Embedding Recovery to Transform Inpatient Mental Health Care: The 333 Model

Article


Kar Ray, Manaan, Lombardo, C., Syed, Zahoor, Patel, Nitin, Denman, Chess and Jones, Peter B. 2019. Embedding Recovery to Transform Inpatient Mental Health Care: The 333 Model. Psychiatric Services.
AuthorsKar Ray, Manaan, Lombardo, C., Syed, Zahoor, Patel, Nitin, Denman, Chess and Jones, Peter B.
Abstract

Objective:

The 333 model is a radical redesign of acute mental health care. Time-limited inpatient pathways for assessment (≤3 days), treatment (≤3 weeks), and recovery (≤3 months) replaced traditional geographical-sector wards. By making beds available, 333 aspired to improve access, deliver early treatment, and shorten hospital stays—generating savings through reductions in beds and out-of-area placements (OAPs). This article compares the model’s performance against national benchmarking and internal targets.
Methods:

The complement of general adult beds (2011–2016) was mapped out. Patient flow data (April 2015–March 2017) were extracted from the National Health Service data warehouse and compared with 2016 NHS benchmarking and 333 targets.
Results:

Between 2012 and 2016, beds were reduced by 44% compared with 17% nationally. OAPs due to bed unavailability became extremely rare. More than 74% (N=2,679) of patients who were admitted to the assessment unit between 2015 and 2017 were discharged back to the community, minimizing fragmentation of care. Median length of stay was one-sixth as long as the national rate, but readmission rates were higher than the national mean because of the model’s innovative approach to managing treatment of patients with personality disorders. Bed occupancy was below the national average, with beds available every night for 2 years.
Conclusions:

With its recovery-focused approach, 333 has reduced length of stay and ensured that a stay on any ward is meaningful and adds value. The article demonstrates that bed and OAP reduction and the delivery of safe care can be achieved simultaneously.

JournalPsychiatric Services
ISSN1075-2730
Year2019
PublisherAmerican Psychiatric Publishing for American Psychiatric Association
Digital Object Identifier (DOI)doi:10.1176/appi.ps.201800284
Web address (URL)https://doi.org/10.1176/appi.ps.201800284
Publication dates
Online10 Apr 2019
Publication process dates
Deposited07 May 2019
Accepted24 Jan 2019
Accepted24 Jan 2019
Copyright information© 2019 American Psychiatric Association. All Rights Reserved. The official published article is available online at: https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800284.
Page rangeIn Press
LicenseAll rights reserved (under embargo)
Permalink -

https://repository.uel.ac.uk/item/843zv

Accepted author manuscript

  • 1
    total views
  • 0
    total downloads
  • 1
    views this month
  • 0
    downloads this month

Related outputs

Delphi study to identify key features of community-based child and adolescent mental health services in the East of England
Howarth, E., Vainre, M., Humphrey, A., Lombardo, C., Hanafiah, A., Anderson, J. K. and Jones, P. B. 2019. Delphi study to identify key features of community-based child and adolescent mental health services in the East of England. BMJ Open. 9 (Art. e022936).
Decision-making in crisis resolution and home treatment teams: The AWARE framework
Lombardo, C., Santos, Mónica, Van Bortell, T., Croos, Robert, Arensman, Ella and Kar Ray, Manaan 2019. Decision-making in crisis resolution and home treatment teams: The AWARE framework. BJPsych Bulletin. 43 (2), pp. 61-66.
PROGRESS: the PROMISE governance framework to decrease coercion in mental healthcare
Lombardo, C., Van Bortell, T., Wagner, Adam P, Kaminskiy, Emma, Wilson, Ceri, Krishnamoorthy, Theeba, Rae, Sarah, Rouse, Lorna, Jones, Peter Brian and Kar Ray, Manaan 2018. PROGRESS: the PROMISE governance framework to decrease coercion in mental healthcare. BMJ Open Quality. 7 (3), p. e000332.