Fiona Couper and Debbie Spain Department of Mental Health Florence Nightingale School of Nursing & Midwifery Partnership Working Fiona Couper and Debbie Spain Department of Mental Health

Learning Outcomes By the end of this session, you will be able to Discuss the meaning of ‘partnership working’ in mental health services Critically examine factors that may prevent and promote partnership working Identify implications for clinical practice Have opportunities for reflection

Background Individuals in contact with mental health services typically benefit from involvement with more than one health professional and more than one agency Partnership working: “any situation in which people are working across organisational boundaries towards some positive end’ (Huxham and Vangen, 2005, p.4 in Tait and Shah, 2007)

Shared Knowledge, Skills and Values Pulling Together (SCMH, 1997) promoted collaborative teamwork while retaining separate professions Ten Essential Shared Capabilities (DH, 2004): broad domains of competency for all workers Clinicians may not have full awareness of other disciplines in terms of scope of practice, values, codes of conduct and organisation

Group work In small groups identify the :- Benefits of team working 2. Barriers to team working

Ten Essential Shared Capabilities (DH, 2004) Working in partnership Respecting diversity Practising ethically Challenging inequality Promoting recovery Identifying people’s needs and strengths Providing service-user centred care Making a difference Promoting safety and positive risk taking Personal development and learning

Shared Knowledge, Skills and Values How do members of your team conceptualise presenting difficulties ? Do all professionals share ideas about the treatment plan ? 7

Some benefits of team working holistic approach to care and support reflects the need to offer Recovery-focused interventions increases efficiency, reduces duplication shared knowledge and expertise better use of resources, value for money improved communication and engagement stimulates creativity combined influence distinct conceptualisations of symptoms / treatment anything else ? (e.g. DH, 2006; SCMH, 2000; Tait and Shah, 2007)

Factors affecting partnership working with service-users attitudes / perceptions nature / severity of mental health symptoms MHA status withholding information relationship dynamic unclear expectations inconsistency resistance staffing levels / retention resource constraints (e.g. McCloughen et al, 2011; Simpson and Brennan, 2009)

Barriers to working with professionals perceptions and attitudes no common shared language inequalities in relationship accountability and responsibility not clear conflict of interests / agenda power struggles resistance ‘a blame culture’ end points / outcomes not clearly identified different organisational policies, priorities, IT structures disagreements re cost bureaucracy reluctance to share team dynamics poor support mechanisms

Triangle of care Service User Professional Carer

The Triangle of Care. National Mental Health Unit(2010) This document provides a guide to the views of users, cares and professionals about best practice. Their view about what constitutes a mental health crisis can differ. Consider some one you have cared for recently and note how:- The user described the crisis The carer described the crisis The Professional described the crisis

Barriers to inter-agency working Five significant obstacles to inter-agency working between health and social services: Structural Procedural Financial Professional Status and legitimacy (Wistow and Hardy, 1991 in Holton, 2001, p.431)

Group work Consider one of the five Barriers and find examples in practice.

Improving partnership working with service-users and their families recognising need being prepared to work together listening acknowledging service-user expertise adopting a collaborative, goal-orientated approach promoting open and reciprocal conversation developing a shared understanding facilitating self-management skills and self-efficacy providing information in accessible formats

Improving partnership working with service-users and families contd. encouraging service-user feedback named / designated nurse / team providing choice evidence-based decision making signposting to PALS and advocacy service as needed emphasising relapse prevention techniques using advance directives / crisis planning when appropriate

Working in partnership in day-to-day clinical practice Strategies include: clear communication: a shared language effective leadership making time meetings ! (need to specify when, where, how often) inter-agency training

Working in partnership in day-to-day clinical practice contd. Strategies also include: identification of individual strengths and resources joint assessments sharing of information / ideas / experience mechanisms for providing feedback willingness to manage change

Enhancing partnership working leadership skills negotiation skills assertiveness flexibility / creativity feedback responsiveness trust motivation skills-based intervention familiarity with policies shared resources clarity in aims clinical supervision

Is there one thing that you could change in yourself to encourage more cohesive partnership working with others ?

Summary and some considerations A need to consider a whole-systems approach to care Service-user involvement in design, delivery and evaluation of services Increasing emphasis on evidence-based practice – we need to develop broad systems for evaluating inter-agency interventions

References Audit Commission (1998). A Fruitful Partnership: Effective Partnership Working. Audit Commission. Department of Health: NHS Modernisation Agency, NATPACT. Working separately together: A guidebook for successful partnering between organisations within the NHS. Leeds: HM Government. Department of Health (2006). From Values to Action: The Chief Nursing Officer’s Review of Mental Health Nursing. London: HM Government. Department of Health (2009). Putting People First. Working together with user-led organisations. London: HM Government. Department of Health (2011). No Health Without Mental Health. London: HM Government. National Mental Health Unit(NMHDU)(2010) The Triangle of Care. London. NMHDU Holton, M. (2001). The partnership imperative. Joint working between social services and health. Journal of Management in Medicine, 15(6), pp.430-445. Involve: www.invo.org.uk

References McCloughen, A., Gillies, D. and O’Brien, L. (2011). Collaboration between mental consumers and nurses: Shared understandings, dissimilar experiences. International Journal of Mental Health Nursing, 20, pp.47-55. Rethink. www.rethink.org Sainsbury Centre for Mental Health (2000). Using opportunities for inter-agency partnership in Mental Health. Taking Your Partners. London: SCMH. Sainsbury Centre for Mental Health. (2004). The Ten Essential Shared Capabilities. London: Sainsbury Centre for Mental Health. Simpson, A. and Brennan, G. (2009). Working in partnership. In P Callaghan, J Playle and L Cooper (eds). Mental Health Nursing Skills. Oxford : Oxford University Press. Tait, L. and Lester, H. (2005). Encouraging user involvement in mental health services. Advances in Psychiatric Treatment, 11, pp.168-175. Tait, L. and Shah, S. (2007). Partnership working: a policy with promise for mental healthcare. Advances in Psychiatric Treatment, 13, pp.261-271.