Carrying out Social Assessments at an Acute Psychiatric Ward A Practice Research Charlotta Hallén

Education in Social Assessment Jorvi hospital psychiatric social workers Anna Metteri, Associate Professor in social work, Tampere University A tool tailored in collaboration for psychiatric social work with adult patients

Social Assessments 1. Gathering information about the patients´ life spam, living conditions, social network and family, education and work, income and social security benefits and matters that might be important around these themes. Based on information given by the patient and on documents.

Social Assessments 2. The social workers conclusion consists of: Assessing changes in the patients capacity to manage his social network, working, income, family ties and living, that are caused by the illness Possible alternatives and suggestions The patients motivation and own assessment on his situation

Social Assessments 3. Several meetings with the patient, 3-5 Time to gather and process the information, and finally produce the report The last meeting is personal feed back on the report, which the patient can comment on or make changes or corrections The report and the information is used within the treatment, separately or as a part of a multiprofessional treatment plan

Why gather information? The sooner the patient gets a good and realistic plan, the better the outcome in recovery By gathering information of a patient you get a picture of what kind of rehabilitation a patient needs and what is possible for him to get.

Treatment at the Acute Psychiatric Ward Short term treatment, average duration 2008 was 18,5 days Aims at minimizing the patients symptoms A team consisting of a psychiatrist, psychiatric nurses, and if needed a social worker, a psychologist and an occupational therapist, is formed for every patient The social workers role is to keep in mind that the patient has a life outside the ward, and that he is returning there.

Symptoms and deficits Paranoia Lack of insight in illness Lack of reality insight Deficits such as distractibility, memory problems, lack of vigilance, attention deficits Limitations in decision making and planning

The theme for my research Difficult and challenging to carry out social assessments with patients in acute ward treatment To find out what makes it difficult and why??? During 1 month I systematically evaluated every patient treated at the ward

Facts Totally 37 patients, 22 men and 15 women patients treated at the ward per day The age range was 18-59, and one clearly elderly The treatment duration varied from 1 day to over 4 months

Three categories of patients Patients who have suffered from mental illness or are in treatment at a ward for the first time in their lives (10) Patients who have been in and out the ward several times, or have suffered of mental illness for a long time (18) Patients whose treatment clearly is supposed to be somewhere else (9)(severe abuse problems, elderly patient)

What I did Daily meetings where I evaluated every patient The evaluation was based on information from patient files given by a psychiatric nurse, and on my own perceptions from situations at the ward during the day or patientmeetings Claryfying questions when needed The patients got a no, yes or maybe - in being ready to engage in a social assessment

The results of the evaluation 1. Reasons depending on the patient Too early: The patient has recently been admitted to acute treatment/symptoms are that severe that any kind of action is impossible The patient is distracted, changes the subject all the time, interrupts others and talks at same time as others, gets stuck in subjects with no relevance/doesn´t talk/is manic/ is unobtrusive/is tense The patient already has program for the day, and two programs would be too much The patient doesn´t want to/ non-receptive to treatment/lacks insight in illness The patient doesn´t want/economically self-sufficient/no need

The results of the evaluation 2. Reasons depending on the wards practices There is no time. The treatment is ending/others matters at work take forehand The patient is repeatedly at the ward/has ongoing treatment elsewhere/the situation is known and under control The patient is not at the ward/is visiting home/is on some introductory visit/is attending a group The patient is temporarily at another ward(somatic) The patients problems indicates that the treatment should be somewhere else, and he will be transferred within a couple of days

Patients that were maybe ready Patients I thought would gain from a social assessment, both personally and as a part of the multiprofessional treatment Not yet ready

Patients that were ready Some patients I considered ready Booked myself to the next meeting In two cases I was told that the meaning of the meeting is ending the treatment In two cases I got this information at the meeting In one case I considered a patient ready when the treatment had lasted for 4 months, and this was 3 days before ending my research. There was no time.

Two social assessments made One consisted of one interview, the next day the treatment ended which I wasn´t aware of. The conclusion wasn´t based on very much and this I had to make on note on. The other lasted for over a month, with many meatings, constantly evaluating the patients condition to engage. We finished it, but the conclusion didn´t sound very accurate to me, with the patients symptoms going up and down.

Conclusions Is not something you do automatically with every patient at the ward Some patients are automatically out of reach of social assessment, because of the short visit to the ward, before being transferred to another treatment. They probably would gain though. Also those in the beginning of the treatment

Conclusions The patients who had suffered of mental illness for a long time, usually has a treatment plan done already. Some might gain of renewing the plan The patients that might gain the most are those who get mentally ill and those who gets admitted to a psychiatric ward for the first time

Some questions How does the fact that most patients at an acute psychiatric ward gets treated against their will affect the willingness and motivation? Can you think in motivational perspectives with these patients? Is motivation the base for success? Does diagnosis give a direction for when a patient is ready? Is being treated for a mental illness acutely in fact a crisis?

Some books on the theme Tossavainen, A. (1996) Johdatus kuntoutukseen ja kuntoutujan sosiaaliturvaan Farkas et al.(2000) Introduction to Rehabilitation readiness. Satka et. al. (2005) Käytäntötutkimus Vartiainen, H. (1999) Psykoottisuuden arviointi. Lääkärilehti 54(3)

Thank You!