communitycare.co.uk Friday 2nd August 2013
In local authority and NHS meeting rooms across the country discussions of mental health good practice are dominated by talk of ‘integration’, ‘care pathways’ and ‘person-centred planning’. For people who have gone through the experience of being detained under the Mental Health Act and compulsory treatment, the basis of good care is simpler.
“Kindness cuts through everything,” says Peter, who has a severe and enduring mental health condition and has been sectioned a number of times.
“It can be very challenging supporting people who are very, very mentally ill. I can say that because I know I am difficult at times. But when you see staff consistently being kind, being polite, just very, very good contact with people, it stands out.”
Kate, who has been involved with mental health services for the past 30 years (“I have bipolar affective disorder – I don’t like that word. I prefer manic depression”), agrees. She remembers one patient telling her that no matter what the conditions on a ward are, “as long as people are kind that’s what matters”.
“On some wards there’s a real ‘us and them’ feeling. The staff are in the office and just let patients get on with it. Whereas I’ve had really good practice myself where staff have been out in communal areas. They’ve taken time to sit and have a chat. Not just ‘have you taken your medication’ and the tick box stuff,” says Kate.
“If you’ve been on the receiving end of good practice you know what it feels like. I think, why can’t everyone have that?” she adds.
This passion for improving care led Peter and Kate to sign-up to the Care Quality Commission’s experts by experience programme. For the past two years, both have been part of CQC inspection teams that monitor the use of the Mental Health Act in services across England.
At a typical inspection, Kate and Peter will focus on talking to patients about their experiences of services. It’s a vital component of the regulatory system. As Kate says, “no member of staff with half a brain cell is going to be abusive to patients in front of inspectors. I rely on patients telling me what is actually going on.”
They’ll ask about how supportive staff are, any problems patients have had, what the food is like, what activities there are on the wards (if any). They will observe practice and make a point of using the patient toilets, checking the kitchens and state of the fridges too.
“If you’re living on a ward seven days a week, you want cleanliness. You want to know that the toilet is clean and has toilet paper,” says Kate. “I don’t like going into a bath that’s dirty. If I don’t like it, why is it good enough for a patient? At the same time you can look at a staff toilet and shower and it’ll be immaculate.”
Peter says that having been on the receiving end of care, experts by experience can “spot things that other people haven’t thought about.” He points to the fact that something like meals can be such an important way of bringing structure to the day when you’re unwell, particularly in the absence of other activities.
On a recent Mental Health Act inspection Kate noticed that the service didn’t have food available after 6pm as the kitchen staff had gone home. She pointed out to the service managers that a patient might be admitted at 8pm having previously been in A&E for four hours so they may not have had a hot meal all day.
“They said ‘well patients can have toast’ and I said ‘I’ve been on wards. I know that depending on who the staff are that night I might get that toast or I might not but I might also need a hot meal’,” she says. “At the end of the session the medical director came up to me and said ‘thank you. It was so good to hear from someone with a different perspective’.”