It has been a long time coming since I have been so busy on writing my 2nd book which is title “Experiencing mental health caregiving – unpaid carers”. I have decided to take a break on my book and do another blog update. As usual I host many carer support groups and carer empowerment forums. This blog post is an update of my Lewisham carer forum.

The speakers for August were Denis Muganga who is the Service Manager for Lewisham In-Patient MH Services and works at South London and Maudsley. Denis is also deputy head of nursing at the mental health wards in Lewisham.

Denis spoke about Reducing Prone Restraint on Lewisham Acute wards. Many families and those caring for loved ones are often worried about the risk of restraint on mental health wards. Once a patient is in the care of mental health inpatient services then it is out of unpaid carers hands and we have to take a step back.

So it was very important unpaid carers get enagement on quality improvement to reduce prone restraint.

DENIS MUGANGA PRESENTS

Denis explained his role as deputy head of nursing is basically looking at day to day provision of care for their patients. That’s both inpatient and the community as well, but within that, we as a team have quality improvemnt. At our services we do have matrons that work on specific things to individual wards and also services. If there are any concerns being highlighted, and then we as a service look to address it. This would include how patients have been involved in their care and how carers have been involved in care. This covers a lot around physically high quality of care plus anything that is in the patient data system which received, scrutinized and helps find out what could have been done differently.

So the project itself, has been a lot of things over the years in terms of progressing towards a postive outcome. So unfortunately in mental health services there might be occasions where you’re having to restrain patients, because of the patient’s presentation at the time where we might have to mitigate risk awareness.

This project is looking at a specific kind of restraints, which we wish to reduce the risk of harm and at the same time reduce risk to injury to staff and patient. So over the years, there has been attempts made by professionals to reduce the use of restraints, which is needed if trying to administer medication or as a result of maybe aggression from the patient. In most cases, it’s not to mitigate violence and aggression, and maybe to administer medication, depending on how what’s going on.

so the initial projects is about reducing the restraint within the within the service that we have in Lewisham mental health services. At Maudsley we have around 4 to 5 wards. One of the first few things we did was to look at behaviors and areas where prone restraints were being used predominantly and see how we could reduce it. So following the data collection, the initial aims we had in mind is to increase the use of safety.

So at the point of this project been introduced at the mental health trust, there is no other routes used across the trust for rapid tranquilisation for administration of medication. This project was then looking at what options that we could obtain some medication, safely administer medication, when there was need for restraint of a patiant. Part of the project is to take into account the patients dignity because obviously, you don’t want to have to reduce someone’s choice, when there is no need for restaint, if there are other options to do that. So we were looking into that as well and on how it improves patient safety and experience in hospital.

so with those things that we had in mind, we wanted to increase options for the patient in order to reduce restraint and this could be done with choice of equipment. One equipment method is a big cushion or bag that you can sit down and administer medication.

Unfortunately what makes it difficult for this project is the restraint being used at that point is not being taught for giving medication on the arm. So, there has to be a review of the restraint position, so that we can accommodate patient safety. So in that sense, you improve patient experience in hospital. So, we looked at that and also look at what the patient wants. So we did an initial questionnaire to understand what does the patient would like in terms of medical administration

QUESTIONS FROM CARER MEMBERS

One of the carer members was interested regarding the 16 staff members that have been trained in restraint so far. The carer wondered how many persons have been trained, up to date and what’s the plan?

Denis mentioned that within the past two years, so that’s PSTS training, which is facilitated every, which is supposed to be renewed every two years. This is part of this project has been part of training for the past couple of years. But what happens is because everybody don’t get trained together, when you go for training and come back, you go back to what you’re used to. So there is ongoing training for everybody.

So the PSTS training, which has been renewed every two years is basically to put staff together and continue to move things at start the project.

Another carer was interested about the presentation when Denis talked about carers, because that’s what they are involved in. The carer was interested in what support Denis gives carers because he mentioned he involved carers, but the member was curious about that support regarding restraints. This is because the carer might get a bit concerned and worried about maybe hearing people screaming on the wards. The carer was curious to know what support was given to carers and what was the feedback because he heard that Denis got feedback from one carer, but he was sure Denis must have more carers to get such kind of feedback, not just the odd one.

Denis responsed that for this particular project, we didn’t go out to get feedback from carers, it was specific to the patient, However in terms of feedback from carers. We haven’t done feedback specifically for carers around restraints. Although we did have carers working towards the end of the project.

More questions and queries came from a large number of carers at the forum, although an interesting question came from our local carer support officer who was interested if that the point of the project was to reduce the use of prone restraint. Especially if there has there any indication that there’s been a reduction in restraints full stop.

MATTHEW MCKENZIE PRESENTS ON CARER INVOLVEMENT.

I do not always have speakers from the mental health services or commissioners regarding changes to health and social care. Sometimes I try and engage my carer forum members on important topics for carers.

I decided to present on the important of carer involvement.

Were I presented on the following.

• What are your ideas of Carer Involvement in services
• What does it mean to involve carers
• Examples of Carer involvement
• Challenges of carer involvement
• Why is carer involvement needed?

We discussed as a group what carer involvement in services could mean and then I presented in detail the following.

Does what it says on the tin “identifying and recognising the importance of unpaid carers and involving them in care”
It can be a small action or a large one.

As long as carers are acknowledged then they should be involved

My view on Carer involvement is not a hard and fast rule and one of my chapters for my 2nd book is around carer involvement, although I did touch on carer involvement in my first book “A caring Mind”, which is available on Amazon.

THE CHALLENGES OF CARER INVOLEMENT

I also presented on the challenges to involve unpaid carers, being the following.

• Lack of resources identifying carers
• Complexities of information sharing
• Lack of staff training
• Lack of carer training regarding mental health.
• Lack of time available for the carer
• E.g. attending appointments, attending carer groups.
• Support information out of date.

I then presented on Examples of Carer Involvement and spoke in depth of the following.

• Identifying the main carer
• Providing carer with information
• Involving carers as soon as it is possible
• Supportive approach towards carers
• Aspects of care planning and discharge
• At the very least listening to carers

….There are more ways to involve carers
NOTE: It is Not the same as involving carers in planning services

Carer members of my Lewisham carer forum added more examples to the points I raised so they can talk to other carers they are networked to.

This was a brief update for my Lewisham mental health carer forum for August 2021