Sussex therapists create new environmental tool for community mental health support

The Safe Home Environment Assessment tool is helping NHS trusts across the country support people with autism and learning disabilities to live more independently in the community

The SHEA tool is helping to support people with learning disabilities and autism to live more independently in supportive community settings

A group of occupational therapists from a Sussex NHS trust have put together a tool which is helping to support people with autism and learning disabilities to transition between inpatient hospital care and community living.

The team from Sussex Partnership NHS Foundation Trust devised The Safe Home Environment Assessment Tool (SHEA) in response to the Transforming Care agenda, which was launched by NHS England in 2015.

And in recent years the software, which cost just £5,000 to build, has been taken up by 35 other health and care organisations from across the country.

The innovation is made up of a number of key elements:

  • A tool which helps identify who may benefit from having an assessment completed
  • The Safe Home Environment Assessment tool itself, which helps to identify high-risk behaviours that need to be considered as part of the planning process, but also recognises individual sensory issues that may be triggers within the environment
  • A site visit tool which matches identified risk issues with the proposed placement
  • A ‘Live’ solutions guide which has useful links to adaptations, guidance, fixtures, and fittings so an individual therapist or therapy team can reduce time spent looking at solutions

The overall aim is to help identify common risk behaviours that need to be considered when planning future accommodation options, such as highly-destructive behaviour, hygiene issues, absconding risk, and sensory preferences, which need to be considered to minimise distress and support dignity and independence.

While the tool is just one component of creating a capable environment, by identifying potential risk issues early in the planning process, it can help with the design of resilient personalised home environments within the local community that can reduce the risk of placement breakdown and re-admission to inpatient facilities.

A feeling of safety

The team is also interested in monitoring the potential emerging link between the physical environment in restraint reduction.

Speaking at the recent Design in Mental Health Annual Conference, Diane Chandler, lead occupational therapist at Sussex Partnership NHS Foundation Trust, said: “Over COVID we have learned more about the importance of feeling safe in the environment in which we live.

“It’s about how can we understand individual needs and the evidence base around design and wellbeing.

“And one thing we can do is to understand individual sensory processes.

“We want to be very value based, not just looking at physical safety, but also psychological safety.”

Exploring the key trigger points in this way, teams can source the right accommodation for each individual.

“Compatibility is important,” Chandler told the conference.

Over COVID we have learned more about the importance of feeling safe in the environment in which we live. It’s about how can we understand individual needs and the evidence base around design and wellbeing

“If you put someone sensitive to noise next to someone who is making a lot of noise, for example, it can be a recipe for disaster.

“The SHEA tool is, therefore, very behavioural.

“We look at how we can rate these different behaviours and get an idea of frequency and intensity. And we identify what are the things need to get right and what are things that might be issues, but which a good care plan and risk assessment might be able to mitigate.

“It’s about reducing risk while knowing you are never going to get it 100% right.”

She said a national shortage of housing stock, particularly accommodation suitable for people with complex needs, often meant service users were housed in properties which did not meet their needs and could even pose a threat to their safety or that of their carers.

Close collaboration

Giving an example, she said one resident managed to remove a door from their property in under 30 seconds and five police officers were needed to help bring the situation under control.

“If you put someone in an adapted 1950s bungalow who exhibits very-high levels of destructive behaviour then it is not going to end well,” she said.

“This type of resident may be better suited to a purpose-built environment and that’s what the tool can help to determine.”

When you have an idea like this, I would say do not get hooked on grant funding because we have found that most people have given their time freely with no budget

And she said that relatively-cheap interventions could have a dramatic impact on health and wellbeing, for example enabling people to choose paint colours when homes are being upgraded.

“One thing that was coming up more and more was about the smell of paint, so we did some work on which paints smell most and which smells last the longest.”

With this feedback the team worked in partnership with Dulux to develop a dedicated autism colour scheme.

“When you have an idea, my top tip is to collaborate with people who know more than you do,” Chandler advised the audience.

“We built the tool for £5,000 and are at the stage now where we are going nationwide, and 35 NHS trusts now use it.

“When you have an idea like this, I would say do not get hooked on grant funding because we have found that most people have given their time freely with no budget.”