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Newsletter: Partnership Matters

Issue 8 (June/July 2003)

Prevention and management of agression - another view
A letter from Dr Maggie Cork
GP Advisor - A new role in the Trust
No longer a diagnosis for exclusion
Can you be a mental health survivor and a mental health worker
Better food - improvements in catering services
Future directions for mental health services in Leicester City
Older peoples' services successfully recruit
Sexual abuse clinical forum

 

Prevention and management of agression - another view

I am glad that the Trust recognises its responsibilities towards its staff members in the Trust's policy on the Prevention and Management of Violence and Aggression. (See Partnership Matters, April/May 2003). I am however deeply disturbed by some aspects of it.

Whilst I recognise that staff members who have acts of violence committed against them, should get all the support they need, I wonder what happens to service users who have acts of violence committed against them, by members of staff.

Acts of violence can be defined as causing damage to a person and constitute both psychological and physical injury, and include the following, which is by no means a comprehensive list.

I would contend that all of the above are some of the reasons why staff members might meet with violence. Perhaps what is worse is that each of the above atrocities can be conducted on service users, a group of vulnerable people, who have few material or emotional resources, who have usually experienced a lifetime of psychological assaults and who come to you for help and hope.

One shot of lightness does appear in your article however. It's the picture of two men arguing. Since they are both dressed in white collars with ties, I realise that they must be managers having a row. They really do look ready to bash each other, so I hope you will be sending them for the support they so obviously need.

Linda Hart

Related item:

Prevention and management of violence and agression

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A letter from Dr Maggie Cork

Chief Executive, Dr Maggie CorkIt feels like a long time since I have written in Partnership Matters, but with the work that lies ahead of us this month and into July, in the form of the 'Making t Sense of the Future' workshops, I feel it is ( important to share a few thoughts with you.

During the last 18-24 months, there has been a great deal of activity across all services in thinking through new service models, service redesign, how we continue to do the 'day job', increasing pressures, etc, etc. Nevertheless, feedback from the staff attitude survey and Improving Working Lives assessments tells us that staff feel that there is not yet a clear sense of direction.

What I and the Board, have been keen to do is to nurture a sense of direction, in partnership with yourselves, so that it can be fully developed at a point that is right for the organisation. The time is now right for us to take that next step - of building on the work that has been undertaken so far and preparing to move on into the future. The Making Sense of the Future workshops will help us draw together and build upon the important work that has happened over the last 18-24 months.

It also feels essential to me that we constantly scrutinise our own practice and that we remain open to challenge and scrutiny in the work that we do. We will shortly be seeking feedback on the value of Partnership Matters as a means of communicating with staff, alongside the Chief Executive's News Update that comes out each month.

We are also keen to explore with you and. others who read these documents whether we should formally widen the scope of Partnership Matters to include other stakeholders and partners with whom we work. Are we at the right point in time when Partnership Matters should reflect the full range of partnerships in which we engage (that is the service users, carers, partners in social care, general practitioners, colleagues within the voluntary sector, our commissioners, etc)? We would like to review in a comprehensive way how we use Partnership Matters as a result of the audit we will be undertaking.

In advance of that work, we are receiving an increasing number of requests to place articles in Partnership Matters, from individuals and groups with whom we work in partnership. In this issue we have a very personal perspective from Linda Hart. Linda refers to a number of areas that we struggle with in our daily work. The recent report from the Sainsbury Centre for Mental Health has reinforced our own view that some of our acute in-patient services have levels of staffing well below the national average. Reports such as this guide and inform the discussions we have with commissioners in taking forward the acute mental health in-patient reprovision project (AMHIRP).

One of the many consequences of this project would be a better ratio of staff to patients. This in turn would lead to a much better experience for service users and for those who care for them, including all our staff - many of whom work in very difficult circumstances. It is not just service users who describe many of our settings as inhuman and who seek to see them changed.

We should all feel impatient to move this situation on and I'm really pleased in this context that we have support from all of our commissioners for the overall service model that the Sainsbury Centre recommends. Clearly we are all working through the detail of potential future arrangements and are grateful for the range of issues raised and comments received through the consultation period; we shall ensure that they are taken forward in the ongoing work. Detailed service planning must be based on service user, carer and staff views and on discussions with our commissioners because, ultimately, it is only possible for us to provide a service that our commissioners wish to buy.

I look forward to meeting many of you at the Making Sense of the Future workshops.

Dr Maggie Cork,
Chief Executive

Related Item:

AHIRP Update

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GP Advisor - A new role in the Trust

Dr Les Ashton, GP AdvisorDr Les Ashton was appointed as GP Advisor, a new role in the Trust, in December last year. His role has been devised as part of the strategy to improve the experiences of mental health service users and carers in Primary care, through improving training and education for the primary healthcare team and promoting effective working arrangements at the 'interface' between primary health care services and our own secondary mental health services.

This means he is involved in work to meet the National Service Framework (NSF) and NHS Plan targets that impact upon both primary and secondary care. He is involved in joint work across primary and secondary care in developing new models of shared learning in communication, consultation and treatment skills. A further important aspect of his work is in the training and education arena working in partnership with the Leicester HEI's. One of his first priorities, a requirement of the NSF, is to become involved with education and training in mental health across primary care.

In describing his role Les says,

"It is a needed role and I'm pleased that the Trust is supporting it. I feel I have been able to bring a primary care perspective to these areas. It is not a representative post but I am pleased to be able to become involved with issues that ease the primary and secondary interface."

There are very few GP Advisor roles in the country and consequently the role is developmental in nature and still evolving. The post is 2 sessions per week, although in fulfilling it Les capitalises on his other activities and links, such as:

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No longer a diagnosis for exclusion

- Launch of Trust Guidelines on Personality Disorder' Clinical Governance Forum held in May 2003 at Alfred Hill Training Centre

This event was a great success, with speakers mostly from within our Trust addressing a booked out forum at the Alfred Hill Centre. Following lunch, Jane Hoskyns, Medical Director, introduced the forum, with a message that we must work together for the benefit of service users with Personality Disorder (PD); and she reiterated that sharing of good practice lies at the heart of the Clinical Governance Forums. She was heartened to see faces present that represented many different areas of the Trust.

Dr Wilson Firth gave an Adult Mental Health (AMH) perspective on Personality Disorder, highlighting the importance of team working for this client group, and management of treatment. Once clients are transferred from AMH to therapeutic settings it is important for AMH services to maintain a role or relationship, without being too close.

Anthony Bree gave an overview of life at Francis Dixon Lodge (FDL). Many service users are the heroic survivors of life, and there is a need to acknowledge that often 'work is messy and you can't avoid the mess!' He spoke about plans for the new FDL Outreach Team and introduced the idea of a managed clinical network.

'...a need to acknowledge that often work is mess any you can't avoid the mess!'

Peter Dent, of Woodlands Day Hospital spoke of matching PD service users to the right intervention, with strategies that are challenging but not too much so. The Woodlands Milieu Group offers a mix of individual and group therapy for those who would benefit from this. Deborah Greaves outlined the process whereby service users who are referred to Woodlands are assessed and then follow a pathway of treatment. Their 'Port Folio Group' pulls together many aspects, and this model will be rolled out to other areas, with Woodlands staff co- facilitating with staff from CMHTs.

Professor Connor Duggan, from Arnold Lodge, gave the Forensic perspective, and posed the question 'Personality Disorder - Why and How should we take it seriously (as service providers)?' He stated that the condition has a major impact upon services. There is further need for training in how to diagnose accurately and better match treatment approaches.

Penny Campling, the main organiser of the event, emphasised the importance of the new Trust 'Guidelines for managing patients with personality disorder'. She spoke of the need to focus on the therapeutic alliance, and the 'dance' to maintain balance between service user and therapist. She also argued that services should be organised in such a way as to mirror the work with individual patients, ie, good links, good communication and balance.

Packs were disseminated that contained the Trust guidelines, and also the National Institute for Mental Health in England (NIMHE) Policy Implementation Guide, 'Personality disorder: No longer a diagnosis for exclusion'.

Further copies of the Trust guidance can be obtained from Francis Dixon Lodge, tel. 0116 225 6800, and the NIMHE booklet is available from tel. 0113 254 5000.

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Can you be a mental health survivor and a mental health worker

I've been a worker in mental health services in Leicester for five years. I've also experienced mental health difficulties myself. In most mental health services, there will be a lot of people like me. The experience of our own psychological pain, or of having had to use mental health services often motivates people to work in mental health. But when you become a worker, you find that it doesn't feel safe to admit to this. There's a stigma around it - the prejudice that you'll always be off sick, be a trouble-maker or "over- identify" with service users. Discrimination is a common experience for survivor workers (Snow, 2002).

The reality is that being a survivor worker can be incredibly positive. And suppressing our true feelings and not being allowed to be open about our experiences is damaging for all workers, whether we've had mental health problems or not. Really engaging with people in psychological pain is important. One of the things that service users say they would like more of from services is for there to be more genuine human connections, less of the 'us and them' between workers and service users. But it's also emotionally difficult and painful for the worker. And if we can't admit that we have feelings, because we're frightened that we'll be criticised for being 'unprofessional', we either carry on trying to deal with everything on our own, and burn out, or we disengage and distance ourselves from service users.

The article below has been written by another worker - a colleague in the Leicestershire Partnership NHS Trust. We've decided to set up a survivor workers group - a group for anyone who works within mental health services in Leicester and has also experienced mental health problems, to discuss our experiences and to support each other. The group will be completely independent and confidential. If you're interested, call Kala on (0116) 210 9652 or e-mail leicsurvivors@yahoo.co.uk.

'Them and Us'?

Honesty about mental health, feelings and emotions brings abut a sense of relief, trust, responsibility and power for workers and service users.

In my opinion there really is no 'them and us' as far mental health workers and mental health service users go. I know 'workers' who have been 'users', 'users' who have been 'workers' and lots of 'workers' who are also 'users'. I've spoken to survivor workers (people who have survived the mental health system) and work survivors (people who have survived the employment system). Trying to box people off makes no sense at all.

I've had mental health problems and I work in mental health. This fact helps me to do my job. I know what it's like to struggle with my mental health and also how patronising and misleading the labels are. I have been on the receiving end of impersonal, irrelevant and condescending services, which have sometimes made my mental health worse.

Workers who've had mental health problems often keep quiet about their own experiences because of fear of discrimination. This reinforces the 'them and us' myth with service users thinking the worker is a breed apart, gleaning all their knowledge from text books only. It encourages an inequality that makes the service user feel inferior (they are the only one with the problem) and lacking and that the worker is the one able to impart knowledge and advice. Honesty about mental health, feelings and emotions brings about a sense of relief, trust, responsibility and power for workers and service users.

When we no longer box people off into stereotyped groups, working together becomes a lot more complex but a rewarding and successful endeavour.

References: Snow, R. (2002) Standing Tall: Report of The 1st National Conference of Survivor Workers UK.

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Better food - improvements in catering services

Catering servicesImprovements in catering services for our in-patient locations were recommended in the CHI report published in July last year. Since that time we have made significant progress by adopting best practice evident in some areas, to assist others in improving the quality of service for patients.

The CHI report recommendations focused on nutritional quality, menu choice and the availability of meals and snacks, including cultural meals. All of this links closely with the requirements of the Better Hospital Food Initiative.

A steering group was set up in September 2002, led by Facilities Services and involving representatives from all service areas, all service providers and the dietetics service. (See membership).

We agreed that our first challenge was to find out how services are provided in each of our 15 in-patient locations and to compare this with a list of key criteria.

This information is available in a report that received Trust Board support in October 2002. The report considers the following:

The following improvements are now in place as a result of the work of the steering group.

tickPatients who are admitted between meals or miss a mealtime can now get a meal.

tickThe views of a wide range of stakeholders, including service users, are included in the review of catering specifications for services at the Bradgate. Brandon and Belvoir Units and the Bennion Centre.

tickThe formation of multi-disciplinary food groups including service users has been recommended and will be adopted for main hospital sites. We hope to roll this out to Treatment and Recovery services.

tickThe Dietetic Service is planning to recruit dietetic assistants.

 

tickWe are assessing the viability of having a centralised service for cultural meals, which would provide patients with more menu choices at an improved cost to the Trust.

tickA condition survey of catering equipment is complete and the data will be incorporated into a 10-year investment plan.

tickChanges in the style of service at the Belvoir Unit have been recommended and are being considered.

tickThe new Hotel Services contract will in future require formal reporting against national key performance indicators.

tickWe have appointed a full time monitoring officer to ensure that improvements continue.

 

For more information, please contact Jennie Anderson on extension 5953 or any member of the Steering Group

Members of the Steering Group: Jennie Anderson, Jane Calow, Wendy Carver, layne Chambers, Lynda Dyer, Julie Glover, Liz Merry, Elaine Moore, Diane Nurse, Nan Rooke, Beckie Skirrow, Liz Tebbutt

 

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Future directions for mental health services in Leicester City

What do you think mental health services in Leicester should look like in a few years?

The City Mental Health Strategy Group, which involves Leicestershire Partnership NHS Trust, service users, carers, Primary Care Trusts, voluntary organisations, the city's housing department and others, has been looking at that question. We've produced a draft strategy for the city for the next three years, trying to incorporate local needs and issues as well as what's required of us by government policy.

The strategy will be used to guide the development and the commissioning of services over the next few years, so it's really important that as many people as possible can have a say about what is in the document.

Currently, our key recommendations include:

If you'd like a full list of the recommendations, or a copy of the complete draft strategy, they are available from:

Kala Subbuswamy, Planning and Service Development Officer, Adult Mental Health Room 204, Town Hall, Town Hall Square, Leicester LE1 9BG Tel. 0116 225 4768.

The deadline for feedback was 31 July 2003, and we're planning to have the complete strategy ready and agreed by October. So please ask for a copy and get your views to us, because your views will count!

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Older peoples' services successfully recruit

National and local recruitment initiatives have resulted in 29 new people being offered posts in Mental Health Services for Older People.

Leicestershire Partnership NHS Trust (LPT) took part in a national recruitment event and we held our own very successful recruitment open day at The Evington Centre. Of the 29 people offered jobs, 13 are qualified staff ranging from D grades to G grades and the other 16 people were appointments to unqualified posts.

The posts are funded from the recently negotiated Local Delivery Plan and will enhance our ability to deliver quality in-patient services. The extra appointments will also reduce the need to use bank and agency staff within Older People's Services and so improve the continuity of care for patients.

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Sexual abuse clinical forum

The Dynamic Psychotherapy Service has run a well attended programme of seminars on the topic of sexual abuse since 1998. The service is now planning to extend the training by establishing a Sexual Abuse Clinical Forum, which would meet quarterly at the Alfred Hill Centre.

The Forum would meet for half-day workshops and topics they plan to address include:

If you are interested in attending the Forum or have suggestions about future events, please contact Tracey Alexander, Principal Psychotherapist, Dynamic Psychotherapy Service, 0116 225 6430.

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