Wrap-around?

“What can we do to offer wrap-around care to our patients?”

In the live Q&A at the end of the NCISH conference yesterday, this question was asked of the panel. The Chairperson directed it towards me. I can’t remember what I said. This morning I woke up with what I would have liked to say.

For wrapping, we need two things. One, the fabric which we are going to use to wrap and the person we want to wrap. Let’s discuss them one by one.

The fabric

The fabric of Suicide prevention in Health-Care is made up of two things – people and systems. Let’s look at them a bit closely.

People

What are the beliefs of the people?

I know of an ENT surgeon from another country who wanted to move to the UK and the only job he could find was in Psychiatry. So, he is now training to be a Psychiatrist. Is he interested in suicide prevention? Do Health-care professionals believe that suicides are preventable? Are they content that simply by treating mental illness they are doing their job?

What are the attitudes and abilities of the people?

When the Emergency department calls to say there is a suicidal individual waiting to be seen, how do they feel? Are they excited to have an opportunity to make a difference? Or is it a drain on the limited time and energy they have? Do they know how to build a compassionate connection with someone who has lost all hope? Have they received any training in Suicide Prevention? Do they have enough self-compassion to look after someone else well?

Do they have the resources and the knowledge to do a good job?

Do they have access to their past history? Do they have beds on the ward? Can they ask a colleague for a second opinion if they have a doubt about how to involve family or friends in their care? Do they know of other resources, like charities, activities and people that may help this person? Do they have comprehensive and informative leaflet they can share with them? Do they have the means to follow them up?

b. Systems

Does the system have capacity? Are the various parts of the system effective and joint-up enough to be able to hold the person they are trying to wrap or are there big holes in this part of the fabric? Do the various parts of the system share the same mental model, a shared knowledge, pre-suppositions, and beliefs that can be used to help achieve mutual goals? Are their practices evidence- based? Do they investigate deaths with a view to learn lessons and implement change? Do they look after the well-being and emotional health of their employees? Do they hold themselves accountable when things go wrong?

2. The person

Allowing space for them to express themselves. Help maintain their sense of agency. Inform them it is safer for them to involve other people who care for them. Equip them with resources. Give them the support they need. Ask them what would help them? Listen. Sit with their despair. Acknowledge it. Keep them connected with their life as they know it. Keep hope alive for them.

Know that the person at the centre of the wrapping is of great value.

Information is useful if it becomes knowledge. Knowledge is useful when it becomes wisdom. So, let us not stop at information.

Ref:

Reaching common ground: The role of shared mental models in patient safety : https://journals.sagepub.com/doi/full/10.1177/2516043518805326

Treatment versus Care

Posted by kidsaregifts20

It was a clean, warm and open space with well-designed floral furniture in pastel blues and greens. It had plenty of natural light and pots of healthy looking plants thoughtfully dotted around the floor. The artwork on the walls was selected by someone who knew their stuff. It would be hard to guess that this was the entrance to the New Hampshire Hospital. which provides acute inpatient psychiatric services for all age groups.

As I was guided through the facility, I was enamoured by a lush beautiful big greenhouse, two well-stocked libraries, a massive gym for staff and patients, 3 cafés, an outdoor patio and play area for kids, a vegetable patch, a healthy colourful aquarium on wheels, loads of Halloween decorations all around, an art workshop and cooking class in progress, television screens, a chapel, a small shop, a pool table, a ping-pong table, lots of board games and cheerful group therapy, treatment and visitor’s rooms.

Each kid had a room to himself or herself with nice bed-linen of their choice. 2 adults often shared a room. The age groups were appropriately separated. The youngest patient there was 6 years old and the oldest a septuagenarian. The nurse’s station was not a demarcated area. It was part of the ward layout. Social workers, occupational therapists, doctors and nurses didn’t wear any uniforms. They were dressed in everyday clothes. Everyone spoke softly and the atmosphere was relaxed and caring.

The most impressive part of the service was the presence of an Aftercare Liaison officer. It is well known that patients are at the highest risk within 30 days of discharge from inpatient services or Emergency department. (Ref: Luxton, June and Comtois 2013) They concluded that repeated follow-up contacts appear to reduce suicidal behaviour.

Aside from following up on these patients, the Aftercare Liaison Officer has the following roles before the patient is discharged:

Speaks, listens and connects to each child and adolescent patient. Educates them and their support system about warning signs of suicide, triggers, risk factors, protective factors and restriction of means of self-injury.
Draws up a detailed Safety Plan with them and their carers.
Helps them identify sources of social support (trusted adults) and develop personal resources through open conversations.
Interface with other professional agencies (eg. for DBT) and community services that will help dilute their identity as a person diagnosed with a Mental Illness. For example, they match their interests to activities such as therapeutic horsemanship, a running group or a Mountain Teen Project.
Engage their parents, families and friends and anyone they would like to involve.
Use technology if possible – MY3App.

I don’t think we have this service in the UK. I know we don’t.

The one thing that is most important to me and worth living for is … to continually express my love for Saagar and help other parents do the same for their kids.

Day 816

Posted by kidsaregifts20

Health and social care, care of the elderly, care homes, care in the community, child care, nursing care, residential care, respite care … The word ‘care’ is used everywhere but what does it mean?

The Cambridge Dictionary defines it as ‘the process of protecting someone or something and providing what that person or thing needs’ and ‘serious attention, especially to the details of a situation or thing’.

Synonyms: caution, attentiveness, alertness, vigilance, observance, responsibility, forethought, mindfulness, regard.

Medicine and nursing are caring vocations. Yet, they are jobs like any other. They pay a salary for a service rendered. The care element can potentially become optional as long as all the boxes are ticked.

‘Continuity of care’ is particularly tricky in mental health as relationships are based on trust and every time a new person takes over a caring role, all the facts need to be repeated and trust re-established, starting from scratch.

Now that I belong to a network of mothers and fathers who have lost their children to suicide, one common theme emerges: “It seems that our sons and daughters didn’t need more resources, more GP’s or more psychiatrists or more nurses. They just needed more care…”

Let’s not use the word carelessly.