Specialist Residential Care
Beverly Cyrus and Lee Smith, founders and directors, set up Cove Care in 2008 following successful careers and achieving senior posts within in-patient mental health services for young people. The services they had worked in, which had developed and refined their skills, included acute units; open CAMHS units; generic tier 4; Specialist Eating Disorder services; PICU CAMHS and Forensic CAMHS.
‘It was clear to us both that there was a real need for specialist residential mental health care’, recalls Smith, a CAMHS Nurse Consultant prior to setting up Cove. ‘At the time (from the mid 1990’s through to 2008) there were no real options for discharge from in-patient (tier 4) settings. Some residential services were known as “therapeutic”, and many of them were really good in that TC (Therapeutic Community) sense of providing psychotherapeutic support, but none really focussed on these young people’s mental health, from a more clinical perspective’. What’s the difference? ‘So a TC could describe how they could develop the young person’s “sense of personal mastery” though a “group therapeutic process”, for example, but not much about how they might put together a research-based care plan for staff for helping the young person cope with hearing voices out of a hospital setting, or be able to provide skilled liaison with the community mental health teams post-discharge to help monitor their mental state and prevent a relapse. And they really needed these supports as well’.
Cyrus describes the position from her positions in mental health nursing, Clinical Services Management and qualified psychotherapy: ‘There was a critical mass of young people in hospitals that fell into the following categories: a) admitted due to a serious psychiatric emergency, successfully treated, but nowhere to be discharged to, and subsequently languishing inappropriately in hospital; and b) only in hospital in the first place because there was nowhere else to help them with their mental health crisis, and also subsequently languishing inappropriately in hospital’. According to Cyrus, there were very few young people admitted to tier 4, assessed and treated successfully, and discharged into the community with appropriate support. ‘We were seeing very poor outcomes post-discharge, and in some cases, the ‘revolving door’ syndrome which, for a 15 or 16 year old, was a tragedy’.
Cove Care was set up to meet both these categories of young people. Smith describes this mission: ‘We wanted to provide residential provisions which were “step-down” facilities from tier 4 hospitals, and also provide safe alternatives to a hospital admission where a young person could be skilfully managed within the community’.
Cyrus further expands on the setting up of Cove: ‘For the first year or so we placed quite a “generic” type of young person, such as those with emotional and behavioural difficulties, as both the social care and the health teams within local authorities didn’t really know about our service or the speciality we were trying to deliver.
‘Then we received a couple of admissions that were more our target group: a young boy with a clear Autistic Spectrum Disorder, but who we helped his multi-agency professional team identify and treat an unidentified psychosis; and a girl who was being discharged from hospital following treatment for depression and Post-Traumatic Stress Disorder but was still considered high risk of self-harm.
‘We worked with both of them for around 2 years, at both of our first 2 registered homes, supporting them to reduce their individual psychiatric symptoms, and lower the severity and frequency of their specific risks’.
The outcomes? ‘Both of them left us with significantly improved mental health and social conditions’, recalls Smith. ‘They had a resilience, a range of coping mechanisms and strategies to help them manage their illnesses that they hadn’t had previously; one was in a college course, the other in employment; and they both moved into semi-independent living-type schemes. Both of their local authorities were amazed at their progress’.
‘As were we, to be honest’, adds Cyrus with a reminiscent smile. ‘That was when we really knew our mission would work, when we saw the actualisation of the potential, when we absolutely knew what we had previously felt.’
And now, over 10 years and well over a hundred young people later, Cove is continuing to realise this potential, receiving repeat-referrals from many local authorities, and directly from tier 4 / in-patient services. They have a specialist service, with specialist clinical and residential staff, for a very special group of young people.