The Tidal Model Project Calderdale

Graham Peace is based at The Dales Mental Health Unit, Calderdale Royal Hospital, Halifax, West Yorkshire.

Grahame writes: In April 2004 like many others, our service area underwent major changes with the closure of one of our two acute wards and the setting up of the Crisis Resolution Home Treatment Teams (CRHTT) this process occurred in all four localities of our Trust, which is the South West Yorkshire Mental Health NHS Trust. .

 I recognised that the culture on the ward needed to change to support the service modernisation process and was charged with this task. I had been introduced to Professor Phil Barkers Tidal Model when I was involved with the Northern Centre’s Mental Health Collaborative in the late 1990's. I decided that this might offer the ward/service what we needed due to its focus on recovery and service user involvement.

2004

In June I set up a project group consisting of ward and community staff, workforce development, PALS, service users, our service user representatives and our clinical governance support team to help me oversee the Tidal Models development and implementation in our locality. I decided that if the model was to be successful, I needed to adopt a whole systems approach.

I developed a series of detailed presentation and written information that I presented for our Clinical Governance Strategy Group and Consultants Advisory Group, I then visited all the Community Mental Health Teams (CMHT), Assertive Outreach Team, Housing, Day Services, Occupational Therapy, ECT, Service User Groups and our CRHTT to try and gain their involvement with the models implementation. Our colleagues over in Huddersfield became aware of the project and asked if they could join with a view to developing the model in their area. In addition, we purchased the Tidal Model Manual and training videos.

We visited Doncaster after they had been mentioned in Mind Ward Watch campaign re their work with Activity Co-ordinators and out of hour’s activity. From that visit we now work closely with our Occupational Therapy staff and have changed the Health Care Assistant role so that it has a stronger focus on activity and engagement. We close the ward Monday to Friday for two hours during the day to visits to allow therapeutic work to take place; ward closure does not affect patient admissions to the ward.

 We continue to make improvements to the ward environment with the introduction of a housekeeper, administrator and minor structural changes to create more private areas to support activity and engagement on the ward. We also have a small weekly budget to support the activity/engagement process.

The Tidal Model offers a framework for service delivery based around recovery and optimism, we have included in this, work on advanced directives/statements to support service user involvement and the recovery/engagement process, this is popular with service users and helps to pull the community and day services workers into the Tidal Model project.

2005

We launched the Tidal model in my area on 31^st January 2005; we developed a training day for staff that is an on-going process that started in February 2005. As we work with the Tidal Model it continues to develop along with the whole spectra of evidence based practice in Mental Health or practice based evidence, as I prefer to see it. One of the developments we have made are core care plans, as we found that the daily care plans needed a focus, we also wanted to develop care plans that represented the Tidal Model’s 10 commitments and domains.

I do not consider myself to be a Tidal Model expert, but as Tidal Model Project lead is only one of many hats I have to wear as a modern matron I’m pleased with the progress we made, but there are still challenges that we need to address. On another positive note, I was very fortunate to be invited out to the health authority in Gibraltar to talk about the Tidal Model and our project, as they are very interested in the Tidal Model as many countries are around the world.

What have I learned?

You need strong leadership and commitment. Team’s and individuals must have a can do, try-try-try again mentality to ensure the model is implemented and practiced, I’ve heard staff say we don’t have enough time or staff etc, but I do believe that quantity is not always the issue, (people will always consider that they do not have adequate resources), having a core group of staff with real commitment is. You also need support at senior levels within the organisation as the Tidal model like any recovery-focused approach has resource commitments and challenges, and it has to work alongside the organisations’ systems, policies and procedures etc. In addition, it is important to have a rolling programme of training due to staff turnover. Lastly, as it says in the Tidal Model, change is constant and as Tidal Model practitioners you must embrace this and see change as a real opportunity.

The Tidal Model must keep on developing if it is to continue to offer contemporary mental health care into the future.

Contact: Grahame Peace  

Email: Grahame.Peace@swyt.nhs.uk

Address: The Dales

Calderdale Royal Hospital

Salterhebble

Halifax

HX3 0PW

United Kingdom

Tel (00 44) 01422 222890