Enhancing a Mental Health patient’s experience

Introduction

This assignment is based on a patient journey encountered in my work experience as a mental health nurse, in a low secure rehabilitation unit for men suffering from a range of mental health and personality disorders, liable for detention under current mental health legislation’s. A detailed description of the patient journey will be cited in the appendix. The assignment will provide the rationale for choosing this journey. It will further critically analyze key healthcare challenges identified namely disengagement, service user involvement in care planning and how these have affected the patient and their supporters. It is important to acknowledge other healthcare challenges such as lack of community services could not be discussed due to the word limits set out for this essay. For the purposes of confidentiality, (Nursing and Midwifery Council (NMC), 2008) Clause 5, the patient name will be referred to as Michael (pseudonym).

Patient Journey

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The full description of the patient’s journey can be found in appendix.

Rationale

The rationale for the choice of patient was derived from my working experience as a primary nurse to Michael on the ward. Furthermore the development of better services for people with mental health has become a national priority in the UK (DoH, 2005).

It’s sometimes easy to underestimate the significance a patient might place on change like being forced to stay in hospital against their will, and miss important signs about how they are feeling. For some patients it can generate negative feelings of being incarcerated .On the contrary, detention of a patient can be perceived as progress and road to recovery by nurses (reference) Consequently increasing patient levels of anxiety if support is not provided making it difficult for nurses to engage the patient in their proposed care pathway (DoH, 2010). Wagstaff, (2011) stated that many patients equate hospital detention and treatment to imprison and lose of independence. Therefore it is important to recognise and value the benefit of listening and responding to patients experience and further recognise that the patient experience is the catalyst for doing things differently to improve the way services are delivered( Department of Health (DH),2003).

Michael expressed his frustration and felt that his life had been interrupted and having to wait indefinitely and is helpless to speed the process.

Furthermore this can impede on his chances of being reintegrated back into the community resulting in becoming hopeless.

4 Key Challenges

Difficulties in engagement

Wagstaff (2011) defines engagement as adherence to treatment and professional agenda another author. Thurgodd (2004) defines it as an experience by clients of acceptable accessible positive empowering service.

The National Service Framework for Mental Health (1999) states that people with severe mental illness must engage with the services available to them throughout their stay in hospital but it can be noted that most patients do not conform to this due to bad experiences of services(Department of Health, (1999).

Therefore patients need to know that staff understand and care about how they feel (DOH,2010) but it can also mean nurses have the responsibility of understanding. Patients in hospital may experience problems such as compliance with treatment and feelings of incarceration which poses as challenges to policy makers and staff involved in the day to day care of patients..Michael expressed his desire for independence and felt it was going to ruin his life

.Priebe (2005) found out that people disengage because they may lose their independence and sense of identity and will have difficulties with accepting diagnosis Michael reported that he had experienced poor services for long period of time both in hospital and in the community When patients get admitted to hospital they are detained against their will therefore the main challenge faced by nurses is patients requesting to be discharged despite proposed treatment working with clients general adult and old age psychiatrists often find themselves in a position where they have a responsibility to deny people freedom of choice by imposing compulsory care and treatment in the service of safety.

There have been differing perspectives on this from people who use mental health services and their advocates. Some assert that there can be no recovery as long as people are detained against their will and subject to force, others that there should be no " recovery free zones " in mental health services. Roberts et al (2008), exploring this dilemma in Advances, developed a view that compulsory care and treatment, when needed, are compatible with a recovery-oriented approach.

Person-centred approaches adopt a similar pragmatic stance. Acknowledgement of the " Bournewood gap ", where people with dementia have been detained de facto but without a legal framework to appeal (Department of Health 2005), has been an important step. In institutional settings where freedom and personal choice can be heavily constrained, small choices may produce a disproportionately large contribution to well-being (Roberts 2008) and there is evidence that people can make reliable decisions about long-held preferences well into their dementia (Brooker 2007).

Paradoxically, in circumstances of incapacity (Church 2007) a high degree of restriction may be more supportive of recovery and personhood than leaving people to " rot with their rights on " (Davidson 2006). Leave restrictions and detention provide boundaries to support safety planning.

Care Planning

The service user involvement in their care is one of the statutory requirements by the NHS and Community Care Act (1990) and The Health and Social Care Act (2001). Additionally the National Service Framework (1999) and the Care Programme Approach (1991) set standards for mental health services and emphasise on the need for user consultation and involvement. As a result the writer realises the importance of involving patients in decision-making about their care to be good practice. One of the concept of clinical governance is that the patient should be at the centre of their health care, meaning that the individual will actively be engaged in all stages of the decision making process ( Funnel, 2003).

The concept of service user involvement is broad and difficult to define as stated by (Simpson et al, 2002). It can be very difficult or in some cases impossible to complete the assessment forms for a variety of reasons. A person in care, especially if being detained against their will in hospital, can be physically violent, may seek to abscond, and may initially refuse to engage with staff. Some, although not actually violent, can be verbally aggressive and uncooperative in answering questions. These situations are common and understandable in people who are being compulsorily detained or treated against their will. Their admission can just fuel their anger, suspicion, and sense of in justice. From previous experience using the principles and practice of the TM, however, untoward or violent incidents are far less common when we persevere in trying to relate to difficultservice-users and, through perseverance and goodwill succeed in doing so.11The sooner the person in care feels understood, the sooner he or she will calm down and become more trustful and co-operative. Of course, the necessary precautions have to be taken to make sure no one gets hurt before this happens. Other service-users cannot relate initially because they are so distressed ,confused or preoccupied with their own thoughts and feelings. They may not be capable of giving coherent answers to questions at this stage. Some may be willing or even eager to talk but have such bizarre thoughts that their answers seem to us unintelligible. These ideas may be considered psychiatrically delusional. But it must be remembered that these ideas are real and very important to the person. It is helpful to accept their validity and imagine what it must feel like to hold those beliefs. These can then be better understood and discussed.

The benefits of service user involvement stem from the view of service users as experts in their own experience of mental disorders and the services offered (National Institute for Mental Health in England, 2003).The National Schizophrenia fellowship (1997) are of the notion that user involvement should improve the professionals better understanding of the impact of mental illness on users, better targeting of services with a knowledge of effective interventions and increased compliance with treatment by users. However Barnes and Bowl (2001) argue, that “user involvement is not a clinical intervention technique”(p95). On the other hand Priebe and McCabe (2006) also state that involving users in planning care may help the professional and user develop a therapeutic relationship.The NSF (1999) stipulates that all service users should be involved in the planning of their care and should have a copy of their care plan. Ryrie and Norman (2004) describe a care plan as a process by which the nurse arrives at a shared understanding with the patient of what the problems/needs priorities to be taken and provides details on what should be achieved. Care plans should identify a client’s specific need including actual and potential problems, measurable goals to work toward for each problem, realistic approaches to reach each goal, time frames for reaching and re-evaluating goals, and individuals with the primary responsibility for each approach (Ryrie and Norman, 2004). Fox (2004) suggests that care planning provides a road map of ways, to guide all who are involved with a patient’s care. Since assessing anyone’s mental health problems depends almost totally on the person’s account of his/her experiences, this account is seen to be very important. The person’s experiences are unique to them, and known completely only by the person themselves. When someone has mental health problems, they often have extreme or upsetting life experiences, that are preventing them functioning in their current situation

Very often, there is a threat to self, the heart of our life experience .Very often the person becomes isolated even from friends and family. It is only by drawing close and listening to their “story” or the account they give of themselves and their experience that we can begin to understand, work out with them what might be done to help.(

The CPA and NSF standard

4 calls attention to involving service users to their own care and view it as managing and co-ordinating care (NICE, 2002). Peck, et al (2002) states that when service users are involved in drawing up their own care plans leads to a positive outcome. However, Webb et al (2002) in a survey to evaluate the implementation of CPA found that the service users were not involved in the care planning procedure and did not have a copy of their care plan. Rose (2003) found that most service users did not understand the CPA process and they were not aware of how care is coordinated and were not involved in the care planning process. Dougherty and Lister (2004) state that clinicians should recognize that the client is the expert regarding their own health care needs; therefore it is important for the clinicians to plan

The National Service Framework for Mental Health (1999) states that people with mental illness must engage with the services available to them However, despite the availability y of many treatments for patient group many avoids them (Sainsburys Centre for Mental Health 1998).The importance is to create a relationship that allows the patients to share their experiences whilst receiving treatment to improve their quality of life.

Lack of services

When the courts order hospitalisation of a patient for treatment it may be argues that the court is concerned more with the therapeutic interventions that focus on the reduction of risk to the public than with the client individual treatment needs (START,2004)Although safety is of paramount it needs to be recognised that individuals can become institutionalised in the system impedeing their journey to recovery.

Conclusion

(approximately 150 words)

References

1. Barker P (2001) (b) The Tidal Model: Developing an Empowering, Person-Centred Approach to Recovery Within Psychiatric and Mental Health Nursing, Journal of Mental health Nursing 8, 233-240
2. Maureen Smojkis (2008), Person-Centred & Collaborative Mental Health Care (Using The Tidal Model) Turning The Tide Handbook, The Centre of Excellence in Interdisciplinary Mental Health University of Birmingham & Birmingham and Solihull Mental Health NHS Trust (Nursing and Midwifery Council (NMC), 2008) Doh, 2005 National Srvice Framework 5years on . Doh, London
3. Thurgood M 2004 Engaging clients in their care and treatment. In Norman I, Rye I the art and science of Mnetla Helath nursing. A textbook of principles and practice. Open University Press Maidenhead.
4. Sainsbury Centre For Mental Health(1998) Keys to engagement: Review of Care for People with Severe Mental Ilness who are hard to engage with services, SCMH, London.

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