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

*** New !!!

(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.

Here in Cornwall, each catchment Area has a Community Team on which there is a Team Manager, Consultant Psychiatrist , a junior psychiatrist, a Team Manager,a Senior clinical Nurse, Social Workers [Adult Mental Health Worker], Community Mental health Nurses, Community assistants,sometimes Clinical Psychologists.

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.
If local Carers now have matters of some concern to themselves, or about their cared for, which were not satisfactorally responded too, the check is that the carer concerned can raise it with the carer official Trust representative on the local Trust Carer Committee.
The Trust carer representative will attend Community Team meetings from time to time to ensure the agenda item 'Carer issues' is raised and dealt with.

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.
Another consequence of the local Tragedy is that Team Managers should now know where they can go to if they need to get past any blocking in the Team meetings - absent clinical leads, poor attendance, concealment etc

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. ]
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. x.

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 procedure to be followed in all mental health Teams for recording the minutes of what was discussed at the weekly review meetings , one item of which is about 'carer issues'.

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

*** 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 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.
The local GP commissioners have been asked to fund ten more admission beds. Three years later - nothing.

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
It was also recommended that a Trust-wide template for recording Multidisciplinary Team Meetings should be developed to include
listing those present,
the actions agreed and
the staff responsible for implementing the decisions taken.

NOW - The Cornwall Partnership Board Trust Care Committee October 2013.

" Recommended the template to have a specific section marked Carer Issues Now accepted..
!!! *** New !!!January 14 .. ACCEPTED NOW and IN place for all team minuting. There it is - carers working together can make sure that their concerns find their way into the 'Team' are discussed and how they were addressed is MINUTED. [ this sort of thing
A famiily carer visits her son 's bed-sit, finds electricity bills not paid - a year behind - something neither the visiting team member nor the 'offically accepted nearest relative contact - a brother chosen by the 'sufferer' - had found out about
. The flat an accumulated mess.
Accepted by Trust early 2012, delivered 2014.

.....[ 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 ' ?!!!
Admission used to be a relief to the continuous burden on families during breakdown as well as giving proper observation time to settle, over enough assured time, diagnostic and medication issues. ]

The Cornwall Partnership Board Trust Care Committee October 2013.

" Recommended the Agendatemplate to have a specific section marked Carer Issues Now accepted..
!!! *** New !!!January 14 .. ACCEPTED NOW and IN place for all team minuting. There it is - carers working together can find their concerns find their way into the 'Team' accepted, and how they were addressed is MINUTED. [ this sort of thing
A famiily carer visits her son 's bed-sit, finds rent bills not paid - a year behind - something the visiting team member had not asked nor found out about
The family relative did ask about and found out.] 3.
page 159
Receiving information .... a vital recommendation
When in receipt of third party information - the documentation must reflect:
a) Whom the information was received from
; b) Specific details of what the information is about;
c) Identify an action plan to address third party concerns.
ci) d) Details of the discussions should be fully recorded including rationale for decision making

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 -

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