Care in the community: Galway cafe offers out-of-hours mental health support

The team is setting up for the second life of Mr Waffle café in Galway city.

By day it’s a popular and well-known spot opposite University Hospital Galway.

By night it becomes Galway Community Café, a peer-led out-of-hours mental health support, a free service offering a safety net for those in distress.

Danni Burke, a peer connector working with those who visit the community café, and involved in research and planning for it from early on, is excited it's finally come together. "We're actually open. Up to now a lot of people ended up going to A&E, like I did in the past. Not that you want to go there, but it's the only out-of-hours place to have a chat with somebody. But it's not the most suitable. People can drop in here instead if they don't need A&E", or indeed for support going to the Emergency Department.

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Safe haven cafes are common in countries with more advanced mental health services, and while this isn't precisely that model, it's the first HSE café in Ireland, and was partially inspired by the Aldershot Safe Haven café in the UK, seen as a best practice format. While Aldershot grew out of institutions and services, and has onsite medical assessment, the Galway café emerged from those who've experienced distress, into the health services, and enveloping community (including via Mr Waffle).

Equal footing

This is health service with a difference, growing out of the community, a collaboration between HSE Community Healthcare West and members of Galway Forum – part of a national network for people who want to improve services – through the HSE’s Mental Health Engagement & Recovery office. The café was designed, built and led by people with lived experience of mental health difficulties and recovery, through a model of policy and services called co-production. Now a key concept for HSE services under its National Framework for Recovery 2018-2020, co-production here involves service users, family/carers and mental health professionals working together on an equal footing to improve services, involving stakeholders from early on, and using local assets.

For years out-of-hours mental health support has been a critical gap. Getting to this has taken over three years of research and planning. How they’ve done it looks like something others could adopt.

Galway Forum members came up with the idea informed by their lived experience of using mental health services. Thom Stewart, who chairs Galway Forum, describes early Forum workshops, codesigning the café. "We had HSE staff coming in the door, pretending to be cafe customers, and then people with lived experience pretending to be staff. We'd mocked-up menus, and just workshopped it out. We went beyond what is normal in engagement and consultation – it's the idea that the people who best understand the problems and possible solutions are those with direct experience."

The model carefully developed in workshops is now an operational manual; “it came out of people rehearsing how they wanted to be treated, how they wanted it to work”. Because of that, both users and staff have a sense of ownership, he says.

The café has just been shortlisted for the HSE Excellence Awards for its innovation, and already other areas have been in contact, hoping to develop similar services. They hope to create a toolkit for groups and services, “an ABC of how to do these kinds of models”, says Stewart. “It would save a lot of time. There’s demand, and people are trying to do this in the community, often voluntarily. In my experience, people burn themselves out, sometimes because they’re trying to process trauma of their own - they need support.”

Niall Ó Tuathail - a Galway-based consultant who works with NHS, and who was also key to driving the project forward - agrees it's crucial the café is under the auspices of HSE, rather than setting up a charity; "shaking a bucket on Shop Street once a year" wouldn't be sustainable. It's also important the four peer connectors working at the café have both training and lived experience of emotional distress, and that they are paid (ultimately by the HSE, but employed by Mental Health Ireland).

Outside, a discreet sign on the menuboard indicates the evening's community café. In future there will be drop-in, but for the time being, Covid means the café offers appointments. The innovative service started on December 3rd, but had to go virtual in January after only a few weeks of operating. It's back open now in person again since mid-May, and already has a lot of regular customers. Open Thursday to Sunday nights, from 6.30pm-11pm, a table can be booked at galwaycommunitycafe.ie or 087 108 5134.

On arrival I’m greeted and brought to a table in the spacious cafe. Customers get a menu, with free tea/coffee and a choice of options to tick: “I would like to . . . Sit quietly/Talk to someone/Ask a question.”

One of the trained peer connectors checks in; “we respond to the individual need”.

Services can include peer support, information about community or statutory supports, social/green prescribing, Wellness Recovery Action Plans, or supporting customers to register with UHG’s emergency department across the road, or acute services, if needed.

In Community Healthcare West, Maria McGoldrick, area lead for mental health engagement and recovery, says there’s strong evidence one-to-one peer support works. “It can de-escalate a situation, and the lived experience gives an ability to understand, and calm an individual’s concerns. Hope is central to recovery. Knowing the café is there for support is a big improvement in the service. It’s been a privilege to be part of this project.” The café is a 12-month pilot, and the HSE is developing phase two: “it’s envisaged an integrated model will be provided”.

It will be informed by café customer feedback, “striving to provide a quality mental health service for Co Galway”.

Even as the Galway Forum was teasing out what people wanted, Ó Tuathail came across the Aldershot café. He tweeted that it would be great to see something similar in Galway.

Kevin Nugent of Mr Waffle, a long-standing community hub, hosting residents' meetings and the Forum in the evenings, offered his space free, making use of slacktime. His support was "such a good offer," says Ó Tuathail.

He observes “I’ve been involved in quite a few reform projects for NHS, and normally patient involvement is quite professionalised: you have professionals to represent patients. It’s top-down. You sit in a boardroom and design what the service should look like and when you’re 95 per cent there you bring the patients in and say what do you think?”

There are absolutely times where the café is not the right place for people, the right place for them is the hospital

With the community café, “I’ve never seen anything like this, where people who use the services are not only involved but are driving it, designing it, owning it. It’s the most impressive service-user-led co-production I’ve seen in my career. Patients, staff, everyone coming together.” He says the Irish acute or emergency service is good, but there are gaps in medium and low-level mental healthcare. “There are absolutely times where the café is not the right place for people, the right place for them is the hospital. We’re trying to provide for when people don’t need to go to A&E but they absolutely need support, that there’s something there, out of hours.”

He reckons Stewart is “a genius at navigating the system and sources of funding and finding opportunities to get projects progressed”. Stewart himself talks about co-production as a triangle of three stakeholders: general community, people with lived experience of distress, and mental health professionals. “For something to move and get traction, they all have to feel a pull that that’s somewhere they want to go, together. The idea has to be validated by all those groups.”

He came at this “based on my own lived experience, as a self-advocate, and from the needs of the community. On a personal level I was trying to process multiple suicides – quite a number of near and dear chose to leave us. I think men need something to do to process the emotion. Like the Men’s Shed approach, I think, men prefer to process their emotions by doing something about it, shoulder-to-shoulder or otherwise. It’s an easier way to work through it than thinking or talking.”

Burke, too has experience of mental distress. “I received care from the HSE for many, many years, so I have quite an indepth knowledge of the system. It definitely would have been helpful to have somewhere like this, instead of having to go to A&E or ringing some outpatient service. To have somewhere safe that you can drop in and have a chat with somebody, and then head off again. It’s really important. We need these in every locality. Hopefully this is the start of a lot of good projects.”

Ó Tuathail agrees. “There should be two or three cafes in Galway and one in every town in Ireland. We’re trying to prove the model and build it out.” He stresses the importance of a group of service users being involved from the beginning, but that it’s a HSE project as well. “It’s really important to allow for further integration with the hospital down the line.”

Psychotherapist and team lead at the cafe Maria Lawton Murray, who also has lived experience of mental health difficulties, says “I believe firmly in the power of peer connection – that connection played a huge part in my own recovery. Feeling connected to others is a basic instinct. A lot of people may feel disconnected when they are distressed, and the cafe can offer a safe place to reconnect with others and the community.”