I’ve always thought of myself as a face to face, engage with a live cohort/audience sort of trainer/speaker until…
I asked yesterday for volunteers to do tutorials with as a form of content marketing. The very first contact I had was for group training over zoom. A little thought later I agreed. I’m about to start a whole new voyage of discovery into online training.
If you’ve been wondering how to get decent quality, interactive training on mental health and social care in these days of lockdown, look no further.
Saffron Cordery is the deputy chief executive of NHS Providers, the membership organisation for NHS hospitals, mental health, community and ambulance services. These guys really do know what they’re talking about.
According to Cordery, writing in The Independent just after the general election, Boris’ government, for all its fine words is setting the NHS up to fail. Not that this comes as any great surprise to those of us who’ve been watching developments since 2010. The Tories, with the help of their LibDem enablers, have been stitching up our NHS, ready to sell it off to the highest bidder for years.
“Although quality of care once you’re in the system has held up remarkably well, timely access to treatment in the NHS has been slipping for years, despite frontline staff working harder than ever – so hard, in fact, that they’re in danger of burning out. Demand has been steadily outstripping supply; gaps in the workforce have widened substantially; our assets have deteriorated; and financial investment has been lower in the past decade than at any point in the NHS’s 70-year history.”
For all his fine words, Mr. Johnson is well aware that his promise of funding falls way short of the amount currently provided to our country’s flagship health service. Even if he restored funding to previous levels the backlog of neglect and decay, of equipment and buildings upgrades would mean a significant cut in comparative terms. The Tories may be promising money but they’re hardly making much of an effort.
Of course they can’t make too big an effort because the money’s already earmarked for tax cuts and perks for big corporations. Which is why the health, mental health and social care sectors are to be left to pick up the slack.
If you thought the last 10 years were bad, just watch this space. There’s far worse to come.
I haven’t posted here for a while. I’ve been busy with other things but now I’m back and I’ll be making a few changes. It’s a new direction… a new road ahead.
I plan to focus more on short, punchy videos instead of the longer ones I’m used to. One or two minutes seems more social media friendly and perhaps easier to fit with peoples’ busy lifestyles.
I hope you enjoy the new style.
Challenging behaviour strategies aren’t necessarily complicated but they are powerful. It’s important then that we use them ethically. This video outlines some of the more basic points about ethics and philosophies of working with people who challenge us.
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.
Sometimes the only way to protect the therapeutic relationship is temporarily to behave as though you have no concern whatsoever for the other person’s point of view. This seems counter-intuitive and it most certainly doesn’t ‘feel’ good but how we feel is often far less important than what we do.
It’s important not to allow anyone to use our emotions against us in order to influence our therapeutic decision-making. That’s a form of emotional blackmail. It’s also a very common behaviour strategy that people use because it often works.
You probably won’t be able to stop someone using this sort of underhand strategy with others but you certainly can stop them using it on you. The trick is to show them that it won’t work and then invite them to bring something better to your therapeutic relationship instead.
Confidentiality 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.
Those of us who work in mental health services, be that for the NHS or in social care settings receive both payment and training for our efforts. However, there’s an army of unpaid, informal mental health carers who receive neither, despite the fact that without their contributions the whole system would collapse.
It’s estimated that informal carers save the NHS more than it actually spends each year and that situation doesn’t look like it’s going to get better any time soon.
The ‘Carers in mind’ project is my attempt to help redress the balance by providing information and training in practical ways for carers struggling everyday to hold their families together, often in truly desperate circumstances.
If you’re a carer involved in mental health please feel free to comment and let me know what you’d like me to cover. I can’t promise to fulfil every request but I’ll do my best.
Please leave a comment to let me know what you’d like me to cover as this series progresses or use the contact form below to get in touch privately.