eLSU Newsletter - Family and Friends Involvement(1)
1. In this issue:
01 Friends and Family Involvement
on Tweed Unit
04 Stepping into a Carer’s Shoes
07 Bradley Woodlands Case Study
08 Families, Friends and Forensic
Units
09 Multi-tasking and Juggling—
Tailoring Family and Carer
Involvement in Forensic Care
11 The Need to Know
12 Informing and Supporting Care
Givers
14 Family and Friends Involvement
at Longhirst
15 Committing to Carers
17 Lunch and Chat
18 Quality Network for Prison
Mental Health Services
19 Membership Resources
20 Useful Links
WELCOME
Welcome to the 9th edition of the Quality
Network for Low Secure Forensic Mental Health
Services’ Newsletter, a themed edition
addressing Family and Friends Involvement in
Low Secure Services. There is a range of
articles written by both patients, families and
members of staff from low secure services
across the UK which explore initiatives that are
in place around involving family and friends in
the service and patient’s care. Many thanks to
all those who contributed to this edition and we
hope you find the articles both interesting and
useful.
Since the last edition, we ran a workshop on
Engaging Patients, Friends and Family in the
Quality Network’s Review Process. This event
was well received with a turnout of over 100
people. We are currently busy finalising plans
for both the MSU and LSU annual forums which
will be held at Royal Society of Medicine this
summer.
Dr Quazi Haque
Chair of the Advisory Group
ISSUE 09 June 2015
Northumberland, Tyne and
Wear NHS Foundation Trust
Friends and Family Involvement
on Tweed Unit
Within NTW NHS Foundation Trust, Tweed Unit is a
26 bedded Low Secure Forensic Learning Disability
ward at Northgate Hospital, Morpeth, in
Northumberland. There are a number of ways
presently used to involve and seek feedback from
both friends and family:-
2. 22
Tweed Unit follow the “Getting to know
you” process which is part of My Shared
Pathway (a recovery programme to provide
a process by which teams and patients work
together to identify future treatments and
goals to move through hospital towards
eventual discharge). This includes the
named nurse undertaking a carer’s
assessment and speaking to the carer at
regular intervals during the patient’s
hospital admission. There are benefits of
the “Getting to know you” process for staff
in that they gain a better understanding of
the patient and the patient’s background
and family carers. Carers also gain a better
understanding of what to expect from the
hospital staff and the treatment of the
person they care for.
There are a Points of You cards available
on the ward. They are an important means
by which both patients and carers can
provide anonymised feedback on the
support and information which they have
received from staff.
There is the Carers’ Charter which sets out
how the Trust will work with and help
carers. It outlines the Trust’s recognition of
carers and outlines specifically when and
how carers will be involved throughout the
patient’s admission to hospital.
This includes that:-
- Carers will be invited to all meetings about
their relative with the patients consent.
- Staff will provide a Carers’ Pack for relatives
that includes information about the unit their
relative is being admitted to and signposts
them to other sources of information including
for carers. However, the carers’ pack will never
replace the care and support that a member of
staff can provide, therefore relatives are always
advised to discuss their concerns with the staff
and ask questions which the pack does not
answer for them.
- Staff provide information about the Trust’s
Carer Involvement Forum. This group meets
quarterly to support family carers within the
Trust.
- Regular telephone contact is also encouraged
24 hours a day especially for relatives who
cannot visit regularly and speak to staff in
person.
NEXT EDITION
Physical
Environment in Low
Secure Services
Some areas that could be
covered:
The environmental design of low secure
services and maintaining patient’s safety
Challenges faced with the environmental
design of low secure services
How these challenges have been overcome
For more information or to submit
articles please contact Amy Lawson at
the Quality Network
3. 33
Tweed Unit also has a Carers’ Champion,
Pauline Bone, Clinical Coordinator who has
agreed, on behalf of the ward, to act as a key
contact for family issues which arise within their
place of work. I ensure that all members of the
team are kept up to date with carer legislation
and informed of local carer services and events.
I also ensure that there is sufficient information
available to enable each member of the team
involve and inform carers in accordance with
the principles of the Carers’ Charter. Obviously
the Carers’ Champion is the link between all
parties; however, it is the responsibility of all
staff to work in partnership with carers and
patients.
Pauline Bone, Carer’s Champion
As a Carers’ Champion the role includes the
following tasks:
To raise awareness of carer issues and
promote carer involvement within the team
To assist in the implementation of the
Carers’ Charter
To pass information to work colleagues
about events or training associated with
carer issues
To act as a contact person for the Carer
Involvement Officer
To help establish links with local carer
services and ensure that information on
these services is included in the Carers’
Packs
To ensure that there is always a supply of
Carers’ Information Packs and that new
stock is ordered when required
To collate information on standards and
performance highlighted through carers
returns on Points of You cards
To attend quarterly meetings of the locality
Carer Champion Forum which are
established to coordinate and support the
role
Due to the fact that some of our patients come
from outside the local geographical area, it is
crucial that regular carer contact is encouraged
and maintained by the staff contacting the
carers by telephone when required, encouraging
them to call the ward if necessary and helping
to facilitate visits by providing them with
contact numbers for local services. They are
also signposted to their local carers’ centres and
online facilities where appropriate.
Pauline Bone, Clinical Coordinator and
Carers Champion
Dr Nicola Phillips, Consultant Psychiatrist
Northgate Hospital
4. 4
I am asking you to step into a carer's shoes for
a few minutes, a carer like me. Imagine you
have never seen your work place before. You
know nothing about "Forensics" except what
you have seen on television. Think back to your
very first visit here perhaps is it for your job
interview? Looking at the entrance what is your
immediate impression? It is welcoming? What
sort of reception do you receive? Will you
consider the effects on communication with the
barriers of the enclosed reception? Do you see
any notices giving information? You see the
staff with bunches of keys and locked doors.
Your keys and mobile phone are locked up. Do
you feel you are entering an alien environment?
Is it like a prison?
The first time I visited the forensic ward where
my son Jack, is a patient, I felt intimidated and
fearful. This was in 2009. I had been given
limited information prior to visiting. When I
went there on this initial visit, the nurse in
reception showed me no compassion. She
l o o k e d i n d i f f e r e n t . I r e c e i v e d
no acknowledgement or information. There was
no information in paper form either. On another
visit, a Charge Nurse came to speak to me in
reception whilst chewing on a chicken bone.
The situation has changed for the better for me
now. There is a warm and friendly receptionist
who lifts my spirits. She always asks me how I
am, introduces herself, makes eye contact, and
is most helpful. She is most efficient and
reliable. When I give her information regarding
Jack's leave, hospital and dental appointments I
know she will record these accurately and will
inform the appropriate person if needed.
The Quality Network held an event in December
2014 highlighting the role of frontline staff in
patient recovery. George and I gave a
presentation about positive experiences we had
had with staff. After this, one individual
expressed the view along the lines that
"No matter how hard you try,
engaging carers is not always
easy and can make the
problem worse".
This statement may be considered in more than
one way. When I asked George about it, he
thought it could allude to the difficult
relationships between patients and their
families. In this article, I am exploring the
carer's relationship with staff instead. This topic
was included in Gail's presentation at the most
recent Quality Network workshop. She
described how she had been affected by the
approach taken by staff. I found this story most
uplifting as she explained how she overcame
her distress and how her son has been
discharged. Strategies of best practice are
worth nothing without good communication. No
-one plans for their loved one to need the care
of forensic services and sensitivity is needed
when working with carers. The work done by
the Quality Network is addressing some of the
difficulties that I have had. They are working
with carers, like me, to improve the care of
patients like Jack. There is no room for
complacency and there is a lot of work to be
done.
When a carer visits your unit they are not
coming as a customer. I visit to support my
son. I feel that my close involvement in Jack's
care helps him to retain some sense of his
identity and self-esteem. I believe a strong
family link helps to reduce the effects of
institutionalization. I am well aware that the
loss of family bonds is a common occurrence for
5. 5
those in forensic care and this is unfortunate
because I see the benefits in Jack spending time
with his family.
When he is well enough, Jack and I have had
some enjoyable experiences. We have often
taken the bus to Blenheim Palace, visit the
lovely countryside. We have been to the Henley
Regatta and even had some holidays in Devon.
Jack was able to strengthen his bond with his
brother on that trip. William has also been
diagnosed with schizophrenia and needs our
support. Our sons had been estranged for some
time due to symptoms of their conditions. I feel
integral to helping my sons to recover. We are a
close and supportive family. I appreciate those
small moments with Jack. When he was well
enough last year he bought me a huge
chocolate slab. BEST MUM IN THE WORLD
was written all over it. This year Jack has been
too unwell to get me anything and of course I
don't expect him to. I appreciate those small
golden moments with him when we enjoy
observational humour. Occasionally we dance
around the kitchen to the tune of "Happy",
which raises my mood.
Jack is now needing yet another medication
review. The Maudsley Hospital out-patient
assessment of his case was that Clozaril is still
currently the most likely medication to help
him. He has become frightened of needles due
to cognitive impairment. I suggested the use of
music to help Jack relax whilst this pain is being
implemented. I have accompanied Jack to
observe William having his blood taken for
Clozoril management. William was most
supportive of his brother, encouraging him to
focus on the procedure and explaining what
helped and that "it was just a scratch and you
get used to it".
In a way it is a shame there has to be policies
and legislation to ensure that carers are treated
with the basics of courtesy and consideration. I
do not feel that many staff have much
understanding of how Jack and William's mental
health problems affects me. This is especially
relevant when I consider how Jack has been
adversely affected by having such a resistive
form of schizophrenia. He has been so unwell
for such a long time. When his mental health
deteriorates so does mine. I find the long winter
here also lowers my mood. I have been treated
for depression in the past and had panic attacks
as well as chronic anxiety. I am a retired nurse
and was working in a busy hospital until two
years ago. I manage my mental health by
various ways. I learnt Mindfulness some time
ago which has been a major tool in my box of
coping strategies. I also asked my employer for
access to cognitive behavioural therapy which I
received and found effective. I have good
support systems in place. We are fortunate to
have a Rethink Mental Illness Carers Service
which provides carers with support, information
and training. The Triangle of Care is in the
process of starting here in November. It is a
policy based on best practice. This triangle
involves the carer, the patient and the
professional and going to be used by many
other Trusts also.
I know a carer who had a difficult relationship
with staff. She has difficulties with the
complexities of the English Language which lead
to difficulty expressing her frustration and
helplessness to staff. She felt she had been let
down by staff from the beginning of her
daughter’s admission to hospital and began to
feel angry. She began shouting out trying to get
someone to listen to her. The language barriers
she faces affects her understanding of
schizophrenia including symptoms, treatment
and recovery. She was angry as she struggled
with her daughter's diagnosis and the
medication she was put on. Yun's view of the
effects of hospitalization causes her further
distress especially as she does not believe her
daughter should have been admitted in the first
place. Yun feels that her daughter started
smoking by being around others who smoked.
6. 6
Why Should I Join the
LSU Discussion Group?
The Quality Network run a discussion group
to enable any member of staff from a
member service to post questions to the
Network and receive responses and
suggestions from other units. This might
include OT’s, frontline nursing staff, security
staff and hospital managers.
This facility is only available to Quality
Network members and is a great way to
receive advise and share good practice
across low secure sites.
“A very useful service, which helps with
a wide variety of tasks ranging from
policy information to ethical issues”
If you would like to join the eLSU discussion
group, please email ‘Join’ to:
lsu@rcpsych.ac.uk
Yun believes that Mia was the victim of a racial
attack. She was denied the right to visit for a
while. This reinforced her lack of trust in the
system.
Yun is now getting the support she needed at the
start of her daughter’s admission. She needed
someone who would listen carefully without
becoming defensive. This would begin to develop
some understanding of why she was so angry.
Yun needed her tenacious spirit to get through
the heartbreak of her background story. Most
people would have found her challenges too
much. Skilled staff are now meeting with Yun on
a monthly basis to help her to establish a sense
of trust. She is encouraged to put aside issues of
the past to look at what is happening with her
daughter in the present time. She is being
considered in a polite and helpful way. This
positive approach celebrates the fact that her
daughter is recovering well. Yun is fortunate. She
can work in partnership with staff towards a
promising future for her daughter.
In conclusion, I feel I work best with staff who
have a positive outlook and are always looking
for solutions and working in innovative ways.
This approach must include listening and
involving Jack and me. When staff are reliable
and have good communication skills then I begin
to have trust and confidence in them. We can
begin to establish relationships that are mutually
trusting and respectful. I am encouraged when I
encounter staff who are interested and focused
on their work. They want to do their very best for
their patients and this includes involvement with
carers, being friendly and warm
makes a difference.
There is a saying;
"Carers start out as
worriers and end up
as warriors".
Maureen Clare
Family and Friends
Representative
QNFMHS
Names and other identifying material have been
changed. Those involved have given permission.
7. 7
Thomas is 22 years old and has a diagnosis of
a severe learning disability and associated
autism. Thomas has been in services since the
age of 16 and has a history of aggressive
behaviour and past diagnoses of psychosis. He
was admitted to Bradley Woodlands in
November 2013. Upon admission, Thomas
would sleep all day and only engage with
support staff when he wanted food and drink.
After the multi-disciplinary team; including
Nurses, the Consultant Psychiatrist and a
Speech and Language Therapist had assessed
Thomas, we were able to create a flexible plan
of care to address his needs and to increase his
meaningful engagement with staff and
activities.
A “core team” of experienced support workers
who worked positively with Thomas was
created and a member of his team was
allocated to work with him every day. A good
working relationship with his parents was
established between Thomas’s named Nurse
and members of his “core team”. Together,
they attended regular welfare meetings to give
advice and receive support from the care team.
The welfare meetings enabled his parents and
the care team to focus on and prioritise
Thomas’s care needs. This enabled his parents
to discuss their hopes for Thomas’s future,
their concerns about his presenting mood and
associated behaviour, as well as helping them
to feel more reassured and confident in the
hospital.
This collaborative working has benefitted
Thomas greatly; improving engagement and
his communication of his needs. Autism specific
prompts were devised such as boards in his
bedroom entitled ‘day’ and ‘night.’ The purpose
of these was to create symbolism to enable
Thomas to differentiate between daytime and
night time hours. Support staff started to use
phrases that were “Now & Next”. These were
introduced to provide a better structure to
Thomas’s routine. Thomas responded
extremely well when he knew what was going
to happen and then what was to immediately
follow.
Thomas is now actively engaging in activities
within the community and recently went on
home leave to see his family for the first time
since his admission. Thomas has also coped
very well when he moved to a larger and busier
apartment within the hospital, which has had a
positive effect on his communication and
engagement skills. Thomas has showed
improvement in his presentation and
functioning as measured by HONOS LD.
All of the above work has benefitted Thomas
greatly and his parents are delighted at the
progress he has made during his time at
Bradley Woodlands. They have especially
commended the input and positive therapeutic
relationships that Thomas has made with both
his named Nurse and his “core team”. The
discharge plan for Thomas due to the good
progress he has made is that future
placements are now being looked into that are
closer to home and provide a less restrictive
autistic specific environment. In the meantime,
weekly walks into Cleethorpes have been
arranged to increase his access to and his
interaction with the community in preparation
for him moving to a more open sociable
environment.
Kath Dye
Hospital Manager
Bradley Woodlands
8. 8
They say you can’t choose your family, you
can’t choose your forensic unit either! Some
people want family and friends close; others
don’t. The forensic world can do both with
varied degrees of success.
This is my view of the differences between
NHS and Private units in how they manage
visits and other forensic family/friends contact,
with a little bit of background thrown in. I have
experienced and witnessed the evolving
practices that manage family/friends contact
for many years throughout high, medium and
low secure services in NHS and later private.
In the early 1980’s, it was huge visit halls,
rigid visiting times, uniformed nurses racing up
and down and many rules to adhere to. It
made for a tense visiting experience. On the
upside, you could have homemade food and
photos of loved ones without written
permission and visitors received travel
assistance. You could also have visits in the
grounds if this was approved.
In the 1990’s, visiting rules were more
relaxed, a more civilised approach occurred.
Longer visit times, visits on the ward and even
‘parties’ where several patients and their
visitors got together in the same place. One of
the most positive experiences was being able
to receive home cooked food; even those who
didn’t receive visits from their friends or family
benefitted from the food brought in from
visitors. Visiting halls were still used but in a
very different way. They were always full of
people talking and visiting other people’s
tables.
All of this changed rapidly. Visiting numbers
were kept to a minimum; we had to stay at
one table with no walking around. We were no
longer allowed home cooked food, visiting
times were shortened, more supervision was
required and visitor had to show a photo ID to
be allowed entry into the unit. There was much
more security and staff needed to make it
easier to monitor.
These drastic changes to the rules were the
result of the patients group. Visits started to
be used as a way to bring contraband into the
service. This included booze, drugs, mobile
phones and on two occasions items that
assisted two escapes from high security,
inclusive of a 20 foot rope and a hack saw!
Within NHS units, this has created a visiting
experience that has more in common with a
prison visit, in my opinion. This impacts on the
quality of the visit and in turn the recovery of
the patient both in and outside of the unit.
Some may say that forensic units are justified
in the vast increases in security and there
probably has been a reduction in contraband
but does all of this have to be at every other
patient and visitors expense. Is it fair that we
are all viewed negatively and constantly
watched as a result?
To be fair, NHS low secure services are a
better experience than medium and high
security for patients and visitors. It still has a
greater staff to visitor’s ratio and they still
need to show ID on entry and cannot bring in
home cooked food. However, they do facilitate
community visits, where with approval you can
have a visit in a local town or city and act as
you would in a ‘natural’ setting. You still have
an escort but they are more discrete. These
visits are more relaxed and can be a big boost
to a patient’s recovery and for their visitors to
see their loved ones given some hope.
9. 9
The private sector appears to have a difference
approach. At Thornford Park, I still have no
homemade food and visitors must show ID and
give notice of their visit. However, you can
receive food which is factory sealed and visitors
are encouraged to feel relaxed. Visits are on
the ward and you can in some cases play pool
with your visitor. Your visits can be several
hours long and staff monitor the visit in a
discrete manner. They also facilitate
community visits.
It would seem that this visit experience is
much more relaxed and gives more to the
patient and visitors. A visit becomes something
to look forward to. But that is my experience
here at Thornford Park Hospital.
Why does the NHS forensic mental health
service visiting experience differ so much with
the private units visiting experience in terms of
the quality, security, time and feel good factor?
Alex Sunyata
Patient
Thornford Park Hospital
South London and Maudsley NHS Foundation
Trust has a low secure unit, Chaffinch Ward, at
the Bethlem Royal Hospital, as well as Ward-in-
the-Community, based at Lambeth Hospital in
Central London. These units care for men from
the London boroughs of Croydon, Lambeth, and
Southwark. Together with community forensic
services, these units create a step-down
pathway as patients’ progress from conditions
of higher security to life back in the community.
Although the social workers in the teams have
traditionally led in making the initial contact
with families, involving carers and families is
seen as multi-disciplinary responsibility. For
those patients who wish their families to be
involved in their care, the teams support them
in a number of ways. For example, ensuring
that family members are invited to CPA
meeting, supporting family members to attend
Mental Health Tribunals, arranging additional
meetings with the multi-professional team as
required, and liaising with family and carers via
email or the phone. The success of these
engagement strategies depends of course on
how involved the patient wants their family to
be, the extent to which the family responds to
invitations and outreach and the clinical team’s
assessment of the family or carer’s role going
forward. Inevitably, the extent to which family
and carers are involved will vary from case to
case. A whole host of factors seems to come
into play. Similar factors seem to influence how
involved a family wants to be. When working
with patients and families who have opposing
views as to what level of involvement the family
should have, we have found it helpful to provide
space to talk through these issues, approaching
the matter sensitively and with a high degree of
flexibility and patience.
In order to boost the potential for family and
carer involvement we have introduced a
number of measures. These are intended to
deepen our levels of engagement and inclusion.
10. 10
· In the summer of 2014 the Lambeth
site launched a Carers’ Group. This
group was set up as a joint venture
between Ward-in-the-Community and
the Lambeth Forensic Community Team
and is open to all relatives/carers
accessing these two services. The
forum meets on a monthly basis with
the logistics of the meetings being
managed by staff. The forum itself is
carer-led with an emphasis on providing
a space for families to connect with one
another as well as giving them an
opportunity to engage with
professionals from a range of
disciplines. Initial indications are that it
is valued and well-attended.
· The provision of a range of formal
family work interventions, from
psychoeducational work to family
therapy proper, was identified as a
service priority some years ago. As a
result of the resources made available
through the academic health sciences
partnership with the Institute of
P s y c h i a t r y , P s y c h o l o g y a n d
Neurosciences (IoPPN) within the Kings
Health Partners, fully-funded M.Sc
degrees in Family Therapy have been
made available to staff. As a result, a
number of members of the low secure
and community teams have undertaken
or are in the process of undertaking
formal training. The two clinical
psychologists providing input to
Chaffinch and Ward-in-the-Community
have both been funded by the Trust to
undertake family therapy training.
· This has also allowed us to forge links
with the Lambeth Family & Couple
Therapy Service and to form part of the
clinical team providing this service. This
enables us to further mainstream and
integrate family and carer provision for
forensic patients.
Ethical considerations and a need to respect
confidentiality (both that of the patient and of
the family) have required a great deal of care
and negotiation, particularly when there has
been a breakdown in communication between
the patient and their family. Sometimes
circumstances have required that the patient
and their family are seen separately. In these
instances it has been particularly important to
maintain a high degree of transparency with
regards the responsibilities of the clinical team
and the limits as to what professionals can and
cannot do, but also what they are obliged to
offer. Where there have been different points
of view and there has been resistance to
considering the other’s point of view, we have
found it helpful to work in pairs or with a
“reflecting team”. We have found that this can
allow for a different dynamic and can foster
increased flexibility with multiple perspectives
coming to the fore. This can also help manage
the risk that professionals are experienced as
siding with one position or another. Finding a
common language, testing out assumptions,
and developing a shared understanding are
some of the tasks that have proved particularly
important.
These complex functions are greatly enabled by
initiatives to steadily build up, over time, a
deeper capacity within staff teams to deliver
sophisticated and needs-adapted family and
carer interventions. This is becoming a key
part of the pathway through forensic services.
In time we hope to build on the Consultant-led
family drop-in clinic run within the MSU by
extending this into the low secure pathway.
We are also actively engaged in developing
restorative practices, based on a model of
restorative justice, in order to repair
relationships in families when there has been
harm, either directly or indirectly, through
offending behaviour or through the impact of
caring for someone with mental health
difficulties.
Dr. Tessa de Reuck
Clinical Psychologist
River House
11. 11
In March 2012 the Hellingly Centre (secure
and forensic psychiatric unit) held its first
Relative’s & Carer’s Open Day. I had the
privilege of suggesting the idea after reading
in the QNFMHS’s newsletter about another unit
putting on such an event. It was the SRIG
(Secure Recovery Implementation Group) of
which I was a member as the patient
representative of the women’s ward that found
the funding, planned and organised the event.
It was fortuitous that one of the wards was
empty and could serve the dual purpose of
providing a physical space for the event and
the opportunity for the relatives and carers
who attended to receive a tour of a ward
identical in layout to the one which their loved
one was a resident. In addition there was a
poster display and representatives from most
of the clinical disciplines in attendance to
explain the therapeutic input provided for the
inpatients.
What I remember most was the discussion at
the end of the day and feedback from the
relatives and carers about their experience of
the event. They articulated the pain and
frustration of having been excluded from
having input into and in many cases not even
knowing what form of care their loved ones
were being given. They spoke of how
wonderful it was to finally have an opportunity
to talk to the clinicians who looked after and
made the decisions regarding their loved ones’
care. They expressed the helplessness they
felt at not knowing how best to support those
who they cared about and who were suffering
from a mental disorder. It was both touchingly
and heartbreakingly clear that they needed to
know and be included in decisions regarding
what happened to those they loved who were
detained under the Mental Health Act.
I recall my own mother’s anger that I was
‘detained’ for what she thought of as an
unreasonable length of time and my father
saying to me after I was discharged and
beginning to be involved with what is now the
IoPPN and King’s College, London, that his
only regret was that mother wasn’t alive to
see me finally liberated and free to rebuild my
life. For your loved one who you have brought
up and cared for to be in secure services and
beyond your influence is intensely painful. It is
crucial for relatives, carers and inpatients that
bonds are maintained, knowledge shared and
that there is an active and open dialogue with
the clinicians who treat and care for those with
a mental disorder who are detained in secure
and forensic psychiatric units.
Dr Sarah Markham
Patient Reviewer
QNFMHS
12. 12
Valuing Care Givers
It is widely recognised that carers play an
integral role in supporting service users to live
more fulfilling and independent lives. There are
around 6 million carers in the UK, but with
increased life expectancy and age related
illnesses this figure is expected to rise. This
means carers need to receive the recognition
and status they deserve. Caring for someone
can be a very rewarding experience, but it can
also have many challenges. Caring can impact
upon family life and social relationships,
physical and mental health wellbeing, finances
and the ability to work, undertake further study,
or pursue leisure activities.
Recent NHS reforms
The NHS reforms suggest wider society must
recognise the vital role of carers and the
invaluable support they give both to individuals
and to society as a whole.
The vision is that by 2018, carers will be
recognised and valued as fundamental to strong
families and stable communities. Furthermore
to support carers to have a life of their own
alongside their caring responsibilities, in
addition:
² Carers will be supported and respected
as expert care partners
² Carers will be able to have a life of their
own alongside their caring role
² Carers will be supported so that they are
not forced into financial hardship
² Carers will be supported to stay mentally
and physically well
Developing a Carer Strategy
Cygnet Hospital Beckton priorities are:
² To recognise and treat Carers as expert
partners in the provision of care.
² To provide information and signpost
carers to access relevant support
² To ensure carers are involved in the
development of services delivery
Transforming the Vision to a Reality
Cygnet Hospital Beckton occupational therapy
service organised an event for carers called
'Informing and Supporting Care Givers’ in
recognition of the fact that care givers play an
invaluable role in helping people recover from
severe mental illness and that they should be
acknowledged, valued and supported. The
programme involved a presentation from the
hospital manager and a series of workshop
activities led by occupational therapy staff to
promote recovery-oriented practice. Workshop
activities included health education leaflets and
discussion, massage and nail art.
There was also a presentation from a former
patient called Michael who gave an articulate
presentation of his story; he shared the
challenges for him to retain the roles of
husband and father whilst being detained in
hospital. Many care givers reported Michael
provided helpful suggestions and inspiration
that they will take away.
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Further forums are planned for November and
June, guest speakers Rachel Waddingham
(Hearing Voices Network) and Ian Callaghan
(National Service User Lead) are booked to
offer inspiration and to improve our work with
carers. We hope our work will provide greater
understanding of carers and the issues
surrounding caring; thus enabling service
changes with carers as key partners in the
provision of consistently high quality of care.
Listening to Care Giver
Needs
Carers of patients from the
hospital's four service areas
attended allowing a good
representation of care
givers from across the
hospital. The feedback on
the event was unanimously
positive with evaluation
forms showing that
everyone who attended the
event stated they had
found it useful and would
like to attend a similar
event in the future.
Feedback ideas:
Written information about the care at Beckton
Creating a newsletter for carers
Getting together with other care givers
Education on mental health conditions
Presentations from ex-service users and
professionals
Health & wellbeing activities to manage stress
Useful contacts and resources
Jennifer Beal
Head of Occupational Therapy
Cygnet Hospital Beckton
References:
NHS Choices 2014. Our health, our care, our
say 2006 White Paper. Making Mental Health
Services Accessible
For further information please contact:
Jennifer Beal, Head of Occupational Therapy,
jenniferbeal@cygnethealth.co.uk 020 7511
2299
Work in partnership with carers
and providers to achieve our
strategic aims whilst maintaining
our commitment to the delivery of
consistent high quality care and
support to those who use our
services.
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Longhirst is a 14 bed female low secure unit
based on Northgate Hospital in Morpeth with a
separate rehabilitation unit which can house
another 4 ladies.
Within this unit it is very important to several of
the ladies that good links are maintained with
their families something which we strive to
achieve. This is especially important to those
who have children and want to maintain
positive relationships therefore staff support is
given throughout this process. Staff will also
accommodate ladies with children by arranging
frequent visits to special occasions/
performances, altered phone call allocations so
as not to disturb the child’s night time routines
etc.
As well as providing the patients with support
around their family contact there is also therapy
available that focuses on relationships they
have with their family and how this can be
improved. Many of the ladies utilise this therapy
with positive outcomes as some have
experienced poor relationships in the past.
We do as a trust and unit have our own policy
that we offer carers an information pack when
first admitted which outlines the working
procedures of the ward such as protected meal
times, phone call times but also introducing
staff and giving a brief outline of planned
treatments. Within the carers pack the carers
champion is also identified as well as describing
their role. It is the carer’s champion who will
become the liaison nurse for the families,
answering any questions and finding or
attempting to find solutions to any concerns/
queries. It is this person who also arranges with
the families when and how often they would like
to be contacted for an update on their family
member’s progress. Many families have said
they felt this was important to them and it also
helped during the admission process. Despite
the identified carers champion a lot of the staff
team will liaise with families and any issues
they may have. In this situation the carers
champion will supervise the process and be
there for guidance.
We do have guidance for the process of family
contact which is known as the ‘triangle of care,’
something that many trusts use over England
and Wales. This process highlights the link
between families, patients and professionals
that enables for a better provision of care for
individuals. It encourages collaboration,
something which is highlighted in the code of
conduct for both nurses and doctors, it ensures
that risk planning is informed and the best/most
reliable information is available. We
demonstrate this by inviting families, both new
and old, to important meetings, allowing them
to be involved in the decision making progress
for patients. It also encourages duty of candour,
something that was highlighted from the Winter
Bourne View case in 2011 and again is seen as
extremely important on this unit.
On Longhirst we have an assessment tool which
evaluates our service delivery, especially
communication with family and friends, through
a traffic light system. There are 38 points to
rate which fall under 6 categories with Longhirst
currently falling into the green rating of 90%.
This is also used as a checklist when meeting
family and friends for the first time to ensure
they feel welcomed and supported as much as
we can offer. Throughout the patients stay we
document our conversations with carers on their
progress notes as well as our triangle of care
documentation. There is also a dedicated form
called the ‘getting to know you process’ that is
filled in regularly so family involvement can be
monitored throughout their loved ones stay at
our unit. This highlights anything extra that we
need to complete.
Longhirst also welcomes feedback and advice
on how to improve such services however
family and friends have often been very
complimentary of our services.
Helen Farrer
Staff Nurse
Northgate Hospital
15. 15
Research has long-shown that the needs of
families and carers of inpatients with complex
mental health needs are not well served
(Radcliffe et al 2012). This is particularly so
within secure services. Bustillo et al (2001)
suggest that families and carers should be
natural allies to professionals, and that
professionals should utilise the intimate
knowledge families and carers have for the
patients with whom they work, yet they’re often
excluded from decisions within the mental
health care and treatment process. In this short
article I speak to this dilemma as a Social
Worker, and now Carers’ Lead, within a low
secure mental health facility, Cygnet Bierley. I
outline the steps we are taking as an
organisation to engage with families and carers
more fully in the treatment and care of their
loved ones, and emphasise the importance of
evaluation within the process.
There is significant evidence to show that
involving family members in the care of their
mentally ill relatives improves treatment
outcomes (see Yum Chan and O’Brien 2011;
Underwood 2014), yet significant barriers exist.
For example, Yum Chan and O’Brien (2011)
suggest that professionals’ struggle with
complying with privacy laws while at the same
time informing families sufficiently. This is
(rightfully) complicated by the patient’s right to
keep information from caregivers, many of
whom want full inclusion in their care (Marshall
and Solomon, 2000). Underwood (2014)
suggests a number of issues, for example, that
carers routinely feel marginalised and excluded,
which can lead to a lack of contact or
motivation; that professionals experience a
serious lack of training, time, resources, and
funding and thus do not, or cannot, consider
supporting carers and involving families as part
of their role. Underwood (2014) also points to
the culture of organisations and broader
systemic issues as exacerbating the barriers
between families, carers and professionals; for
example, he identifies supportive management
and a collective responsibility for carers and
families as crucial ingredients for professionals
not becoming isolated in this work.
To counter these barriers, Cygnet Bierley has
recently introduced the role of Carers’ Lead, a
single point of contact for carers to seek
information, support and help negotiating
mental health systems. This role builds upon
the good practice of an Involvement
Coordinator and existing positive efforts to
engage carers within the organisation. In
addition, the initiative is tasked to explore new
ways to better engage carers in patients’ care
and to continuously evaluate these efforts. Our
first activity was a Lunch and Chat Session,
through which we consulted with carers and
family members. Carers’ voices emphasised
that they can often feel a lack of empowerment
and understanding around procedures, laws,
and forms of treatment. For example, from the
feedback we have had from carers thus far,
they articulated a need for information about
the different therapies available at the hospital;
education on the legal aspects of the Mental
Health Act; and information about forms of
illness, diagnosis, medication and their side
effects. This is indicative, then, of the extent to
which carers might gain empowerment and
confidence through a fuller knowledge of a
variety of aspects of their relative’s care.
Further, this work has revealed the power in
simply providing a space for carers to share
similar lived experiences of supporting family
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members through the mental health system.
We suggest that listening to carers and families,
and providing what they require, can enable
them to realise their true value in the treatment
process.
To sum up, I hope this brief article has
emphasised the importance of engaging carers
and families in their relatives’ care. In short, not
only does listening and committing to carers
create better collaborative care, but most
importantly of all, it can lead to improved
outcomes for the patient (Herz et al 2000).
Fostering working relationships with families
and carers is therefore a crucial aspect of our
practice, as well as an ethical and principled
one. We hope that the initiatives established at
Cygnet Bierley and the role of the Carers’ Lead
in championing partnership working with
families and carers can contribute to current
best practice models.
Luke Jones BSc Hons.
Social Worker and Carers’ Lead
Cygnet Hospital Bierley
References
Bustillo J.R., Lauriello J., Horan W.P., et al.
(2001) ‘The psychosocial treatment of
schizophrenia: an update’, American Journal of
Psychiatry,158,163–175.
Herz, M.I., Lamberti, J.S., Mintz, J., Scott, R.,
O’Dell, S.P., McCartan, L., & Nix, G. (2000) ‘A
program for relapse prevention in
schizophrenia: a controlled study’, Archives of
General Psychiatry, 57: 3, 277-283.
Marshall, T. and Solomon, P. (2003)
Professionals’ responsibilities in releasing
information to families of adults with mental
illness’, Psychiatric Services, 54: 12, 1622–
1628.
Yum Chan, B.W. and
O’Brien, A. (2011) The right
of caregivers to access
health information of
relatives with mental
illness’, International journal
of Law and Psychiatry, 34:
6, 386:392.
Underwood, R. (2014)
‘Major barriers
implementing family
involvement for patients
with psychosis’, RELIABLE
MENTAL HEALTH
RESEARCH, POLICY and
GUIDANCE. Online.
Available from http://
www.thementalelf.net/
publication-types/systematic
-review/major-barriers-
implementing-family-
involvement-for-patients-
with-psychosis/#_ENREF_6
(accessed 18/04/2015).
17. 17
Cygnet Hospital Bierley has recently launched a
new initiative for carers called 'Lunch and Chat'.
Through a series of quarterly events the aim of
the initiative is to evaluate the ways in which
Cygnet Hospital Bierley already engages with
carers, and to look at various ways to better
engage carers in patients’ care.
The first 'Lunch and Chat' event took place on
the 21st March 2015 and was a great success.
The carers who attended were invited to
provide feedback on the service at Cygnet
Hospital Bierley and the support they have
received so far from the hospital. Carers were
also asked what staff in the hospital could do to
make the hospital more approachable and help
carers feel more supported. Carers also had the
opportunity to ask questions about the
therapies and facilities provided at the
hospital.
The feedback from the first event was really
positive. Carers told us that they really valued
the opportunity to chat with others in similar
circumstances; and that they felt recognised by
the hospital as being integral to the recovery of
their family members. Some said they felt
empowered through knowing more about the
hospital and facilities it provides. Carers also
provided lots of ideas for the next three
upcoming events, these will be taking place in
June 2015, September 2015 and February
2016.
Based on the feedback we have received some
of the topics that will be covered in future
'Lunch and Chat' events will include:
Information about the different therapies
available at the hospital
Education on the legal aspects of the
Mental Health Act
Medications and their side effects
Diagnoses of different mental health
conditions
Cygnet Hospital Bierley's Social Worker Luke
Jones, who organised the first event, said,
"Historically psychiatric services in general have
perhaps not done enough to engage with carers
so this is an important step forward. We were
delighted with the response we've had so far
and we look forward to a bright future of
working collaboratively and effectively with
carers."
Luke Jones BSc Hons.
Social Worker
Cygnet Hospital Bierley
18. 18
Membership Resources
The LSU network are updating the
‘membership resources’ section of
their website with up-to-date
policies.
If anybody has any policies that
they are prepared to share then we
would be very grateful to receive
them.
Any policies that are submitted will
be put onto the Quality Network
website in a password protected
members area to enable the
sharing of resources.
For more
information
contact the LSU
Team at
lsu@rcpsych.ac.uk
The Royal College of Psychiatrists College
Centre for Quality Improvement is in the
process of developing a Quality Network for
Prison Mental Health Services due to be
piloted in 2015.
The Network aims to facilitate quality
improvement and change in prison mental
health services through a model of
openness and engagement.
Member services will be able to benchmark
their practices against similar services and
be involved in a supportive network,
benefitting from; a detailed service report,
a national aggregated report, visits to other
prison mental health services, peer-review
training, attendance to our Annual Forum
and workshops, the Quality Network’s
newsletter and access to a dedicated email
discussion group.
The Standards for Prison Mental Health
Services have been developed to
encourage a multi-disciplinary approach to
quality improvement in prison mental
health services. By sharing best practice
and by involving key players, for instance
patients, frontline staff and senior
clinicians, a network would allow for
improvement via an open and engaged
forum.
The final version of the standards should be
available in Spring 2015. A set of core
standards being developed by the British
Standards Institute (BSI) and the CCQI will
supplement these specialist standards and
will be used as part of a pilot programme of
the Quality Network for Prison Mental
Health Services.
For further information,
visit our website:
www.qnpmhs.co.uk
