Tag Archives: care

Online video training

“Very thorough and high quality…” Abi, Student nurse

Now less than half price. Lifetime access for only £12.99

Do you work in mental health services?

Are you a support worker, student nurse or just an interested person who’d like to know how to make more sense of mental health and disorder?

Do you find it hard to see how all the different disorders and peoples’ approaches to them fit together?

Do you have difficulty getting other professionals to see things as you do?

Would you like to be more effective in working with the people you care for?

Then this online video course is for you.

Picture on the box workbook: title page

People learn best when they have questions and they remember best when they have a ‘schema’, a ‘picture on the box’ to help make sense of what they’re taught. That’s what this training is all about. Over two and a half hours of video instruction alongside a range of information and exercises in the accompanying workbook help you to make sense of the seemingly overwhelming field of mental health and disorder.

And all for much less than the cost of a good night out.

Picture on the box workbook: Sample page (psychosis 1)

You can have all this for less than you’d pay for a take-away meal. But unlike a take-away, the benefits of this training will last your entire career.

Click the link below to get full access to the course videos and workbook.

https://www.tamtalking.co.uk/p/onlive-video-training-the-picture-on-the-box/

Video training online

Now less than half price. Lifetime access for only £12.99

Here’s the introductory video for the first of several video training courses with accompanying PDF workbooks and exercises. This one’s an overview of mental health and disorder for workers and carers called ‘The picture on the box’.

I also plan to develop video courses on…

Anxiety

Depression

Psychosis

Self Harm

Personality disorder

Mental capacity act

Risk appreciation in health and social care

And my own self-help method called ‘The No Surprises method’.

Apart from ‘The picture on the box’, if there’s anything that you (or your wider contacts, come to that) would prefer me to work on sooner rather than later please let me know, even if it’s not listed. I can cover a whole lot more mental health and/or social care topics that I haven’t yet planned out.

Go on, get in touch. You know you want to

Beware the saviour fantasy

Newcomers to care, especially mental health care often believe that they not only can but actually will ‘save the world’. They genuinely expect that their winning personality, supported only by a nice smile, a cup of tea and a chocolate digestive will solve every psychological problem there is. They’re the saviours and their naivety puts everyone at risk.

Most of us grow out of such expectations early on in our careers. We may have begun wanting to save the world but now we just want the world to go away and leave us alone. We’ve had the naivety of inexperience kicked, beaten or otherwise drummed out of us in no uncertain terms and we’ve learned that we can only do so much in our little corner of the system. We knuckle down, get good at our particular task or set of tasks and keep that original, positive spark of enthusiasm alive with realistic expectations and the ability to take delight in smaller successes.

But some people never grow out of their saviour fantasy. They never overcome the innocence that may well have led them into the job but that also makes them beat themselves up every day because they haven’t yet fixed everything. They may not show it often but these overgrown saviours are racked with guilt because of the impossible task they set themselves. If you’re one of these saviours please read on…

It’s pension day and Mary, a kindly octogenarian toddles out of her local post office clutching a wad of notes in her gloved hand. She never did manage to catch up with all that modern internet banking nonsense and has always been a little suspicious of computers managing her affairs. ‘That’s what cheque books and cash are for’, she reasons. Her handbag hangs nonchalantly from her elbow as she fishes in the apparently inexhaustible, portable cavern for her purse.

Suddenly – two young thugs come dashing toward her. One snatches the cash, knocking Mary to the ground as he does so. The second stamps on her head for good measure, causing bright red blood to stream from her ear onto the pavement.

You run to her, screaming at passers-by to call an ambulance as you cradle the unconscious old lady in your arms. You feel helpless and angry as she breathes her last, still held tight in your embrace. You’re angry but you’re not guilty. You tried to help, after all. You never caused this and at least you had a go, unlike the rest of society who seem only able to cross the road and look the other way.

Mental health care’s like that. We didn’t cause the problems our patients have developed. Often it took them years to become this ill. That’s not your fault and you’re not to blame. At least you’re trying to help!

Beware the saviour fantasy

MCA: Who decides?

When assessing an individual’s mental capacity it is important that we confine ourselves to assessing that person’s ability to make this particular decision (or type of decision) at this time. This is what the Act means when it refers to ‘time and decision specific’ assessment.

At first glance this seems obvious and clearly reasonable. However on closer inspection it brings up a number of issues relating to ‘established practice’ that need to change. It also provides many workers from support workers to nurses, social workers and many others with a very real source of anxiety. Here’s why.

In the past capacity decisions tended to be made by certain professionals such as psychogeriatricians or psychologists. One typical approach would be to ask a doctor to come and assess a service-user’s capacity, not in relation to a specific issue but ‘globally’. This would be done using one of several techniques, the most common in UK being the Mini Mental State Examination (MMSE).

The MMSE is a reasonable tool to assess cognitive deficit and is helpful in diagnosing certain conditions such as dementia but it is not an assessment of capacity. Diagnosis is not the same as capacity. The fact that a person has a particular diagnosis does not tell us anything about their capacity to make particular decisions. The MMSE is not decision specific unless the care and treatment being offered relates to the service-user’s ability to count backwards from 100 in 7s or to name the current Prime Minister.

The MMSE does not inquire into preferences of diet, whether or not a person understand how to cross a road safely or what time they would like to go to bed. These are the sorts of questions that must actually be assessed on a day to day basis when we are making decisions about a person’s capacity.

The other major problem with ‘global’ assessments of capacity (apart from the fact that they do not asses capacity in the first place) is that they are not time specific. A psychogeriatrician’s assessment at the start of the month will have little bearing upon the service-user’s day to day decision-making capacity at the end of the month. So unless we can persuade the Dr to visit each service-user every mealtime to assess their capacity to choose between carrots and peas we have to use a different system.

Fortunately the Mental Capacity Act provides us with just such a system and, although unfamiliar to many it is very straightforward and in fact reflects what we’ve all been doing since early childhood anyway. You see assessing capacity is not difficult in itself so long as you understand it – and also understand what we are NOT expected to assess just as clearly as what we are expected to assess.

The Mental Capacity Act is clear….

“The decision maker is the person delivering the care or treatment”
This means that the support worker who decides that Albert needs a bath is responsible for assessing whether or not Albert has the capacity to consent to that bath. If he or she decides that Albert does not have the capacity to consent to that bath then the support worker is also responsible for deciding whether or not the bath would be in Albert’s best interests.

This may seem unfamiliar when it’s written down like that but actually that is precisely what has happened day in and day out in practice for decades in health and social care settings. Nobody calls the GP every time they think a resident in a care home might need their hair washed – they just decide. What the Mental Capacity Act does for us is it provides us with a way to show that our decisions make sense and gives us the legal backing to be free from prosecution for assault so long as we can justify our actions.

Part 5 of the Mental Capacity Act is subtitled ‘Protection from liability’ and deals with just this issue, ensuring that care workers can do what is necessary so long as they can show that the individual lacked capacity and that their actions were both proportionate and in their best interests. This is very empowering for care workers because it allows them the respect they deserve in making day to day decisions and provides them with legal protection at the same time.

A duty of care myth

Hanged if you do… hanged if you don’t!

Many people are confused about their duty of care. They think they’re somehow responsible for the actions of other people. This leads them to try and prevent people from doing things that they have a perfect right to do because it might be risky. In truth our duty of care is actually much simpler than most people imagine:

  • Do all that you reasonably can;
  • Don’t break the law;
  • You are not responsible for the actions of other people;
  • You are responsible for your own actions in the situation you’re in;
  • Care workers are judged upon process, not outcome.

Complete the contact form below to arrange training for your staff.

Personality disorder and compassion

Sometimes a single day’s training makes all the difference. You can access such a training day here.

Personality disorder training meme MTCTWatch a video on Personality Disorder below

Complete the contact form below to arrange training for your staff.

Introduction to Self Injury

This 1 day Introduction to self injury training course is only a basic introduction to the topic. It’s intended for social care workers who may or may not have any prior experience of the subject.

working-with-people-who-self-injureThe course challenges the prejudicial myths, value judgements and assumptions that surround self-injury and the people who habitually cut, burn or otherwise harm themselves. It offers practical guidance in working with people who repeatedly harm themselves without getting bogged down in unhelpful criticism and blame.

By comparing self harm to more ‘acceptable’ (but often more harmful) coping strategies like smoking, drinking or general impulsivity we normalise the action as a means of self-soothing before extending the comparison to less dramatic strategies like walking, bathing or even just watching a favourite film.

The aim is not to make participants experts. Rather the course is intended to remove prejudices and offer a simple explanatory model that isn’t based upon value judgements or unsupportable assumptions about manipulation or attention-seeking.

Click here to discover more about how Mind The Care Training can help you and your staff.

 

How can a dead Greek and a medieval monk help care workers?

Socrates was an ancient Greek philosopher. He used questions to help people reach new insights or knowledge. Each question moved them a little closer to solving their problems. The technique takes a bit of practice but it’s not rocket science.

Socratic questions follow a fairly simple pattern and just a handful of rules (see the infographic below)

Socratic questions meme

It’s very simple in theory but it does take practice to perfect.

It’s always better for a person to see the truth for themselves than to be told what to believe by someone else. Socratic technique helps people to draw their own conclusions.

Occam’s razor

William of Occam was a monk who lived in the 14th Century. He suggested that:

If one thing is true then other things should also be true.

For example, if it is true that the man next door sings louder than the sound of a jet aircraft taking off then it should also be true that we can hear him from our sitting room. If this second statement (that we can hear him) is false then the first statement (louder than a jet) must also be false. The razor ‘cuts away’ errors in thinking to help us understand the truth of the situation.

Another way to use Occam’s Razor is to consider the simplest explanation. The simplest answer isn’t always the right one but Occam’s razor does give us a neat way to approach problems.

For example, if one theory suggests that water pushes a water wheel and another suggests that the water wheel is actually pulled around by unseen ghostly hands then the simplest explanation is that the force of water is what makes the wheel move. Both theories have the same outcome – the wheel turns – but one involves a whole new set of circumstances (ghosts obsessed with mechanics) whereas the other provides a perfectly adequate explanation on its own. If we go with the ghostly hands explanation we must also explain where the ghosts come from and why on earth they’d be interested in water wheels.

Ockham’s razor would dismiss ghostly hands and lead us to the far simpler explanation that the force of the river turns the wheel. Only if the simplest theory turns out to be wrong should we start to think about ghosts with a water fetish!

Hanlon’s razor

The other ‘Razor’ rule, ‘Hanlon’s razor’ is similar. It’s a way of keeping perspective when things don’t turn out as we’d like them to. It’s used to ‘cut away’ knee-jerk assumptions about other peoples’ motives. Hanlon’s razor says…

Don’t assume malice when incompetence will do

To put it another way – the fact that my actions hurt you could just as easily be the result of my stupidity than a desire to cause you pain. I might not have meant you any harm. Realistically most people don’t go around dreaming up ways to hurt others – they have too much to do just sorting out their own problems. There are exceptions to that but malice isn’t the norm. Indifference and incompetence are usually far more likely.

By combining Socratic technique with the basic principles of Occam’s and Hanlon’s razors we have a perfect blueprint for therapeutic conversations. And all we need to do is ask the right questions.

  • If this is true would this also be true?
  • What is the evidence?
  • How does this evidence fit with this assumption?
  • What other explanations might there be?
  • Which explanation is the simplest (and most likely to be true)?

It’s much more effective to ask questions than to tell another person what to think. Let them come to their own conclusions. That way they just might believe them.

Mental health care needn’t be complicated

Training room.jpgI used to think that mental health care would be really complicated. So I looked for complicated theories to underpin everything I did. For many years I studied and tried hard to negotiate my way through the complex world of mental disorder. And because I looked for complicated answers, complicated answers were all I found. That was a great mistake.

The more I studied, the more I realised that good quality mental health care doesn’t need to be complicated. It may not always be easy to deliver but that doesn’t mean it should be hard to understand. Often the simplest solutons are the most effective.

Eventually I realised that there are some straightforward, basic principles that we need to follow. Everything else flows from there. These are the simple ideas that make the difference between good care and bad, between illness and recovery.

If only someone had distilled those principles for me when I first began. My early career would have been so much easier and more effective. But nobody did that in those days. That’s a great shame.

So I’ve done it myself. I’ve boiled down the basic ideas into usable, teachable concepts that every care worker can quickly understand and apply. These are the fundamental principles that underpin every Mind The Care Training course and seminar. Subscribe to this page and come back often to find out more.