The following review will discuss the issue of service individual participation in the release/transfer method. The review was compiled by the author inside a nineteen bedded Forensic Mental Health unit. The ward was at full capacity at the time of writing this review.
The service users' all had different degrees of mental condition, each with another type of history, level of cognitive awareness, degree of institutionalisation and willingness to adapt and change. This review will evaluate to what magnitude service users are participating with the treatment planning/release planning process in the ward and present possible recommendations on how this technique may be upgraded.
The review will consist of an introduction, seeks of the review, ways of data collection, studies on some questions and answers on the amount of service end user involvement in the discharge process, conclusions, and possible recommendations for change. It will conclude with a representation piece. 148
During this placement the author decided on a subject to review, this subject matter was service customer involvement in release planning. While collating information for the review some questions arose these questions were:
Does the service individual feel contained in decision making?
How will the staff involve the service consumer in your choice making if at all?
Has release been discussed with the service individual?
These questions lead to the writer constructing some key questions to handle in the review these will be discussed further in the results. 91
The data for the review was gathered more than a ten week period within the ward. The author consulted service users' notes, attended multidisciplinary team conferences and conducted a series of semi-structured, someone to one interviews with service users and staff, including a expert, doctors, ward director, nurses, nursing assistants and occupational therapists.
A literature search was also carried out using accredited databases including CINAHL and the English Medical Index. Relevant journal articles were found on these databases using keywords such as service user, engagement and mental health services. Nursing research books were also used to assemble information along with internet sites underlining national procedures and models for mental health nursing. 110
How are decisions made within the positioning area regarding discharge planning?
Throughout the weeks on this position research was carried out by the author on guidelines and strategies for release planning. The one in particular that was found to be relevant was the Treatment Programme Procedure (CPA). CPA is approximately early identification of needs, assignment of people or organisations to meet those needs within an agreed and co-ordinated way and regular reviews of improvement with the patient and attention providers. CPA is also about including family or carers at the earliest point. The Care Programme Methodology requires that patients should discover copies with their care ideas and it's been more and more common for patients who've been the responsibility of forensic psychiatrists to have copies of documents relating to their treatment. (DOH 2008).
Systems were set up for comprehensive attention planning. There is evidence showing that the service users' sociable, educational and occupational needs were taken into account in the care planning process and other specialist interventions were available.
In addition to the, in some cases, discharge planning was noticeable from an early on stage (shortly after admission), although in other conditions a couple of months possessed elapsed before any report noted those conversations. Discharge planning is enhanced by the Care and attention Programme Strategy (CPA) a multi-disciplinary health care planning systematic procedure which involves service users and their carers'. Good care Programme Approach is the platform for health care co-ordination and tool allocation in mental health services. Decisions for release are made through the multi-disciplinary team which contains consultants, ward director, nursing staff, occupational therapy and social staff. This will move forward to a tribunal where in fact the service user will be asked to take part, here all the evidence will be put forward and a conclusion will be made. If the service user is restricted then the decision will be produced by the First Minister.
Most service users have permanent mental health problems and complex cultural needs and have been in connection with mental health services for more than two decades so never think about release. Being in medical center for such a long time has become part with their lives so service users see it as pointless being discharged, "what would I really do" 360
What decisions/participation does indeed the service customer have in this process?
Service users' are encouraged to be fully involved with all areas of their care as far as they are able to. Service users past and present hopes should be taken into account, their views and views with regards to their treatment solution must also be registered, as mentioned in the Mental Health (Good care and Treatment) Act 2003. The guidelines of the act underpin any decision made relating to a detained service customer in Scotland. The Milan Committee committed a section in the take action that described high risk patients it explained that service users should have the right of charm to be moved from a high or medium secure service to that of your facility with lower security conditions. (Mental Health Care and Treatment Scotland Action 2003).
Within this positioning care and treatment programs are reviewed frequently. Service users are expected to talk with their key staff member and other associates frequently, care ideas are examined at these meetings and a mutual agreement will be determined, on the best way forward, after the care plan has been decided by all the service user has to stick to the care plan.
Service users have the ability for regular one-to-ones with their key employees (every week basis) or more regularly if indeed they require. Service users have the opportunity to put forward their thoughts on discharge and another facet of their good care at the review, such as their protection under the law beliefs and their right to a tribunal (The People Rights Action 1998). The review occurs every four calendar months, again this is a multi-disciplinary conference and service users are asked to wait with the support of advocacy or someone with their choice. The Human Rights Function 1998 offers legal effect in the UK to certain fundamental protection under the law and freedoms within the Western Convention on Individual Protection under the law (ECHR). These privileges not only have an effect on matters of life and death like flexibility from torture and getting rid of, but also influence your protection under the law in everyday routine: what you can say and do, your values, your right to a fair trial and many other similar basic entitlements.
During enough time spent on this location it was observed that service users and key staff met at the start of the week to discuss how they noticed things have been for the kids, the service customer has the chance to discuss what changes they wish to happen, this is then noted in the service users' notes and taken ahead to the scientific team that week where it would be talked about if any changes in treatment and treatment would take place, the service customer is then informed of any changes and decisions made. The chance arose for the writer to take part in these every week reviews, in this one-to-one time most service users could actually point out their thoughts and emotions about issues that they had came across that week and describe what restorative strategies they used to complete it.
The service customer will discover a duplicate of the Treatment Plan Objectives, or enlightened in detail of the articles of the treatment plan, in the event that any learning or specific reading or terminology difficulty information should be provided in a way that is most probably to be grasped.
Arnstein (1969) constructed a "ladder of contribution" which identified eight periods of user contribution in services, including mental health. These stages ranged from no participation to user managed services. The aforementioned service users would be placed on the sixth rung of the ladder in the relationship range as they agree to reveal planning and decision-making duties.
Does this position area reflect it's practice on local or nationwide guidelines regarding service end user involvement in discharge planning?
When asked their views about them the Ward director and senior nursing staff presented paperwork which reaffirmed current practice within the ward. The Ten Essential Shared Capacities (ESC's, ) he discussed was the model now being followed on the ward, has just been implemented into this area of location within the last two years, that your ward personnel have adopted well by giving a person-centred approach whenever you can. This new person-centred model embraced the ethos of the aforementioned, and senior staff pressured that good practice dictated that service users have the opportunity to correctly influence delivery of care and support. A review of plans and methods as well as discussions with personnel provided information that the guidelines were actually in place.
Throughout the positioning, the author pointed out that efforts were being made all the time to nurse based on the new model. Included were regular one to one trainings between nurses and service users to listen to their views and thoughts, these already took place prior to the ESC's were presented. Moreover some personnel do find it hard to adopt the ESC's and the mental health work because of the restraints of the environment (secure ward), however they are ready to embrace the opportunity for further education and support.
Identify barriers and constraints.
While on position and doing this review the author noted that one of the barriers to effective involvement came from some of the service users, due to the complex nature of the area the service users got become institutionalised and found it difficult to be thinking about discharge at this stage in their lives, so they just acknowledge just how things are and don't get too much engaged as far as care plans are participating and say what they think the personnel want to listen to.
In secure settings engagement of service users in analysis and treatment can be difficult, as there is a potential risk of perceived coercion.
Moreover with the lack of medium secure facilities around this can hinder service users from shifting within the given time limit decided, as there are no procedures.
Most service users were more concerned about their futures and life post discharge. They needed their time taken between occasionally to be concerned with setting up them for release. It was frustrating for many service users that they thought that little in the way of such planning was taking place
High secure items should ensure that at the idea of discharge patients have a copy of their release care and attention plan in a suitable format which include appropriate information about the circumstances that may result in their go back to secure mental health provision.
However a recommendation that high secure units should ensure that factors to be weighed in assessing relapse are part of the risk assessment included in the discharge plan of all patients.
The National Service Platform for Mental Health says that 'Service users and carers should be engaged in planning, providing and analyzing training for all healthcare experts' (Division of Health, 1999). This is actually the case in most health care provisions but also for more education, training and information to become more easily available.
Strengthening an individual perspective and consumer participation in mental health services is a key part of policymaking in many countries, and also offers been urged by World Health Business (WHO) in order to establish services that are better customized to people's needs and used more properly.
In this review, I need to reflect on the situation that occurred during my clinical placement to develop and utilise my interpersonal skills in order to keep up the therapeutic relationships with service users. In this particular reflection, I will use Gibbs (1988) Reflective Cycle. This model is a accepted platform for my representation. Gibbs (1988) consists of six phases to complete one cycle which is able to improve my medical practice continually and learning from the experience for better practice in the future.
During the first week of position I was urged to work closely with my mentor. This provided me the chance to orientate myself to the ward and get an overview of the needs and requirements of the service users. This also provided me with the chance to observe how the medical team done the ward. During this time period I have learned that if the concept of interprofessional working is to achieve practice, pros need excellent team working and communication skills. Good communication, as we have staged in our group work theory, is essential in the effective delivery of patient treatment and poor communication can bring about increased risk to the service users. I have learned the valuable skills necessary for good communication and can copy these into practice by adapting to the neighborhood communication methods. The NMC tips that at the point of registration students should have the required skills to talk effectively with acquaintances and other departments to boost patience health care (NMC, 2004).
In finish of my reflective project, I talk about the model that I selected, Gibbs Reflective Cycle(1988) as my construction for my reflective part. I state why I am choosing the model as well as some debate on the top of doing representation in medical practice. I am able to discuss every stage in the Gibbs (1988) Reflective Pattern about my ability to develop my therapeutic relationship by using my interpersonal skills with service users for this reflection. 369