Promoting dignity in mental health

1
Promoting dignity in mental health

• Sandra Williamson
• December 2009

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How I became involved

• Could you help with the single sex audits?
• You are interested in dignity, fancy getting
  involved in some work?

3
The importance of contextfor understanding
dignity in mental health care

• We felt that the national/ regional campaign
  was very acute focused and did not represent the
  realities of mental health care.

4
Approach

• Move to single sex accommodation
• Build on existing work by identifying and
  collating dignity related activities
• Use service users as experts
• Share and extend good practice
• Harness support for change
• Identify and address weakness

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Key influences on the delivery of mental health
care

• Mental Health Act 1983
• Community Care Act 1990
• Human Rights Act (1998)
• National Service Framework for Mental Health
  1999 NHS Plan (2000)
• National Service Framework for Older People
  (2001)
• Capacity Act ( 2005)

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• These policies reflect the prevailing ideas in
  society about individual rights
• The effect in mental health care was to move from
  a custodial approach to an approach that values
  the freedom of individual to make choices and
  maximise their potential.
• The contradictions/challenge being in the area
  of care for those whose illness posed a threat to
  their safety or the safety of others

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The Ten Essential Shared Capabilities for Mental
Health Practice

• Working in Partnership.
• Respecting Diversity.
• Practising Ethically.
• Challenging Inequality.
• Promoting Recovery.
• Identifying Peoples Needs and Strengths.
• Providing Service User Centred Care.
• Making a Difference.
• Promoting Safety and Positive Risk Taking.
• Personal Development and Learning.
• (DH 2004)

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Initial thoughts

• Identify leaders and interested individuals
  across the organisation and promote ownership
  with the issues
• Build on existing good practices
• Service user involvement
• Trust values
• Link with quality assurance measures
• Involvement with partners
• Links with education

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What was already happening

• Mental Health Commission visits
• Increasing engagement with service users
• Privacy and dignity policy (2006)
• Privacy and dignity in other policies e.g Rapid
  Tranquillisation physical , chaperone
• Protected meal times
• Dementia care mapping
• Essence of Care ( communication privacy and
  dignity)
• Few complaints
• Single sex accommodation

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Single Sex Accommodation

• Helped to raise issues of Privacy and Dignity-
  promoting discussion and reflection

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Individual Team Initiatives

• Service user groups
• Service users on interview panels
• Service users feedback
• Articulating and publicising expectations
• Protected meal times
• Children involved in planning new children's unit

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Service Users Outcomes Group in Acute In-patients

• Group of staff and service users in acute care in
  Oxford aim to
• Set out the standards what you would expect to
  see
• Use this group to make some positive change

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• The first area for improvement was the
  manner in which staff greet Service Users and
  Carers.
• It was suggested
• introduce this as part of induction programme
• make it a Trust priority
• Use NVQ qualifications in customer service
• Notices have been put on the ward entitled
  hospitality clarifying what patients and
  visitors should expect and what to do if these
  expectations are not met

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Communications Team Initiatives

• OBMH is working with staff on PD promises that
  they will make to service users and carers
  (translating the national acute/physically
  focused agenda)
• The promises have to be able to apply across a
  range of settings including community (service
  users homes) and also to non-clinical staff

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• we are keen that the promises fit in with work
  already happening wherever possible instead of
  being something that creates more pressure for
  staff or are just words we say without doing
  anything around it.

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Privacy and Dignity Promises ( currently out for
consultation)

• We promise to listen to you and treat you as an
  individual
• We promise to address you appropriately, in the
  way you wish
• We promise not to allow language or other
  communications issued to become a barrier to
  understanding
• We promise to make sure you have access to
  information and choices appropriate to your care
• We promise to let you know how to access advocacy
  and support services if you need them

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Education initiatives

• Trust student nurse induction ( RCN Dignity DVD)
• Communication with universities
• stressing the need for dignity to be explicit
  in the curriculum
• Simulation of Practice sessions - Rapid
  Tranquillisation and Observations

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Oxfordshire group

• Multi agency group hosted by social services
  addressing dignity in care.

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Plan

• Set up group to coordinate activities
• Representatives of different groups
• Ward representatives
• Essence of care leads
• Communications team
• Dignity lead

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First meeting

• Outcomes
• Agreement that this is an issue
• Good practice and information shared
• Agreement that different approaches needed

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Dignity Group Plan

• Communications team to continue to consult staff
  on trust values/promises and liaise with
  executive team
• Pilot RCN DVD on one ward
• Liaise with productive ward team particularly
  around working lunches.
• Liaise with IT re. adding what would you like to
  called? to new patient records system
• Review Privacy and Dignity Policy
• Push for Privacy and Dignity to be included
  explicitly in Trust induction
• Seek wider input
• Collect examples of good practice

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Challenges ahead

• Current climate
• Resistance to change

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An example of good practice

• when I was very ill, I was unable to speak
  properly for about 3 months and had to rely on
  typing things on my computer or writing things
  down.  This meant the staff had to be patient and
  sometimes appointments went on longer than they
  normally would but it made me feel that people
  cared and helped towards my recovery.

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References

• Department of Health (2000) The NHS Plan a plan
  for investment, a plan for reform
  http//www.dh.gov.uk/en/Publicationsandstatistics/
  Publications/PublicationsPolicyAndGuidance/DH_4002
  960
• Department of Health (DH 2004 ) Ten Essential
  Shared Capabilities Accessed 16/3/08
• http//www.opsi.gov.uk/acts/acts2005/ukpga_2005000
  9_en_1accessed 1/12/09
• http//www.opsi.gov.uk/acts/acts1998/ukpga_1998004
  2_en_1 accessed 1/12/09