oxleas NHS Foundation Trust. We also work closely with the Probation Service, local GPs and other health providers, alongside the local Public Protection Unit of the Metropolitan Police and MAPPA when required.
The Tilt approach
Our rehabilitation and recovery approach places clients at the core of our services, providing consistent opportunities for them to maximise their choice and control, continuously seeking ways to encourage:
- Hope – ‘It is still possible to achieve life goals’
- Control – ‘Taking a sense of control over one’s life’
- Opportunity – ‘Building a life beyond illness’
As a recovery focused organisation, we aim to create a culture of wellness by recognising the link between mental wellbeing, physical wellness and reduction in substance misuse. A key feature of Bridge’s approach is the regular multi-disciplinary meeting that is held weekly in our 24-hour service.
Bridge has extensive experience of successfully managing risk in-house and reducing reliance on external services.
We place an emphasis on “relational security.” Our staff takes a holistic view of clients, understanding the influences on our support such as the staff teams involved (especially Bridge staff and clinicians) and the importance of staff observing their environment. This includes, for example, balancing flexibility with the management of boundaries.
Because of this, we are able to identify ‘early relapse indicators’ with clients, clinicians and other stakeholders, as part of the support planning process – involving, for example, close awareness of the clients’ history, their ‘risk history,’ and knowledge of previous relapse indicators.
Case study: providing crisis support
A mental health crisis occurs when a person reaches a breaking point where they are no longer able to cope without urgent help and support. They may readily experience these feelings themselves or it may become apparent through their behaviour.
Alongside a client’s care plan, we implement a crisis, relapse, and contingency plan.
When things aren’t going well, staff talk to the client and, where appropriate, carers and family members, to gain their views about what might be happening and how the client can best be supported.
Staff work closely with the clinical team throughout this process and ensure that all important information is handed over immediately and any advice given is acted upon straight away. Extra support is given to clients during this time.
We recognise that for many in this client group, when there is a deterioration in their mental health or emotional well-being, this can often be accompanied by an increased risk both to themselves and other people.
In these situations, we increase staffing numbers at the service to facilitate increased levels of support to our client, while ensuring that continuity of service is maintained for the others.
Staff use their de-escalation skills to ensure levels of risk do not increase. Consideration is also given to the physical environment. For instance, at times it’s necessary to take such measures as restricting access to the kitchen or ensuring communal areas are free from anything that can be used as a weapon or projectile.
In the most recent client survey 100% of residents said they were clear about behavioural expectations at Tilt and no respondents said that they felt unsafe at the project. In the most recent staff survey, no members of staff responded that they did not feel supported at Tilt.
Working with the NHS commissioner and teams
Going forward, Bridge will continue to be highly invested and committed to a clear partnership model with Oxleas for the continued success of Tilt. This model has been key to our record of client recovery, extremely low re-offending rates and clients’ integration back into local communities.
We believe our positive working relationship with Oxleas will continue to be developed through:
- clear lines of communication between teams
- clear clinical and social care responsibilities between teams
- a structure of joint meetings, training, away days and care planning that has ensured care is consistent and safe
- plans for risk taking that seeks to maximise the practical outcome (e.g. finding a job) for clients