Tag Archives: health care

Carers in mind: Concerning confidentiality

Confidentiality form 3Confidentiality can be a real headache for carers. Whether their loved one is being cared for by the NHS or by some other health or social care organisation they often have great difficulty in getting the information they need to care for their relative or friend as the vital part of the care team that they actually are. But does this really need to be the case?

It’s true, of course that people have the right to privacy, including those people who need care services – a fact that few carers would deny or seek to change. But patients and service-users don’t necessarily want to keep EVERYTHING private. Very often the problem arises, not because people have the right to confidentiality but because of the way that workers approach the issue when discussing confidentiality with them in the first place.

It’s important to be nuanced in matters of confidentiality. too often the question is asked…

“Do you want your family to know about your care?”

Really we ought to be far more specific. We need to differentiate more between the types of information we can disclose and that we should not. After all, there can’t be too many young men who would want their mothers to know all about their sex lives or other, equally personal details. Professional care workers need to be much more specific about the types of information to be disclosed and also about which family members or friends it will be disclosed to.

Most carers don’t want the intimate details of personal issues anyway. They do want to understand about medication regimes, care planning, symptoms and side effects, relapse profiles and plans and they need to know who to contact when things go wrong. This requires far more nuanced discussions than typically happen in over-stretched care services. So here’s my solution…

Click here to download a form that you can use to help workers determine just what information can be shared and with whom. It takes all the difficulty out of the equation for care workers by providing them with clear, unambiguous guidance about what they can and cannot disclose.

It is important that the form is completed collaboratively with a representative of the professional care team. The organisation working with the patient or service-user will have legal issues to consider and the worker may need to speak to their management about the form. Don’t ‘ambush’ them with the form. Let them know about it in advance. Ideally give them a copy to discuss with their management first. That way there should be no problems when you do sit down to complete it.

Complete this form at a time when the patient has the mental capacity to make the decision. Staff will not be able to abide by confidentiality decisions made when the patient lacks the capacity to decide.

Please feel free to get in touch, especially let me know of your experiences in using the form. It’d be great to hear from you.


Don’t blame people with mental disorders…

“Don’t blame people with mental disorders for behaving like people with mental disorders”

Too often mental health workers expect far more from their service-users than they are currently able to give. Then they blame them for having the very problems that brought them into mental health services in the first place. This is a fundamental misunderstanding of mental illness, of the process of recovery and of the role of mental health workers themselves.

It’s true that people are just people and there really is no ‘us and them’. But when people are struggling it’s not fair to expect them to perform at their best. Instead we should practice ‘therapeutic optimism’… Accept the person’s current difficulties but continue to expect them to overcome those difficulties with a succession of little steps.

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To arrange training for your staff please complete the contact form below…

Mental health recovery: A care workers’ guide to the stress and vulnerability model

If you enjoyed this tutorial please subscribe to my youtube channel. Lots more videos on mental health and social care to come. You can subscribe to the website and Facebook too. Just click on the left of the screen or scroll down if you’re viewing this via mobile.

This video tutorial outlines the stress and vulnerability model as a tool for mental health recovery. It’s intended for anyone with an interest in mental health and recovery as well as workers at all levels in mental health and social care.

We begin with an overview of the 3 main symptom groups of mental disorder before outlining the model itself and the progressive role of anxiety, depression and psychosis.

Next we consider categories of vulnerability and stressors before defining recovery and providing a brief overview of how it might be achieved.

Finally a collection of slides are included for download. Screenshot the images and save them in a word document to make handouts for reference.

To arrange training for your staff please complete the contact form below…

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.

Privileged glimpses 18: Behaviours that harm the individual

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

Behaviours that harm the individual

For those of us who work in health and social care it can be very distressing and frustrating to see our service-users undermine their health, their social situation or their state of mind. At times like these there is a temptation to intervene and simply try to prevent the behaviour. Of course sometimes this is appropriate and necessary, for example if the service-user appears to be actively suicidal, but not always. Often there is a judgement to be made between potential damage or harm and the benefit of experience that will help the service-user to learn from their mistake. Everyone learns best from consequence and it’s not necessarily helpful to shield people from the consequences of their actions. The more we intervene and prevent people from making mistakes the less they grow and develop in our care.

This might seem like a simple point to make but it’s also a fundamental principle that goers to the very heart of health and social care work.

If we accept that our job is to help people to be all that they can be and in most cases to grow beyond the need for our help then we must also help them to learn how to cope without us. They need the skills and understanding necessary to survive in the ‘real world’. It’s our job to help them to develop these skills before they leave us. After all, there’s no point expecting them to survive outside our care if we haven’t helped them to prepare, to take a few (managed) risks, and to learn how to deal with disappointment too.

Part of that preparation, that development is to learn how to take responsibility, understanding that actions have consequences and that in the ‘real world’ we all have to face them. We do our service-users no favours by teaching them that they don’t need to face the consequences of their actions.

This is why, for example, a service-user who damages property should be given a bill. This is why the young person who sulks and refuses to come down for dinner should go hungry (provided that there’s no physical or psychiatric reason behind the refusal). People learn from the consequences of their actions and it is not the job of social care staff to prevent that learning process from happening.

So when the challenging behaviour is detrimental to the service-user themselves the first decision to be made is whether to intervene at all. If you do intervene it should be because the risk of harm to the individual is greater than the benefit of them learning from their experience. Often a debrief after a mistake is much more productive than intervening to avoid the mistake in the first place.

I’m assuming that, before we even begin to consider behaviours as challenging the normal process of discussion and ‘advice’ (always something to be cautious about) has been followed and the service-user has not responded to that.

This is why most of the time we focus very little of our attention on the challenging behaviour itself. Much more time and effort should go into the debrief and the process of encouraging behaviours we want to maintain rather than trying to discourage behaviours that we want to reduce. Generally speaking the more that we focus upon a behaviour the more it recurs anyway so only intervene if you have to.

Remember that our duty of care doesn’t ask us to prevent the development of coping skills and independence – only to assess and manage the risks associated with that growth so far as is reasonable and lawful.

Privileged glimpses 17: Challenging behaviour means …

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

There are many different definitions of challenging behaviour. Some rely upon long lists of activities and behaviours that society sees as unacceptable. Others attempt to define the concept philosophically by referring to the works of ethical or moral authorities, sometimes dating back thousands of years. Throughout this series we shall use a fairly simple definition.

Challenging behaviour means

Challenging behaviour is a combination of two criteria:

  1. Behaviour that we don’t like;
  2. Behaviour that we think we need to respond to.

According to this definition both criteria must be met before we can say that the behaviour is challenging. For example, someone somewhere has been attacked within the last thirty seconds (a statistical certainty). I am not challenged by that because I am not in a position to respond to it. Therefore the behaviour is merely something I disapprove of but it is not actually challenging to me because there is nothing for me to do about it.

It’s important to get the sense of this definition clearly in mind before we go any further with this topic. Much of what people think of as challenging behaviour is not really challenging at all. We don’t have to respond in every case. Arguably, if we do respond and try to prevent people from doing things that they have a perfect right to do then the truly challenging behaviour is our own – not that of the service-user. Disagreeing with the care staff is not necessarily a challenging behaviour – it’s just a choice.

One of the most common problems among health and social care workers is the assumption that they have to ‘deal with’ behaviours that they do not personally agree with. This isn’t always true and by adopting a more flexible approach to the choices of service-users we can avoid many of the conflicts that make this work so difficult in practice.

Another important theme is the right of the worker (and others) to be free from abuse, assault or harassment. The law in UK, in particular the Health & Safety at Work Act (1974), is very clear on the responsibility we all have to keep ourselves safe and the need for proper assessment of risk. This is intended to ensure the safety of the service-user but also that of the worker and the person’s other carers or relatives. We’ll also consider ways to strike a realistic and reasonable balance between the needs of all concerned and the rights of all people to be safe and free from abuse.

Different types of challenging behaviour require different types of approaches. This is one of the most fundamental principles of challenging behaviour work and yet it is overlooked with alarming regularity. Just as with other challenges we come across in life, behavioural regimes and strategies are most effective when we take the trouble to understand the problem before we begin work on the solution.

In the broadest sense behaviours can be divided into two basic categories:

  • Behaviours that harm the individual;
  • Behaviours that harm other people.

Of course some behaviours will fall into both these categories so it’s not quite so simple as all that but this way of thinking does, at least provide us with a starting place. In the next post we’ll begin to look at these categories in turn.