Here is the March update from another of the forums I chair for Mental Health unpaid carers in Lewisham. The carers forum is based at Carers Lewisham and we are always on the lookout for other carers wanting to become members of our forum.

As with other carer forums. We come together to discuss carer issues, get engagement from our Mental Health trust being South London & Maudsley and also get engagement/focus groups from other parties. It is not unknown that members from other trusts tend to pop down to observe or engage with the forum for networking purposes.

For March, the group discussed a vital important question relating to SLaM’s recent quality improvement project. The forum was asked the following question.

What’s the most important thing that SLaM could do to improve the quality of their services?

With a good turn out, I presented why carer forums need to examine its Local mental health trusts quality of services and what as a forum we can do about it.

With support from Ulalee (Carers Lewisham, carers advocate and representative). The group fed back the following.

• Some members feel it takes too long to engage with the patient and their carers and family.

This might be due to lack of staff or miscommunication, I do not have the answers, but in the past there was more engagement with patient and carer, now many seem to feel engagement tends to happen mostly when medication is prescribed.

• Need more interpreters to help in engagement/dialogue with mental health services.

One of our members does have difficult with English and is currently getting help from Carers Lewisham in their situation, but feels interpretation could be useful in the service.

• Access to information when a serious incident takes place regarding families and carers (inpatient).

Some members feel confidentiality is getting in the way too much, although they do understand there is a need for it.  A member is querying why there is a lack of confidentiality booklets and why it is taking so long to print more out, however they are happy with the content of the booklets.

• Follow up regarding the event, should be improved.

Some members hear too many stories from other carers that their ‘loved one’ is back on the ward, they do understand that the service user may have wished not to take medication, but members feel follow up after a mental health crisis is poor and the quality of follow up services should improve.

• Improvement in medications (what the medication is meant to do “information about medication”)

Not only should there be improvement in the quality of medications, but information about medication side effects should be provided.  I have been on some wards and community treatment bases and have seen medication leaflets placed around, but members feel there should also be monitoring and discussion with the patient and carer on how medication is getting along.

• Training of staff should improve in quality (mental health to avoid misdiagnoses)

There is a feeling the reason why so many patients end up back on the ward is because monitoring of medication is lacking, so patients come off medication due to side effects and sometimes the medication might not be working at all.  The forum members feel perhaps training staff might help.

• Engagement to the community in regards of how families and carers can access training

Staff should be trained not only on ward engagement, but engaging with family and carers in the community.

• Lack of social workers, need more to help improve quality of services.

It was noted that some areas under SLaM are affected more, but it is felt this was not SLaMs fault, but there is still a need for more social works and less burden on SLaM staff to end up documenting procedures/reports all the time.  Members feel the spirit of psychology/psychiatry is becoming too clerical and engagement has gone out the window.

• Long waits for therapy / GPs should be more informed.

The gatekeepers to SLaM services e.g. GPs should be more informed about how family and carers (mainly those supporting mental health needs) can get help.  The forum also requires engagement from the CCG on such matters and wish the CCG and SLaM work in partnership on carer awareness among Lewisham GP surguries.

• Providing better quality of support information & communication to Patient and Family/carer

Members feel more communication with patient/carer could improve, but we are not sure how this could be done.

• Dignity and respect to family / carer

Members of the forum are hearing stories and experiences of mental health staff becoming aggressive towards patient or carer.  Many members feel perhaps work pressure, bad relationship and lack of training could be causing this.  Family & Carers and patient deserve dignity and respect since trauma can be catching.

• Carers not involved regarding Admissions, revolving door of mental health service.

It could be confidentiality problems again, the forum does not know, but we feel family and carers are not always involved in ward rounds with the patient and would like to hear from social services department or those responsible for social services at the trust.

• Explain to family/carer why the ‘cared for’ as been admitted (preventative measures)

Too many stories and experiences of loved ones being admitted time and time again to the Ladywell Unit, feel their is a blame game on the patient refusing treatment.  Members think their certainly should be a trust responsibility as well.  Members want some improvement on why their ‘loved one’ is being admitted time and time again.

• Also to keep the patient out of the ward (discharge plan)

Members feel the follow-up is lacking, a bad discharge plan increases the likelihood of the patient being admitted again.  Members feel information from SLaM’s patient database is obscure, something is wrong when patient/carer is not getting all information from the database.  The forum wants engagement for representatives of EPJS to explain what work needs to be done on the patient system and why it is so hard for patient/carer to be sent information regarding ‘care plans/emergency plans/carer engagement info’ and so on.

• Should work to improve quality of communication to family/carer and also patient.

Too many stories of care plans not containing information or information not making sense.  Members of the forum understand there is pressure on staff to document reports, but still want quality to improve.

• Have experienced carer not knowing what to do, it should also be a trust responsibility.

More of a problem for new carers, but it can be difficult getting hold of mental health staff, which is why support from Carers Lewisham has been so critical.  With the loss of SLaM’s carer support officers and also the loss of Carers Lewisham Mental Health advocate; family and carers are feeling the brunt of service cuts as it is hard to know who to go to for Mental Health carer requirements.

The forum members look forward from carer leads out in the community and would want to hear updates of SLaM carer lead network meetings.