The Woodlands Managing Alcohol To Support Recovery In Mental Health

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Claud Hicks
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1 The Woodlands Managing Alcohol To Support Recovery In Mental Health Case Study: What Is Working Well From The Nottingham Perspective By Dr David Rhinds & Kevin Howard

The Woodlands The Woodlands comprises two buildings for people presenting with substance misuse problems: Great Oaks is our mixed gender 15- bed residential building and is where the service users

Each gender specific area contains a TV lounge, bathroom, outdoor smoking area and service user en suite bedrooms. There are 9 male and 6 female bedrooms.

2 The Woodlands The Woodlands comprises two buildings for people presenting with substance misuse problems: Great Oaks is our mixed gender 15- bed residential building and is where the service users will sleep, relax, have their meals and receive most of their medical treatment. The Woodlands has gender specific sleeping areas. Each gender specific area contains a TV lounge, bathroom, outdoor smoking area and service user en suite bedrooms. There are 9 male and 6 female bedrooms. Tall Trees is The Woodlands therapeutic building. Service users will attend Tall Trees to access their daily Recovery programme utilising the multi - gym, sensory/relaxation room, ADL kitchen, Lounge area and meeting room. The Woodlands is staffed by a multidisciplinary team with specialist knowledge, skills and experience of the management and provision of care for people presenting with substance misuse problems. All treatment plans are specifically designed in negotiation with the service user to address and meet the needs of the individual. All service users have a care plan in which their treatment plan is clearly identified which is signed by the service user as being appropriate, realistic and achievable and sustainable. All care plans are reviewed daily with the service user and more formally once a week with the MDT when the service user is invited to be present. Care plans are flexible and are amended according to service user presentation, clinical need and negotiation. Care plans include a risk assessment which incorporates childcare issues; this also considers the service users thoughts and comments. Full consideration is given to those presenting with a dual diagnosis as well as those with physical healthcare needs.

and enduring needs a history of severe withdrawal including seizures low doses of substitute prescribing 60mg methadone or less for detoxification Stabilisation Options Methadone & buprenorphine

The Woodlands terms of treatment violent or aggressive behaviour/ damage to person/property formation of sexual relationships at The Woodlands with peers theft from The Woodlands persistent self

issues/domestic violence mental health co-morbidity problems neurological disorders Wernicke s encephalopathy/korsakoff s syndrome arrangements in place to move on to long term residential

3 The Woodlands: What We See? Inclusion Criteria aged 18 plus opiate/opioid, alcohol, stimulant, and benzodiazepine misusers chaotic poly substance misuse a history of unsuccessful community based interventions a range of complex and enduring needs a history of severe withdrawal including seizures low doses of substitute prescribing 60mg methadone or less for detoxification Stabilisation Options Methadone & buprenorphine Alcohol detoxification & methadone stabilisation Alcohol detoxification & buprenorphine stabilisation Alcohol Detox Treatment Medicated detoxification via Benzodiazepines Exclusion Criteria breach of The Woodlands terms of treatment violent or aggressive behaviour/ damage to person/property formation of sexual relationships at The Woodlands with peers theft from The Woodlands persistent self harming behaviour racist behaviour breach of The Woodlands smoking arrangements substitute prescribing for stabilisation on prescribed dose of medication pregnant women vulnerable adults safeguarding issues/domestic violence mental health co-morbidity problems neurological disorders Wernicke s encephalopathy/korsakoff s syndrome arrangements in place to move on to long term residential rehabilitation written referral to The Woodlands pre-admission consultation funding agreed for out of area admissions Crack cocaine detoxification & methadone stabilisation Drug Detox Treatment Methadone Buprenorphine Benzodiazepines Stimulant detoxification GHB detoxification Mephedrone detoxification Cannabis detoxification Detoxification & stabilisation for pregnant women Establishment on relapse prevention medication i.e. disulfiram & acamprosate Alcohol detoxification via alcohol has been offered any attempts to access nonprescribed/illicit drugs smoking cannabis drinking alcohol absconding or attempting to abscond from The Woodlands physical needs demand more expert general medical intervention mental health requires more intense acute psychiatric intervention admission within the previous 6 months admission date and funding to residential rehabilitation not finalised funding not agreed for out of admissions

4 The Woodlands Recovery Pathway Aftercare is key in any recovery journey. The Woodlands seeks to engage our service users with aftercare support in their area with the goal of sustaining their recovery. Family Support Lets Talk Wellbeing Benefits Advice SMART Recovery Recovery College Women s Aid Friary Drop In A.A. Local Colleges Volunteering Return To Work Step Ahead Framework The Woodlands provides Involvement Double Impact telephone support for all our expatients, 24hrs, 7 days a week. BAC-IN Cruse Screening Preparation Programme Aftercare

The Woodlands: Numbers For The Year April 2013 - March 2014 The Woodlands admitted 319 service users from across the East Midlands

Of the remaining 199 service users, those with a primary drug referral, 42% presented with levels of alcohol consumption that

Breakdown By Locality Nottingham City Alcohol Referrals 37 Nottingham City Drug Referrals 70 Nottinghamshire County Alcohol

5 The Woodlands: Numbers For The Year April March 2014 The Woodlands admitted 319 service users from across the East Midlands region. Of those were admitted for via a primary alcohol referral. Of the remaining 199 service users, those with a primary drug referral, 42% presented with levels of alcohol consumption that required medicated detox. Breakdown By Locality Nottingham City Alcohol Referrals 37 Nottingham City Drug Referrals 70 Nottinghamshire County Alcohol Referrals 51 Nottinghamshire County Drug Referrals 98 Out Of Area Alcohol Referrals 32 Out Of Area Drug Referrals 31 Dual Diagnosis Of the 319 service users admitted to The Woodlands 23 were formally under the care of Dual Diagnosis services. However, how many do we see with undiagnosed co-morbidity

6 The Woodlands: Future Challenges Tendering The Woodlands has commissioning arrangements with 6 different bodies spread across the East Midlands region - all of which will go through regular re-tendering. Funding For dual diagnosis patients CCG/Public Health England Divide Expectations Detox is good for many things, but keeping people of drugs and alcohol isn t one of them, inpatient detox is not the cure many expect. Evidence We are constantly being asked to evidence long term outcomes and rightly so! However, is it all about the detox? Complexity Patients be coming more complex, living longer and multiple pathologies along with multiple medications. It s becoming increasingly unsafe to detox in community

Welcome to The Woodlands Great Oaks Tall Trees

Welcome to The Woodlands Great Oaks Tall Trees Welcome to The Woodlands The Woodlands provides a welcoming and friendly environment for services users, families and carers. It is a purpose built facility with a unique contemporary design. The Woodlands