Patients may be referred for out-of-area (OOA) placements for a variety of reasons, including a lack of local service provision to meet the requirements of patients with complex or longer-term needs. OOA placements can lead to patients experiencing social isolation from family and friends, as well as disjointed access to local services. In addition, placements can be costly in comparison with locally provided services. Mental health Intensive Support Team (MhIST) is a specialist community rehabilitation service within Cheshire and Wirral Partnership NHS Foundation Trust which was established in June 2021. Although the team does not have specific diagnostic inclusion criteria, patients referred will typically have a high level of complexity in addition to severe, treatment refractory symptoms and impaired social, interpersonal and occupational functioning.

We analysed routinely collected data to explore two methods by which MhIST is reducing referrals for OOA placements including i) direct diversion of patients who would otherwise have been referred for OOA placements to the community with MhIST support, and ii) facilitating discharge from local high dependency inpatient rehabilitation services in order to improve patient flow, which in turn additionally enables repatriation from pre-existing OOA placements.

We identified a cohort of 33 patients who had been supported by MhIST for ≥3 months. This cohort includes seven patients who would otherwise have been referred for an OOA placement. Further analysis for this group showed that initial referrals to MhIST were received from community mental health teams (CMHT) (n=1), acute inpatient wards (n=4) and high dependency inpatient rehabilitation services (n=2). Two patients (29%) were discharged to supported accommodation, and five (71%) were discharged to independent accommodation. Within the wider patient cohort identified (n=33), 66% of patients are living independently in the community.

In total, 13 patients have been discharged from high dependency inpatient rehabilitation services to MhIST during the review period.

MhIST uses a multi-disciplinary model which offers an intensive level of support and a high frequency of interventions. The team includes support workers, nurses, doctors, occupational therapists, psychologists and social workers, and in addition links with other community services involved in housing, employment and social projects. A bespoke and flexible approach allows complex needs to be addressed within local services, and here we highlight the role of MhIST in reducing referrals to OOA placements.