We’ve been running Tilt since 2013, in partnership with Oxleas NHS Foundation Trust, and for most of that time it’s stayed the same size: an 18-bed service for men leaving secure hospitals with long-term mental health needs and an offending history. I’m now looking at expanding it, and I want to explain why, what we’ve actually learned from over a decade of running it, and what commissioners should realistically expect from us as we do.
Why expand at all
Forensic mental health remains one of the most under-resourced parts of the care system. Secure hospital placements are expensive to run, and a lot of people stay in them far longer than makes clinical sense, not because they still need that level of security, but because there’s nowhere suitable for them to move to. Every conversation I have with commissioners tells the same story: demand for a service like Tilt outstrips what we, or anyone else running something similar, can currently offer.
That’s the honest reason we’re looking at growth. Not because bigger is automatically better, but because we have people sitting in beds that cost far more than they should, waiting for somewhere like Tilt to have a space.
What the last decade actually taught us
Over the past five years, our reoffending rate at Tilt has stayed at 1.58% a year. More than 64% of residents have moved on to independent or less supported accommodation. Those figures have come from a specific way of working that took years to get right, and that we’d be foolish to abandon just because we’re growing.
Every resident gets a key worker and a STaR worker from our team, alongside a responsible clinician and care co-ordinator from Oxleas, combining occupational therapy with psychological care where it’s needed. Our team and the Oxleas clinical team meet weekly as an MDT to go through how patients are doing and flag any concerns early on. Should a client’s mental health begin to worsen, that gets flagged straight away, with access to an on-call forensic psychiatrist out of hours. Our staff implements adapted care plans the clinical team has already prescribed, which in most cases means someone stays at Tilt through a crisis instead of being readmitted to hospital.
That structure is what produced those numbers, and it’s the part we’re least willing to compromise on as we grow.
What we’re scaling, and what we’re not
We’re currently in active planning and partnership discussions around expanding Tilt’s capacity. I’m not going to pretend we have confirmed locations or timelines yet, because we don’t, and I’d rather be frankt about that than announce something before it’s real. What I can say is what we’re committed to carrying forward: a referral pathway that already works, weekly MDT meetings with clinical partners built into the structure from the very start, key workers and STaR workers assigned to every resident, and a trial period that lets us properly assess whether a placement is right before someone commits to it long term.
What we’re not doing is treating expansion as simple replication. Each new site will need its own partnership with a local clinical team, built the same way our relationship with Oxleas was built: through jointly working together to manage risks and through people who actually know each other’s work.
What commissioners should expect from us
If you’re a commissioner with pressures you’re currently managing, whether that’s people stuck in secure settings with nowhere appropriate to move to, or areas that require additional support in your local forensic pathway, let’s chat. Early conversations shape where and how we grow, and they help us plan around the needs that are actually there rather than the ones we’re guessing at.
What you can expect is a model that’s been tested for over a decade rather than a new concept dressed up as expansion, and partnership work we’re not willing to rush just to grow faster.
If you’d like to talk to me about your local forensic pathway, please get in touch through our contact page.
Further Reading
The Economics of Community Forensic Support
Meeting NHS DSP Toolkit and CE+ Standards in the Age of AI
How We Work with NHS Mental Health Commissioners to Fill the Gaps in Local Services
