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2018-19 Strategy & Congress Consultation

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2018-19 Strategy & Congress Consultation

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Every year, the RCN Mental Health Forum will run a consultation with members to help set our policy and strategy for the year ahead.
As part of that, we need to hear from you about what will make a difference for you, whatever field or setting of mental health services you work in.
We are running this consultation to the end of October 2018. Once complete, we analyse the results and create proposals and work programmes. This information is then used to shape the agenda for RCN Congress in May 2019, and from there to shape the policy of the Royal College. It also helps us to dedicate resources to new projects that complement your clinical skills.
To contribute, click on the pink "+" button in the bottom right of this window. You can start a new topic or respond to something already here. There is no limit to the number of comments or posts you can make. Please feel free to share this consultation with your colleagues. Remember this is a public platform with unrestricted access.
Thanks for your input!
Ed Freshwater
Chair, RCN Mental Health Forum

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I work in a cmht and wonder what the plan is for services to offer short term support for those facing a challenge or difficulty, that do not have a severe and enduring mental illness, do not meet criteria for care coordination but are too risky/complex for primary care? A short term mdt, psychsocial approach would be helpful. Crisis teams offer an alternative to hospital mainly using the medical model but in the city I work people's issues are usually reactive to social and interpersonal issues. The cmht cannot cope with the amount of referrals for those meeting the criteria outlined above, and due to long waiting times the clients are not receiving timely interventions, leading to escalation of risk and therefore being picked up by emergency or crisis services.  Is it not time to adapt community services to local need?

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I also work in a CMHT. A few potential topics..

I see a variety of strategies being used to cope with no available beds. This is happening more often than not. I have seen patients sectioned but sitting in a&e for several days. We now operate a waiting list for admissions effectively, with the riskiest at the top. This then leads to a delay in treatment for the patient, but also extra workload for CMHT practitioners, trying to support the patients in the community for longer......this leads nicely to my second point.... short staffing. Caseloads are high where I work( and I don’t thinks that’s too unusual) and therefore stressful, which in turn results in higher rates of staff sickness, which results in difficulty retaining staff, which results in high caseloads! A vicious circle nigh on impossible to break out of without additional resources.

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I understand other NhS staff had the law that covers them in general practice reviewed. What plans are in place to protect mental health staff even though the risk of assault exists??

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How to use digital technology in community mental health, particularly rural areas (young people and adults)

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How to use digital technology in community mental health, particularly rural areas (young people and adults)

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Do we even have a 'mental health' service?

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Do we even have a 'mental health' service?

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I have worked for many years as a CPN or even a community mental health nurse! I have recently started working with a doctor's organisation which does not use NHS 'mental health' services. 'Over the years I've noticed that people in CMHTs (CPN, social workers, OT's etc, unquestionably carry out an unmeasured administrative burden (approximately 80% of the working day) to the detriment of patients/clients. I wonder how many people challenge this or even have time to think about it, in between constant data entry inputting. Is it any wonder CPNs are losing their therapeutic skills and there is limited access to psychosocial interventions? 🤬

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defining safe and therapeutic staffing level in all areas, same level of commitment as scrap the cap we need to set red lines. this will address the issues of poor moral,retention, look at skills and career progression. i think members would take this on as it is clinical

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defining safe and therapeutic staffing level in all areas, same level of commitment as scrap the cap we need to set red lines. this will address the issues of poor moral,retention, look at skills and career progression. i think members would take this on as it is clinical

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engaging with the independent sector,private therapist counselors, nursing homes there could be more activist out there than the accredited reps which are primary in the NHS at this time but this workforce is growing.

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engaging with the independent sector,private therapist counselors, nursing homes there could be more activist out there than the accredited reps which are primary in the NHS at this time but this workforce is growing.

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I work in a home treatment team and remember when the crisis resolution model was first brought in around 2004, devolving day care and respite into the new model. Well, I think there's a place for both. Bring back respite and day services alongside hbtt. They work. They keep people out of hospital.

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Level of access to psychosocial interventions

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Level of access to psychosocial interventions

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As a student nurse I have unfotuently been very disheartened by the low number of people who are, have been, are given access to therapies. Whereas i have noticed that psychiatric medication is always, if not mostly advised, given to people even without any conversations regarding any type of psycho social intervention, to at least go on along side the prescribed medication.

In theory therapies are being portrayed as the most beneficial type of intervention that we, as health professionals can deliver to people. However that doesn't seem to be the case in practice.

This has truly made me re-think about my chosen career, observing current preferred methods interventions.

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I work in an NHS education team and part of my role is talking to schools and colleges. There are many young people who are interested in a career in mental health and they have the right values and a positive attitude. However they are put off by what they hear about working conditions in the NHS

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There has been a huge recent focus on Perinatal Mental Health the RCN however appears to have no influence in comparison to the RCM and other health professional organisations

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Hi- i am concerned about the patients who slip between the net- especially those with high functioning autism. There is currently no service in our county to support those in a mental health crisis with asd so the patients have been admitted to a and e which is stressful and has too much sensory output for some people with autism. This has pushed a friend of mine into a traumatic breakdown and i watched as busy staff were unable to deal with the situation as they are simply too busy.
What is the autism strategy for children and adults who suffer with their mental health when their primary need is asd??
Vicky - northamptonshire

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Locality based care or specialist care pathways spanning large areas?

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Locality based care or specialist care pathways spanning large areas?

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I'm interested in CPNs experiences of working in designated functional pathways (such as psychosis, complex needs (usually a euphemism for people with a diagnosis of personality disorder). I heard at the MHNR Conference that South London & Maudsley have reversed their pathways to locality model after 7 years experience.  I've recently completed two mh strategies (manchester and north wales) and both services opted for locality based models linked to existing community resources.  Do these pathways provide a better quality of care? or are you finding that people 'fit less' in these services than in other models such as locality based CMHTs?Anyone from SLAM that could share their experiences?

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Shifting the focus to mental wellbeing from mental health but not forgetting those with severe and enduring mental illness 

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Shifting the focus to mental wellbeing from mental health but not forgetting those with severe and enduring mental illness 

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I am concerned that unless we begin concentrating on Wellbeing, health services will continue to be expected to manage the needs of a population. We need to strengthen MH nursing in areas of education, housing and citizens advice. We do however also need to remember those most vulnerable and debilitated by mental illness. They are the hardly reached.

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Can you please think about the development of group interventions for people with mental health difficulties and this being supported by peers alongside nurses etc.

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I work within an arena developing dementia strategy across an organisation and developing dementia education . I am quite senior and broadly experienced, I contribute widely to information and supportive material. My colleagues local national and forum based platforms share stories of ageism and prejudice regarding the client group and staff working in dementia service . Colleagues say that a lack of inclusion at levels of NHS hierarchies is both detrimental to heart and sole and people with dementia need. How might the RCN create the opportunity for RMN;s to reflect this marginalised position and actively support culture change?. We are but little fish in a big ocean and have a little voice in the the influence of BIG concepts . The meaning associated with personhood and person centred integrated care to smooth the passage of people across rigid disconnected . Little voice in services and little traction is a frequent story. It is within mental health services there is the greatest disinterest in dementia development and the specialism. Keeping in mind that older ages psychiatry came about because people with dementia were simply misplaced and abandoned without such a MH discipline. It is with despair I write this. I do my bit as do we all but ageism, prejudice and ignorance dooms is all to poor dementia care in our own and family futures. The demographics should alarm more than they seem to do . 

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I work within an arena developing dementia strategy across an organisation and developing dementia education . I am quite senior and broadly experienced, I contribute widely to information and supportive material. My colleagues local national and forum based platforms share stories of ageism and prejudice regarding the client group and staff working in dementia service . Colleagues say that a lack of inclusion at levels of NHS hierarchies is both detrimental to heart and sole and people with dementia need. How might the RCN create the opportunity for RMN;s to reflect this marginalised position and actively support culture change?. We are but little fish in a big ocean and have a little voice in the the influence of BIG concepts . The meaning associated with personhood and person centred integrated care to smooth the passage of people across rigid disconnected . Little voice in services and little traction is a frequent story. It is within mental health services there is the greatest disinterest in dementia development and the specialism. Keeping in mind that older ages psychiatry came about because people with dementia were simply misplaced and abandoned without such a MH discipline. It is with despair I write this. I do my bit as do we all but ageism, prejudice and ignorance dooms is all to poor dementia care in our own and family futures. The demographics should alarm more than they seem to do . 

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The importance of post-diagnostic support for people with dementia.

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The importance of post-diagnostic support for people with dementia.

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I work in a memory service in the south-east and we're lucky to have an Admiral Nurse in our team (even though her hours were cut to 30hrs when she came into post). However upper management are forever reviewing the need for such a service and it saddens me that the importance of Admiral Nurses is not appreciated.

There has been a big push for years for people to be assessed for dementia in a timely manner in order for treatment to start etc, but there is a lack of support after diagnosis. Services rely heavily on other organisations such as Age UK and Alzheimer's Society for dementia navigators/advisors, however there doesn't seem to be a push for experienced nurses to be in post to provide specialist support for carers of people with dementia. Will the RCN push NHS providers to be more aware of this much needed role and encourage them to commission services from Dementia UK?

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My biggest concern is the  number of acute admission wards with far too many beds; the lack of single bedrooms for all in-patients, the lack of space for  quiet time and/or parallel  recreational and therapetuic activities on in patient wards; and responsible clinicians who are overcautious in their granting of Section 17 leave. It's no good making services more accessible, if this is what very unwell people are faced with when they are admitted to in-patient facilities

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My biggest concern is the  number of acute admission wards with far too many beds; the lack of single bedrooms for all in-patients, the lack of space for  quiet time and/or parallel  recreational and therapetuic activities on in patient wards; and responsible clinicians who are overcautious in their granting of Section 17 leave. It's no good making services more accessible, if this is what very unwell people are faced with when they are admitted to in-patient facilities

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my concern is the lack of acute beds to  assist in care. I work in  a complex care dementia home and we currently have 4 residents who have a major deterioration in their mental health. Instead of admission the hospital avoidance team are involved. Understand its better to keep them in a familiar environment but these residents are acutely unwell and need hospital assessment

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my concern is the lack of acute beds to  assist in care. I work in  a complex care dementia home and we currently have 4 residents who have a major deterioration in their mental health. Instead of admission the hospital avoidance team are involved. Understand its better to keep them in a familiar environment but these residents are acutely unwell and need hospital assessment

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Our trust is introducing a no smoking policy across the board for inpatiI can see that on secure settings, there is time to work with the patients on smoking cessation as patients are there

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Drug and alcohol liason services. Specialist nurses with experience in this area are hard to come by. Some exist within hospitals but acute settings don't employ these specialists as standard. Those who do often run limited hours services. As such, people battling addiction face significant health inequalities.

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Drug and alcohol liason services. Specialist nurses with experience in this area are hard to come by. Some exist within hospitals but acute settings don't employ these specialists as standard. Those who do often run limited hours services. As such, people battling addiction face significant health inequalities.

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Good models do exist, but are often underfunded and underdeveloped. Addiction deaths are on the increase and acute services are not sufficiently equipped to identify and manage people. Specialist teams must be developed.

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I have seen that the RCN have expressed their opposition to fully owned subsidiaries, which is a good thing. It would be worth highlighting the divisive impact this would have on patient care and staff safety. There have been talks/rumours in our trust about HCA moving onto FOS. This means that on one shift you would have qualified nurses working for the Trust and HCA for another company. This increases the risk of bigger staff turnover in HCA, staff not singing from the same hymn sheet,  not undergoing the same training etc....All this would have a massive impact on staff's cohesion.

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We have no voice

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With the fast pace of change along with an ever-evolving mental healthcare service, I think it is imperative that staff have funded Continuing Professional Development (CPD) opportunities.  IT`s important that they have the opportunities to keep up to date with current legislation, policy and practice. It would seem that much of the CPD that is offered, is now delivered by the Trust which does not always enable the Nurse to gain perspective external to the organisation. If we are to increase our effectiveness and provide the highest standards of care, then we have to be supported to keep current and have the knowledge to underpin the most effective practice. 

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With the fast pace of change along with an ever-evolving mental healthcare service, I think it is imperative that staff have funded Continuing Professional Development (CPD) opportunities.  IT`s important that they have the opportunities to keep up to date with current legislation, policy and practice. It would seem that much of the CPD that is offered, is now delivered by the Trust which does not always enable the Nurse to gain perspective external to the organisation. If we are to increase our effectiveness and provide the highest standards of care, then we have to be supported to keep current and have the knowledge to underpin the most effective practice. 

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Suicide awareness for ALL nurses, not just mental health staff

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Suicide awareness for ALL nurses, not just mental health staff

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Following on from very emotive debate in Belfast, I would look to propose a resolution to encourage Trusts and private employers nationwide to provide basic suicide awareness and intervention training to all staff, whether they work in mental health or not.

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Discussion: experiences of self-harm attending emergency departments

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Discussion: experiences of self-harm attending emergency departments

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Discussion to explore how their experiences could be improved - input welcomed from service users, ED nurses, and MH staff who accompany service users to ED.

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Discussion about mental health of nurses and support workers

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Discussion about mental health of nurses and support workers

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Especially RMNs / mental health support workers. There is an even greater pressure to be mentally well, because we are the ones who fix others, and with increasing pressure on services and staff, keeping one's own mental health in check can be a delicate balancing act. I have changed jobs this year, and hadn't realized how stressed-out I was in my last job until I moved, I'm so much happier now (although still stressed!)

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I work in a CMHT for older adults, my team have high caseloads and read through the comments above, this seems to be a common theme. my concerns are not only about higher stress levels but also we have a common goal about keeping the patient at home in the community but where are the extra resources to support that? again as above where are the resources for CPD? I am interested in being part of a forum for mental health nurses

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I work in a CMHT for older adults, my team have high caseloads and read through the comments above, this seems to be a common theme. my concerns are not only about higher stress levels but also we have a common goal about keeping the patient at home in the community but where are the extra resources to support that? again as above where are the resources for CPD? I am interested in being part of a forum for mental health nurses

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All developments such as Street Triage, Crisis services, Mental Health Assessments in A&E, Early Intervention, Psychiatric Decisions Units, dedicated Place of Safety Units, are exciting developments. Whatever the new models, they are never funded/resourced to make them work for services users family/carers or staff.  Interface and clear pathways is what needs to be focused on to be responsive and prevent tragedies occurring 

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All developments such as Street Triage, Crisis services, Mental Health Assessments in A&E, Early Intervention, Psychiatric Decisions Units, dedicated Place of Safety Units, are exciting developments. Whatever the new models, they are never funded/resourced to make them work for services users family/carers or staff.  Interface and clear pathways is what needs to be focused on to be responsive and prevent tragedies occurring 

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Thanks, Ed and forum for opportunity to comment. I 've read all postings and comments to date.

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Thanks, Ed and forum for opportunity to comment. I 've read all postings and comments to date.

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So much is needed. -  how do we prioritise ?
As a carer of a family member with severe depression, I consider that one of the most important things is for client / patient to be listened to and taken seriously.
Individual who is ill needs respect, loads of time and attention !!!, and to feel that they are not alone or abandoned. Not sure how this can be achieved, however some seemingly small steps / changes in approach can make a big difference.
All good wishes for your endeavours.

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In my area there’s is absolutely no provision for those with a diagnosis of dementia under 65. Following diagnosis they await turning 65 in a CMHT have no access to respite, day centres. I would appreciate any information for others working in dementia services & how they care for those with a diagnosis under 65

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When are those involved with people who suffer mental illness going to get over the love affair they have with cure-all community care?
As someone who had to retire early from my nursing career because of serious mental illness, I have only experienced the shortcomings of care in the community (or, 'couldn't-care-less-in the-community', as one MP dubbed it) since I moved back to my home city. I have actually been TOLD in a letter, that is 'working for me' and that it has 'kept me out of hospital'. The arrogance of someone stating these two things to me when there is no evidence to support either, is beyond me. As far as I can see, the drivers of wholesale reliance on this form of responding to people who are acutely or seriously ill, are firstly political. Everybody knows that far too many beds have been closed, resulting in patients being passed around wards and hospitals like unwanted parcels. . I know, I've been there. No one wants to say, like the emperor and his clothes, we've got to replace some of those beds for fear someone will start shouting nasty little words like 'institutionalisation', or worse, 're-instutionalisation', or even worse, 'asylums', at them. Would anyone seriously advocate a return to those days. No, they wouldn't, so stop making it an excuse to ignore statements such as:

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I work on a busy acute inpatient unit. The difference between HCA who have no understanding of mental heath and no opportunity to extend there skills are worlds apart from the well trained experienced HCA who have had support and educational opportunities. I have experienced staff who have an understanding of all manner of mental health presentations and through experience and training formal and informal, supervision and reflection the staff have gained skills in assessment, behaviour management, physical health monitoring and so much more. Alongside this the hca have extended there skills and can care plan under supervision, carry out ECG, bladder scans, bloods, carers champions and so much more. We need to support and celebrate our colleagues and have an understanding of what a HCA can achieve for our patients and carers, support the HCA to grow. I know I would flounder without the support of the HCA and want to do anything I can to raise the profile and opportunities HCA have. From a very grateful Ward Manager Thank you to all the hard working HCA out there

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May I suggest that the Forum put on Roadshows in the 4 countries, discussing strategies for prevention and management of violence and aggression? This is an everyday concern for mental health nursing staff, and I am sure there's skill, expertise and knowledge among Forum members that could benefit staff and patients.

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addressing needs, care and compassion in the context of diagnosis

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addressing needs, care and compassion in the context of diagnosis

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I 'm calling for a debate and the potential for an action plan to address the never ending and ever changing criteria to ask for access to mental health services at an inter-professional level. The reconfiguration and re-naming of mental health services is not easy for professionals who work with the displaced and homeless  to refer to: hoops to jump through are all too often barriers to help and treatment.
Lets, at least, have a conversation please.

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Protecting staff , from unsafe worksloads and attitudes that come from higher up in thrusts,  the culture in this country needs to be changed. Nurses being worked to the brink covering for short staffing and sickness . Trusts sickness policilies are also dangerous and ‘ encourage ‘ nurses to work when they are not fit due to Ill health. In our job we should feel we can have any needed sick leave without fear of being disciplined for more than one sick period in 12 months this is unsafe and adds to the overall stress already felt.

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What ive noticed in the past ten years is a flight of staff from these teams and why?I just think care co ordination needs to be re defined with the onus on a cc with a caseliad of 30 +is not feasible.I would first look at how this can be changed.Secondly the vast majority of GP referrals are reactive people in crisis generally with UEPD traits.Clogging up the system.constant crisis mamagement burning out staff constant fear of Si's.So i would start stating by law the max number each cc can hold.So cc feel protected

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Consistent and effective physical health care remains a priority.  There are some really good practice examples but all nurses need to be confident to  provide basic PH checks and have collaborative conversations around promoting healthy life changes. Nurses are in a strong position to advocate for service users to ensure that they have parity in terms of access to quality physical health services.

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Consistent and effective physical health care remains a priority.  There are some really good practice examples but all nurses need to be confident to  provide basic PH checks and have collaborative conversations around promoting healthy life changes. Nurses are in a strong position to advocate for service users to ensure that they have parity in terms of access to quality physical health services.

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I work in a DGH and the care of patients on the wards who happen to have a mental health diagnosis is poor. Is there an agenda to have the general sector address the needs of mental health patients who are also physically ill, having more dual qualified nurses would be great but courses and funding non existent?

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I work in a DGH and the care of patients on the wards who happen to have a mental health diagnosis is poor. Is there an agenda to have the general sector address the needs of mental health patients who are also physically ill, having more dual qualified nurses would be great but courses and funding non existent?

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I would like to suggest that this is also a vital point in the patients journey in which they should be supported in having the difficult conversations about what they want their care to consist of in the future. People do not recover from this diagnosis; in the sense of returning to how they were before. Early Brave / Difficult Conversations’ around advanced care planning will support unnecessary treatment plans and give the person with Dementia chance to step off the tightrope for quantity of life and embrace quality supported by nurses who specifically trained for this.  

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Can we please consider promotion of the nurse therapist, we are losing so many nurses to 'therapies'; we need to embrace these skilled nurses and offer them an arena to maintain their 'nurse' title

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Calling for action for a children's and young person's nursing curriculum

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Calling for action for a children's and young person's nursing curriculum

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In the era of calling for parity, we need to start thinking about succession planning for our CAMH services. If we had direct training for CAMH then this would ensure specialist training from the point of access. We have child centred curriculums for physical health, lets have them for mental health too

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Please can we have one- I would be happy to support running it 😊

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I work in custody and following MHAA find we can be waiting many hours before beds are found. Custody is not the place for vulnerable people

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Some one needs to review this process. General nurses don't need any training in mental health but mental health nurses need training in physical health. Let's get rid of the double standards!!

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I currently work in a CAMHS CRHTT and it's the third different team I've worked in based in the West Midlands and all three teams have worked in totally different ways. I would love to see one specific model of Crisis used nationally and one that is more similar to that used in Adult Crisis teams. Anyone disagree with this and if so what do you think?

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SO much evidence that CAMHS needs greater funding, not just in preventative school-based services, but at specialist community and in-patient level - see Future in Mind and the recent National Audit Office reports. We are simply not training enough staff, not enough profile within curricula, or priority at commissioning level - even promised funding has been diverted by CCGs to other projects - see reports of the 1.4 bn and where that went... Whilst the CYP-IAPT project has helped with increased therapeutic trainings it has a model of genericism which marginalised nursing skills. MHNs and other nurses need to establish, value and highlight the fit between their skills base and what young people want from staff.

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My area of expertise is the above. I am recovery coordinator and recovery college manager. The work i cooedinator