Review of Good Practice StatementEngaging People, Observation of People with Acute Mental Health Problems

Jamie Malcolm & Anna Wimberley

• Legislation and policy changes that reflect changing philosophies of care – principle based

• Greater emphasis on risk management in care planning, and observation as a tool in overall care and risk management

• Greater emphasis on involvement of families/carers

• Environmental awareness – new purpose built facilities

CHANGES AND DEVELOPMENTS

• Developments in observation practice - upskilling

• Lessons learnt from reviews of the suicides of inpatients since 2008

• Mental Welfare Commission review of enhanced observation – clear recommendations for improvement for NHS boards

• Use in other clinical settings

KEY CHANGE AREAS  Process-centredCurrent practice: an approach that is based on standardised levels of observation ‘general, constant, special’

Person-centredFuture practice: an approach that is based on an individual care plan/safety plan, prepared with the patient that sets out when, where, how and by whom continuous one to one engagement with a member of staff is required

Allows staff to intervene as specified in the patient’s care plan and to:

• provide support towards recovery

• be a ‘participant observer’

• prevent, contain and reduce any risks arising from the person’s behaviour

• maintain a safe environment

• provide care and treatment in accordance with the person’s overall care plan, and

• record and report on the person’s physical and mental state, progress and behaviour.

ENHANCED THERAPEUTIC ENGAGEMENT (?)

• supportive of the patient’s recovery and do no unnecessary harm to them

• a clearly understood part of the care, operation and culture of the clinical area

• fully integrated in the patient’s overall care plan

• as far as possible, carried out with the patient

• used when the patient is not consenting or unable to consent to any restrictions placed on them, then the provisions of the relevant legislation are used to protect their rights

BASED ON EXISTING GOOD PRACTICE THE INTERVENTION WILL BE:

• carried out only when necessary and there is no effective less restrictive alternative

• not highly visible in a way that carries a risk of stigmatising the patient concerned

• undertaken by staff with the necessary knowledge, skills and information who are confident and supported by management in positive risk taking, and

• based on the principles of the Mental Health (Care and Treatment) (Scotland) Act 2003 and complies with the requirements of human rights legislation.

THE INTERVENTION WILL BE:

• 3 national working groups

• Draft guidance – 50% of the way there

• Lots more to do!

• Original timescales revised to allow for wider engagement and consultation and development of implementation support

WHERE HAVE WE GOT TO?

• Reference group

• Focus groups

• Patient, family and carer verbal/written information (Mental Welfare Commission)

• Access to independent advocacy is easily available (Mental Welfare Commission)

SERVICE USER/PATIENTS/FAMILIES AND CARERS

• Respect

• Trust

• Relationships

• Engaging

• Therapeutic opportunities

• Perspectives

SERVICE USER/PATIENTS/FAMILIES AND CARERS: KEY WORDS

• Multidisciplinary focus groups within each NHS board involving all relevant specialties/services

• Discussion and engagement with key stakeholder groups

• Testing

• Develop implementation support package (patient and family written information and prompts for verbal information/practitioner education and training/legal framework/local policy development)

• Final guidance revision

PROPOSED NEXT STEPS

1. What is your experience, what are the key things that matter to you?

2. What’s the best approach to consultation and collaboration?

3. What are the key things that will make a difference and improve patient/service user/family experience?

DISCUSSION QUESTIONS