REBUILD (Post-Detox) Pathway

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Stabilisation-based, intermediate rehabilitation care beds for people who are homeless or at risk of homelessness, following in-patient substance misuse detoxification or stabilisation.

Mildmay is a provider in the Pan-London Substance Misuse Programme, part of the Homeless Health London Partnership.

Transformation Partners in Health and Care Homeless Health London Partnership page

Care pathway

We provide SEVEN Intermediate Rehabilitation beds for people who are sleeping rough or at risk of homelessness, following in-patient substance misuse detoxification or stabilisation. The service comprises of private ensuite rooms located within a dedicated section of the ward to maximise peer support and create a safe environment conducive to recovery.

Our patients receive support and expert care from a full multidisciplinary team throughout their treatment journey, from initial referral through to discharge and aftercare.

Our model of care is to restore a person’s independence and facilitate motivation towards recovery. Each person is fully involved in planning their care, which is tailored to:

Take personal preferences and individual circumstances into account.
Meet the specific medical and psychological needs.
Generate a sense of ownership.

A daily programme of one-to-one and group interventions provides meaningful occupation, whilst evidence-based psychosocial input engenders a deeper understanding of substance misuse and improves motivation to rehabilitate.

We aim for the programme we offer to be varied, and in addition to health promotion and talking-therapy sessions, we provide holistic input such as art therapy, access to gym groups and access to spiritual support.

AIMS

Build on the outcomes from IPD and support sustained treatment, engagement and recovery
Deliver a safe and supportive intermediate rehabilitation residential setting
Provide sufficient varied and skilled clinical and psychological assessment and intervention to maximise positive treatment and recovery outcomes
To manage different aspects of care for alcohol and/or drug abstinence or stabilisation, associated medical pathology and improving physical and psychological health and wellbeing
Participate in a multi-disciplinary partnership with London LAs, IPDs, community substance misuse teams, London Homeless Substance Misuse Enagement Team, rough sleeping teams, housing, specialist general health services (i.e. hepatology, respiratory, alcohol related brain ), mental health services, social care services, safeguarding, domestic abuse services and tertiary care to provide a holistic service for people who sleep rough/in hostel accommodation/risk of reurn to the street
Place service users at the centre of delivering holistic care, promoting health, well-being and life chances
Raise the aspirations of service users and lower barriers to care to strengthen engagement with treatment by building trust and understanding in the service provided.

Discharge planning

We liaise with external organisations such as inpatient detox facilities, rehabilitation units, homeless hostels, community drug and alcohol teams, community mental health teams and homeless pathways teams in relation to each individual patient, ensuring that each discharge is planned carefully with the patient’s input and consent and that patients continue to access the best possible support, dependent on their individual circumstances.

Our Admissions Manager, Social Worker and Substance Misuse Recovery Worker, in particular, have well-established links with relevant agencies.

Formal and informal service user feedback mechanisms will continue to ensure expert involvement in the design and delivery of a safe, accessible, and effective service and we will continue to work with individuals in our care to embed continuous improvement.

Admission criteria

Patients can be admitted to Mildmay Hospital following detoxification treatment at acute centres in London like the Addiction Clinical Care Suite (ACCS) for homeless people at Guy's and St. Thomas’s Hospital.

Intermediate rehabilitation support is provided for people who are sleeping rough, or at risk of sleeping rough (following in-patient substance misuse detoxification or stabilisation, usually at the ACCS).

Intermediate rehabilitation beds are available:

if a Local Authority is unable to access a suitable residential rehabilitation facility at the time of referral to ACCS.

for those requiring on-going assessment and care post a ACCS stay i.e. additional support to manage co-existing physical and mental health needs/ongoing social care assessment.

Referrals

Referrals for intermediate rehabilitation care beds are made by the Lead Contact within each Local Authority substance misuse team. Lead Contact details are listed in this spreadsheet. Please note: Lead Contacts in each Local Authority will have approval to make referrals and agree on funding packages.

Stabilisation-based beds provided by Mildmay Hospital

As with access to the ACCS, referrals for the Intermediate Rehabilitation beds are made by the Lead Contact within each Local Authority substance misuse service.

Copy in: admissions.mildmay@nhs.net to your In-Patient Detoxification (IPD) referral to ACCS or another IPD provider.

The Mildmay Hospital Admissions Manager (Direct telephone line: 020 7613 6347) will liaise with the Lead Contact and ACCS or other IPD to facilitate a timely and seamless transfer of care.