What Service Users and Carers Want From Review
Chat Issue Spring 2007
Introduction
This report sets out what users and carers want from the Strategic Review. The report is based on communication within the group, contact with users, carers and advocates, an informal survey and focus groups. The message from users and carers is not one of despair at current services, which are seen as a good platform. Users and carers have practical ideas for improvement and seek change accordingly.
THERE ARE FIVE KEY AREAS WHERE CHANGE IS SOUGHT
1) THERE MUST BE MORE SUPPORT AND MUCH EARLIER INTERVENTION BEFORE ADMISSION TO SECURE CARE.
Action is needed in the following areas.
- Nobody with a severe mental illness should be placed in prison.
- Diversion schemes across Wales {as agreed in the National Service Framework for Wales}.
- More contact with CPNs
- CMHTs (Community Mental Health Teams) ensuring that people receive the right care, at the right time with the right level of security.
2) WE NEED TO SEE MORE ENGAGEMENT WITH PATIENTS ON THE PART OF STAFF IN SECURE CARE
Action is needed in the following areas.
- Nurses engaging with patients in a therapeutic way-more listening and proper recording of the mental state of patients under their care.
- Psychological therapies to be offered, as a norm.
- More contact with RMO (Responsible Medical Officer).
3) PEOPLE ARE EXPERIENCING CHRONIC BOREDOM-THEY NEED MORE REHABILITATIVE ACTIVITIES.
Action is needed in the following areas.
- Proper occupational therapy to be offered to all patients.
- Meaningful activities linked to resettlement.
- More appropriate activities for women.
4) PATIENTS MUST BE ENCOURAGED AND SUPPORTED IN BEING ACTIVELY INVOLVED IN THEIR OWN CARE MEETINGS-AND THEY SHOULD RECEIVE REGULAR FEEDBACK ON THEIR CARE AND TREATMENT FROM THEIR RMOs.
Action is needed in the following areas.
- Patients need to receive an induction into secure care, where they are encouraged to take part in their care meetings and to use the services of the patient advocates. This needs to be embedded in the culture of all secure units.
- Meetings should be user friendly. Patients should not have to walk into a room with 20 people waiting to talk about their own client. Meetings need to be set up to be with the needs of service users as paramount.
- There need to be specialist advocates and they should be independent and promoted by the culture of the organization.
- Patients need to be involved in collaborative risk assessment and management.
- There needs to be an annual consultation of users and carers views and experiences of secure services.
- Patients need to be given full information on choices of medication in terms of their efficacy, management and side effects.
5) AFTER-CARE AND RESETTLEMENT MUST BE IMPROVED
Action is needed in the following areas.
- Patients need to be engaged in activities designed to ease resettlement and paroles need to be focused on this.
- CPA (Care Plan Approach) and risk management must be aligned.
- There must be assertive engagement, under CPA, by CMHTs, following release from secure care.
- There needs to be a range of low secure and non-secure supported housing in all areas covering the pathways to independent living.
- There need to be community advocates for people leaving secure care.