April 2014: -

.... in your most need to be by your side ... Everyman

*** New !!! More trouble for the the Ward nurses.
The Supreme Court decides that the 'Deprivation of Liberty' test is to be "of continuous control and supervision and not being free to leave ".

How apply this to Informal entry to admission Ward - of someone who has a degree of, but fluctuating, active schizophrenia.
brings issues for the nurses ... at week ends, overnight.

This is Page 1.

Page 2. ...dealings with the 'Teams'

The site is edited by a retired psychiatrist who has looked after someone with the schizophrenia condition, at home,
affected by the negative form of schizophrenia, for the last twenty years.
The highlit links take you to another page. You return via the back arrow at the top of your screen or from a link at the bottom of a page

contact me if you want to help me out with my my views, email about some issue of caring service that is promising, or unsettled and unsettling : at davidwatch@winteryates.plus.com or or text to 07581384722.

[ There is a limited general psychiatry section links ]

A website, principally for carers about and carers for schizophrenia; family, community, and professional service caring, who should - must ! - give voice for the best interests of those cared for who can't, and don't, voice for themselves. ,.....]

The site tries to do two things.
helping carers to inform themselves about the working practices of the Mental Health Trusts so as to help carers influence these, by putting into the system their own experience of the services to their 'cared for'.
caring on and after first illness
The caring journey

1.b How to guide behaviour towards some recovery that is based on an understanding of what has changed at the start of the illness.

To explain the cause(s) of schizophrenia
, from a change in the the structure of the brain that allows schizophrenia to come out of that change.

*** New !!!

(1.) Carers need to continue to know that the standards of community Team practice in their area meet best practice. Too often it is only a belated Inquiry Report into Care and Treatment provided in the area, issued two to four years after a tragedy that reveals the actual working team practice inadequacies.

This is one arrangement that puts ongoing carer experience into the local mental Health Trust deliberations

a Mental Health Trust Carer's Committee. It's Terms of Reference and Constitution
The local Trust is at the preliminary stages of putting an infromation section called 'carers corner' on it's website. Hopefully developed from Carer experience. Carers Corner
a local 'leaflet for carers' has been set out on the 'Carer Corner'.

. You will know how difficult it can be for representative carers in an area get to know the working practices of Community Mental health Teams towards schizophrenia [ 'Confidentiality' : ' you may be their carer in some way but - 'they are adults 'now' - it's their choice', we have to respect it. ]
Your challenge will be " Is it in the best interests of their illness".

How to help carers provide their observations of actual team practice delivery.

An example

In January I cleared this Front Page to campaign for HTAS to be applied locally
HTAS is a Royal College of Psychiatrists Standards template for mental health Trust Community Team practice, including [ page 23 ] -- this is it what you should expect as good practice towards Carers'.
Our local Trust carer Committee requested this be adopted following the Report of an Inquiry locally.
In response the local Mental Health Trust Governance together with the local Clinical Commissioning Group, has started to lay down changes that will deliver the consideration of carer experience into the Trust delivery of service to the serious and enduring mentally ill.

Discussion is now going on between the local Trust provider of service and the local Clinical Commissioning body to provide an assurance of local Standards that would meet HTAS. The Trust had a recent experience of an HTAS inspection of in-patient Standards, so were able to compare an HTAS inspection, with the subsequent visit of the Care Quality Commission making their assessment of the same Service.
There were unsatisfactory findings that HTAS had missed The CQC visit went further than HTAS in its first Report, requiring a follow up Review to check that the unsatisfactory findings they had found were being addressed:..

Carers should - must - find out who is their local Care Quality Commission representative and prepare themselves to be ready with a route to put their observations of service to them, when an inspection visit - usually at short notice - is planned.
It's another route for carers to exert influence by putting in their observations on local Services delivery


3. A carer leaflet [ in preparation] is to be handed out at first contact meeting that explains the working practices of the Team service: how Carers can be involved, and what standards guide the service.
One important new standard is to produce a Standard procedure to be followed in all mental health Teams for recording the minute minutes of what was discussed at the weekly review meetings , one item of which is about 'carer issues'.

go to Page 2

*** New !!!.

The lessons from Inquiries after Homicide are not being learnt nationally.

One constant failure is that there is present in the Community, especially known to carers, information that the Mental Health team involved did not get hold of, had put in place no process for receiving it, so that clinical judgement was undermined. Often there was no regular team meeting at which the Consultant always attended so that his/her highest qualified experience, could hear about situations and give guidance to a full response from the team.

[The mandatory independent External Inquiry system is now increasingly handed over to private business run bodies.

Better to hand the Inquiry system governance over to the Care Quality Commission.

Whenever tragedies are Inquired into, the findings should be taken into account - with those others examined previously, at a national level, and the Reports with those lessons distributed to all Mental Healh Trusts, to sign off that they have read them. Police administrations, Child safety agencies: with the request that they read the Reports, and respond with what changes, if any, are put into place in their own departments. Otherwise the lessons remain in the local Area agencies, and elsewhere get filed away and forgotten.

Most counties now have 'places of safety' areas with a small number of 'beds' to which police can use Mental Health Act powers Section 135/136 to enter people that they think are behaving in a way that leads them to think there is mental illness. But who wll staff them? [ Police county services have been using 135/136 custody sections on around 500 people each year, unwillingly as custodial cells deemed unsuitable for proper care assessment needs.
Police Federation Survey:- "The detention of the mentally ill in police custody, instead of a health-based place of safety, is a growing issue for forces throughout the country. The onus is being put on the police service to fill the gaps and with depleted resources and often insufficient training to deal with this important issue, an unfair expectation is being put upon the police and members of the public who require specialist assessment and support are being put at a disadvantage." ]

A number of problems identified by CQC arise from a shortage of available mental health beds, or appropriate community alternatives, for patients in crisis.

Leading to Out of Area placements. Last year from Cornwall [ 500,000 ] ninety [ 90 ] people were placed Out of Area; some faraway.
The local GP commissioners have been asked to commission ten more admission beds.

The Care Quality Commission has issued it's annual 2012-2013 today January 28 2014.


It's a damning Report and points to a collapse of provision of duty of care and to my mind to provision against CARER risk

. For me the best provision was and is for is a timely 28 day Observation Order [ sec 2 MHAct ] admission to give enough time for a review of illness degree, repair any lapsed treatment programme.

A series of failings in the way mental health services are being commissioned and run is damaging the care of patients detained under the Mental Health Act and undermining their rights, a January 28th report by the Care Quality Commission has found.

The CQC said improvements were "urgently needed" in NHS and social care services after its Monitoring the Mental Health Act 2012/13 report found evidence of substandard inpatient, crisis and out-of-hours care. NHS commissioners in many areas had also failed to meet their statutory duty under the Act to plan for cases of mental health patients requiring hospital admission as a matter of "special urgency", the report said.

There were 50,408 Mental Health Act detentions in 2012/13, the highest number on record. The number of people detained under the Act has risen 12% in the past five years, the CQC said.

A recent investigation by Community Care and BBC News found that over 1,700 mental health beds had been closed since April 2011, with bed pressures harming patients and staff care.

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