Safe spaces: scoping report

Annex A

Safe Spaces: Current Examples

Crisis Centre (Edinburgh)

The Edinburgh Crisis Centre is run by the Third Sector Organisation Penumbra and opened in 2006, the service was commissioned due to a gap in provision being identified where there was no out of hours provision for individuals in mental health crisis and distress and requiring non clinical support. This was the first service of its kind to open in Scotland. The service is aimed at over 16’s resident in the City of Edinburgh. Emotional support is provided on a 24-hour basis either via telephone, text, e-mail or in person and an agreed support approach is in place to determine the most appropriate input or advice for onward referral. The centre works hard to link into a whole host of community supports, having strong local links with e.g. Community activity services, GP link workers, Social Prescribers, welfare officers, homelessness workers, Police Scotland and mental health services both statutory and voluntary.

The crisis centre provides 24/7 telephone, email, text and face to face support for individuals experiencing crisis and distress. Use of telephone and text message is the most common method of contact and ongoing engagement. The service does not define crisis and distress, noting that if the individual identifies as being in crisis and/or distress the service will support them. The service is open to working with individuals who are substance affected however, the person needs to be able to engage in the discussion.

Where support is not provided on site a follow up appointment may be offered the following day. In an instance where the individual on site is both being substance affected and actively suicidal and therefore a safety concern, the service will look to hold the individual until Police Scotland are able to collect them and consider community triage or using the Legal Place of Safety.

The service has contact with around 150 individuals each month, over half are new callers who have never used the service. Often repeat users have a break of a week, month, year before re-engaging. The service does have a small number of individuals who seek support every day and the focus is on finding longer term services such persons can receive support from more appropriately. Generally, the centre works hard to promote engagement with other service providers as the crisis centre wishes to empower individuals to navigate a crisis. This can be challenging when some individuals’ lives are challenging, and they identify as in crisis every day.

Appointments on the same day or night can be scheduled with a secure door entry system in place for safe staffing protocols. On occasion a contract taxi can be sent to bring the individual to the centre, this mainly happens in the evenings. The service has a ratio of 1 staff member per 2 service users on site (in person). On each shift, there are 2 staff members, the service then is limited to supporting 4 service users on site at any one time. Due to the nature of short-term support provision capacity for on-site support at short notice at the centre is able to be maintained consistently. The centre is currently going through changes in regard to Care Inspectorate registration requirements. Currently staff are required to review an individual’s on-site support every 8 hours with the longest period of on-site support being 48 hours approx. However, follow up support by phone etc still remains available. Discussions are ongoing regarding the centre registration and assistance in implementing a more flexible registration status has been requested.

The service is run on a self-referral basis however partner agencies such as the Royal Edinburgh Hospital can support individuals to make their self-referral,.

The service is funded by the Edinburgh Health and Social Care Partnership, overall, the model works particularly well in Edinburgh due to a high density and fluid population, in a high demand area for mental health support.

Hope Point, Wellbeing Support (Dundee)

Hope Point aims to be a place of safety providing a relaxed environment which is comfortable and welcoming. The space is a psychologically informed environment which promotes relaxation and calm. The centre is run by Penumbra and is a new service which is available 24/7 for those experiencing emotional distress. The service had a soft launch on July 31st 2023 and launched in August 2023.

The local Third Sector Interface Dundee Volunteer and Voluntary Action facilitated engagement from local people, third sector organisations, NHS health and Wellbeing, Community Health Inequalities and Team networks. A total of 68 people participated in the engagement and contributed to the design of the centre. Discussions around access, quality of care, user experience and available services were all captured by the engagement process and helped shape the service.

The wellbeing centre is welcoming, easy to access and focussed on reducing distress and promoting mental health and wellbeing. Support is directed by individual needs and connects to a range of community-based resources and statutory services. Structured conversations with trained practitioners will provide a quick and compassionate response. To support each person as effectively as possible the service will operate 24/7 and support will be available at a time and format of their choosing. Conversations can take place face-to-face, , by phone, or text.

The Hope Point team have employed Peer support workers who bring their own lived experience with them. Having people with lived experience in Hope Point, was strongly advocated during the planning and consultation phase with stakeholders.

The centre utilises skills of active listening allowing the staff to assess the current situation, identify personal goals, strengths, risks and barriers and finds steps forward. If the person would like any family or friend involved this will be facilitated.

The centre offers; safety planning, wellness recovery action planning, self-management tools, anxiety management programme, cognitive behavioural toolkit, support to access on-line CBT, referral to group support, connecting to community resources, connecting to specialist services, wellbeing workshops and step-up referral to other agencies. Staff are trained in safeguarding procedures and pathways are being developed with NHS 24, Police Scotland, Scottish Ambulance Service, Carseview, DBI Tayside and those providing short term accommodation.

The Dundee Mental Health Paramedic Unit (Triage cars, Scottish Ambulance Service) links closely with the Hope Point team and discussions have been had surrounding possible co-location in the future.

Hope Point, in recognition of registration challenges, has instead partnered with Hillcrest Housing Association to provide accommodation (they are situated in the local community). Hope Point operates a similar staffing ratio to the Edinburgh Crisis Centre.

Hope Point have had 2466 contacts in their first 8 months of opening (Aug 2023 to March 2024), supporting 728 people, with over 1573 contacts made through self-referral.

58% of people access the support between 8 am and 6:30 pm Mon - Sun.

48% of people accessed support in person, 46% by telephone, and 6% via text message.

Hope Point does not operate a referral system however data is collected on how people hear about the service and includes a range of stakeholders, with the third sector, primary care, and Police Scotland among the top cited . We will continue to monitor referral numbers as part of the wider data work on unscheduled care.

Where appropriate, a distress measure is used where people self-rate the degree of their distress on a scale of 0 to 10. This takes place at the start and at the end of an intervention with Hope Point staff. 94.5% of people receiving support from the centre saw a decrease in their score. The average service user saw a decrease in their distress rating of 4.01 points.

A year-end report will be published in the Summer of 2024, after the service has been operational for a year. A formal evaluation will take place, timescales TBC.

‘Invisible’ support was provided in the initial launch stage from a Senior Social Worker and Clinical Psychologist to support the team with establishing thresholds and initial partnership arrangements. The overall requirement for input was low and reduced accordingly.

Robust working relationships still exist so the team can seek advice and support if required. The Service currently utilises an agreed pathway with the Crisis Resolution Home Treatment Team (CRHTT) based at the Carseview Centre. This allows for clinical advice and assessment if required on a 24/7 basis. An initial triage of the referral would be carried out over the phone with a face to face assessment arranged if deemed necessary. A member of Hope Point staff will accompany the individual if they consent to this.

Links with other statutory Services including Social Work, CMHT and Learning Disability Teams allow contact with duty workers if the staff team have concerns surrounding an individual. The team participates in multi-agency case conferences where high risk or need is identified.

The Neuk (Perth and Kinross)

The Neuk is a community based peer led service in Perthshire offering a therapeutic space where people can come and feel emotionally safe, supported and receive person-centred help for their immediate mental health needs during a crisis.

The service supports people aged 16 and over in Perth and its surrounding areas experiencing distress or a mental health crisis, who are at risk of suicide or self-harm. The Neuk originally opened 24 hours a day, 365 days a year and previously had an option for those assessed as in need to stay overnight. This is no longer provided as funding was aligned to have the centre available when there is consistent demand. Support is now available from 9am until 9pm seven days per week. The Neuk receive 75% of their referrals during normal operational hours of 9-5 Monday to Friday, with 53% of the service users being male and 47% female.

When a person initially reaches out for help from the Neuk they are supported by peer workers with lived experience of mental health issues, known as ‘Wellbeing Mentors’. They use non-judging, compassionate interpersonal skills and lived experience in a way that engenders trust and reduces distress. This initial contact aims to develop a trusting relationship that enables people to tell their stories, explore their current situation, make choices, and share decisions about the care and support they need.

Wellbeing Mentors carry out a collaborative assessment which includes assessing the risk of self-harm or suicide in the context of wider risk factors, such as the person’s history of previous attempts, and other risk factors including hopelessness and substance use. Together they develop a person-centred plan that will help manage their distress and potentially their suicide risk. This will often entail a safety plan to identify coping strategies, maximise strengths, and other personal or community resources to reduce the risk of harm and involve family, friends, or carers where possible. Where risk or healthcare determines, Wellbeing Mentors will seek further intervention from NHS mental health services, or the police

The Neuk offers 6 wellbeing sessions to those who repeatedly seek support from the service, with the aim of assisting the individual to develop decider skills which aim them in stabilising their emotions. The Neuk also implemented the Timothy Agnu model of Emotional Regulation Pathway involving Decider skills for responding to repeat attenders.

The Neuk’s support can be accessed through three routes.

• Self-referral during times of urgent need by phoning, texting or attending the Neuk.
• Police Officers or paramedics responding to an emergency can bring individuals experiencing suicidal thought, or distress to the Neuk.
• Health service providers refer people for immediate same-day support.

The Neuk have worked in collaboration with Police Scotland and developed information sharing protocols which includes a safe handover from Officer to Neuk staff and vice versa if behaviours are escalating and Police support is required. If the individual is affected by substances, unable to meaningfully engage and the risk of harm is low, the Neuk will offer pro-active follow-up the following day instead of attempting to engage with the individual at the time of presentation. The Neuk also works in collaboration with the Scottish Ambulance Service, the Community Mental Health Team and the local psychiatric hospital supporting in the assessment process and sharing of information.

The overarching philosophy of the Neuk is crisis support that incorporates the principles of peer-to-peer, recovery-focused, and trauma-informed approaches. The Neuk centre also uses its expertise to deliver a programme of suicide intervention, prevention and safety planning training for local community-based workers who may come into contact with people in distress and crisis. This is a one-day course endorsed by NHS Tayside and is facilitated in-house by Neuk staff. In 2022, they delivered training to 150 community-based workers.

An independent evaluation ‘A Safe Place: The Neuk Mental Health Crisis Centre^[31]’ published in February 2023, demonstrated positive impacts from the perspective of service users, staff and partner organisations.

The Lighthouse (Perth and Kinross)

The Lighthouse is a Perthshire community based service offering crisis support for anyone aged 12–18, in their city centre based crisis centre and in school and who is at risk of self-harm, suicide or emotional distress or crisis. The service is available Monday–Friday 10 am–4 pm and outside of these hours provides a crisis line available 7 days per week, 10 am – 10pm. The Lighthouse is a safe space for all, providing a non-judgemental, welcoming and calm environment. The lighthouse provides a crisis line which is available to support adolescents with self-harm and suicidal behaviours, with the option of sign posting if appropriate, to services such as CAMHS. The Lighthouse also provides practical crisis intervention and crisis management support empowering the individual to craft their own safety plan which they create with staff support. The Lighthouse promotes a ‘whole family support’ model where parents/carer/siblings are able to access support and resources to ensure sustained recovery is wrapped around the whole family.

Referrals into the Lighthouse are made with the individual’s consent, guidance teachers can refer on the individuals behalf or self-referral is accepted. Individuals can call the service, Facebook message or email in. The Lighthouse work in collaboration with the 11 high schools in the Perth and Kinross area accepting referrals for the whole of the Perth and Kinross area. The service visits all 11 schools and run one-to one sessions. Sessions include; crisis management support and planning sessions, sessions which are focused on developing coping mechanisms and harm reduction strategies, providing learning about what’s happening the brain with anxiety, panic attacks, and low mood and information sessions on allowing the time and space to learn how to keep safe, and healthy.

The Time, Space, Compassion case study^[32] further explores how practice supports young people at the Lighthouse.

Woodland View (Ayrshire and Arran)

NHS Ayrshire and Arran have officially opened a nurse-led Mental Health Assessment Hub at Woodland View in Ayrshire and Arran's Ayrshire Central Hospital. The aim of the hub is to better support patients by avoiding the need for acute admission.

A proposal was drafted and outlined that the service will provide a safe space for adults over the age of 18 and under the age of 65. The service aims to promote recovery, self-regulation and the development of skills to manage distress/crisis. The Hub will have access to 5 beds with a maximum stay of up to 72 hours. The hub will have Band 7 Advanced Nurse Practitioners from the ANP Team and Band 6 Charge Nurses and Band 5 staff nurses from Intensive Community Psychiatric Nurse Team running the service. If an individual’s presentation escalates and a detention needs to be considered, the hub will have access to sector or on call consultant and junior doctor cover if required. The Hub is also ensuring policies for transferring a patient to acute care if their physical health deteriorates.

The service will offer intensive assessment and minimise length of stay, only considering an overnight stay, if necessary. It will also provide lockers for individuals to store their items while at the Hub, giving access to a kitchen for self-service of hot drinks and lunch. The proposal aims to move away from a ward setting and will emphasise the role of providing intensive assessment and treatment in a controlled environment to enable the individual to move on to the best option for ongoing care, treatment and support as soon as possible.

An opportunity arose to test out the Hub under operational conditions, over a 4-week period with 2 of the 5 beds, through a soft launch in early 2024.

Care was taken to ensure it was not perceived as a traditional inpatient environment and the purpose of the Hub was clear; providing a short term 72-hour service to determine the next steps for individuals, rather than a long-term acute unit. The aim is to create a more community focused experience for people by using people’s own medication within the Hub and provide an opportunity to get to know their local community Intensive CPN team members, who would assess and treat individuals in the Hub and if identified as the best option could continue their support at home.

Good communication between staffing teams was essential for handovers for patients who were moving to another inpatient unit or discharged home. Capacity did not become a concern during the soft launch. The Hub received assistance from colleagues who are developing the new Forensic CAMHS Unit in Ayrshire and were able to utilise Band 3 Healthcare Assistants. This role was considered beneficial, consideration is therefore being given to making this a core role within the Hub.

Unscheduled care teams have exclusive access to the Hub. The care outcome breakdown of the 15 admissions during the 4-week period; 30% transferred to acute services, 38% to intensive services in the community, 23% to existing care, and 9% to GP. No one stayed in the Hub for the full 72 hours, and most people left in under 30 hours.

Patient feedback was available via a QR code on leaflets, this was not utilised during the 4 weeks, but positive feedback was received from staff, patients, and relatives through paper feedback.

The service recently fully launched in September 2024, it will be helpful to monitor and evaluate the benefits in due course.

The Haven (Edinburgh)

The Haven[33] is based at The Fraser Centre in Tranent. Developed by Edinburgh Children’s Hospital Charity (ECHC), it is a well-being and resilience service to families living within the catchment area of Ross High School.

It aims to support families with children struggling with their mental health, and to prevent problems escalating to the point where professional intervention is needed. The Haven is open to any child or young person with a mental health concern, and to any member of their family. It offers support in a relaxed and informal setting and provide interventions including family support groups, signposting, fun activities and a drop-in service for those who may just need a cup of tea and a listening ear.

The Haven will be piloted in Tranent for two years to ascertain demand and its success. It is modelled on the charity’s existing hospital “Hub”, which delivers similar interventions to children and families visiting Edinburgh’s Royal Hospital for Children and Young People (RHCYP).

Chris’s House (Wishaw and Dalkeith)

Chris’s House^[34] stands for ‘Centre of Help, Response and Intervention Surrounding Suicide’ and has been set up to offer a safe environment where people in, or approaching, suicidal crisis can have a safe place to go and get professional counselling support. The service has two centres one based in Wishaw (North Lanarkshire) and the other Dalkeith (Mid Lothian). Both services have varying opening hours with some evenings operating until 9 – 10 pm. The service also provides a crisis phone line with is accessible 24/7. The service is a non-medical crisis centre which offers integrated support.

It offers cosy rooms, carefully designed to offer guests an environment they can feel comfortable in. The service offers an individually tailored programme for each user, being assigned to a volunteer who will develop a strong rapport to help them through the crisis and support them to counter depression, negative and despairing thoughts and exchange reasons for dying with reasons for living. The centre utilises active listening and offers appropriate therapies on a short-term basis, to aid individuals in distress to start in their recovery journey. The service also works in partnership with other established agencies to offer the best possible ongoing care.

Mikey’s Line (Highland)

The Hive^[35] Inverness, or The Hive Project as it was originally known, first out of hours mental health crisis centre, is based in Inverness. It provides a safe place to those who are in need of it and offers face to face support aimed at reducing social isolation, supporting people to maintain their mental wellbeing, supporting people with their mental health or emotional issues and for those in crisis. They also have outreach Hives Easter Ross, Tain and Alness and Nairn.

The website describes the service providing free, impartial, confidential and non-judgemental support for anyone to attend on their own, or accompanied, if preferred on initial visits. Staff and volunteer support workers will listen, support, guide, advocate where needed, signpost where appropriate and provide other support, including with coping strategies for the future.

Appointments are made by booking by telephone or email and opening hours range depending on the hive between every day to 1 day and hours between 16:00 – 21:45.

Mikey’s Line also provide text and Multimedia support for adults and young people, as well as bespoke in-person young persons service (age 11-24) and undertake prevention and anti-stigma work.

The Stafford Centre (Edinburgh)

The Stafford Centre^[36] is a drop-in service offering a safe environment to relax in the company of others and begin to build supportive networks. The centre aims to offer help from when the individuals first walks through the door and provides guidance on the best activity or support for recovery. The centre has many welcoming and supportive groups which build resilience to improve skills, confidence and promotes decision making. They offer many creative and wellbeing activities, from art sessions to an outdoor walking group, and a main café area where service users can chat and feel welcomed by building supportive networks.

The Stafford Centre provides access to counselling, providing a safe and confidential space for individuals to talk about the challenges they are facing, receiving advice on their welfare rights, and practical and emotional support for carers experiencing poor mental health. The Centre also runs the Signature Project, also provides support free from judgement to men with Post-Traumatic Stress Disorder (PTSD), and the Veterans Community Café is run by veterans for veterans and their families to offer peer support and a safe space to chat.

The centre is open 9:00-16:00, Mon- Fri.

Evening/overnight Street Teams

There are number of services across Scotland, such as Street Assist in Edinburgh and Street Aid in Glasgow, providing medical and welfare aid which aim to reduce vulnerability within the night time economy, making sure the people receive immediate support and return home free from further harm.

Street Aid^[37] in Glasgow is a pre-hospital medical and welfare charity helping tackle the pressures on both the ambulance service and EDs by providing on scene care in the city centre of Glasgow helping people get the right care from the right place. Their volunteers come from all walks of life and take on different roles with the charity from being a control room dispatcher, fundraiser or building support worker to being a part of their medical street team.

The specialist medical street team volunteers come from a range of backgrounds including first aiders, first responders (FREC 3 and FREC 4), Ambulance technicians, Registered nurses and paramedics, doctors and students within different healthcare fields.

They operate Friday - 19:30 to 04:00, Saturday - 19:30 to 04:00, and Sunday from 19:30 to 00:00 (Under review) in Glasgow City Centre.

They also work during big events such as music festivals or other events that bring lots of people into the city centre. We work with partner agencies to help provide cover to the city on those dates.

Other Safe Space (not specially targeted at mental health)

Café Kweer (Edinburgh)

Café Kweer^[38] is a sober safe space for the LGBTQ+ community. The space aims to add to the LGBT+ landscape of venues identifying a gap where most LGBT+ venues are centred around alcohol consumption and loud music. The space is provided to anyone to use, it provides a space for book clubs, to stitching groups, to just a coffee and cake evening.

Hot Chocolate Trust (Dundee)

The Hot Chocolate Trust^[39] is a city centre youth work organisation in Dundee supporting 300-400 young people each year with their journeys into adulthood. The Hot Chocolate Trust work with young people, aged 12-21, who hang out in the city centre and offer a safe and warm place for them to engage in various activities. Three open door youth work sessions are held every week (Tues & Wed 7-9pm and Sat 3 -5pm) and include relationship building and activities from mental health and wellbeing to music and art to sports, games, activism and cooking.

The activities are decided by the young people and trust aims to deliver and meet their needs. From these sessions grow individual support with youth workers, group work, employability support, creative arts and lots more opportunities. The Trust blends responsive, holistic youth work with specialist work and resourcing (e.g. creative arts, education, employment and training support, activism) to maximize young people’s participation, agency, responsibility and outcomes.

Simons Community Women’s Emergency & Supported Accommodation Services

Simons Community have been providing specialist services to women experiencing, or at risk of homelessness^[40], for many years. The service has been run by women, for women, housing & homing 55 women every single day & night through their emergency and supported accommodation services. They also operate Street Teams, Hubs, outreach teams, Housing First and SCS Homes.

Glasgow - They have four women’s supported accommodation sites (39 beds) across Glasgow. This includes two sites (with a total of 16 flats) where women can live independently in their own flats but access 24 hour support from their team who also have a flat on site. They also have an eight bedroomed townhouse, all en suite, with communal living areas and a 15 bedroomed townhouse, all en suite, with communal living areas used for emergency accommodation.

Edinburgh - Working in partnership with City of Edinburgh Council and Cameron Guest House Group their team run a 12-bedded emergency accommodation service for women in Edinburgh that provides support 7-days per week. Their Street Team has direct links to this accommodation, ensuring that they can immediately refer women into this safe place as quickly as possible.

Lanarkshire - They have four self-contained bungalows promoting independent living to four females. our team also have a bungalow on site. The service provides intensive housing support to women who have experienced homelessness, trauma, mental health and addiction issues inclusive of challenging behaviours and chaotic lifestyles.

Simons Community Access Hubs

The Access Hubs^[41] are places where anyone experiencing, or at risk of, homelessness can drop in for information, advice, care and support. This can include help with benefits, health, finances, legal advice, access to the digital world and more.

The Hubs are intended to be one-stop shops, saving time and making it much easier for people to get the support they need, under one roof. They have a Support Hub in Edinburgh and Glasgow. No appointment is necessary.

They run multiple classes throughout the week including; welfare rights, benefits advice, legal advice, health clinics, education classes, barbers and much, much more.

Penumbra Milestone: step down unit for people with ARBD

Penumbra Milestone is a step down unit for people with ARBD^[42] who no longer require medical intervention yet they are currently in an acute hospital setting and cannot go directly home with support.

They provide intensive, multidisciplinary support and treatment to improve outcomes for people with ARBD who are in acute hospital in Lothian, and reduce the number of days that people with ARBD spend in acute hospital settings despite no longer requiring acute medical care.