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 Foundaon 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:-
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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 2
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 3
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
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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
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
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:
Health and Social Care Advisory Service www.hascas.org.uk An evidence based service development organisation working in all spects of mental health and older people’s services across the health and social care contiuum
Institute of Psychiatry www.iop.kcl.ac.uk The largest academic community in Europe devoted to the study and prevention of mental health problems.
National Forensic Mental Health R&D Programme www.nfmhp.org.uk Recently completed programme of research funding to support the provision of mental health services for people with mental health disorders who are offenders/risk of offending.
National Institute for Health and Clinical Excellence www.nice.org.uk An independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. Includes the National Collaborating Centre for Mental Health (NCCMH), a partnership between the RCP and BPS.
National Offender Management Service (NOMS) www.justice.gov.uk/about/noms Brings together the work of the correctional services.
Prison Health www.dh.gov.uk/health/category/policy-areas/social-care/offender-health A partnership between the PrisonService and the Department of Health working to improve the standard of health care in prisons.
Offender Health Research Network www.ohrn.nhs.uk
The Offender Health Research Network www.ogrn.nhs.uk The Offender Health Research Network is funded by Offender Health at the Department of Health, and is a collaboration between several universities, based at the University of Manchester.
Centre for Mental Health www.scmh.org.uk An independent charity that seeks to influence mental health policy and practice and enables the development of excellent mental health services through a programme of research, training and development.