Review of Good Practice Statement Engaging People, Observation of People with Acute Mental Health Problems Jamie Malcolm & Anna Wimberley

Legislation and policy changes that reflect changing philosophies of care – principle based Greater emphasis on risk management in care planning, and observation as a tool in overall care and risk management Greater emphasis on involvement of families/carers Environmental awareness – new purpose built facilities CHANGES AND DEVELOPMENTS

Developments in observation practice - upskilling Lessons learnt from reviews of the suicides of inpatients since 2008 Mental Welfare Commission review of enhanced observation – clear recommendations for improvement for NHS boards Use in other clinical settings

KEY CHANGE AREAS Process-centred Current practice: an approach that is based on standardised levels of observation ‘general, constant, special’ Person-centred Future practice: an approach that is based on an individual care plan/safety plan, prepared with the patient that sets out when, where, how and by whom continuous one to one engagement with a member of staff is required

Allows staff to intervene as specified in the patient’s care plan and to: provide support towards recovery be a ‘participant observer’ prevent, contain and reduce any risks arising from the person’s behaviour maintain a safe environment provide care and treatment in accordance with the person’s overall care plan, and record and report on the person’s physical and mental state, progress and behaviour. ENHANCED THERAPEUTIC ENGAGEMENT (?)

supportive of the patient’s recovery and do no unnecessary harm to them a clearly understood part of the care, operation and culture of the clinical area fully integrated in the patient’s overall care plan as far as possible, carried out with the patient used when the patient is not consenting or unable to consent to any restrictions placed on them, then the provisions of the relevant legislation are used to protect their rights BASED ON EXISTING GOOD PRACTICE THE INTERVENTION WILL BE:

carried out only when necessary and there is no effective less restrictive alternative not highly visible in a way that carries a risk of stigmatising the patient concerned undertaken by staff with the necessary knowledge, skills and information who are confident and supported by management in positive risk taking, and based on the principles of the Mental Health (Care and Treatment) (Scotland) Act 2003 and complies with the requirements of human rights legislation. THE INTERVENTION WILL BE:

3 national working groups Draft guidance – 50% of the way there Lots more to do! Original timescales revised to allow for wider engagement and consultation and development of implementation support WHERE HAVE WE GOT TO?

Reference group Focus groups Patient, family and carer verbal/written information (Mental Welfare Commission) Access to independent advocacy is easily available (Mental Welfare Commission) SERVICE USER/PATIENTS/FAMILIES AND CARERS

Respect Trust Relationships Engaging Therapeutic opportunities Perspectives SERVICE USER/PATIENTS/FAMILIES AND CARERS: KEY WORDS

Multidisciplinary focus groups within each NHS board involving all relevant specialties/services Discussion and engagement with key stakeholder groups Testing Develop implementation support package (patient and family written information and prompts for verbal information/practitioner education and training/legal framework/local policy development) Final guidance revision PROPOSED NEXT STEPS

1.What is your experience, what are the key things that matter to you? 2.What’s the best approach to consultation and collaboration? 3. What are the key things that will make a difference and improve patient/service user/family experience? DISCUSSION QUESTIONS