During my 8 weeks Mental Health Elective Posting in Year 4 Semester 1, I was sent to Edmonton Community Mental Health Team (CMHT) London, United Kingdom to give me a better understanding and full experiences of the available mental health services in that country. I went to a few mental health services such acute care ward, home treatment team, day hospital, and community mental health resources such as MIND and Park Avenue.
From the whole elective posting of mental health module, I learnt that just having the knowledge are not enough for me to manage patients with mental illness but the experiences, involving in multidisciplinary team, linking with the other mental health resources are the important component as well.
People who are dealing with mental illness need psycho-education as well as social aspect, thus as a nurse, it is important to communicate with other professions such as Consultant Psychiatrists, Mental Health Social Workers, Occupational Therapists, as well as Psychologists who are act as the first line of response for the mentally ill in the community.
Throughout this 8 clinical posting, I was not only able to manage mentally ill patients in pharmacological aspect, but as well as managing them in psychological and social aspect. It was an amazing opportunity and I hope by sharing this experiences, I will able to give an ideas on how to improve and promote the development of mental health system in Malaysia in the future.
Edmonton Community Mental Health Centre Consists of two teams. The team acts as the first line of response for the mentally ill patients in the community. The teams are integrated and multidisciplinary which comprise of Community Psychiatric Nurses (CPNs), Social Workers (SWs), Psychiatrists, Occupational Therapies, Psychologists and Pharmacologists. Each of the CMHT’s is managed by a Team Manager.
During Referral/Allocation Meeting, the CPNs or SWs on duty would bring up cases which have been referred to discuss with the team and decide which cases that need to be assigned to a care-coordinator while who did not fit the referral criteria will be referred to the patient’s GP or other appropriate resources. The community mental health team also monitors patients who have been recently discharged from wards and Home Treatment Team and able to function well in the community.
CMHT were also run the Clozaril Clinic which physical health checks will be done once every 2 weeks to monitor white blood cells count, vital signs as well as side effects of the medications. They were also run the Depot Clinic Injection to administer anti-psychotic I/M Injection every Wednesday then after that a Clinic Meeting will be conducted to discuss any matter arises as well as identify which patients did not attend to the clinic, thus a care-coordinator will visit to the patient’s home and administer the medications.Care program Approach (CPA) and Care-Coordinator
CPA is a means of coordinating all of patient care to try to meet their individual, cultural, linguistic and gender needs arising from their mental health problems.
When patient first come into contact with mental health services they will be assessed to find out about their health and social care needs. A named person (a care coordinator) will be there to support them and be their main point of contact. A written plan for patient care will be drawn up with them and there will be regular reviews of patient care.
Care coordinator will be responsible for coordinating/ overseeing care plan, and make sure it meets patient needs. They will be responsible for ensuring contact with the patient is maintained by phone call or home visit the patient as often as needed. They will meet the patient before any review meeting to discuss patient needs.
Needs assessment of client will be discuss together with client’s family/caregiver. The care-coordinator will discuss upon patient’s feeling, what mental health services that patient using, what other help that patient need, accommodation and financial status, whether patient have any legal problem, what medication patient’s on, including the effect and the side effect, and whether patient is due any health checks.
Care plan will develop during CPA review which include a list of patient health and social care needs, a plan of how patient needs are going to be met, the name of the person who is going to help patient to get what he/she need, symptoms that patient/care giver recognize that indicate patient are becoming unwell, what to do if patient is in sudden need of psychiatric help, what strategies patient use to help themselves to cope and the date of the next review of the care plan. Patient will be given a copy of the care plan.
For CPA Review Meeting, care coordinator will review patient’s care plan regularly with the patient and the meeting should happen at least once a year. Patient will receive a letter inviting patient to attend, detailing others invited and who patient would like to come with them. During CPA Review Meeting, patient will able to ask a care giver, a friend or an advocate to come with them. Patient will able to put forward their views and wishes about their treatment and care. Patient will able to discuss new and different treatments as well as to ask questions about their care. Patient also will able to raise any concerns that they may have about their care and treatment.
Mental Health Resource Centers: MIND and Park Avenue
Park Avenue and MIND are the mental health resource centers for mental illness people to gain independent and confidence by developing living skills, learning coping strategies, promoting positive engagement with local community resources, and enhancing personal well-being by focusing on community participation.
Client can choose what activities they want to do as they provide so many services and activities such as Internet and emailing training, Anxiety Management, Health eating and Cooking, Gardening, Photography Group, Hat making, Visiting Museums, Art Galleries and Libraries, using Public Transport (tubes, trains, buses) and Journey Planning, Voluntary Work, collage Courses, Sport Programmes such as Swimming, Gym, Fitness Programmes, Local Walking Group and Counseling Session for hearing voices group which facilitated by qualified counselor. I managed to involve in some of the activities such as Hat making, Photography Group, Yoga, Photoshop and Books Group.
The service also assisted the service users to furnish and equip their new home, and have learned the necessary daily living skills to be able them to shop, cook, clean, lauder, budget and pay bills, to living independently. They will also be engaging and participating in their local community and have been supported to access opportunities in both paid and voluntary employment, education and training, and leisure.
Psychiatric Wards : Chase Farm Hospital
I was sent to the Psychiatric Male Ward at Chase Farm Hospital for ward experience. The acute in-patient ward holds 16 patients including voluntary and involuntary patients and from what I heard, the number of beds will be cut down few more because the system (NHS) decided the mental illness patients should be more focused in the community area rather than being admitted. In the ward, each patient has their own room, bathroom, locker, and table. There is a seclusion room where it hold patients who are unstable (aggressive) or uncooperative. The room is monitored by CCTV camera that connected to Nurses Counter and Ward Manager’s room. There are a number of facilities provided in the ward such as a pool table, a wide-screen TV and DVD player, PlayStation2, videogames, exercise equipments, backyard for smoking, and occupational therapy room equipped with games and other stimulated activities.
The routine in the ward was a bit different where they have a Family Meeting, Community Meeting, stimulating activities, recreational activities, occupational Therapy sessions and many more. All activities are scheduled appropriately. Community meetings held every Thursday, where all the patients and staff sit together and discuss issues of concern such as treatment, feeling about illness, current affairs and many more. Family Meeting is where the patients, doctor, in-charge nurse and patient’s family members/ caregiver are sit together and discuss any concerns about the illness, treatment and patient’s progress.
There were also “one-to-one” patient care system, which one nurse will in-charge for one patient, depends on what patient’s condition are. After the discussion about patient’s condition, the ward manager will assign “one-to-one” during Ward Round Meeting every morning. The nurse who does the “one-to-one” will has to observe patient’s behavior, talk and discuss with patient, listen to his/her concerns during the whole shift, and document every progression. I also involved in preparing meals for patients where the nurses prepared breakfast and lunch, and the good thing is the patients can choose what they want to eat/drinks. It was a brilliant idea to let the patients choose what they want as this will promote the patients to make their own decision and try to gain independent.
Day Hospital (ARC): Active Recovery Community
The ARC is a multidisciplinary approach team where all health care professions work together such as Doctor, Nurses, Occupational Therapies and the other staff.
Patient will be admitted under the care of Consultant Psychiatrist. Patient also will be allocated with the Key Worker from the team. They will coordinate patient from admission to discharge. Key Worker could be either a nurse or occupational therapies.
Every patient has a named nurse who will manage patient medication, in consultation with the doctor and be involved in monitoring patient health. The nursing staff will also be involved in running groups as part of the therapeutic group programme. Occupational Therapies involved in discussing patient ability to function and manage their daily activities and be involved in setting treatment goals with the patients.
The other staffs include Art Therapy, Music Therapy, Clinical Psychology, Psychotherapy, Family Therapy, Group Analysis, Cognitive Behavioral Therapy, Social Workers, Patient Affairs and Liaison Officers (PALS), and Administrative Staff.
The basic aims of group are to improve patient motivation, confidence and self-esteem, encourage communication, share experience with others by listening and responding, offer and receive support, gain knowledge and coping skill, increase self-awareness and awareness of others, encourage decision making and help to cope with tension and anxiety.
The aims can be achieve by variety of therapy groups Physical activities (Yoga, Thai Chi and exercise), Expressive Group ( Creative writing, Art therapy, Music therapy), Practical groups ( Horticulture, Arts and Crafts), Daily Living Skills ( Community Groups and Cookery), Relaxation Groups, Discussion Groups ( Current Affairs) and Sharing Experiences (Women’s Group, Support Group, Group Analysis).
Therapy Groups such as Music Therapy, Art Therapy, Border-link Group and Group Analysis will have a greater focus on exploring feelings, emotions and thoughts, reflecting on ways of relating to others, experiencing new ways of relating, reflecting on how the group works and relating to one another.
Overall, managing the mental health patients are always challenging to me, it will never be easy as what most people thought. Nurses have so many roles to direct the care of mentally ill patients and there are so many things to be improved for the future mental health nursing in Malaysia.
I loved everything that I had learnt during the whole mental health elective posting. The chances to learn and to see how much develop of the mental health system in the United Kingdom was really inspiring and was a life enriching experience for me , which I will appreciate for the rest of my life.
I hope by sharing this a bit of information and experience, it would provide us an idea on how can we make changes in the future nursing profession.