Criteria for admission

Referral to rehabilitation services will be considered for:

• People who have had frequent or long term inpatient admissions and require a period of stability to enable them to achieve optimum recovery. 
• People with complex psychosis i.e. a primary diagnosis of psychotic illness (this includes schizophrenia, bipolar affective disorder, psychotic depression, delusional disorders and schizoaffective disorder)
• People who are detained under the Mental Health Act and under forensic detentions
• People who display some willingness to accept some responsibility for their care and recovery
• People whose previous engagement with services has been difficult or sporadic

Specifically, this service is for:

• Adults aged 18 - 65 years
• Usually service users with an enduring mental health diagnosis
• As a step-down for people who are transitioning from conditions of greater security (including forensic services or out of area placements) towards more independence in the community
• To provide engagement and an in-depth assessment of a person with complex psychosis:
  • as soon as it is identified that they have treatment-resistant symptoms of psychosis and impairments affecting their social and everyday functioning
  • wherever they are living, including in inpatient or community settings
  • In particular, this should include people who:
    • have experienced recurrent admissions or extended stays in acute inpatient or psychiatric units, either locally or out of area
    • live in 24 hour staffed accommodation whose placement is breaking down
• Ideally the service user should agree to the admission and be willing to work collaboratively with Forest Close but this is sometimes not the case and it is not necessary (and therefore should not be used as a reason for not accepting a referral)
• Unescorted leave should be trialled prior to admission to Forest Close
• Clinicians and teams can also make referrals for advice on assessment, diagnosis, risk, engagement, treatment, placement, care packages and other aspects of individual care of people with major and complex mental health needs

The team will use metrics to assess the demand for mental health rehabilitation services and the quality of response to referrals, which will include the number of referrals, time from referral to assessment and time from acceptance to transfer to Forest Close. The length of stay in each component of the service user rehabilitation care pathway and supported accommodation will help assess whether the whole system is working effectively. Similarly, readmissions and placement breakdowns will identify where discharge plans have not provided adequate support and the team will review and address the unmet component of the previous care plan.

Exclusion criteria

Although each referral will be considered individually, in most situations, the following will not be suitable for admission:

• Forest Close is not a specialist rehabilitation unit so where a service user has a primary diagnosis of EUPD, moderate cognitive impairment, organic nature i.e. dementia, acquired brain injury or eating disorder we would signpost to a specialist service.
• Young people under the age of 18
• Individuals who require support from rehabilitation teams but are able to live in the community for example with support from the Assertive Outreach Team or Community Enhanced Rehabilitation Team.  
• When the severity and imminence of a person’s risk to themselves or others is so high that they cannot be safely managed in a rehabilitation setting
• People who are not ready to abstain from illicit substances and are still actively engaging in heavy drug use
• People who have a high short term risk of suicide requiring intensive observations
• People who are still in an acute phase of their illness 

The current service user mix would also be taken into consideration at the time of referral.

If the referral is rejected the team will routinely provide suggestions for an alternative treatment and support pathway that is deemed to be more suitable as the next step in the person recovery.  

In addition to the above, we cannot admit unless the following criteria are met:

• Service user to be on no formal observations/engagement 
• No serious incidents or episodes of restrictive practice in the previous four weeks
• Unescorted leave to have been taken successfully for a period of two weeks in most cases
• Cannot be admitted with a Tribunal date pending
• Not in process of changing medication or acutely unwell