1. Crisis Management Aim – to develop understanding of the process of managing crisis in community mental health care

2. 1 Community Mental Health Nurses Junior Psychiatrist Carer 4 CMHT Administrator General Practitioner Support Worker 2 Approved Social Worker CMHT Manager Crisis Team Leader 3 Consultant Psychiatrist CMHT Support Workers Police Officer For each occupation, consider – What are the general roles & responsibilities of this occupational group? Do they have specific roles in relation to crisis management? TASK 1 ROLES

3. TASK 2 THE BACKGROUND Read the Case Study Michael Teens Twenties Thirties Now, 34

4. TASK 3 CRISIS MANAGEMENT Play your role according to your knowledge of it. The task for the group, as the scenario evolves, is to – a.identify and analyse the issues b.make decisions on actions c.make decisions on communication & liaison

5. The CMHT Administrator takes a phone call from Michael’s Housing Support Worker. The Support Worker says that they are worried about Michael – they have noticed that during the past week he has become more isolated, he is not coming out of his flat, he’s drinking, associating with shady characters. She says she can hear Michael talking to himself inside the flat, and he is short with other residents. MONDAY

6. Michael’s CMHN manages to see Michael. The report from the Support Worker is confirmed by his CMHN. The CMHN further assesses Michael’s mental state. Michael says that he believes people in the other flats are stealing money from him. He’s drinking 3 cans of strong lager a day and is not taking his olanzapine regularly. Michael is having problems getting off to sleep, and feels anxious and irritable at times. However, he is cooperative and willing to work on staying out of hospital. He agreed to the following care plan to see the CMHN twice that week (Wed & Thu) to stop drinking the Support Worker will see Michael every day, take him shopping and check he is taking olanzapine 10mg daily The CMHN makes an out-patient appointment with the consultant for the following Monday. The care plan goes to the MDT for discussion Are the other CMHT members happy with the care plan? TUESDAY

7. Michael’s CMHN calls on Wednesday, but Michael is not in. What should s/he do? WEDNESDAY

8. Morning On Thursday, another resident phones, saying that Michael has been seen in the street, gesticulating, and in a right state. What should be done? THURSDAY Afternoon The CMHN calls and sees Michael in a dishevelled state. There is a smell of urine in the flat. Michael’s speech is disjointed. He is talking about other residents ganging up on him, stealing money. One resident says he has been threatened with a knife. The Support Worker no longer feels able to visit alone. The CMHN suggests admission to hospital to Michael, who refuses. What should be done?

9. What have you learned? Aim – to develop understanding of the process of managing crisis in community mental health care