Posted on: 14 December 2023
The Stepdown Service was set up three years ago to support patients by moving them from mental health inpatient services into a community-based, recovery-focused environment.
Since November 2020, it has provided a consistent alternative to extended stays on acute mental health wards by making transition back into the community less daunting for patients.
Stepdown offers 24-hour live-in care in temporary accommodations with in-reach from a community team made up of an occupational therapist, a nurse and a social worker, as well as a support worker provided by our partner, LifeCome Care.
With the help of CNWL’s Stepdown Service Manager, Col Te Aho, this article explores how the service has developed and what it offers patients today.
What can patients expect?
Stepdown receives referrals from inpatient services and offers places to those experiencing a range of social care issues. Most commonly residents are:
- Requiring respite
- Waiting for mainstream housing
- Waiting for supported accommodation
- Waiting for repairs or deep cleans to their accommodation
- Applying for repatriation
- Homeless
Each accommodation has a 24-hour stay-in support worker but residents should require low-to-medium individual care. More details on who wouldn’t be eligible for Stepdown can be found here.
Whilst enjoying an environment where they can relax and recover, residents are visited by CWNL Stepdown staff and supported with managing their medication and working towards their move-on plan. On average, residents are expected to stay for four weeks but this is always dependent on each individual’s needs.
“Going the extra mile”
Staff from Rethink Mental Illness, another CNWL partner, can visit the accommodations and link individuals in with their befriending services and support groups. Stepdown staff have also been known to engage with residents through cooking groups, gardening clubs, make-up activities and group trips to the local gym.
Col Te Aho described his experiences working with Senior Support Coordinator, Sonia Jhumat, to help people settle into new accommodations after stepdown: “we’ve been very happy to transport furniture, assemble beds, cut down bits of tree that had overgrown into someone’s flat! We want to offer this practical support whilst also thinking of innovative ways to help with move-on plans. We once had someone who was applying for asylum but they’d lost their passport. We knew the person had studied so we contacted their university and tracked down a scanned copy.”
Col also attributed the stepdown’s success to its many working relationships with partners like Lifecome, Rethink, HSP and Hestia, GP Services, Local Authorities, The Home Office, as well as CNWL’s inpatient and Community Access Services.
What are the benefits of Stepdown?
By helping patients move back into the community gradually, it lowers the risk of relapse and creates more spaces on inpatient wards.
Residents also find the accommodation much less restrictive than a ward. They can cook their own meals, go shopping, have visitors, and are generally free to come and go as they please. They can spend regular time with friends and family, whilst still having regular access to health and social care support.
Each patient has a different recovery journey – someone who is becoming stable on an inpatient ward may be destabilised when a new patient arrives who isn’t at that stage yet. Step Down ensures all residents are at a similar stage of recovery, offering them a safer, more therapeutic environment to recover in.
What Stepdown has achieved:
Up to summer 2023, the Step-down accommodations have housed and discharged 819 residents. Between February 2022 and February 2023, the average length of stay for residents dropped from 44 days to just 31.
Previous residents have given feedback that Stepdown:
- “Helped me with applying for benefits and applying for new accommodation”
- “Gave me some time to think and come out of noisy hospital which was stressful”
- “The entire project has been beneficial to my particular situation and I appreciate the chance to sort my problem out”
- “Would like to do more activities I get bored sometimes”
In response to this feedback, Stepdown is committed to ensuring weekly workshops are maintained across all sites, helping residents to keep active and busy.
We also spoke to Selena Phillips who described the impact stepdown has had on her recovery:
“I have a diagnosis of schizoaffective disorder and it was like I was in a revolving door going in and out of hospital. In December 2022, I was discharged and invited to stay in one of Westminster’s stepdown accommodations. The support I received there was amazing and I would not be where I am today without Col, Sonia and the rest of the team.”
She continued: “they helped me to find housing, they accompanied me to appointments, I experienced some crises that were handled by the team in a way they never had been before. I truly believe they helped me to break the cycle and stay out of hospital.”
In this short video, Selena sent a thank you message to the team.
Col Te Aho concluded that “it is incredibly satisfying to help someone secure safety and shelter, to help prevent relapse, and see a patient make the journey through all the confusion and anxiety of moving back into the community.”