New at Caring
How to behave
Hippocampal new cell proliferation failure in continuing schizophrenia brings difficulties in their daily living. Reducing the incoming information load in a daily life, by providing a fixed routine, building it on from a reduced expectation at the beginning, in a friendly setting as in an occupational day centre, helps, where regularity and repetition with plenty of uninterrupted time and less going on, provides a less stressful setting, gives a relieving care situation, where problems can be addressed with enough unhurried attentive support. Households should try to develop the same kind of daily routines.
UK Mental Health Act guidance
|(1.) Carers need to keep updating themselves to know that the standards of community Team practice in their area deliver best practice. Know the teams, who the members are: their working practice often changes|
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.
Often a failure in communication between carer/observer and the NHS clinical service deliverers.
This is one arrangement that puts ongoing carer experience into the local mental Health Trust deliberations.
The Teams meet regularly each week on the same day, who attends is minuted [and who not],what agenda the meetings follow , [ amongst which now - following an intervention by the local Trust Carer Committee - is a regular item … ' any CARER Issues' …
All team Members are to raise matters, if there are ongong issues of concern to/by carers in their community service. To be resolved, by whom listed, what will be done, is minuted, what was done confirmed, minuted at the next meeting.
I emphasise this because a common historical occurrence was that things brought up by carers [ 50 carer phone calls in the case of a local tragedy ] did not get to such a meeting – there were no such meetings- so they were not able to be discussed by clinical leads in such a team meeting, they were not there - or if they did, they were not minuted for a record.
Now if carers speak or write to their Community Team [or to the Trust chief executive ] about an issue, it will be raised before the whole weekly team meeting.
What else -
A 'hub' meeting: the Community Teams meet together with the local GP's in their area, monthly.
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 information section called 'carers corner' on it's website. Hopefully to develop, developed from Carer experience. Carers Corner 4.
a local 'leaflet for carers', issued to every carer, 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. ]
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.
|*** 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.
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.
A number of problems identified by Care Quality Commision visits 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.
Addendum:- Cornwall:- Recommendations from an Inquiry after homicide
The Recommendations are an indication of what was not in working practice at the time of the tragedy - January 2010
Action Plan Page 144
" Recommended the template to have a specific section marked … Carer Issues … Now accepted..
.....[ N.B. t .... The Cornwall Community Service is awaiting yet another decision about the intent of Community Teams, faced with 'No beds' nationally and locally the unacceptable number of Out of Area placements - this next issue is unresolved !: Some Trusts will be asking local Commissioning funding for more beds, some for Community team 'strengthening ' ?!!!
" Recommended the Agendatemplate to have a specific section marked … Carer Issues … Now accepted..
4. A clear route for (Team) managers to use to raise issues … ( that they did not, and why they could not, resolve )
Reflects the difficulties team managers are in when team members persist in going it alone, or not bringing matters to team meetings, or not even attending
Carers Strategy One Year On: More Help For Carers
help about , assessments, allowances,
direct payments , personal budgets etc.
probably slanted for general caring
[ never an understanding that schizophrenia is different ]
but the facts are there ... carers allowance
a remarkable and useful website for victims of homicide in the mental health services
Delayed Inquires after Tragedy unacceptable
Homicide Report Inquiry List -