Mental Health - West London Mental Health Trust

Mental Health
www.wlmht.nhs.uk
Matters January 2011
“Life boards”
supporting recovery
Become a member
of our Trust
Our values
Togetherness
Responsibility
Excellence
Caring
Cubbon’s
corner
Peter Cubbon
We heard at the end of last
year from the Care Quality
Commission (CQC) that
our efforts to improve the
organisation are making a
difference. They released
a statement about our
‘tremendous efforts’ when
they lifted the final two
conditions on our registration.
It’s reassuring that our efforts
are not going unnoticed
and I’d like to thank you for
supporting the changes.
For all of us, the challenge of
2011 will be to drive change
and improvements at an even
greater pace than last year. To
this end we’re sharing with
staff a second consultation
document on our plans to
simplify the management
structure of the organisation.
We need to make the changes
so we’re in a position to
provide high quality, patient
focussed care and remain
viable as we adapt to
budgetary constraints in every
element of our funding.
Another significant change
which we’re making progress
with is the move towards tariff
based services. When we assess
patients we now ‘cluster’ them
using criteria which have been
set for mental health services.
This means that patients are
now being grouped according
to their condition and severity
of illness. In the future when
commissioners purchase our
services, we’ll be paid based
on the tariffs linked to the
patient clusters and pathways
they are on for their recovery.
This new system should help
us to ensure we’re adequately
funded to provide care for the
patient populations we see,
and that we are competitive.
I’d like to thank staff in our
local services who have already
been clustering patients and
inputting this information on
RiO. The way you’ve adapted to
this change in practice puts us
ahead of many other London
trusts.
Another priority this year
will be to push on with our
Foundation Trust application.
To achieve this we’ll be
working on becoming a
membership organisation
which will bring us closer to
our local communities and
I believe by giving them a
greater voice in the decisions
we make, it will help us to
improve the organisation. You
can read more about this on
pages 16-17.
I look forward to working with
you again this year and may I
wish you and your families a
happy and healthy 2011.
Peter
chief-executive@wlmht.nhs.uk
Editorial team
Mental Health Matters is written by the Communications
Team, for staff and patients of West London Mental Health
Trust. We’d love to hear from you with your news or views.
Do get in touch with us!
Tara Ferguson Jones: tara.ferguson-jones@wlmht.nhs.uk
Ali Nunan: alison.nunan@wlmht.nhs.uk
Telephone: 020 8483 2283
Cover: Dr Shamender Talwar, Hounslow
2 Mental Health Matters
Editor, Tara Ferguson Jones interviews
Anna Smith (see interview on page 20)
Trust news
Clive Bonnett,
Senior Clinical
Nurse Specialist at
Broadmoor Hospital,
has been awarded
an MBE for services
to healthcare in the
Queen’s New Year
Honours List.
Clive has worked
at Broadmoor for
37 years, initially as
a nurse and since
the1980s as a specialist
risk and safety trainer. He has made significant
changes to how we prevent, manage and reduce
violence across the Trust.
Clive said: “It’s an absolute honour to be awarded
an MBE. Broadmoor is an incredible place to work
and I feel I have achieved so much here. I won the
Lifetime Achievement Award in the 2009 Quality
Awards and with the MBE this is a fantastic finale
to my career.”
Learning lessons
We’ve been told by NHS London and the
Care Quality Commission (CQC) that we’re
embracing change and moving in the right
direction. This change was recently highlighted
by the attendance of 120 staff at our second
annual learning lessons workshop.
Steve Trenchard, Director of Nursing and Patient
Experience, hosted the event with support from
Dame Sally Powell who spoke ardently of her
reasons for becoming a Non-Executive Director
following personal experiences as a carer. She
also expressed her recognition of the excellent
work being carried out here.
There were four informative presentations, led
by representatives from the SDUs, on lessons
learnt. These created lively discussion and were
a tribute to the willingness of our staff to learn
lessons from incidents.
Angie Middleton, Incident Review Facilitator
says: “Although, this workshop is still in its
infancy it was evident that it is instrumental
in helping us to learn from incidents and
represents our commitment to embedding
best practice across the Trust.”
Director of High Secure Services, Leeanne McGee,
said: “I’m delighted that Clive has been recognised
before his retirement in March and I’m sure his
colleagues and the patients he has cared for will
join me in offering our sincere congratulations.”
Enhanced engagement
and observation policy
An updated version
of this policy has
been published on
the Exchange. To tie
in with the new policy
we’ve produced an
information leaflet
for service users and
carers which has been
distributed via the
Heads of Nursing.
Contact your Head of
Nursing if you need
more copies.
Lee Allen, Hammersmith & Fulham
Mental Health Matters 3
Trust hosts
national event
It was a great honour for the Trust to host a
Prescribing Observatory in Mental Health (POMH)
regional event at the Cassel Hospital, at the end of
last year.
POMH-UK is a membership organisation which aims
to help healthcare organisations improve prescribing
practice. Working with its members (of which we
are one) POMH identifies topics within mental
health prescribing and develops audit-based quality
improvement programmes.
These one-day workshops give health practitioners
from a range of providers the opportunity to learn,
share ideas and raise standards in prescribing practice.
The day opened with an introduction from
Krysia Zalewska, the Programme Manager for
POMH. There then followed a number of local
presentations including one from Dr Alice Parshall,
Clinical Director of Ealing SDU, who shared with
the audience our positive experiences of changing
practice as a consequence of POMH audits.
Nick Broughton and Alice Parshall
Professor Tom Barnes, lead for Clinical Effectiveness
at the Trust, presented feedback on the findings of an
audit carried out here on medicines reconciliation.
Sarina Martin, Head of Clinical Effectiveness and Audit,
said: “The event allowed time for benchmarking,
listening and sharing. As a Trust we should be proud
of the work we’ve done empowering clinicians to take
ownership of and run so many of POMH’s audits in this
last year. This is helping us in our drive to provide safer,
more effective services for patients.”
Dr Nick Broughton, Medical Director who closed the
event said: “In these times of making savings within
the NHS we must not forget that the quality of care is
our top priority. If we provide good quality, consistent
care, then ultimately we will be more cost effective.”
Organiser Paulette says: “We were delighted
to welcome Peter Cubbon, Steve Trenchard,
Jonathan Scott, Mary McCaffrey, Jeremy Mulcaire
and other professionals who came to show their
support to carers.
“Christmas can be a sad time for people who
have a relative who has mental health difficulties.
They may be isolated in their grief at a time when
it is usual to rejoice and be merry. The party gave
an opportunity for carers to leave their sadness
behind for a while, establish a new network of
friends and have a bit of fun together in the
knowledge that they are not alone.
4 Mental Health Matters
Jean joined us in November 2010
as Interim Director of Local Services.
onwards, to enable us to run quality services within
our means. I’m also responsible for making sure the
SDUs / CSU meets performance targets.
Career history?
I have over thirty years of experience working within
the healthcare sector in the UK and Europe. I spent
fourteen years within the commercial healthcare
sector in product development, sales and marketing
and for the past seventeen years I’ve worked in NHS
board level positions, including six years as a Deputy
Chief Executive.
The role is not just internally facing. A key aspect is
about making sure we keep abreast of PCT changes
and evolving GP consortia arrangements, building
relationships so we safeguard the funding we’ll need
to run our services in the future.
What’s been your greatest career achievement
to date?
I’m proud of teams I’ve developed over the years
who’ve dealt with change positively and made a real
difference to patient care.
Time out for carers
A carer who has links with our Trust, Paulette
Ranaraja, ran a trust-wide Christmas party for
carers. It took place at the Haven Green Baptist
Church in Ealing.
Board talk
Jean George
“The food was provided by CAPE (Community
Activities Project Ealing), by Sri Lankan chefs
and by carers. We were entertained by ‘Voices
in Harmony’, a group of performers who enjoy
raising money for charity, and a collection for
Rethink was organised to help local carers.”
What attracted you to WLMHT?
The challenge! I also wanted to work back in
London and fancied a change from the acute sector
where I’ve been recently.
Describe yourself in four words?
Focused, analytical, team player, tenacious.
Aim of your role?
The short-term goal is to bring together the
management structure of the three local Service
Delivery Units into one Clinical Service Unit (CSU).
We’ll be basing decisions on feedback from the
recent consultation and in line with the Trust’s
values, ensuring that appropriate care pathways are
developed for our patients, within the challenging
context of today’s health economy.
I’m working with SDU leads to improve performance
in areas where we know there are issues and we’re
developing cost improvement plans for 2011
What’s to be gained from merging the
management structure of three service areas
into one CSU?
It’s clear there are pockets of good practice at the
moment. We’ll be able to more effectively share
areas of excellence by managing the services as one.
This will also give us the opportunity to review
governance structures to drive consistency. For
example, many of you have told me that team
briefing doesn’t work in the organisation. By
streamlining and de-layering the organisation we
can improve this so we have an informed workforce,
who are clear on what’s going on and what’s
expected from them as employees. In terms of
improving consistency of care we’ll also be working
to redefine and standardise roles and responsibilities
so that people receive excellent care no matter
where they’re being treated.
Next steps in the local services consultation?
The next stage consultation document will be shared
with staff shortly. If you would like to discuss it with
me in more detail please make contact with my PA
Kim Broadbent (kim.broadbent@wlmht.nhs.uk).
My door is always open if you want to talk to me
and contribute to the process of transformation
we’re undergoing.
Mental Health Matters 5
Recovery
through football
CQC and
Mental Health
Act Managers
Lilian Hove, Ward Manager on Pearl Ward with Mental
Health Act Managers, Ann Martin and Glen Barnham.
Working with us to
improve inpatient services
We’ve been putting a great deal
of effort into driving up standards
on our inpatient units. We’ve had
support to achieve this by the
presence on our wards of Mental
Health Act Commissioners from
the CQC and Mental Health Act
Managers. They’ve been working
with us, talking to patients and
staff so they can highlight to us
the areas we need to focus on
for improvement.
Mental Health Act
Commissioners
from the CQC
CQC visits are statutory, with
inspectors visiting inpatient
units of trusts up and down the
country. The team from CQC
is normally made up of Mental
Health Act Commissioners
specialising in mental health
which means they have a
thorough understanding of the
complex nature of our work.
They carry out unannounced visits
to inpatient units and when they
visit a ward they know to show
their ID to the staff on duty.
Their primary role is to uphold
and promote the rights of
detained patients. They do
this by talking to staff and
patients and by looking at our
documentation, for example
to check consent has been
properly documented. They
also look at staffing levels and
attitudes, and make a note of
any environmental issues which
we could improve.
CQC inspectors give feedback
to the ward manager or nurse in
charge on the day of the visit so
swift action can be taken. They
then report back formally to the
Trust with a written report which
we must respond to.
Mental Health
Act Managers
We have around 30 Mental
Health Act Managers who are
appointed by the Board. They
are local people from a range of
backgrounds. Their primary role
is to sit on panels to hear appeals
against patients’ detention. To help
them become better informed
and to help us improve standards,
the Mental Health Act Managers
also visit wards on an informal but
unannounced basis. Like the CQC
visitors, they know that they need
to bring with them ID.
As with the CQC visits, feedback
goes to the Mental Health Act
Law Group. Pressing concerns are
dealt with there and then on the
ward, with other matters going to
the group for action. They work to
help us by getting honest feedback
from patients and staff about
conditions and the atmosphere
on the ward. Their work ensures
that representatives from the
local community have first-hand
knowledge of life on our wards.
Diagnosed with suicidal depression,
Gareth Gwillym, service user at Lakeside
Mental Health Unit, speaks about his
recovery and how football and a few
special people have turned his life around.
“I was referred to Hounslow Hawks, a service
user football team, in May 2010. Before I
started playing for the Hawks I was always
feeling scared, shy, worried, alone and suicidal.
I relied on drugs and alcohol to get me through
each day - I felt like I was going nowhere in life.
I also felt down all the time, which made me
feel like life was not worth living anymore.
“The experience of playing for the Hawks is
amazing as it is such a fun and exciting team to
play for. The Hawks have excellent coaches, Lisa
and Michelle. Thanks to them, I have decided
what I want to do in the future –coach! They
have helped me get to where I am today.
“Lisa and Michelle helped me pass my Football
Association Level 1 coaching course. I attended
a taster afternoon at Tottenham Hotspur
Football Club and was invited to attend the
coaching course. The course was one week
long and I travelled two hours a day to get to
Tottenham in order to complete it.
“Lisa and Michelle let me coach on training
days so I get more experience, and I’m hoping
to get experience at a local football club before
I complete my level two coaching course.
“Now I feel excited, happy, bubbly, active
and living. I no longer feel suicidal. I know I
have Michelle and Lisa to turn to when I need
someone. I am clean from drugs and alcohol
and have been for seven months now. I do
feel like my life is going far and it’s all thanks
to the Hawks and a special thank you to
Michelle and Lisa.”
Gareth’s coach, Lisa, said: “It’s amazing how
well Gareth has progressed in such a short
space of time; not only as a player but also in
his own personal development. He now has a
focus for his future goals and ambitions. He is
a valued member of the club and is supported
by the other members of the team, especially
when he is running his coaching drills!”
Summary
Both Mental Health Act Commissioners from the CQC and the
Mental Health Act Managers have an important role to play in
protecting patients’ rights. They are our ‘critical friends’ in
helping us to improve care and provide the best possible services.
6 Mental Health Matters
Mental Health Matters 7
Improving patient
through
relationships “life boards”
“The human spirit is far more powerful than any
drug in the world, and that is what needs to be
nourished with work, play, family and friendship...
the simplest of things.” Dr Shamender Talwar,
Honorary Psychologist at Lakeside Mental Health
Unit believes this principle is central to recovery, as
he, staff and patients, create positive change on
Dove Ward through the Life Board Project.
Dove Ward, at Lakeside Mental Health Unit, provides
in-patient care to older people. Medical, psychology
and nursing staff work with patients to create
collage boards which reflect the life of the patient.
The inspiration for what goes on the boards comes
from patients, their families and friends.
(Cover) Dr Shamender Talwar
Sarah Ghani, Consultant Psychologist and project
lead explains: “The process of developing the board
helps us to gain a better understanding of the
patient – what they like and what they’re interested
in. Once the life boards are complete, they also
make for a great talking point, encouraging the
patient and all around them to remember who they
are as people. Members of the team can now more
confidently engage with patients, their families and
friends because the boards help us to understand
their stories, not just their diagnoses.”
Shamender said: “All professionals involved are now
aware of the patients’ likes and dislikes which really
helps us support their recovery.”
From the left: Multi Disciplinary Team - Lynsey Turnbull, Dr Shamender Talwar, Dr Nevil Cheesman, Hilda Muranda,
Victoria Miles, Ayanna Dalrymple, Dr Azath Kamil, Sarah Ghani and Jenna Beattie with patients on the ward.
“The life boards are an excellent medium to
engage people in therapy and allow them
to express themselves and connect with
positive memories from their lives.”
Jenna Beattie, Occupational Therapist
“I believe it’s a sense of belonging and a
road to recovery for all patients involved
with life boards.”
Lynsey Turnbull, Staff Nurse
“The life boards are used for all patients, but
particularly for those with dementia. They
focus on preserved abilities rather than current
impairment. The goal is to improve the person
centred care as well as involving carers to
enhance current relationships. The life boards
are used in care planning on the ward.”
Dr Nevil Cheesman, Consultant Psychiatrist
“The life boards have improved relationships
between the patients and doctors.”
Dr Azath Kamil, SHO
“It is reassuring to see the connection the
patients make with the life boards. It makes
them relax and become less anxious.”
Hilda Muranda, Ward Manager
I feel the lifeboards are a new beginning
and it helps me express myself. It gives me
confidence to look after myself better.
Arthur Tyler, patient
I think it is a useful tool, helping patients
focus on happy memories through their
path to recovery.
Ayanna Dalrymple, Staff Nurse
Sarah Ghani
8 Mental Health Matters
Mental Health Matters 9
Improving the
visiting experience
Broadmoor
Recovery
planning
The communications team worked with a project team at
Broadmoor Hospital to produce a series of short DVDs to
help us improve the experiences of carers visiting their loved
ones at the Hospital. Project team members included David
Cochrane, Carol Frost, Shaun Bhattacherjee, Kelly Poulter,
Serena Allen and Kevin Roberts.
Carol Frost, Social Work Manager says: “We heard from
some carers that they felt too daunted to come and visit the
hospital. Others who did come said that they felt intimidated
by the complex security measures in place and annoyed by
the length of time it can take to get through security. We
made the films to encourage more carers to visit and to give
us an opportunity to explain the rationale for the security
checks and measures in place. We’ve produced DVDs for
child visitors, teenagers and adult visitors.”
Patient, Joe discussing his recovery plans with Staff Nurse, Pravin Ramnath.
Patients are being offered recovery plans to help
document the progress they’re making. These have
been sent to all inpatient areas and community teams.
Head of Nursing, Anne Aiyegbusi says: “In West
London Forensic Services we’ve been working to
develop a recovery orientated service with high
levels of service user and carer involvement in our
meetings, training and staff selection. The new
recovery plans for service users will help us to take
this a step further forward.”
The DVDs are being shared with visitors and carers via the
social work team. There’s also a new leaflet to accompany
the DVD.
Carol adds: ”We’d like to give special thanks to Eric Stewart,
Alison Mobey-Lister and Sherine Justice, from Broadmoor’s
reception team, who gave up their own time to help us in
making the films.”
Broadmoor staff share
their travel plans
We ran a travel survey at Broadmoor Hospital
to find out how people travel to and from
the site and to get their views on using other
travel options.
The results of the survey will be used to
shape the Hospital’s travel plan which is being
developed to encourage people to travel using
more sustainable means.
Vickie Holfcroft, Programme Director for
Broadmoor Redevelopment said: “We had an
excellent response to the survey, with over
400 participants. The survey showed that the
10 Mental Health Matters
Anne says: “The plans are maintained by service users
who may choose to invite other people to provide
support in completing them. Supporters may be carecoordinators, carers, occupational therapists or any
majority (71%) of respondents travel by car
(lone), with an additional 8% as car sharers,
with the remaining 11% either walking or
cycling. Further to this, a significant proportion
of car driver (lone) respondents expressed an
interest in car sharing. This information will
help us shape our travel plan and I’d like to
thank everyone who filled it in.”
The names
of all who
filled in the
survey were
entered into
a prize draw
to win Marks
& Spencer’s
vouchers.
Vickie Holcroft (left) with one of the lucky winners,
Healthcare Assistant, Patrycja Bolewska.
Good news for recovery
Following a highly competitive application process
the Trust has been selected as a national ImROC
recovery pilot site. Director of Nursing and Patient
Experience, Steve Trenchard says; “This is excellent
news for the Trust because it’s yet more evidence
that we really are moving forwards and that things
are improving.”
The ImROC recovery project is delivered by a
partnership of Mental Health organisations (NHS
Confederation, the Centre for Mental Health and
the National Mental Health Development Unit) and
will run at the Trust for the next two years. Thirty
six trusts applied and we were one of six in the
other person who the service user feels is important
in terms of helping to maintain their wellness. The
plans will offer a more balanced approach to working
towards improved health and reduced risk with the
service user as an active participant in the process.”
Recovery folders (also called CPA folders) have
been sent to community sites for patients to use
in discussion with staff. Mary Ernest, CPN at the
Limes says: “The recovery booklets are beautifully
presented and enticing to use. Service users should
find them a great aid in keeping a record of their
activities and plans. They are user friendly and it’s
good that service users each have a folder in which
to store their care plans.”
country selected for the project which sets out to
improve the quality of services to support people
more effectively towards recovery.
Anne Aiyegbusi, Head of Nursing for West London
Forensic Services and ImROC project lead for
the Trust explains: “This means that we’ll receive
a package of expert consultation, training and
development which will help us to improve services
so that they become more recovery oriented. I’m
delighted that our hard work has paid off and that
we’ve been chosen as a pilot site for this project
which will help us to transform practice and deliver
significant benefits for our service users.”
We’ll keep you posted on this project through our
internal communications.
Mental Health Matters 11
Research at West London
Mental Health Trust
Do financial
incentives work?
Dr Niraj Arora, principle
investigator for the Trust during
the study, explains: “We identify
patients who’ve been prescribed
depot anti-psychotics - an injection
that releases medication over a
number of weeks - but who have
a history of missing treatments
and with whom all conventional
methods to achieve adherence
have failed.
Around one per cent of the
population has an ongoing
psychotic illness, with symptoms
such as hearing voices, delusional
ideas, mood swings, lack of
concentration and behavioural
problems. Anti-psychotic
medication helps to control
symptoms and prevent relapses.
Yet, for various reasons not all
patients take their prescribed
medication, despite the best
efforts of our teams.
As part of our drive to help more
people to stay in the community,
the Trust is taking part in a 12
month study to explore the effect
of offering a financial incentive to
encourage people to stick to their
treatment programme.
12 Mental Health Matters
“If someone decides to take part,
they’re randomly placed into one
of two groups – the control group
who have no change in their
treatment, and the experimental
group who are given a £15
incentive each time they receive
the depot medication. After
12 months, the researchers will
compare the results of patients in
the two groups.”
The study is funded by the
Health Technology Assessment
Programme and so far has involved
47 patients across the Trust.
The idea of offering financial
incentives – cash for drugs - may
seem controversial, but the study
has full Research & Development
and Ethics Committee approval.
Dr Arora says: “There are
understandable ethical concerns
about rewarding people for taking
medication. However if people
continue to take medication
they’re less likely to relapse and
have to be admitted to hospital
with enforced medication.
“Although it’s too early to report
concrete results, researchers expect
that the cost of the intervention
will be more than offset by
savings for hospital admissions.
Our teams have reported that
previously disengaged patients
are now engaging well, even
calling to confirm appointments.
Some people are also starting to
appreciate the benefit of their
medication as previous poor
engagement had prevented it from
taking full effect.”
The study will continue until later
this year, when the results from
all the participating Trusts will be
investigated.
Dr Arora is keen to see
more clinical staff involved
in similar research to get a
better understanding of the
evidence behind mental health
interventions. He says: “As
clinicians, we’re always trying to
do the best by our patients. We
look at NICE guidelines and best
evidence, but if we can be more
directly involved in increasing
understanding it will make us
more connected to the work we
do on the ground.”
Trust doctor
reveals impact
of untreated
ADHD on
costs of crime
Dr Susan Young, Broadmoor Hospital
Compared with population rates, a
disproportionately high number of offenders
with ADHD are being dealt with by the UK
criminal justice system. For example, 45%
of youth offenders and up to 30% of adult
offenders experience the condition.
These alarming statistics from a recent paper
published by Dr Susan Young, Consultant Clinical
and Forensic Psychologist at Broadmoor Hospital,
reveal the true extent of untreated ADHD as an
underlying cause of crime.
In the ground-breaking paper, Dr Young not only
explores the connection between ADHD and
criminal offending, but also provides insight into
the treatment of ADHD offenders and how this
could reduce crime. She also looks at how early
intervention has the potential to divert youths
away from a criminal path.
Compared with population
rates, a disproportionately
high number of offenders
with ADHD are being dealt
with by the UK criminal
justice system. For example,
45% of youth offenders and
up to 30% of adult offenders
experience the condition.
The paper was published in the October 2010
edition of ‘Expert Review of Neurotherapeutics’,
an international monthly journal that provides
expert commentary on the use of drugs
and medicines in clinical neurology and
neuropsychiatry. The paper, co-written by Emily
Goodwin, King’s College London and Institute
of Psychiatry, is descriptively titled: ‘Attentiondeficit/hyperactivity disorder in persistent
criminal offenders: the need for specialist
treatment programs.’
Dr Young said: “Failure to recognise and
treat ADHD offenders is likely to have serious
consequences for mental health and social
outcomes. The high rates of ADHD among
this group, the consumption and costs of
the resources they incur, mean that it is not
a condition we can afford to ignore. Given
that ADHD is a treatable condition with
interventions available that are used to
effectively treat ADHD symptoms and related
behavioral problems in the general population,
the enormity of this problem and its associated
costs are too great to bear.”
Mental Health Matters 13
Is your
patient ready
for treatment?
Dr Andrew Hadler from the community mental
health team in HMP YOI Feltham and Dr David
Reiss, from West London Forensic Services, were
invited to prepare the programme for a national
conference on treatment readiness.
The conference was chaired by Prof Mary McMurran
of the University of Nottingham and the day was
seamlessly organised and facilitated by Donna Reid
from West London Forensic Services. The Trust was
represented on the panel of speakers by Dr Alex Lord,
Simon Draycott and Nicola Miller who work in the
Paddock Centre.
Andrew Hadler says: “As mental health professionals
we often find ourselves negotiating the territory
between differing perspectives. For example, when
supporting clients in working against the effects
of social exclusion, this may be both the cause
and the consequence of mental illness. Or whilst
implementing the recovery principles, we consider
our clients to be experts in their own condition and
encourage them to make an equal contribution to
decisions regarding their care, yet at times good
practice in clinical risk management will determine
that the client’s choice cannot be respected and
admission may be required on a compulsory basis. 1
“An awareness of such tensions goes to the heart of
good practice in delivering mental health care and is
enshrined in the legislation underlying our practice. It
remains the case, however, that the treatments which
we offer our clients are at times reluctantly accepted
and this observation is by no means unique to the
field of mental health.
Nurse led
research
“The concept of readiness for treatment offers
a variety of approaches to the practitioner who
seeks to engage a patient in treatment, when
“engagement” is an issue. It has been developed
within the discipline of psychology, primarily though
work with clients with a diagnosis of personality
disorder or a history of offending behaviour. It
incorporates an understanding of factors describing
the internal world and personal history of the
client, as well as the features of the treatment and
the setting in which it is offered, combined with a
refined understanding of the concept of motivation
and the effects which the challenges posed by the
treatment will have upon the client.
“Feedback from the conference was consistently
positive, with 100% of those present confirming
that they would recommend the conference to
a colleague.”
From the left: Lawrence Jones, Rampton Hospital, Jina Barrett,
The Tavistock Clinic, Dr David Reiss, Professor Mary McMurran,
Institute of Mental Health, University of Nottingham, Dr
Andrew Hadler, Nicola Miller, Dr Alex Lord, Dr Gabriel Kirtchuk
In November we held our first research master class
for nurses. The aim of the event was to give nurses
the tools they need to run research projects with
the longer term aim of improving work practice. It
was led by Dr Craig Ritchie, Director of Research &
Development and Steve Trenchard, Director of
Nursing and Patient Experience.
Lisa Curry, Research Co-ordinator says: “One of the
challenges for us is getting patients to understand the
benefit of research projects and getting information
to them about ongoing studies. By having nurses and
other clinicians onboard with our research agenda
we’ll be able to offer more patients the opportunity to
get involved.
Sandra Bailey, Head of Nursing in Hammersmith &
Fulham said: ”The day was a turning point for many
nurses who attended. The workshop brought to the
fore the need for nurses to undertake nursing research
which will benefit the care we offer to service users. It
is fantastic that the Trust is making such a tremendous
effort to encourage nurses to get involved in research.
It was a very productive day with nurses leaving the
workshop with lots of ideas for future research activity.”
“On the back of this successful day, we will be
holding another master class in May this year, and
will continue to hold them every six months, rotating
around sites within the Trust. Keep an eye on the
Exchange and Monday Matters in the upcoming
months for more information.”
The day saw forty nurses show interest in either
organising or participating in research related
activities. Nurses:
• Found out how they could get involved.
• Participated in research jargon-busting sessions.
• Heard from others currently involved in research.
• Listened to service users and carers talk about their
experiences of taking part in research.
• Provided feedback on the barriers they’ve had.
• Found out about the benefits of promoting
research work.
Check out the research nursing page on our website
at www.wlmht.nhs.uk/research. If you have a piece
of research, or are interested in learning about, or
participating in research, please get in contact with us
on 020 8354 8738 or research@wlmht.nhs.uk.
Reference
(1) Eastman N, Mezey G. Choice and social inclusion in forensic psychiatry: acknowledging mixed
messages and double think. Journal of Forensic Psychiatry & Psychology 2009; 20:503-507
Our thanks to Creative Commercial Photography for the photographs on this page of the magazine.
14 Mental Health Matters
Mental Health Matters 15
Open Minds
Become a member to make
a difference to mental health
We’re working towards becoming a Foundation
Trust (FT). Being an FT means we’ll have more
freedom and control, which will give us a better
opportunity to invest in service development and
make local decisions for the benefit of our service
users, carers, staff and community partners.
To become an FT we need members who will be
involved with our Trust on a range of levels. This
could involve simply receiving information a few
times a year, to running for Governor and helping
the Board make decisions about our services. Our
membership base will include staff, service users,
carers, university and school students, Facebook
members, local authorities and general community
members. By becoming a member, people will also
be helping us challenge the stigma associated with
mental health, in supporting the national time to
change anti-stigma campaign.
Staff - you’re now a member!
Everyone who works at WLMHT will automatically
be signed up as a member of the Trust which means
you’ll have the opportunity to lend your support to
our campaign work to combat mental health stigma.
As a member you’ll also have an input in developing
the Trust as we move towards becoming an FT.
Being a member means you get all the benefits
listed above, but we’re also keen for staff to
support us to sign up others. This could involve
coming with us to football or rugby games,
having photos taken for our publicity materials,
going to local libraries or community groups, or
better yet, going to your own community groups
to encourage people to sign-up. We all work in
mental health and understand the negative stigma
that surrounds it, so if you want to be involved in
some way, please let us know.
If you don’t wish to support the Trust in its ambitions
to become a membership organisation, you can opt
out by sending an email with your full name and
position to member@wlmht.nhs.uk
16 Mental Health Matters
This month, we’re launching our membership
campaign which is called:
Open Minds: Become a member to make a
difference to mental health.
We are aiming to recruit 7000 members by
June 2011. Our members will receive a range of
benefits, including:
• NHS discounts.
• Being able to contribute to our future
development.
• Access to membership hubs which include
internet access and meetings areas (coming soon).
• Information about the Trust.
• Access to the member only area of the website
which includes service user and carer blogs and
other important tools and resources (coming soon).
• The ability to run for the Board of Governors,
which will work alongside our Trust Board to make
decisions and shape the running of the Trust.
Service users, carers
and community members
If you would like to become a member, please
visit www.wlmht.nhs.uk to sign up. You will
receive all the benefits listed on page 16. We
are also asking for people to get involved with
events and recruiting members, as well as
appearing in photos, film clips and sharing their
stories through blogs and media articles. If you
would like to volunteer your time or services,
please get in contact at member@wlmht.nhs.uk.
We would love to hear from you!
Who’s involved?
We already have some big
names on board including
Brentford Football Club and
Harlequins Rugby Club. We’re
also speaking to Fulham
Football club as you read this
to explain how they can be
involved. We’ll be attending
some home games with signed
football jerseys or tickets to
give away to those who join up
as members on the day.
We also have indie pop/rock
band, Storey, on board, who
are writing and recording a
single about recovery for us.
We are then asking senior
school students to design a
front cover for the single, which
will be printed and sold, with
all profits donated to our antistigma charity – from which all
funds will be spent locally.
We’ll be launcing this
competition in March. If you
have connections with a senior
school in one of our local areas
that might like to be involved,
let us know!
If you are a member and want to get involved with our campaign
– please get in touch at member@wlmht.nhs.uk or 020 8354 8325.
Mental Health Matters 17
Brain bank
headlines
Re-designing
our clinical pathways
Dr Michael Maier, Curator of the Corsellis Collection
Our famous Corsellis Collection, turned heads
as Ealing Gazette visited the collection in
November. The extract below is from the
Ealing Gazette article ‘Collection of 6000 Brains
comes to West London,’ by Jane Harrison.
A brain collection, started in Essex more than 50
years ago to try and unlock the causes of mental
illness, is now in the hands of West London Mental
Health NHS Trust. Expanded to include the brains of
a variety of patients, the Corsellis Collection is still
being used world-wide to try and combat current
illness. As modern techniques emerge, its potential
is enormous.
Tucked away on the St Bernard’s site is one of the
most incredible and unlikely collections you can
imagine – over 6,000 brains dating back to the
1950s, perfectly preserved in what looks like small,
round Tupperwares.
Some are whole, while others are small slices – they
look like beautiful segments of coloured broccoli
when stained on slides – and the formalin (salt
buffered formaldehyde) they are swimming in is
slightly cloudy, a relief for the squeamish.
This meticulously documented piece of history is the
Corsellis Brain Collection, the first in this country,
and magnet for medical experts across the globe.
They were originally collected by Prof Corsellis, a
consultant pathologist at Runwell Hospital in Essex.
As his reputation grew, Corsellis received brains
from all over the country.
18 Mental Health Matters
The collection is now in the capable hands of its
curator Dr Michael Maier, Consultant Psychiatrist
at West London Mental Health Trust and honorary
lecturer at Imperial College, and its manager
Dr Matthew Williams, Research Associate at
Imperial College. The collection is not only the
blue-print for other brain collections or banks,
but has become a vital research tool world-wide.
Dr Maier said: “Prof Corsellis started collecting
to gain research and became famous because of
his more interesting results. His work revealed the
condition dementia pugilistica, or “punch drunk”:
the damage to the brains of boxers. The evidence
from his study changed legislation. In amateur
boxing, boxers now have to wear headgear
and they’ve changed the number of rounds in
professional fights.”
While the answers to some conditions are still a
long way off, the Collection also has great potential
as modern science continues to evolve - the scope
for the future is tremendous. Research on brain
collections and archives will be the only way to find
out if an apparently new disease is really new and
the potential of DNA research on the brain has yet
to be explored.
Dr Maier said: “One of our most exciting events is
our link to Brain UK last year making the collection
available to the research community. In the past no
one had access to large Collections. The bigger the
study the clearer the answer.”
Clinicians, managers, patients, carers and
stakeholders are working to re-design care
pathways across our local services. The reason
we’re re-designing services is to ensure we’re able
to deliver the requirements of the Government’s
White Paper 2010: Liberating the NHS. The paper
states that NHS organisations should put service
users at the heart of everything with a focus on
continuously improving those things that really
matter to them and carers. NHS trusts are also
expected to empower clinicians to innovate so
they have the freedom to improve services. We’re
expected to deliver on these aims within today’s
challenging economic conditions, which means
that the changes we make have to be significant
to deliver the required improvements.
Three pathway programme boards have been
set up to work across our local services. The first
task for each board has been to formulate the
patient journey, from referral to discharge, for the
three areas of adults; children, young people and
families; and people with cognitive impairment
and dementia.
The pathways we’re working on will be based on
national clinical best practice, NICE Guidance and
the Map of Medicine (www.mapofmedicine.com).
One of our main aims for the next two years is
to become a Foundation Trust, and the redesign
of the clinical pathways is fundamental to this.
The other two important strategic programmes
are the redevelopment of Broadmoor Hospital,
and the redevelopment of our St. Bernard’s site.
It’s important for us as a Trust that we don’t work
on these programmes and projects in isolation.
To that end, key risks and issues around all three
pieces of work are being identified and logged,
as are the interdependencies between pathways,
other programmes, and with forensic services
are being managed through our Programme
Management Office (PMO).
Stakeholder engagement is one of the most
important projects within the pathway redesign
programmes, and a Stakeholder Engagement
Strategy has been written so that we’re clear on
who, what, how and when the engagement takes
place. Work to engage stakeholders has started,
and will be on-going through further work on the
redesign to implementation.
We’re re-designing the patient pathways to:
• Improve patient experience and safety by
supporting an ageless, consistent service.
• Improve service quality and performance.
• Improve efficiency.
• Decrease in-patient beds and delayed discharges.
• Give us a better chance of achieving Foundation
Trust status.
A single point of referral is being looked at as a possible way forward for the Trust.
Below is an example of the kind of pathway we could adopt to help us deliver on these aims.
Referral
0 – 99+ years
GP or other.
Recovery/CMHT/
GP follow-up.
Single point of access
Perhaps via our
Contact Centre.
Signposting to relevant
professional or service.
Treatment/discharge or
transfer to other service.
Assessment
– at home, in hospital
or in the community.
Mental Health Matters 19
My working
Anna Smith
life Physical
Moving on up
Starter
Activity Advisor
Welcome to Sharon Rooney who has been appointed as Designated Police
Officer. During the past eight years she has worked undercover for the
robbery squad in Ealing. She has been trained to deal with sexual offences
and Achieving Best Evidence (ABE) which is used in audio visual interviews
with victims and witnesses.
Sharon says: “It’s good to get away from the station and deal with crimes
from beginning to end. It’s also interesting not being in uniform and seeing
how people react differently when I’m in plain clothes.”
Your role?
I work in the St Bernard’s gym and am responsible
for promoting and facilitating sports and fitness
sessions for inpatients and acute and community
mental health service users.
What did you want to be when you were
at school?
A policewoman.
What do you like about the job?
I love it when I see someone mastering a sport or
activity like swimming, table tennis or cycling and
becoming passionate about it. Many people come
to us having never played sport or even exercised in
a gym before. We work with them on it and then
we see them coming back time and time again.
I also enjoy participating with the service users in
various sports and activities.
We work hard to make sure we’re continually
meeting the needs of service users using our
services. For example we’re in the process of setting
up a women’s football team, because the women
told us they wanted one. I’m really proud of the
circuits class we’ve introduced too. It’s proving really
popular with both the men and the women.
Is it true that gyms get busier in January?
Yes, without a doubt. We’ll be working with
service users encouraging them to keep exercising
all year through.
20 Mental Health Matters
How long have you worked here?
Five years.
Best memories from your time in this job?
I’ll never forget a service user versus staff basketball
game we held a while ago. At one point in the game
the staff team was 17 up, until the service users won
on the buzzer. It was energetic and fantastic!
I was also really touched to receive a Christmas card
from one service user who joined the gym last year.
In her card she said: “Thanks for making all my
healthy dreams come true.” It’s rewarding to think
that we’ve played a part in her recovery.
Pastimes / hobbies?
I play football for a team in south London,
basketball and table tennis (occasionally).
How do you travel to work?
I get the train and then either bus or fold-up bike to
the Ealing site.
New Year’s Resolution?
My aim is to have my four year old swimming by
the end of 2011. By the end of the year I’d like to
be confident that every member of staff on the site
knows about the gym and the opportunities on offer.
Leavers
During his time
at the Trust, Jim
Tighe, Safety and
Security Management
Specialist, has been
involved with many
initiatives, including
the introduction of the
lone worker devices, crime prevention and reduction
and hospital watch. Jim says: “It’s been wonderful
working with so many people who are both
innovative and dedicated to improving peoples’ lives.”
Jim is returning to South London and Maudsley as
a Clinical Team Leader in the forensic service. Karen
Keeling will be taking on specific aspects of Jim’s role
in the interim and can be contacted on 020 8354
8318 and 07971314500.
Milan Petrovic
joined WLMHT
in September
1983. Since then
he has worked
in various roles
before coming the
Trust’s Health and
Safety Advisor.
He says: “It has
been a privilege to be part of a dedicated Health
and Safety Team and I’d like to thank Gail Miller
and Bryan Joseph who have supported us all to
facilitate so much positive change.”
Milan’s new role is within a health & safety
team in the private sector.
Peter Foster, Facilities Service Manager, joined the Catering Department at
Broadmoor over 18 years ago and has witnessed many changes. He says: “It was a
very different place without all the electronic and computer aided systems we have
now - not even e-mail!”
Peter has a job lined up as a Facilities Manager in the private sector. He says: “I’ve
enjoyed the diversity and freedom of my role. Every day brings different challenges
that test you and because of that, my breadth of knowledge and experience has
expanded considerably. I’ve worked with some good people who strive to provide
an excellent service and I shall miss their enthusiasm and commitment.”
Mental Health Matters 21
Congratulations
The domestic and portering staff at St Bernard’s
held a double celebration during their Christmas
party. Many staff within the service were awarded for
completing NVQs in adult literacy as well as support
services in health care. Some of the domestic staff also
completed the Cleaning Operator Proficiency Certificate
awarded by the British Institute of Cleaning Science.
Barbara Wood, Director of Estates and Facilities, says:
“Well done to all who received qualifications. Living
and working in a clean, tidy environment plays a huge
part in supporting our patients towards recovery. In the
past year, our domestic staff have played a huge role in
improving the standards of cleanliness across the Trust.”
Maggie Wilson was overwhelmed with joy when
her colleagues made a special cake to celebrate
her 30 years at the Trust. Maggie joined as a part
time secretary for the Senior Nursing Officer in
1980. She has been in her current post as Head of
Administration for Ealing since 1996.
Catherina Clarke, Deputy Administration Manager
says: “Maggie is one of the most optimistic
people in the John Conolly Wing. She has a
great saying that when ‘one door closes, another
opens’ and finds good in everything. She leads by
example, is kind, patient and reliable.” Business
Manager, Alex Tickell adds: “I have only known
Maggie for a year, but in that time I’ve noticed her
strong work ethic and total dedication to the job
in hand, her team, Ealing SDU and above all, the
Trust. It’s a pleasure working with Maggie and I
hope we continue to work alongside each other
for a long time.”
Maggie (left) with her colleague Bernadette Gracias.
22 Mental Health Matters
Martin
Morgan
Consultant OT
for the Trust has
been awarded
sponsorship
from ICAN
(International
Creative Ability
Network) to
visit South Africa to learn a highly acclaimed OT
methodology from Vivienne Schultz. Vivienne is a
globally recognised social entrepreneur who has
introduced this successful occupational therapy
method within South Africa.
In South Africa, the A2B methodology
has enabled over 900 of the most socially,
educationally and economically disadvantaged
people to learn the skills to set up their own
businesses and make a living for themselves.
All projects using the A2B methodology have
succeeded in breaking a sense of hopelessness
within a dependency culture and replacing it
with increased motivation, and entrepreneurial
characteristics that have enabled participants to
gain and maintain long-term employment or start
their own business.
Martin plans to bring the methodology to the
Trust where he will trial it in work rehabilitation
and Hammersmith & Fulham. He says: “I’m
thrilled to have this opportunity and believe that
participation in the project will help us to stay
at the cutting edge of contemporary evidencebased practice.”
Outside In
Director of Communications
Lucy McGee
It was a busy end to last year from a
media perspective. Attempts to promote
Broadmoor Hospital as a centre of
excellence bore fruit, with sustained
interest in the BBC’s Exchanges at the
Frontier from Broadmoor in several
national dailies. The BMA Journal
published a long and interesting piece,
following an interview with Mrigendra
Das. We’ve met with the Guardian
and the Today programme to discuss
coverage of the Women’s Service at
The Orchard and the medical advances
in forensic psychiatry at Broadmoor
Hospital, respectively.
These opportunities developed from a
press briefing we ran on secure mental
health care with the Science Media
Centre (www.sciencemediacentre.
org). Nick Broughton, Mrigendra Das,
Aideen O’Halloran and Jimmy Noak took
questions from national journalists, all
specialists in writing about health or
science. Their appetite for information is
significant and helps us position forensic
services as being first and foremost
about health and not crime. If we can
talk facts, data and evidence, we can
help the media generate better public
understanding of and support for the
work we do, and contribute to destigmatising our patients.
Broadmoor staff were also portrayed
positively through the coverage in the
local press about the Hospital’s Quality
Award wins, and also through the news
of Clive Bonnett’s being awarded an
MBE – huge congrats to Mr Bonnett!
for being bold enough to step up
and be interviewed by the Sun last
year. They talked openly about their
work, the challenges and some of the
misconceptions they, and patients, face.
The half page article in the Sun on
January 4 is a landmark piece of positive
coverage because it reaches audiences
(9 million people a day) who would not
normally hear this message. Even if it
makes just 1 in 100 readers think again
about their prejudices, it’s progress.
Lucy McGee
lucy.mcgee@wlmht.nhs.uk
And finally, a massive thanks to Shaun
Bhattercharjee, Emma Wadey, Ken
Wakatama and AnneMarie Seaton
Mental Health Matters 23
Every picture
tells a story
Butler House
at the top
of the game
Agim Melkaj
The atmosphere was intense as staff and service
users played in the finals of the St. Bernard’s Annual
Badminton Competition in December. The winning
team was a service user from Butler House with
Agim Melkaj, Physical Activity Advisor. Organiser
Emma McIntosh said: “Badminton is really popular
here at the gym as it improves physical and mental
health, and gives people a good opportunity to
make new friends.” Weekly classes are run every
Wednesday throughout the year from 2-4pm. To
find out more call the gym team on 020 8354 8166.
From left: Dr Kaoru Arai, Consultant Psychiatrist, Yoshifumi
Takagi, Psychiatric Social Worker, Dr David Reiss, Director
of Forensic Psychiatry Education, Dr Ian Treasaden, WLFS
Consultant Psychiatrist, Satomi Nakato, Nurse, Dr Masatoshi
Kuga, Consultant Psychiatrist, Dr Ryoji Miyata, Consultant
Psychiatrist and Mariko Hinneh, WLFS Psychiatric Nurse.
Staff in West London Forensic Services shared
their expertise with a group of multidisciplinary
healthcare professionals from Japan.
Dr Daisuke Okazaki, from Japan’s Department
of Health, Labour and Welfare thanked Dr David
Reiss from West London Forensic for organising
the programme. He said: “You’ve given our
students a fantastic opportunity to develop and
learn and for that we’re extremely grateful.”
Signing
their values
pledge
Good shot
Head of Nursing for Broadmoor,
Jimmy Noak (left) and Pat Clark,
Activity Co-ordinator, were delighted
to congratulate the winners of the
Christmas pool competition on Leeds
ward. Pat says: “This was one of a
number of special events we ran for
patients during the festive period. It
helped to keep the patients occupied
over what can be a difficult and
emotional time and it was great fun
for all involved.”
24 Mental Health Matters
Welcome
Last year we began rolling out our values of togetherness,
responsibility, excellence and caring, across the Trust. Most
teams have now had a values workshop to help them put the
values into action to drive improvements at the Trust. Pictured
are members of the PA team, at Trust HQ, from the left:
Charlotte Robinson, Dawn Smith, Kim Broadbent, Mandy Bassi
and Jacky Vincent.
PA Jacky Vincent said: “The values workshop was a worthwhile
team building exercise which helped us to understand what the
values mean for us in our interactions with each other inside
and outside of the team. It’s good to have them on our wall as
a daily reminder.”
If you’d like a values workshop for your team send an email to:
communications@wlmht.nhs.uk and we’ll arrange.
MHM is produced by the Trust’s Communications Team. Call us on 020 8483 2283.
Mental Health Matters is printed on recycled paper