Keystones

A Message from Lord Pickles and Lord Blunkett, followed by Keystones's best practice article

The ability to listen and learn from one another has always been vital in parliament, in business and in most aspects of daily life. But at this particular moment in time, as national and global events continue to reiterate, it is uncommonly crucial that we forge new channels of communication and reinforce existing ones. The following article from Keystones is an attempt to do just that. We would welcome your thoughts on this or any other Parliamentary Review article.

Blunkett signature Rt Hon The Lord David Blunkett, MP
Pickles signature Rt Hon The Lord Eric Pickles, MP

www.keystonescare.co.uk

THE PARLIAMENTARY REVIEW
Highlighting best practice
28 | KEYSTONES
Directors Naomi Aksu, Neil
Mansfield and Michelle Healy
Art exhibition to showcase
services users’ work
Keystones is a high-needs mental health supported
accommodation provider with a specific focus on trauma-
based recovery. Directors Naomi Aksu, Michelle Healy and
Neil Mansfield all have substantial experience in mental health
care and they came together with a passion and belief that
most people suffering from enduring mental health conditions
can be rehabilitated in the community with the right ethos and
support. Naomi elaborates.
We believe that a holistic approach is essential, and we focus on recovery from
trauma. Using a person-centred approach, we carefully explore our services users’
goals, aspirations and challenges using a multidisciplinary team of therapists and
support workers. A wide range of therapies, including music, art and drama,
activities and communication styles have significant value in improving wellbeing,
and this is evidenced by the success of our service.
Our team use an open, optimistic, curious and explorative approach that includes
positive risk-taking, in order to emphasise service users’ skills and personal qualities.
Building trust is central to achieving progress, self-discovery and change, and open
and honest communication is integral to our working practices.
Standards and methods
At Keystones, all of our staff have achieved a high standard of professional
qualifications within their field – including psychology, occupational therapy and
social work – which enables us to work in a holistic manner. After 27 years in
FACTS ABOUT
KEYSTONES
»Directors: Naomi Aksu,
Michelle Healy and Neil
Mansfield
»Managers: Hannah Ralph,
Dave Whittaker and Hannah
McConnell
»Established in 2006
»Located in Horfield, Bristol
»Service: Supported
accommodation for adults
with significant mental health
issues
»No. of employees: 26
Keystones
29KEYSTONES |
BEST PRACTICE REPRESENTATIVE 2019
the field, it is clear to me that over
90 per cent of mental health service
users have suffered trauma. Despite
this, trauma is rarely addressed
in mainstream services. Our staff
undertake regular training on trauma-
focused approaches and these have
been highly successful in helping our
service users with enduring mental
health conditions to learn to relate
real-life traumatic experiences to
current anxieties, voices and paranoia.
This provides them with understanding
and meaning and helps to reduce
their fear, which is one of the main
obstacles preventing recovery.
We were involved in provider
consultation events leading up to the
recommissioning framework in Bristol.
We had regular council input into the
needs of service users with significant
mental health conditions. We are
highly regarded and regularly receive
positive feedback from service users
and mental health and social work
teams. I have regularly been requested
by Bristol City Council and mental
health providers to present on reducing
risk in mental health supported
accommodation, including sharing
our internal policies and procedures.
These presentations have been widely
appreciated and our procedures on
minimising risk are now utilised by
several organisations.
We take a collaborative approach,
involving service users and
multidisciplinary teams to plan and
carry out support in a dynamic and
empathic manner which focuses on
the “recovery model”. This enables us
to recognise the best strategies at each
stage of recovery.
Open communication is recognised as
an essential tool to reduce the risk of
relapse. The building of relationships
and trust are prioritised before work
towards trauma recovery begins. We
actively encourage service users to be
honest about their substance use and
avoid using a punitive approach as the
fear of repercussions can discourage
people from seeking support. When
working within the mental health field
it is essential to consider addiction as a
symptom rather than a cause.
Effective communication
All of our communication needs to be
direct and in person where possible,
as this develops good rapport and is
more productive. All of our staff are
open, honest, respectful, empathic,
non-hierarchical and non-authoritarian.
Collaborative communication between
all Keystones staff through daily staff
handovers ensures we can utilise the
range of individual experience and
skills our team possesses. This is also
an opportunity for reflection and
debriefing for staff, as our roles can
be emotionally challenging. Self-care is
important and it is discussed regularly.
This approach has many benefits,
including risk reduction.
We also maintain detailed, up-to-date
notes and use care and risk overviews
so that our care plans are current. With
service user consent these are shared
with others involved in their care,
such as family members, to ensure a
consistent approach.
Director Naomi Aksu
with service users
Our staff
undertake
regular training
on trauma-
focused
approaches and
these have been
highly
successful
THE PARLIAMENTARY REVIEW
Highlighting best practice
30 | KEYSTONES
Quick fixes are not working
Within high-needs mental health care
there are often crises and potential
for traumatic events. We successfully
navigate and overcome such events,
with the whole team pulling together
supportively. A critical incident plan is
essential to prepare for such events.
In 2016, Bristol community support
services were recommissioned to
make savings. We understand these
local cuts were necessary as a result
of reduced government funding in
this area, but we feel this decision is
misguided. Quick fixes may be cheaper
in the short term but are not cost
effective in the long term.
There are limited recovery resources
available for those with long-term
mental health conditions and as a
result, the cost of caring for this group
is likely to be ongoing for their lifetime.
Investing in rehab placements that use a
trauma-based perspective may be more
expensive initially, but there is evidence
indicating that savings will be made
in the long term through breaking
relapse patterns. This is reflected in the
success of our service in preventing
re-hospitalisation and thus saving the
government thousands in NHS costs.
Currently, community support
budgets are unable to cover the
costs of therapists and we receive
no funding for them. We fund our
qualified therapists from profits as
we understand it is an essential need
in trauma-based recovery. Providers
offering this level of rehabilitation are
extremely rare and while the five-year
NHS plan looks great in principle, the
resources are not available to put it
into practice.
We have been successful in
empowering our service users to
recognise early warning signs and
request help. Crisis support and
short-term hospital beds are extremely
limited and voluntary admissions are
rarely possible, leading to further
deterioration, often to the point that
the service user is detained under the
Mental Health Act. This increases the
length of hospital admissions and
risk to self, staff and community, and
can lead to the loss of housing and
placements.
Our vision
We hope to set up a network of like-
minded organisations in Bristol that
acknowledge the link between mental
health and trauma and promote
the option for service users to speak
openly and process their experiences
rather than short-term treatments. We
will continue to work with therapies
creatively and explore causes, rather
than just concentrating on symptoms.
Our journey is with the service user,
and we will continue to build trusting
relationships.
Lastly, we will communicate with local
councils and government in the hope
they will recognise the need to fund
companies that focus on trauma-
based rehabilitation and prioritise early
intervention and enduring mental
health conditions. This will lead to
substantial savings and bring benefits
to sufferers.
We will
continue to
work with
therapies
creatively and
explore
causes, rather
than just
concentrating
on symptoms
Using creative therapies
to express emotions

www.keystonescare.co.uk

The Parliamentary Review Publication, in which this article originally appeared, contained the following foreword from The Rt Hon Theresa May MP.

The Rt Hon Theresa May MP's Foreword For The Parliamentary Review

By The Rt Hon Theresa May MP

British politics provides ample material for analysis in the pages of The Parliamentary Review. For Her Majesty’s Government, our task in the year ahead is clear: to achieve the best Brexit deal for Britain and to carry on our work to build a more prosperous and united country – one that truly works for everyone. 

The right Brexit deal will not be sufficient on its own to secure a more prosperous future for Britain. We also need to ensure that our economy is ready for what tomorrow will bring. Our Modern Industrial Strategy is our plan to do that. It means Government stepping up to secure the foundations of our productivity: providing an education system that delivers the skills our economy needs, improving school standards and transforming technical education; delivering infrastructure for growth; ensuring people have the homes they need in the places they want to live. It is all about taking action for the long-term that will pay dividends in the future.

But it also goes beyond that. Government, the private sector and academia working together as strategic partners achieve far more than we could separately. That is why we have set an ambitious goal of lifting UK public and private research and development investment to 2.4 per cent of GDP by 2027. It is why we are developing four Grand Challenges, the big drivers of social and economic change in the world today: harnessing artificial intelligence and the data revolution; leading in changes to the future of mobility; meeting the challenges of our ageing society; and driving ahead the revolution in clean growth. By focusing our efforts on making the most of these areas of enormous potential, we can develop new exports, grow new industries and create more good jobs in every part of our country.

Years of hard work and sacrifice from the British people have got our deficit down by over three quarters. We are building on this success by taking a balanced approach to public spending. We are continuing to deal with our debts, so that our economy can remain strong and we can protect people’s jobs, and at the same time we are investing in vital public services, like our NHS. We have set out plans to increase NHS funding annually by an average by 3.4 percent in real terms: that is £394 million a week more. In return, the NHS will produce a ten-year plan, led by doctors and nurses, to eliminate waste and improve patient care.

I believe that Britain can look to the future with confidence. We are leaving the EU and setting a new course for prosperity as a global trading nation. We have a Modern Industrial Strategy that is strengthening the foundations of our economy and helping us to seize the opportunities of the future. We are investing in the public services we all rely on and helping them to grow and improve. Building on our country’s great strengths – our world-class universities and researchers, our excellent services sector, our cutting edge manufacturers, our vibrant creative industries, our dedicated public servants – we can look towards a new decade that is ripe with possibility. The government I lead is doing all it can to make that brighter future a reality for everyone in our country. 

British politics provides ample material for analysis in the pages of The Parliamentary Review 
The Rt Hon Theresa May MP
Prime Minister