This is how to provide nurse-led emergency mental health care

This year the Lotus Assessment Suite at South West London and St George’s NHS Mental Health NHS Trust won a Nursing Times Award for its contribution to mental health crisis care.

Deputy Director of Nursing, Sharon Spain, says the unit came about in order to provide an alternative to A&E. “A service user who becomes unwell in a crisis comes to A&E and it can be chaotic, impersonal and not conducive to their mental health,” she says.

“They can get treated very differently because their problems are due to  their mental health not physical. It can be daunting for them. They  often feel stigmatised and people don’t always understand what it’s like to have a mental health crisis.”

A relaxed and informal atmosphere

The Lotus Assessment Suite works hard to provide an alternative environment, starting with how it looks. “It’s very informal, comfortable and relaxed. It has an open door and doesn’t have a ward feel to it.” says Sharon.

Patients can watch TV or listen to music. There is a lounge to relax in where you can help yourself from a breakfast bar offering food and drink and a small garden.

“Even though it’s a small environment, it doesn’t feel like a restrictive place where you’re worried about being locked in, sectioned or forced to take medication,” says Sharon.

Prolonged assessment

Not only is the environment more conducive to mental health, patients aren’t whipped through at speed. Instead they can stay up to 72 hours for continual one-to-one nurse-led assessment.

“Someone’s condition can change very quickly when they’re in crisis,” says Sharon. “They can quickly improve or deteriorate. Continual assessment helps you to make a really clear decision about what’s the best next step.”  

Nurse-led care

The fact that they working towards a nurse-led service adds to this ability to make good decisions for the patient. “Of course we value our medical colleagues,” says Deputy Director Spain. “But we’re also really passionate about individual care planning and being able to make difficult decisions for our patients out of hours when we don’t necessarily have a consultant psychiatrist available.”

We want our patients to be transferred to the most appropriate service or home in a timely manner. Nurses carry out the admissions and assessments to prevent patients staying in the suite longer than they have to, adds Deputy Director Spain. “The nurses work very closely with the  patients and carer’s where appropriate. They work with them, with their anxiety. Sometimes people can feel quite frightened. They need a short period of intensive care and here that’s exactly what they get.”

Back into the community

And it seems to be working. Since its launch 71% of service users assessed in the Lotus Suite returned to the community instead of being admitted to inpatient wards.

“Staying on a busy ward full of people who are unwell sometimes can have a negative impact on someone’s ability to progress and get better quickly,” says Sharon. “In the Lotus Assessment Suite most people aren’t acutely unwell so you don’t have that level of severity – you’re able to make decisions about a person’s mental health in a lot calmer environment.”

Staying on the ward can also encourage dependence on 24/7 care. “Moving from somewhere where you have your meals provided for you and someone always there to support you can make going back into the community by yourself a bit daunting. Whereas at the Lotus Suite we make a lot of time to put the support needed in place to confidently and safely go home.”

Making improvements

That’s not to say that there isn’t room for improvement.

Currently the Lotus Assessment Suite can only accommodate  five people at a time but Sharon would like to be able to take in more. “It would be great to have more capacity to take more people through,” she says. “We would also like to have more room for people to relax and more support at discharge with some of the more practical things, like housing and benefits.”

But Sharon says they are proud of what they have achieved so far: “We’ve worked really hard on setting up the assessment suite and the team have brilliant ideas and they’re so creative. It’s so important to be able to care like this, I’m really proud of my team, the Nursing Times Award is well deserved.”