As Head of Clinical Intervention at Phoenix Futures, Gabrielle Epstein has been at the forefront of developing the approach for blended substance use and mental health provision at New Oakwood Lodge, a new CQC–registered Therapeutic Community, based in Derby.
Tell us about New Oakwood Lodge and what needs it is seeking to address.
New Oakwood Lodge provides coordinated mental health and substance use care in one location. People experiencing co-existing mental ill health and substance use may struggle to access mental health treatment due to their substance use and struggle to access substance use treatment because of their mental health. People can become stuck unable to get the help they need where they live.
A residential placement, with appropriate detox, could be an answer for them as it enables people’s care to be coordinated in one location, but many rehabs lack the mental health treatment capability and are not set up to coordinate care across mental health and substance use needs nor do they provide a range of specific mental wellbeing activities.
This means that people with a co-existing interdependent need can struggle to access the care they need anywhere. They face a huge health inequality.
Accessing residential treatment requires a high level of organisation, support, and resilience. There are multiple assessments and appointments to attend which can be difficult for people who struggle to express themselves and find talking about traumatic life experiences triggering. We see people too easily labelled as ‘non-compliant’ or ‘unengaged’ when in fact a history of trauma may act as a barrier to sharing openly or anxiety may result in non-attendance at assessment sessions. People who lack support and confidence are disadvantaged.
Furthermore, if people can access rehab, then the unfamiliarity of the place, having to be with so many new people and talking about feelings so openly can be too much.
At New Oakwood Lodge the skills needed to support people excluded from other forms of support have been brought together in a multi-disciplinary team. Essentially, we’ve made accessing multiple forms of treatment (which can be incredibly complicated for some people to access) simple for everyone by delivering it in one place in a single treatment episode.
Can you talk us through the interventions on offer at New Oakwood Lodge?
The environment, protocols and treatment offering at New Oakwood Lodge are designed to provide the necessary support and interventions individually to maximise Community Members’ engagement in treatment.
The programme is based on the Therapeutic Community approach – people live together and learn from each other. The community helps individuals emotionally and supports the development of behaviours, attitudes, and values of healthy living. The structured group programme enables people to share and learn together in groups facilitated by expert staff.
Treatment incorporates 1:1 counselling utilising CBT to support mental health and substance use. Our Recovery through Nature programme enables people to come together with a common purpose to complete conservation tasks. Being with others, exercising together and working to create a positive environmental impact is proven to aid mental well-being. We bring together these core interventions, and other specialist interventions so that they fit together in a blended approach to care.
The team at New Oakwood Lodge is made up of a psychologist, counsellor, registered nurse and therapeutic workers in a multidisciplinary team supported by our Clinical Governance Committee headed up by a senior consultant psychiatrist. They work together across different disciplines of care to create an environment and milieu to deliver coordinated and personalised care bolstered by peer support.
What other approaches add to the Enhanced Environment at New Oakwood Lodge?
The length of treatment will typically be longer than usual due to an extended assessment and welcome/induction process at the start of treatment. We also expect the discharge period to be longer and more comprehensive.
We are currently working toward the Enabling Environments accreditation from the Royal College of Psychiatrists. We are a member of the Enabling Environment Network which has been set up to encourage and support services that wish to ensure that everyone thrives, succeeds, and achieves more positive outcomes.
We take a modern approach to mental health meaning that we treat people, not just conditions. We enable people to be themselves in the safe, open, and caring nature of the Therapeutic Community.
Can you tell us more about blended substance use and mental health care?
At New Oakwood Lodge we provide mental health care coordinated with drug treatment and vice versa. Mental health interventions are specific to individual needs and equip and empower people to feel included, safe, and able to receive and offer support to others.
Mental health interventions exist in a reciprocal loop with drug treatment. So that 1-2-1 behavioural interventions for depression, for example, focus on helping people engage with their peers in groups, and activities that make up the everyday routine of residential treatment. Similarly, the safe and caring community of the service is an ideal environment for people to practise what they learn from 1-2-1 CBT interventions for anxiety.
There are a number of targeted mental health outcomes that we aim to achieve with our blended approach for example, improvement in peoples’ mental well-being and health including treating anxiety and depression, reduction in mental health crises and suicide/self-harm attempts, improved retention, reduction in early leavers and a potential reduction in psychiatric medication
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