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

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

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:

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

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

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

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

· 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

opportun i ty to engage wi th

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

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

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.

13

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.

14

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

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

16

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

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

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

19

20

Department of Health www.doh.gov.uk

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.

QIPP www.dh.gov.uk/health/category/policy-areas/nhs/quality/qipp

College Centre for Quality Improvement www.rcpsych.ac.uk/quality.aspx

College Traiing www.rcpsych.ac.uk/rainingpsychiatry/eventsand curses.aspx Offers courses for professional development in mental health care.

www.qnfmhs.co.uk

Useful links

Contact the LSU FORENSIC team

Renata Souza, Programme Manager RSouza@rcpsych.ac.uk 0203 701 2684

Sam Holder, Deputy Programme Manager LSU SHolder@rcpsych.ac.uk 0203 701 2669

Megan Georgiou, Project Worker LSU MGeorgiou@rcpsych.ac.uk 0203 701 2701

Amy Lawson, Project Worker LSU ALawson@rcpsych.ac.uk 0203 701 2670

Francesca Coll, Project Worker LSU FColl@rcpsych.ac.uk 0203 701 2672

Royal College of Psychiatrists Centre for Quality Improvement 21 Prescot Street, London, E1 8BB The Royal College of Psychiatrist is a charity registered in England and Wales (228636) and in Scotland (SCO33869)©2010 The Royal College of Psychiatrists

Edited by Lawson. A