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94% of patients* with acute mental illness can be successfully treated in their homes

1 in 3 patients with acute mental illness will end up in hospital if left untreated

BREVIN Live-In

The alternative to a psychiatric hospital admission or to give the necessary support at home for early discharge.

specialist mental health treatment
Round the clock 24/7, live-in or 12hr specialist mental health nursing
home care for mental health conditions
The viable alternative to inpatient hospital treatment
specialist mental health treatment
Expert aftercare helping to expedite discharge from hospital
home care for mental health conditions
Reduced risk of readmission to hospital upon discharge

BREVIN Live-In is a unique service in the private sector delivering specialist mental health nursing at home when inpatient admission is being considered or for inpatients treated in hospital but who wish, and are able, to be discharged home.

A small proportion of patients with mental illness develop very severe symptoms, where standard outpatient treatment and brief nursing visits delivered by BREVIN Home Treatment are insufficient (see BREVINHome Treatment). Their condition graduates to a degree where there may be an elevated risk of further deterioration of health & self-neglect, or of self-harm or harm to others, which may become manifest if left unsupervised or untreated.
*In England, out of the 1,836,996 people that were in contact with mental health services between 2014 and 2015, 94% did not spend any time in mental health hospitals, which indicates that most of the care was provided in the community. Source: Mental Health Foundation, Fundamental Facts About Mental Health 2016

The treatment needs of patients under these circumstances involve four key elements:

Swift optimisation of treatment

  • Establishing the correct medication regime and doses early
  • Changing or adjusting regular medication, and monitoring side effects
  • Identification of additional treatments e.g. CBT or other forms of therapy for cognitive, emotional and behavioural remodelling

Prompt response to changing circumstances

  • Early identification of worsening or improving circumstances
  • Adjusting support based on need, with flexible levels of engagement and observation
  • Timely provision of reassurance, companionship, de-escalation, relaxation
  • Administering further as-required (PRN) medication to relieve distressing symptoms when they arise or to prevent escalation of acuity.

Containment

  • Strong relational security - the professional bond between the member of staff and the patient - enabling development of a safe, therapeutic and trusting relationship, helping to overcome common challenges e.g. motivating a patient, persuading them to adhere to the treatment plan, swaying them from acting is a reckless way
  • Stable, pro-recovery physical environment in the least-restrictive location
  • If treatment is delivered by a clinical entity, policies and procedures that maintain safe, effective, well-led, responsive and caring services

Time

  • Allowing patients time to respond to treatment.
Mental health nurses carry out the greater part of this work, whether in a hospital setting or at home, regularly reviewing the patient’s mental state and monitoring their risks, supporting patients and responding to circumstances, engaging and observing them, and liaising with the patient’s doctor to make necessary medication and care plan changes.
The aim with these patients is to safely manage and treat them in the least restrictive environment. The choice of where treatment takes place - whether in hospital or at home - will depend on, amongst other factors:
  • Patient or carer preference
  • Illness type and severity
  • Nature of potential risks
  • Rate at which illness is changing or responding to treatment
  • Household make-up (e.g. presence of relatives, carers or young children)
  • Past history
  • Personal financial circumstances and local resources
  • Experience of treating clinicians
Thus, a rapidly deteriorating patient who does not consent to voluntary treatment and presents high, unpredictable risks is less likely to be managed outside a psychiatric hospital. Some will need inpatient admission under the Mental Health Act. However, many patients with severe mental illnesses for whom private psychiatric hospital is being considered may not present these risks or, if they exist, are manageable with 1:1 mental health nursing support at home.

Their consultant psychiatrists may be unaware of BREVIN Live-In; patients may prefer to remain at home and continue to have their relatives around them, providing support and caring for them.

In Hospital:

  • 2-3 weekly visits by a psychiatrist at set times
  • 24/7 nursing care
  • Group therapy sessions
  • Structure/Containment in a group environment
  • Removal from social and biological stressors

However:

  • Patients have little control over which professionals are involved in their care
  • Nurses have:  
    • multiple non-care related and administrative tasks
    • allocated caseloads of between 4-6 patients
    • often less experience
  • If patients present a high risk, an additional nurse may need to be allocated at a further significant daily cost
  • Hospital surroundings are often not agreeable to many patients
  • Patients have little influence on their environment or patient composition
  • Group therapy can be undesirable due to group size, suitability of subject, frequency of sessions, being too unwell or preferring individual therapy
  • Individual therapy is not generally available
  • Patients with existing community-based therapists are unable to access their support.

At Home:

  • Flexible nursing care, from 12hr, 24hr and live-in
  • Structure/Containment provided on individual basis
  • Reviews by psychiatrist as required
  • Psychiatrist available for advice (as in hospital)
  • Broader range of individual therapy and other treatments

And:

  • Patients have more control & choice
  • Individualised treatment plan, team composition & frequency of sessions
  • Stronger therapeutic relationships with 1:1, often more experienced staff
  • Personal management and co-ordination of care
  • Familiar home surroundings, less disruption & distress
For many years, I treated patients that needed high level support at home for when they were discharged from hospital or did not wish to be admitted to a mental health hospital. BREVIN offers this opportunity for these patients

Dr Vince Gradillas
CEO and Consultant Psychiatrist, BREVIN

Please contact us on 0203 941 2000 to speak to a member of our enquiry team:

At BREVIN, discretion and privacy are cornerstones of our service. We would love to keep you up to date with you by post, email and other electronic means with information about our service, news about BREVIN and engaging articles about mental health. Please be reassured we'll treat your information with the utmost care and will never pass it to other parties.

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Here are some useful considerations when enquiring about our service:

  • We treat adults over the age of 18
  • We are regulated by the CQC
  • Our treatment services are available in London and the surrounding areas
  • We can work alongside your existing clinical team
  • We do not need a referral
  • We can work with your existing GP or appoint one for you
  • We do not work with patients whose level of severity is mild or moderate without a significant level of dysfunction who are likely to improve with treatment under a psychiatrist or therapy alone;
BREVIN Home Care Ltd, 52 Grosvenor Gardens, Belgravia, London, SW1W 0AU
Brevin Homecare Ltd trading as BREVIN is regulated by The Care Quality Commission. ©BREVIN 2018. All rights reserved.