We often get asked “How do people get to work with you?” It’s a mix. Sometimes we are approached by commissioners in mental health who want to explore options other that years in self declared specialist inpatient units. Other times relatives contact us and we direct them to people in their local organisations who can fund our work. Other times clinicians feel that restriction is harmful for those they work with and ask us to get involved. Below is an account of how we got involved with someone. If we can help someone you work with to avoid or step down from a self declared “specialist” placement, do get in touch.
I first came across Beam consultancy when I heard Keir Harding speak at an occupational therapy and personality disorder conference. A little while after, I commenced my role in a community mental health assessment team where I worked with a client who self-harmed on a mostly daily basis, was suicidal and frequently put their life at risk.
They had many inpatient admissions and frequent contact with A&E and emergency services. There were multiple safeguarding alerts, risk panel meetings and MDT reviews with no improvement in their well-being or reduction in risks. The CMHT psychology service declined to work with her as their mental health was deemed too unstable. During one admission an out of area placement began to be discussed by the wider team. My client had not responded well to inpatient treatment and in fact rather than containing risk, their self-harming increased during their admissions. They were keen to explore other options that would enable them to receive therapeutic treatment in the community, remaining at home with their partner. Recalling Keir's seminar at the conference I decided to contact Beam for more information on their placement avoidance package.
I emailed and booked a telephone discussion to talk about my client and what Beam could potentially offer. Keir and Hollie were positive that Beam could work with my client and advised that the next step would be an assessment with them. This was extremely reassuring to hear, particularly given their prior experience of being declined for therapy.
I then contacted our local CCG to have a further discussion with the lead commissioner for mental health services regarding funding of an assessment. Not having worked with Beam before, she was eager to find out more and liaised directly with Keir and Hollie. She gave the go ahead for the assessment and recommended that I complete an application for Continuing Healthcare funding. This involved outlining the 6-week assessment offer from Beam with funding also being requested in principle for the full placement avoidance package. This was to avoid any potential funding delays if the assessment progressed to intervention. The application involved demonstrating the clinical need for the treatment and cost to health (or in this case life) of not having the treatment. Once completed I submitted to panel and had the funding approved. Throughout this process Keir and Hollie regularly checked in with us to offer any support needed with funding panel.
From here the assessment was arranged. Due to COVID restrictions this was completed via a mix of face-to-face appointments and video calls with Keir and Hollie. There were various sessions with my client, their partner and with myself and my colleague (I was joint working by this stage). This led to a very comprehensive formulation with an offer for a further 12-month intervention. Prior to the intervention commencing we convened a risk panel meeting attended by the trust's Patient Safety Lead, local CCG and CMHT managers. When convention was leaning towards a “specialist” inpatient treatment, it was important to develop a risk management plan for the proposed treatment in the community with full sign up from all those involved in their care as well as senior managers.
As part of the placement avoidance package Keir and Hollie offered twice weekly sessions with the client and access to telephone support in-between sessions should she need it. There were also formal supervision sessions for staff working with her as well as additional advice, guidance and support via email and phone calls. My client completed the 12-month intervention and during the time Beam worked with them, they had only one further brief inpatient admission which was early in the assessment phase. They remained living at home with their partner throughout her treatment.
“I have nothing but positive things to say about my experience of working with Keir and Hollie. I fully believe that they changed the course of my client's life. Having previously worked in acute inpatient services, I have seen many clients presenting with similar difficulties, being sent to out of area placements. I had not seen any clients who had benefitted. I felt that they were on the same trajectory.”
Keir and Hollie helped me to work from a place of curiosity and compassion rather than from a state of fear. Prior to Beam's involvement I had felt that my only input was firefighting and "managing" risks. Our therapeutic relationship was strengthened by Beam's support as their formulation refocused me on my client as a person rather than a "safeguarding alert" or a "client in red zone" (CMHT zoning). They were steady, calm, and reassuring and with their support and I felt that I was part of a team holding the risks together. We were able to move towards an intervention that addressed the root causes of my client's difficulties rather than a sole focus on stopping the risky behaviour. It all felt less reactive and hopeless.
On a personal level, I learnt so much from Keir and Hollie's vast knowledge and experience. This enhanced my clinical skills and has been transferable to other roles. I would highly recommend working with Beam. They are passionate in their support of their clients; they help you reflect and challenge what’s working and not working. I think the outcome for my client speaks for itself, they avoided placement with their package.
The above is very deliberately kept anonymous but we are both profoundly grateful that someone took the time to write this. We know who you are and we really appreciate it.