Working with friends and family during times of crisis: Islington Acute/Crisis strategy for carer engagement Dr. John Hanna, Consultant Clinical Psychologist, Highgate Mental Health Centre January 2012

Islington Acute/Crisis Services Mental Health Liaison Team Two Crisis Resolution/Home Treatment Teams Two Crisis Houses Assessment Ward Four Acute Treatment Wards Specialist Services for Aging in Mental Health Ward Psychiatric Intensive Care Unit Access to Women-Only Acute Treatment Ward

Unique challenges for acute/crisis Confidentiality When paranoia interrupts close, positive relationships Assessing service user’s reasons for denying carer involvement Confidentiality of carer disclosure Sharing information Pre-admission advance directives Carer disclosure leading to MHA assessment Leave, discharge arrangements Complex categories: General, personal, personal-sensitive Carer expectations of acute admissions Separation—temporary and longer term Family/social network dysfunction, abuse, absence Young carers Out-of-area carers

Triangle of Care Self-Assessment Findings—9 teams within Islington Lack of carer-aware training for staff Variable “carer champion” support across teams Identified challenges relating to parameters of confidentiality/information sharing Limited service information available to carers

A renewed carer strategy for Islington Acute/Crisis Services A working party on improving working with carers and delivering the Trust’s Carer Strategy—representatives from all acute/crisis service line services, alongside Islington Carer’s Centre, IBUG, BUF, FT’s carers lead (Set up in early 2011) Co-production toward three shared objectives Information leaflet for carers, family and friends on acute/crisis service pathway to support informed engagement—completed and ready for formal approval and dissemination Confidentiality/sharing information strategy for carers, service users and staff—completed and ready for formal approval and dissemination Staff training on working with social networks during crisis—delivered to service line managers Carer champions to be established within each acute/crisis team To receive staff training as above (Spring 2012) Good practice adherence projects undertaken within each team (Spring 2012) Working toward concordance with NICE guidance on family work within Acute/Crisis service line