The Challenge

 We know that suicidal behaviours are very common in people with emotional sensitivity who may be
labelled with ‘ Personality Disorder’. Research has shown that between 8-10% of
people with this difficulty will complete suicide, more than 50 times the general population rate of suicide (Linehan
2006).

 People who experience complex trauma and emotional sensitivity (Personality Disorder)
can often find themselves in crisis, with recurring suicidal behaviour and self harm.
For some people this can sit alongside transient psychotic experiences, as well as intense
anxiety, depression and anger. As a result some people can be regular users of psychiatric and acute hospital
emergency services.

From crowd sourcing on Twitter somebody describes what it felt like to be in a mental health crisis.

 “Being in so much turmoil that all my thoughts are about ending it, and now not later. So
fed up that things are never going to change. The need to escape is great.
Anywhere off this earth will be better.”

However, once admitted to the ward impulsive and high risk behaviour can escalate, causing concern for the service user and staff. This can often lead to longer lengths of stay on the ward and restrictive interventions.

We want to work with peer experts to offer an improved service user experience of mental health crisis care.

The Idea

We are looking for funding to employ peer workers to work alongside clinical staff as an Assertive Intervention Stabilization Team  (ASSiST), offering a 12 week structured psychosocial intervention for people with complex trauma and/or emotional sensitivity who are in crisis on acute wards or with the Crisis/Home Treatment teams. The ASSiST model was developed by Dr Rex Haigh and Dr Natasha Berthollier in Berkshire. The overall aim of the model is to offer an in reach to service users who are in crisis, focussing on increasing resilience through the development of strategies to manage emotional problems and risk behaviour in a community based setting,
thereby reducing the use of Mental Health inpatient services when safe, effective alternative is available. Peer workers can represent hope and explore treatment options in an atmosphere of optimism and empowerment.

The  ASSiST Model has been comprehensively evaluated and has been shown to be successful:

1. Improved service user experience of care
2. Reduced length of stay on acute wards and with Home treatment teams, leading to reduced costs which have been re-invested in community services
3. Improved outcomes for Service users

The Plan

Over the last 6 years SHSC FT has been working on improving the quality of care offered to people who experience mental health difficulties associated with complex trauma and emotional sensitivity.
Following a review of services, we employed a Peer Expert to coproduce and deliver a staff-training package and psycho education groups for service users, family and friends. We now employ a number of paid
peer recovery workers and the plan would be for the peer workers on the ASSiST programme
to be supported by this existing network.

 Staff in SHSC FT have already visited and established good relationships with Berkshire and the next steps are for Dr Haigh and Dr Berthollier to run a workshop for staff and service users in Sheffield.

We will collect pre and post outcome measures, including bed usage, to compare with Berkshire and to put together a business case to reinvest savings to create permanent peer recovery posts.

Existing links

• the Berkshire ASSiST team

In Sheffield:

• Rethink who provide the SHSC crisis house
• local Emergency departments and Liaison Psychiatry
• the University of Sheffield (for help with outcome measures and research)

Who benefits

• Service users  – they tell us that input from peer workers helps them helps them to hold hope, to feel empowered and more connected

• Peer recovery workers report feeling that employment gives independence and a sense of purpose and a sense of empowerment about improving services

•  Staff working in the Trust

• Q Community: we will share this model and our broader experiences of working with peer experts within SHSC FT and offer opportunities for Q members to visit. Our Peer Expert Sue Sibbald has a national profile around service developments for people with emotional sensitivity. We will work to give regular updates on the developments and use social media, blogs, Twitter and other established platforms to reach out to generate broader interest and reach out to harder to reach service users.

We recognise that the Sheffield care pathway for complex trauma/emotional sensitivity needs to evolve further and we want to continue to improve, with co-production at the heart of new developments.

 We are also keen to contribute to a body of practice-based evidence to support service users to receive improved quality of care, and ultimately to reduce self-harm and completed suicide.