Pioneers in patient care: consultants leading change
North East
Innovation: Bradford Home Treatment Service
Dr Patrick Bracken
University of Bradford, Department of Applied Social Sciences, Bradford
Job Title: Consultant psychiatrist
Speciality : Psychiatry
A mental health crisis can be a harrowing experience and hospitalisation, which is often seen as the only way to help someone with a mental health problem, can at times make the situation even more disturbing for the patient and their family. In Bradford however, a scheme is in place that provides intensive care and support for patients 24 hours a day, seven days a week – in their own home.
When Dr Patrick Bracken and his colleagues set up the Bradford Home Treatment Service in 1996, it was one of very few in the country. It was established in order to help patients by working through their problems in a ‘normal’ environment. Dr Bracken says: “The real innovation in this service is our philosophy of care. We aim to work alongside people and this means not imposing our values or concepts upon them. We have tried to get beyond the conceptual framework of traditional psychiatry.”
“It is important to us that we are self-reflective about our work and critical about the care we provide. We employed a critical service user patient in a development role when we set up the team. We also encourage users to apply for posts with the service. I think this ensures the service does not have a ‘them and us’ culture, which is often quite prevalent in mental health work.”
The service gives practical support, with staff visiting the patients once or twice a day, every day. Dr Bracken says: “We make sure there is enough food in the fridge, that people have any benefits they may be entitled to, and that if they have any other practical problems we can help get access to appropriate services.
“We also work on getting patients out of the house – which can play a vital part in a person’s recovery. In the context of this practical support we are available to talk over the various emotional and relationship problems that patients struggle with. We keep these discussions ‘ordinary’ and don’t frame them as therapy or counselling. We do use medication but in low doses and try to avoid it if possible.”
Dr Bracken estimates that 50 per cent of patients admitted to hospital with mental health problems could avoid admission if they were referred to a home treatment team. One patient had had two admissions to hospital in the previous six years and was referred by a GP as an urgent case. This patient was allocated a key nurse and through working together they managed to identify the underlying causes of the patient’s mental problems. As a consequence the patient has been drug free and well ever since and family relationships have considerably improved.
Dr Bracken says that after nearly 20 years in psychiatry he finds the most important ingredient in effective care is time, which is often in short supply. He says: “The work we do is very labour intensive and we need a large team to provide 24-hour cover. While the Bradford team has not had great problems in attracting staff, I acknowledge that one of the main problems facing new mental health services is recruitment. I believe that we will have to think radically about this in future. One way forward is to think about employing more service-users. After all they are often ‘experts’ through experience.”