ANNUAL REPORT FOR JERSEY FOCUS ON MENTAL HEALTH: RE MENTAL HEALTH PATIENT ADVOCACY JULY 07 – JULY 08
Direction of Jersey Focus Advocacy
In-patient support remains the priority of the advocacy service and the advocacy service is available to all patients who are admitted to Orchard House.
However the service has now been extended to provide one day a week working with clients and staff of the Acute Community Mental Health Team and work is also being carried out on a more regular basis with the patients and staff on the Mental Health wards at Clinique Pinel.
In total over 160 clients have requested and received help from the Patient Advocate on over 930 occasions, some of these requiring extensive and prolonged involvements.
Working relationships
Working relationships have been extended to include closer and regular working with the Acute Community Mental Health Team based at the General Hospital and Chez Marguerite, and with the teams based on the psychiatric wards for the elderly at Clinique Pinel. The Patient Advocate is a member of the Ward Functional Managers Team which meets monthly and has now also been invited to join the Functional Managers Team for the Acute Community Mental Health Team.
Monthly meetings take place between the Unit Manger on Orchard House and the patient advocate as a confidential forum to maintain good communication. Every three months a meeting is also held with the Head of Nursing, Mental Health.
Involvement with other groups
Advocacy participates in regular meetings with the following professional and service user groups including;
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Mental Health Joint Steering Group
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Functional Managers Orchard House
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Functional Managers Acute Community Team
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Orchard House Patient Community Group
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Advocacy worker for Mencap
Legal Aid
The Legal Aid office continues to be extremely helpful and supportive, enabling fast and flexible access to legal advice for advocacy clients. Good legal representation has been provided for clients seeking support at Tribunals and appropriate representation has also been facilitated for clients with litigation, facing criminal charges, or other legal issues in the community. This link with advocacy is particularly valuable as many clients would normally find it difficult to access legal aid services by themselves. It would however be most useful if all firms providing Legal Aid were now to participate in full training on the Tribunal process.
Jersey Police
The police continue to be regularly contacted on behalf of, or alongside service users. This excellent working relationship has helped both clients and the police, and ensures that each listens to the other’s point of view in a more relaxed and constructive environment. The Police respond very well to all the Advocate’s requests and are willing to attend on clients either on the ward or at Chez Marguerite where clients can make informal/formal complaints or raise concerns about their treatment by the police. All such complaints have been thoroughly investigated and reported back in person to the client, together with any learning action points which the police have taken on as a result. This has certainly reassured many clients and hopefully has led to greater understanding and respect on both sides.
Citizens Advice Bureau
Clients are regularly referred to CAB for advice on detailed or complex issues such as debt management or Benefit Entitlements. This referral enables service users to gain access to CAB services fast and effectively but also serves to empower the client by showing what alternative external resources are available, and to take responsibility for resolving the issues with appropriate help. Reciprocal support and advice is occasionally sought by CAB from the Patient Advocate.
MAIN ISSUES DEALT WITH BY ADVOCACY
A significant amount of time is spent by the Patient Advocate in individual meetings with clients on the wards. This enables clients to express their concerns or complaints, to raise questions and gain information, and to prepare for meetings with consultants, other professional staff or outside agencies.
The Patient Advocate accompanies a large number of clients to Ward Rounds or meetings with the Consultant, and also accompanies or represents clients at formal meetings with for example the Children’s Service or the Police.
With the recent introduction of extending the role to the Acute Community Team, time is spent in multi disciplinary team meetings presenting an advocacy perspective, and meeting with individual clients at Chez Marguerite or in the Psychiatric Out-Patients Clinic.
Typically the main issues dealt with include;
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Medication
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Home leave
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Appeals against Detention and Articles
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Mental Health Law- providing information for patients
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Information about the Mental Health Service and clinical approaches
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Complaints about; nursing staff, consultants
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Complaints about treatment by the police
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Support at Ward Rounds
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Access to activities
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Range and timing of activities
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Human Rights – incapacity advocacy
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Removal of children by Children’s Service
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Employment – loss of job, unfair treatment, liaising with employers
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Debt management, bank charges
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Criminal charges
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Visitors to ward
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Access to services in the community
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Alternative residential placements or accommodation for elderly clients
In-house community meetings
This is a valuable opportunity for patients to express their views on the practical running of the ward but unfortunately meetings do not occur as regularly as intended. Wide ranging topics raised by patients include the type, variety and timing of activities and outings, quality and variety of food, heating and air-conditioning, access to cigarettes, etc. Patients do find it frustrating however that many of the simple requests and suggestions frequently repeated by them still fail to be met.
DEVELOPMENTS SINCE LAST REPORT
AIMS
The patient advocate is now a fully accredited Reviewer for the AIMS programme through the Royal College of Psychiatrists. Reviews have so far been undertaken in Woolwich and Huntingdon on acute mental health in-patient wards.
This involves ensuring that rigorous standards and criteria are met on all aspects of ward policy and practice. The purpose is to improve the quality of acute inpatient wards and the standards have been developed from a literature review and in consultation with stakeholder groups. It is particularly useful for advocacy as it offers an excellent opportunity to gain Best Practice examples from other wards.
Health Care Commission
The Healthcare Commission assessment, which is all evidence based, was completed towards the end of last this year. The results will be transparent but the anticipated date of publication has not been met by the HCC so results are not yet available.
Mental Health Tribunal Training;
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In November 2007 the committee of Jersey Focus funded a one day training course which was provided in Jersey by UK professionals who have extensive practical experience of working with Mental Health Tribunals.
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All Tribunal panel members, medical and social work professionals, legal representatives, mental health service managers and administrators were invited to attend.
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The feedback from those who attended was excellent. The objectives of ensuring a greater understanding of the principles and process, the impact of ECHR on Jersey legislation, and improving local practice were all achieved.
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The Mental Health Directorate has now decided to repeat and fund this course early in the New Year for those staff previously unable to attend.
Advocacy Input with the Acute Community A&E Liaison Team
In last year’s Annual Report it was mentioned that very few if any referrals were received via the Psychiatric out-patient clinics. As a result of discussions with the Acute Community Mental Health Team Leader and the Clinical Lead, the Patient Advocate now spends at least one day per week working closely with this team. This team offers a number of services which includes liaison with A&E. The primary objective is to increase appropriate access to advocacy for service users. This is achieved by making the role and benefits of advocacy for patients more widely known to mental health nurses and actively demonstrating how advocacy can at the same time support the team’s objectives. The service is based on direct referrals from nurses in the Acute Team and clients are seen at an appointment based clinic held in Chez Marguerite.
The role has clear boundaries in that input is time limited and the advocate works hard to manage the expectations of both clients and staff. The main function is to empower clients by providing good information, making clients aware of opportunities, helping them to consider the consequences of any choices or decisions, and signposting or facilitating access to a specific service.
Clinique Pinel
A number of training sessions have been provided for managers and staff about the role and availability of advocacy for patients on Cedar, Lavender and Beech Wards. Advocacy is made available on request either directly by patients or by staff on their behalf.
Training Provision
Training sessions about the role and value of advocacy have been provided for;
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Mental Health staff working in the community
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Consultants psychiatrists and doctors
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Staff nurses in the Acute Community Mental Health team
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Ward staff on Cedar, Lavender and Beech at Clinique Pinel
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Social Healthcare students at Highlands College
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Nurse Cadets
Training Received
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Dangerous and Severe Personality Disorder- London
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Behavioural Family Interventions - Jersey
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Advocating for patients with Personality Disorder - Rampton
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Child Protection Foundation- Jersey
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Control and Restraint refresher–Orchard House
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Non-physical interventions – Orchard House – ongoing.
ISSUES WHICH ARE ONGOING:
The following are issues which will hopefully be addressed by the managers and staff on behalf of clients in the coming year.
ORCHARD HOUSE
Provision and use of Therapeutic Activities
Since the introduction of an Advocacy Service patients have consistently complained that the provision of activities is poor despite excellent facilities being available. Activities are limited to part of the working day with still nothing available in the evenings or weekends. As stated in previous Annual Advocacy Reports:-
"patients are very keen to see a more imaginative range of activities which responds to individual interests and addresses the needs of the current client group. Whilst excellent facilities are provided these are under-used and for much of the day stand empty. More significantly they do not feel integral either to the ward, or to the Treatment Plans for individuals. The involvement of nursing staff in actively encouraging participation appears to be limited. Whilst ideas are regularly floated by patients at Community Meetings little progress is visible in terms of patients being offered "normal" weekend activities such as DVD/film nights, barbecues, etc. "
Patients have also requested more group work or activities associated with daily living, such as Assertiveness training, Anger management, and budgeting skills.
Alternative therapies are also often requested."
A trial over a number of weeks of providing evening and weekend activities was universally hailed as effective and popular. However since the pilot was discontinued no such service has taken place. At present service users feel that the Therapeutic Activity Service does not meet the many simple needs constantly identified by patients and nursing staff.
Patients have suggested that Orchard House implements a service with cover provided for sickness and annual leave, and specifies an imaginative and varied programme which is sufficiently flexible to address in-patient needs at any one time.
RECOMMENDATIONS RE TRIBUNAL PROCESS ETC
Mental Health Tribunals
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As mentioned earlier in this report there is still a need to educate legal representatives from a wider number of firms and hopefully this will be addressed early in the New Year.
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Further discussions will be held with the Chairman of the Tribunal and the Director of Mental Health as part of an ongoing process to review practice and procedures.
Article 6 Appeals
The law is currently in the process of being re-drafted to enable the Tribunal Chair or Vice Chair to take on the role of reviewing Article 6 28 day detentions, as opposed to this being carried out by the Minister of Health. This is part of further updating the process and procedures to ensure the law and its application becomes Human Rights compliant.
Alarms
Unfortunately, despite long standing assurances, the activity wing where the advocacy office is based remains un-alarmed.
Smoking
Despite repeated requests the Cigarette vending machine which was abruptly removed from Orchard House has not been replaced. Many psychiatric patients are addicted to smoking and whilst they accept that this is a habit they should give up they do not believe it is appropriate to force them to so at a time of their greatest distress and vulnerability. In the same way patients who have been detained under Articles of the Mental Health Law are not permitted to leave the ward. They do not wish to be dependent on staff or friends to bring in cigarettes – indeed patients firmly believe that the ability to buy cigarettes as and when required remains one of the few things they are able to choose to do whilst locked within the acute ward. A case was recently taken to the ECHR by patients at Rampton and whilst this was lost an Appeal is currently being mounted along the lines set out above.
Patients have expressed surprise that valuable ward staff time is taken up by staff driving on a daily basis to the petrol station at Five Oaks in order to purchase cigarettes as required by patients.
CLINIQUE PINEL
Cedar, Lavender, Beech - concerns
As a result of views expressed by patients, a variety of issues which impact on their package of care have been raised with the management team. As a result patients will be given greater opportunity to participate in decisions about their care.
Facilities on Cedar, Lavender and Beech wards
Patients comment that the wards are tired, gloomy and in need of re-decoration and that all three wards need to improve the standard of facilities provided. Many patients have no real access to outside space and have to sleep in multi bedded wards which offer inadequate privacy.
Some patients have expressed that they are charged for long term care provided in rooms which they think possibly would not satisfy the standards set for private residential homes. This is particularly distressing for those patients who wish, but are unlikely ever to be able to, return to a home of their own.
The Mental Health Directorate is now pursuing "Aims for the Elderly Accreditation" for Cedar and Beech Wards during the course of 2009. This process will undoubtedly address many if not all of the issues currently causing concern to patients. The Patient Advocate has been invited to participate in this process.
Citizen Advocacy
As a result of working more closely with Clinique Pinel a potential has been identified for citizen advocacy input for those suffering from dementia. Citizen advocacy can be provided by volunteers who befriend individual clients and assist them in expressing their needs, concerns and preferences. The Director of Jersey Focus is now actively encouraging those charities involved in caring for the elderly to consider providing this support.
OVERVIEW OF IN-PATIENT CARE
ORCHARD HOUSE
I believe that the acute in-patient mental health service provision in Orchard House continues to be of a very high standard. The team is clearly committed to improving patients’ health and seeks to provide and maintain excellent professional care. Nursing staff do their best to maintain high standards of clinical and personal care, and to work where possible in co-operation with patients, respecting the needs and dignity of each individual. The high quality and the attention to detail of the Orchard House environment is greatly appreciated by patients and their families, and is described as reflecting respect and support at a time when they feel at their most vulnerable. The positive relationships between staff and patients are evident and are highlighted below - these comments reflect the vast majority of views expressed.
Patients’ comments about the ward on discharge questionnaires;
Nearly all boxes covering the environment, nursing care and standards of the service provided for in-patients have been ticked as excellent or very good, with individual comments reflecting this as shown below;
"Excellent – staff will do all they can to help you"
"The most help I’ve ever had. I owe you my life"
"All have true dedication to the job"
"My primary nurse was most attentive and gave his time willingly"
"All the nursing staff were very helpful – thank you for their support"
Comments re Advocacy from patients’ discharge questionnaires;
"The patient advocate made me feel safe and well looked-after"
"Sympathetic, helpful and friendly"
"Her knowledge can calm the most anxious patient"
"Helpful, positive, efficient, follows through queries and questions, approachable"
"Good service. An asset to the unit"
"Very caring and exuded reliability"
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