Montague Court is an eighteen-bed mental health long term complex care locked rehabilitation hospital for men. Dartmouth House is a thirteen-bed mental health long term complex care locked rehabilitation hospital for men. Dartmouth House also benefits from a three-bed Annexe, each which en-suite shower rooms, complete with an open plan communal kitchen and living space. This is linked by an adjoining door to the main hospital where service users can be afforded limited and structured semi-independence. This allows individuals to be monitored and supported whilst testing skills of independent living.
The organisational goal is to support service users to realise their potential. This starts with improvement and developments in quality of life, leading to a gradual progression through the recovery pathway to eventual discharge. Service users reside in the service whilst being assessed using the agreed set of tools to measure clinical outcomes:
- Baseline Physical Health Monitoring assessment and associated care plan
- Within the first 8 weeks of admission we will aim to have an effective baseline assessment of need through completion of:
- Model Of Human Occupation Screening Tool (MOHOST)
- Recovery goal planning interview
- Recovery Star
- Personal, social, developmental and psychiatric history assessment
- Quality of Life assessment
- Residential Rehabilitation Engagement Scale
These tools will aid the clinical team in decision-making regarding increased self-management until the time is appropriate for them to move into a less restrictive setting. Options for Care starts the journey with each service user with the aim of discharge, or transfer to a less restrictive setting within 24 months. There is a recognition that each person’s journey is individual and unique and for some this will take less time and for others it may take longer.
All bedrooms have en-suite facilities. Our therapeutic spaces include IT facilities, outdoor space, pool table, space for quiet reflection, outdoor area and therapeutic kitchen for individuals to develop cooking skills.
Within services, we offer a range of activities to develop the individual with both a therapeutic and social focus. Activities of Daily Living, focusing on budgeting, food hygiene, self-care and housekeeping. The group program has been devised to address the current service-users’ needs as identified in MOHOST assessments, and include communications group, music appreciation, arts and crafts and exercise sessions such as walking and swimming. The program is updated regularly to reflect changing needs.
Developing positive habits and socialising outside the unit is essential to support the individual in working towards their individual goals. For leisure and educational pursuits like shopping, using public transport or accessing local colleges.
All activities are tailored to individual needs and wishes based on the assessments completed during the initial assessment period, prior to CPA reviews and using the SAFE (Shared Assessment, Formulation and Education) approach to develop detailed, supportive care plans in partnership with service users.
The SAFE approach delivers:
- an integrative model for understanding risk and problematic behaviour.
- shared risk assessment and management processes using the START risk assessment tool.
- approaches to reducing team and carer barriers to effective care.
- a formulation-driven strategy for managing complex and challenging behaviours.
Involving the whole team in delivery of the SAFE approach affords the clinical team the opportunity to develop plans for promoting safety, as opposed to plans that are focused around ‘managing’ and ‘preventing’ risky behaviours.
The mental health hospitals are staffed from a full-multidisciplinary team:
- Registered Managers
- Registered Nurses
- Occupational Therapy
- Health Care Assistants
- Activity Workers
This is complimented by visiting allied health professionals, such as Chiropody and Physiotherapy. Both units have close and established working relationships with local GP practices and Pharmacy services. Regular input and contact is encouraged with community mental health teams and Care Co-ordinators.
- Predominantly adults of working age (although we are able to admit older people, offering them a full assessment of needs before looking at most appropriate setting).
- Resistant to standard psychiatric treatment with a history of failed interventions and currently unable to function independently in the community.
- Likely to have an extensive history of contact with statutory mental health services and a reluctance to engage with these.
- May be detained under the Mental Health Act (1983), 3, 37, 37/41 or informal.
- Primary diagnosis of mental illness with complex needs; this would typically include Schizophrenia, Schizo-affective disorder or bipolar affective disorder; although no diagnosis will warrant exclusion for assessment.
- May have a secondary diagnosis of learning disability or personality disorder
- Forensic history.
- On enhanced CPA.
- Have problematic engagement with services and treatments.
- Have persistent treatment resistant symptoms.
- Have poor social and coping skills.
- Have problematic co-morbid substance misuse.
- Have some challenging behaviours.
- Vulnerable to abuse, exploitation from others or self-neglect.