Forensic inpatients

Overview

The Trust have been testing out a range of methods and approaches that may be best suited to different groups or audiences. Discovery interviews ensure that a person is provided with an opportunity to narrate their own story using a series of prompts. The Trust pilot was to test out this methodology with patients who had recent experience of being detained under the mental health act 1983 (amended 2007)

The project aim was to test out using a discovery interview approach to capture the experience of patients who had been detained and who were currently in Trust inpatient areas. The service area focus for testing out the pilot was on forensic services and aimed to capture a more in-depth understanding of the patient journey. In addition, the Trust wanted to capture a diverse sample of people’s stories to provide a wider understanding of experience.

Who did you consult with and what did you ask?

The interviews were aimed at:

In-Patients currently receiving care and treatment on our medium and low secure wards (Newton Lodge/Bretton Centre)
In-Patients currently receiving care and treatment on our learning disabilities ward (Newhaven)
A carers perspective of a loved one who was an in-patient who had received care and treatment at our mental health ward in Barnsley (Kendray Hospital)

Once service users were identified to be interviewed, the engagement team had to gain copies of consent to record their voice and ask for equality monitoring data to be collected. The team then arranged a suitable date/time for the interviews with the staff on the wards.

We arranged for the interviews to take place on the wards in a private area, so that the person could talk freely and privately. A staff member from the ward was also present so that the person felt comfortable knowing someone was in the room that they knew. The prompts for this piece of work were:

Experience of admission
Experience of being detained in hospital
Experience of day-to-day activities on the ward
Share views and thoughts on care and treatment
Hopes for the future

The service user interviews were carried out in person in the units and the laptop voice recorder function was used for recording sound and the media file was saved. For the carer’s interview a mobile phone placed on speaker and the voice recorder of the laptop was used to capture the interview. All interviews were recorded and typed up in full to analyse and compile the report of findings.

What did they tell you?

From the interviews which took place those interviewed told us that:

The assessment process can be daunting – can this be broken into sections, especially for patients who have Autistic Spectrum Disorder (ASD)/Autism
A welcome/induction pack shared on admission should be referred back to during the stay as there was too much information to take in when unwell at admission point
Clear explanation of restrictions that can be put in place is needed
Clear explanation of different types of leave requests and how they are granted
The need to understand range of activities on offer and where service users can influence new activities
More support to tackle ‘bullying’ on wards
Exposure to other mental health conditions and behaviours did have an impact
Medications side effects and impact on patients could be better explained (e.g. increased appetite, weight gain, sedation, drooling, speech affected)
Staffing: not enough staff to support physical needs of service users
Staffing: concern about lack of regular staff for support and relationships
Staffing: lack of staff has impact on supporting leave entitlements
When medications were stopped in community, service users reported becoming unwell with behaviour escalated, some led to criminal activity and arrests by the police

What did you do?

The findings have been written into a report which was presented at the Mental Health Committee on 8 March 2022. The next steps will be determined by the committee and the findings will help to improve services and influence the process and future inpatient stays. We will also provide copies of a ‘you told us, we listened’ approach to wards to add into their own inpatient feedback mechanisms.

An opportunity has arisen to also develop an animation to share on the Trust website to communicate to other service users, families, carers, key stakeholders and the public “What to expect when you are detained under the Mental Health Act” seen below.

In addition, the WY&H Forensics involvement team are interested in learning from the approach and may use this as a tool going forward. As approaches become embedded people who use services gain more confidence in the approach and participate. The aim would be to generate that interest.

Where can you find more information about this work?

The ‘Discovery Interview’ approach will also be documented, and tools will be made available on the team intranet page so that staff can use the approach in other Trust settings, including community teams.

What to expect when you are detained under the Mental Health Act Discovery Interviews Animations

The animation shows what happens when you are detained.

It shares the example of a journey a person may follow if they are admitted into a forensic ward and the support, care, and treatment they will receive.

It also explains some of the restrictions you can expect if you are detained. People who are admitted also receive a welcome guide, so they have the information they need.

This guide includes information about the ward and what to expect. We hope this animation provides enough information and assurance to people who use the service including, families, carers, friends and loved ones.

We have translated versions of the animation into BSL, Polish, Gujarati, Urdu and Romanian.

Animation