| We were building Trust: not to upset them at our interview - pressing about their illness make them anxious ?; suppose they become ill in the interview - what could we do | A. at your first contact interview, you must say it is our practice always to see carer separately. Carer is building trust as well; that is not helped if interviewer/interviewee is withholding information shared by them from carer. Carer is vulnerable. If an interviewer is not able to press successfully for the degree of illness indication during an interview, then there must be a balancing system in place so that up-to-date observation of what has gone on between interviews is available to interviewer and MHAct decider. [ make a note and check with the carer ...? ... carer write it down and post - for their eyes only |
| It was confidential. we could not ask carers how ill the interviewee were in between appointments : interviewee would object see 1. | [ I am the carer upon whom they depend without my support they would be ill - I need to know what is going on in this inner illness.] |
| it was their choice | yes we know they have less insight and fluctuation capacity - they had capacity in our interview - no we didn't press them see ' gaining trust' above. |
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. They were not ill enough as we saw them ... what happened at home or in the community we can't know about . Anyway it's hearsay - not allowed - and we don't have the beds. Besides the admission wards are noisy and unsettling in behaviour there. We don't provide calm wards anymore; community care is a better way. W4 couldn't fund nice wards anymore with what the loca NHS Primary Care Trust give us. The healthy co-operative ones get to the money first. |
. ... because you aren't bothered to find a way to ask, or be told ! Social workers used to be the link to the family views and their current experience - feeding that in - not now . Missing that you must invite me to write you regularly - or a substitute way of telling you this is what I have observed about their illness. That may say what you will not see at a formalised interview - they are still ill at a degree which warrants Mental Health Act. Hearsay is not evidence for Court ... it is evidence for you to appraise. There are ties in this illness when you need a situation where you can observe an illness, taking some time to do so ... witing and watching time .. Bed occupancy at more than 85 % did not give that ability. Too much stress and strain on staff. Worse now with agency workers breaking contiuity. You can't expect the family home to do this people have to go to work - there are other family members needing care and obligation. Families cannot sustain one- one containment. Home is not a place that can be locked in when people run off. |
| we can only go on what we are told in interview - see trust and confidentiality above. Nobody told us about what they had observed [ they should have; their fault ] Contacting us it's up to them to find a way. Our staff are always changing, giving you a contact point would'n't work ..... | why not give a carer upon whom sufferer depends a guaranteed point of access, one stop local tel no and a fail safe alternative. |
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ooh no, we can't tell them what they need to do to stay well - use our authority .... [ although we do know what they should do ] - it's their choice you see,human rights to live in neglect, to not do anything interesting or useful, or that requires them to be out and abouit with others sharing an interest - it's their choice, they are entitlesd to privacy. It's not possible to secure a longterm activity that can be met twice a week, and that X would accept. Any way that's the L:A Social Services responsibility. they don't meet the threshold . You should speak with the GP ... what , confidentiality again ...... They can't be forced to take up activities - [ although activities 'exercises their neurons ] - and just as well; there aren't any available. If we had such a service; best interests are all very well but we don't have the staff to encourage and see them into regular activities in the week. |
... you are giving expert advice - you can tell them they won't stay well unless they take up some regular activity It would give them a meaningful engagement in a routine they welcome, and the family carers a time to their ow lives. |
| . they were no longer on our books they did not attend appointments - they weren't at home, same again - can't have that, wasting our resources. speak with their family or neighbours - we couldn't do that ... 'trust and confidentiality' see above ' | you have the carer contact no. and address: use one or the other. and tell the GP ! |
| Nobody asked us to see them some where else convenient for them - carers or patients; In any case , they would not come. If they did they would not be able or willing to tell us about any illness. Oh no, we couldn't see you ... see 1. 2. above | what about the local supermarket or library |
| There was no point in putting it into the Care Plan because there was no resource. We don't have that kind of aftercare service. We don't provide the longterm occupational activities that we usd to in hospitals. We discharge them back to the GP. |
Social workers in the team don't do social work as it was - seeing the family keeping in touch providing a social history, doing carer assessments, asking carers about their 'breaks in the week'. Get a Carer Assessment and put in for breaks in the week. ask the GP to complain to the local Primary Care Trust[ [PCT ] that the delivering mental health trust does not have the funding from the PCT to find 'breaks within the week' for carer and sufferer,Why not Register this as a Service Deficiency or as an Unmet Need at Needs Assessment stage of the Care Programme Approach or at Review. |
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What ? section? -- if only there had been 'beds' - to follow with Community Treatment Order. ? : then we would have to do and provide something in aftercare, and be responsible if anything goes wrong - work for us - not ill enough ....remember .... we can't do everything overwhelmed with acute work - forensic ..... ?? !!1 We give Home Treatment now instead We prefer them as informal patients, because then it's their choice; and less legal documentation. There is no aftercare obligatioon [ if we manage to avoid a decision for [ by postponing ] 'continiuing health care needs' at the Care Programmw Approach meetings. It's a complicated document process anyway. |
yes, I know wards used to be managed by segregating by acute and severity against calm wards for those who would be made worse by the turmoil of others , by using shift work so that the nights and weekends were covered and staff were not tired out. The cooking and cleaning were done by someone else. There was no other work going on but care and treatment Home treatment means the whole family are burdened, night and day, weekends: the observation required means family members giving up work to cover . Children still have to go to school. It's too much. |
Something else that is lost is a rule to follow to be able to decide on who is the accountable lead figure.
The lead figure is the people who are currently in touch with the care situation, and the patient being cared for.
They stay as the lead responsibility to do what is required, only losing the lead and their accountability, when some other people have been spoken to, and have accepted the responsibility, have obtained the connection with the patient, tell the previous lead people that they have met with the patient, and that they know that thery are now accountable for being the lead figure in care. On accepting the lead, but recognising they will have to hand lead back, that will have been already cleared with the first team. at the hand over, and the return made ready.
If that has not been agreed in advance then they will have to reverse the process with the original team.
An
issue that has proved difficult to resolve is getting the information about behaviour in the community as seen by family and community , and putting this into the decision maker of the community team.
Social workers used to take family histories, remained in touch with families , and that was a channel sufficiently well used, to work in practice for home support. Families were usually up-to-date with the family patient when the patient was 'in the community', able to keep up with, or find out about , any observations of change in behaviour.
The route in with these observations is not now so clear and well worn into common practice.
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