The Waltham Forest Crisis Alternative

This specification outlines the development of a Mental Health Crisis Alternative in Waltham Forest, a third sector-led service providing non-clinical, community-based mental health support. The service will focus on supporting those experiencing or wanting to prevent a self-defined mental health crisis who do not require immediate medical attention. It will offer timely interventions aimed at preventing escalation to statutory services like psychiatric liaison or emergency departments. This initiative aligns with local needs, addressing the unique demographic and socio-economic factors of Waltham Forest. Although the term ‘Crisis Alternative’ is used here, the name of the initiative will be decided in collaboration with service users and will highlight that the spaces are welcoming, homely and peaceful e.g. incorporating words such as ‘sanctuary’, ‘haven’, ‘harbour’, ‘welcome’, ‘healing’ ‘connection’.<br/><br/>Waltham Forest is home to a diverse population of approximately 278,000 people, with significant communities from White British (34%), White Other (19%), Asian/Asian British (20%), and Black/Black British (15%) backgrounds. The borough has a large Eastern European community and is the 12th most deprived borough in London, with high levels of deprivation concentrated in the southern areas of Leyton, Walthamstow, and Higham Hill.<br/>There is a growing population of refugees and asylum seekers, many of whom face barriers in accessing mental health services, such as language difficulties and stigma. Waltham Forest also has a history of underrepresentation from its South Asian communities in mental health service presentations, high rates of A&E attendance amongst Eastern European communities, and high rates of hospital admission and detention experienced by Black men. This highlights the need for culturally appropriate outreach and service development, and for this ‘crisis alternative’ offer to look, feel and operate in a way that noticeably differs from statutory mental health services, so that people might seek support earlier, before a crisis is reached. The mental health needs of the population include common disorders like anxiety and depression, which contribute to emergency department (ED) attendances and require community-based alternatives to prevent escalation.<br/><br/>Service Aims<br/>The primary aims of the Waltham Forest Mental Health Crisis Alternative are to:<br/>• Provide immediate, non-clinical support for individuals experiencing or wishing to prevent a mental health crisis, preventing escalation to statutory services like emergency departments and psychiatric liaison teams.<br/>• Reduce pressure on emergency services by offering a safe, non-medical alternative to hospital-based crisis interventions.<br/>• Address mental health inequalities by providing targeted support to underserved and underrepresented groups in Waltham Forest, including the Eastern European, Black African and Caribbean, refugee, and Asian/Asian British communities.<br/>• Promote early intervention and de-escalation through crisis listening, safety planning, and peer support, empowering individuals to manage their mental health and avoid future crises.<br/>• Enhance community resilience by offering practical support and linking individuals to appropriate local services, thereby reducing social isolation and promoting long-term mental wellbeing.<br/>• Collaborate with local VCSEs and statutory services to ensure an integrated care pathway, allowing smooth transitions between community and clinical services where needed.<br/><br/>Strategic Context<br/>This service supports the objectives of the North East London Integrated Care Board (ICB) and aligns with the Waltham Forest Joint Strategic Needs Assessment (JSNA), which emphasizes mental health as a key priority. The NHS Long-Term Plan and the North East London Joint Forward Plan highlight the importance of non-clinical, community-based crisis services that reduce the pressure on statutory services, emergency departments, and inpatient facilities. The Crisis Alternative will serve as a critical component of Waltham Forest’s mental health crisis pathway, complementing existing services such as the Walthamstow Community Hub.<br/><br/>Budget Available: £250,00 per year<br/>Contract Length: 2 year initial contract term with option to extend for a further 2 x 12 months <br/><br/>Service Model<br/>Access and Referral Pathways<br/>• Self-Referral and Third-Party Referrals: The service will be accessible to anyone aged 18+ in Waltham Forest, as well as referrals from family members, carers, VCSEs, and statutory services.<br/>• Hours of Operation: The Alternative will operate from 5:30 PM to 11 PM, five days a week, providing out-of-hours support to residents and then 2.00 PM to 10 PM at weekends and bank holidays<br/>• Locations: The service will be delivered at accessible and non-clinical community venues that offer support in the north, south and central of the borough <br/>• There will be strong pathway links with MIND in Whipps Cross Hospital/ICAH/NHS 111 press 2 and CREST <br/><br/>Service Delivery<br/>• Crisis Support: The service will provide a safe, non-stigmatising environment for immediate emotional support. The core interventions include:<br/>o Crisis listening and de-escalation: One-to-one sessions to help individuals manage their distress and reduce the intensity of their crisis.<br/>o Safety Planning: Development of personalized crisis management plans, including practical coping strategies and signposting to other services.<br/>o Peer Support: Trained individuals with lived experience will offer non-clinical, empathetic support.<br/>o Practical Support: Assistance with housing, financial, and employment-related issues that may be exacerbating the crisis.<br/>o Outreach and Culturally Sensitive Support: Proactive outreach to Eastern European communities, refugees, and individuals facing language barriers, ensuring communication in culturally appropriate ways through partnerships with local VCSEs.<br/><br/>Staffing<br/>The Crisis Alternative will be staffed by a combination of:<br/>Peer Support Workers from diverse backgrounds, trained in crisis management.<br/>• Mental Health Practitioners for complex case management and oversight.<br/>• Volunteers, particularly from local communities, including those with multilingual capabilities to support non-English speakers.<br/>• Particular care will be taken to encourage applications from people with local connection to the area, and who represent the diverse communities of WF. <br/>Crisis Alternative staff, and NELFT staff who will be interfacing with this service, will undertake Compassionate and Relational Enquiry (CARE) training offered by NELFT. Additionally, interfacing NELFT staff will receive training from Crisis Alternative colleagues around understanding and working alongside peer workers, and understanding the ethos and practices of the organisations delivering the crisis alternatives. This will support a more consistent approach and stronger working relationships.<br/><br/>Safeguarding and Risk Management<br/>• The service will implement robust safeguarding policies and risk assessment protocols to ensure the safety of staff and service users.<br/>• Strong partnerships with statutory services, including links with MIND in Whipps Cross Hospital/ICAH/NHS 111 press 2 and CREST and will facilitate smooth escalation for individuals requiring higher-level interventions.<br/><br/>Monitoring and Evaluation<br/>The service will be monitored using the following Info requirements and patient outcomes<br/>• Number of individuals accessing the Alternative on a daily/weekly/monthly basis.<br/>• Demographic data, including ethnicity and language, to ensure diverse community engagement.<br/>• Rates of successful crisis de-escalation and referrals to statutory services.<br/>• Reduction in ED presentations for mental health crises.<br/>• There will be a continuous process of seeking user and carer feedback to assess service satisfaction and cultural appropriateness, openly feeding back changes made as a result of this feedback. Data about who is and isn’t making use of the service will be used to target outreach and feedback-seeking to communities that are under-served and may benefit from increased access to the service e.g. homeless, refugee, disabled, LGBTQ+ and racially minoritised groups.<br/><br/>Value and benefits <br/>• Improving access to mental health support<br/>• Improve experience of people experiencing mental health challenges<br/>• Improve experience of carers supporting people with mental health challenges<br/>• Improve the outcomes for people who use the service.<br/>Ensure people receive the right care by the right service in the right place.<br/><br/>The service specific outcomes are.<br/>• Reduced demand on emergency services, particularly for anxiety and depression-related ED presentations.<br/>• Improved access to mental health services for underrepresented groups, including Eastern European and refugee communities.<br/>• Increased community resilience through empowerment and crisis prevention tools.<br/>• Enhanced collaboration between statutory and VCSE services in Waltham Forest.<br/><br/>The service specific outcomes are designed to ensure the café achieves a positive impact on the system as well as the quality of life of individuals. Outcome will require tracking of individuals’ use of the health system when the service us set up. All outcomes should enable efficiency cost savings through a reduction in referrals to Acute crisis mental health services and acute and emergency services.<br/>If positive financial outcomes are achieved, thought will then be given to how these savings can be re-invested in sustaining and further improving the wellbeing of the community.