Service User And Care Involvement Analysis Social Work Essay

This reappraisal will dwell of an debut, purposes of the reappraisal, and methods of informations aggregation, findings on a series of inquiries and replies on the extent of service user engagement in the discharge procedure, decisions, and possible recommendations for alteration. It will reason with a contemplation piece.

The undermentioned reappraisal will discourse the issue of service user engagement in the discharge/transfer process. The reappraisal was compiled by the writer within a 19 bedded Forensic Mental Health unit. The ward was at full capacity at the clip of composing this reappraisal.

The service users ‘ all had different degrees of mental unwellness, each with a different history, degree of cognitive consciousness, grade of institutionalisation and willingness to accommodate and alter. This reappraisal will measure to what extent service users are involved with the discharge be aftering procedure in the ward, if any, and give possible recommendations on how this procedure may be improved.

Purposes of the Review

During this arrangement the writer decided on a topic to reexamine, this topic was service user engagement in discharge planning. While collating information for the reappraisal some inquiries arose these inquiries were:

Does the service user feel included in determination devising?

How does the staff involve the service user in the determination devising if at all?

Has discharge been discussed with the service user?

These inquiries lead to the writer building some cardinal inquiries to transport out in the reappraisal these will be discussed further in the findings.


Methods used to build reappraisal

The information for the reappraisal was collected over a 10 hebdomad period within the ward. The writer consulted service users ‘ notes, attended multidisciplinary squad meetings and conducted a series of semi-structured, one to one interviews with service users and staff, including a adviser, physicians, ward director, nurses, nursing helpers and occupational healers.

A literature hunt was besides carried out utilizing commissioned databases including CINAHL and the British Nursing Index. Relevant journal articles were found on these databases utilizing keywords such as service user, engagement and mental wellness services. Nursing research books were besides used to garner information along with web sites underlining national policies and theoretical accounts for mental wellness nursing.



How are determinations made within the placement country sing discharge planning?

A Forensic Mental Health Unit is non portion of the prison services it is a service that specialises in the appraisal and intervention of people who have a Mental Disorder. Harmonizing to the Mental Health Care and Treatment Act 2003 a mental upset is an unwellness such a personality upset or larning disablement defined by the act, whereby the mental upset has been a lending factor to the individual piquing.

Throughout the hebdomads on this arrangement research was carried out by the writer on policies and processs for discharge planning. The one in peculiar that was found to be relevant was the Care Programme Approach ( CPA ) . CPA is approximately early designation of demands, assignment of persons or administrations to run into those demands in an agreed and coordinated manner and regular reappraisals of advancement with the service user and attention suppliers. CPA is besides about affecting household or carers at the earliest point. The Care Programme Approach requires that service users should be provided with transcripts of their attention programs and it has been progressively common for service users who have been the duty of forensic head-shrinkers to hold transcripts of paperss associating to their attention. ( DOH 2008 ) .

Systems were in topographic point for comprehensive attention planning. There was grounds to demo that the service users ‘ societal, educational and occupational demands were taken into history in the attention be aftering procedure and other specialist intercessions were available.

In add-on to this, in some instances, discharge/transfer planning was apparent from an early phase ( non long after admittance ) , although in other instances a few months had elapsed before any papers noted those treatments. Discharge planning is enhanced by the Care Programme Approach ( CPA ) a multi-disciplinary attention be aftering systematic attack that involves service users and their carers ‘ . Care Programme Approach is the model for attention co-ordination and resource allotment in mental wellness services. Decisions for discharge are made through the multi-disciplinary squad which consists of advisers, ward director, nursing staff, occupational therapy and societal workers. discharge counsel 4. This will travel frontward to a tribunal where the service user will be invited to take portion, here all the grounds will be put frontward and a determination will be made. If the service user is restricted so the determination will be made by the First Minister. When a service user is restricted it means an order has been applied to them as they are seen by the act to be a more serious wrongdoer, this so means that the Home Office is responsible for allowing discharge and a representative will be invited to the Tribunal ( MHCT Act 2003 SECTION 37/41 ) .

Most service users have long term mental wellness jobs and complex societal demands and have been in contact with mental wellness services for more than twenty old ages so ne’er think about discharge. Bing in infirmary for so long has become portion of their lives so service users see it as pointless being discharged, “ what would I make ” . 488

Section 117 AFTER-CARE

Prior to 1983, no statutory proviso was made for the after-care of patients discharged from infirmary. Section 117 introduced and defined formal after-care. In peculiar it stated:

“ It shall be the ditty of the wellness authorization and the local authorization to supply in concurrence with voluntary bureaus after-care services for any individual to whom this Section applies, until such clip that the wellness authorization and local authorization are satisfied that the individual concerned is no longer in demand of such services “ .

Section 117 of the 1983 Mental Health Act applies to patients who have been detained under Section 3,37, 37/41, 47/49, 48/49.

Before a determination is taken to dispatch or allow leave to a patient, it is the duty of the RMO to guarantee, in audience with other members of the multi-disciplinary squad, that the patient ‘s demands for wellness and societal attention have been to the full assessed, and that the attention program addresses them.

The Section 117 meeting

The purpose of the meeting is to pull up an after-care program, based on the most recent multi-disciplinary appraisal of the patient ‘s demands.

During the meeting the following countries should be covered as appropriate:

Housing Fundss Relationships/family Employment Social demands

Psychology/mental wellness troubles Relapse forecasters Known hazard factors

When the attention program is agreed the squad should guarantee that a cardinal worker is identified to supervise the attention program. The Care Co-Ordinator can come from either of the statutory bureaus, and should non be appointed unless they are present at the meeting, or unless they have given their anterior agreement.. The procedure for Sec 117 can be found in Trust Policy and Procedure and applies to all patients accepted by psychiatric services.

What decisions/involvement does the service user have in this procedure?

Within this arrangement the attention and intervention programs are reviewed on a regular footing. Service users are expected to run into with their cardinal worker and other squad members on a regular footing, attention programs are reviewed at these meetings and a common understanding will be decided, on the best manner frontward, one time the attention program has been agreed by all the service user has to adhere to the attention program. ( discharge counsel ) no.16

Rights, Relationships and Recovery ( 2006 ) : The Report of the National Review of Mental Health Nursing in Scotland

Service users ‘ are encouraged to be to the full involved in all facets of their attention every bit far as they are able to. Service users past and present wants should be taken into history, their positions and sentiments with respects to their intervention program must besides be recorded, as stated in the Mental Health ( Care and Treatment ) Act Scotland 2003. These wants and facets will be turned into a attention program that is single to the service user. The rules of the act underpin any determination made associating to a detained service user in Scotland. The Milan Committee devoted a chapter in the act that referred to high hazard patients it stated that service users should hold the right of entreaty to be transferred from a high or average secure installation to that of a installation with lower security conditions. ( Mental Health Care and Treatment Scotland Act 2003 ) . This nevertheless seemed to be the job across the board, deficiency of medium/low secure installations to dispatch /transfer appropriate service users to.

Service users have the chance for regular one-to-ones with their cardinal workers ( hebdomadal footing ) or more on a regular basis if they require. Service users have the chance to set forward their ideas on discharge and any other facet of their attention at the reappraisal, such as their rights, beliefs and their right to a court. The writer attended these independant courts while on this arrangement and at these courts people had stated that their human rights had been violated ( The Human Rights Act 1998 ) . They felt they were still being discriminated against for offenses they had committed 20-30 old ages ago and experience they were being held under “ inordinate security ” hence the ground for the tribunal to appeal against this degree of security. this would intend they would be granted grounds entree on a test period which may be supervised, so go unsupervised for a test period to see how the service user would get by, this in bend will take to a farther court taking topographic point in a set clip agreed for illustration 4 or 6 months off, where the service user may be granted discharge/transfer to a lower secure unit depending that all commissariats that had been put in topographic point had been adhered to, for illustration, hazard appraisal reviewed, intervention government being followed, attend all social/therapy/strategy groups that were agreed.

The reappraisal takes topographic point every four months, once more this is a multi-disciplinary meeting and service users are invited to go to with the support of protagonism or person of their pick. The Human Rights Act 1998 gives legal consequence in the UK to certain cardinal rights and freedoms contained in the European Convention on Human Rights ( ECHR ) . These rights non merely affect affairs of life and decease like freedom from anguish and violent death, but besides impact your rights in mundane life: what you can state and make, your beliefs, your right to a just test and many other similar basic entitlements.

During the clip spent on this arrangement it was noted that service users and cardinal workers met at the beginning of the hebdomad to discourse how they felt things had been for them, the service user has the chance to discourse what changes they would wish to go on, this is so recorded in the service users ‘ notes and taken frontward to the clinical squad that hebdomad where it would be discussed if any alterations in attention and intervention would take topographic point, the service user is so informed of any alterations and determinations made which they have the right to appeal against ( The Human Rights Act 1998 ) . The chance arose for the writer to take portion in these hebdomadal reappraisals, during this one-to-one clip most service users were able to show their ideas and feelings about issues they had encountered that hebdomad and depict what curative schemes they used to acquire through it.

The service user will be provided with a transcript of the Treatment Plan Objectives, or informed in item of the contents of the intervention program, in the event that any acquisition or specific reading or linguistic communication trouble information should be provided in a manner that is most likely to be understood.

Arnstein ( 1969 ) constructed a “ ladder of engagement ” which described eight phases of user engagement in services, including mental wellness. These phases ranged from no engagement to user controlled services. The above service users would be placed on the 6th round of the ladder in the partnership scope as they agree to portion planning and decision-making duties.


Partnership, like community, is a much abused term. I think it is utile when a figure of different involvements volitionally come together officially or informally to accomplish some common intent. The spouses do n’t hold to be equal in accomplishments, financess or even assurance, but they do hold to swear each other and portion some committedness. In engagement processes – as in our personal and societal lives – edifice trust and committedness takes clip. dispatch counsel 16.6 908

Does this placement country reflect its pattern on local or national policies sing service user engagement in discharge planning?

( Mental Health Care and Treatment Scotland Act 2003 ) .

( The Human Rights Act 1998 ) .

When asked their positions on the topic the Ward director and senior nursing staff presented certification which reaffirmed current pattern within the ward. The Ten Essential Shared Capabilities ( ESC ‘s ) DOH ( 2004 ) he explained was the theoretical account now being followed on the ward, has merely been implemented into this country of arrangement within the last two old ages, which the ward staff have adopted good by supplying a person-centred attack every bit much as possible. This new person-centred theoretical account embraced the ethos of the above, and senior staff stressed that good pattern dictated that service users have the chance to suitably act upon bringing of attention and support. A reappraisal of policies and processs every bit good as treatments with staff provided grounds that the policies were really in topographic point.

Throughout the arrangement, the writer noticed that attempts were being made all the clip to nurse harmonizing to the new theoretical account. Included were regular one to one Sessionss between nurses and service users to hear their positions and ideas, these already took topographic point before the ESC ‘s were introduced. Furthermore some staff do happen it hard to follow the ESC ‘s and the mental wellness act due to the restraints of the environment ( unafraid ward ) ; nevertheless they are prepared to encompass the chance for farther instruction and support. 211

Identify barriers and restraints.

Before a determination is taken to dispatch or allow leave to a patient, it is the duty of the RMO to guarantee, in audience with other members of the multi-disciplinary squad, that the patient ‘s demands for wellness and societal attention have been to the full assessed, and that the attention program addresses them.

Section 117 of the 1983 Mental Health Act applies to patients who have been detained under Section 3,37, 37/41, 47/49, 48/49.

While on arrangement and carry oning this reappraisal the writer noted that one of the barriers to effectual engagement came from some of the service users, due to the complex nature of the country the service users had become institutionalized and found it hard to be believing about discharge at this phase in their lives, so they merely accept the manner things are and do non acquire excessively much involved every bit far as attention programs are involved and merely state what they think the staff want to hear.

In unafraid scenes battle of service users in appraisal and intervention can be hard, as there is a possible hazard of sensed coercion. Furthermore with the deficiency of medium secure installations around this can impede service users from traveling on within the specified clip bound agreed, as there are no commissariats.


Recommendations for Development


Most service users were more concerned about their hereafters and life station discharge. They wanted their clip between now and so to be concerned with fixing them for discharge. It was thwarting for many service users that they felt that small in the manner of such readying was taking topographic point. Continue to supply service users with support and accomplishments needed appropriate to their map and accomplishments already held, for illustration cooking groups, IT groups.

Supply groups that enhance societal accomplishments such as get bying scheme groups, choler direction, alcohol/drug treatment/groups.

High secure units should guarantee that at the point of discharge patients have a transcript of their discharge attention program in a suited format which includes appropriate information about the fortunes that might ensue in their return to a unafraid mental wellness proviso such as? ? ? ? ? ?

However a recommendation that high secure units should guarantee that factors to be weighed in measuring backsliding are portion of the hazard appraisal included in the discharge program of all service users.

The National Service Framework for Mental Health provinces that ‘Service users and carers should be involved in planning, supplying and measuring preparation for all wellness attention professionals ‘ ( Department of Health, 1999 ) . This is the instance in most wellness attention commissariats but for more instruction, preparation and information to be more readily available.

Strengthening the user position and user engagement in mental wellness services has been a cardinal portion of policymaking in many states, and besides has been encouraged by World Health Organization ( WHO ) in order to set up services that are better tailored to people ‘s demands and used more suitably.



In this reappraisal, I need to reflect on the state of affairs that took topographic point during my clinical arrangement to develop and use my interpersonal accomplishments in order to keep the curative relationships with service users. In this contemplation, I am traveling to utilize Gibbs Reflective Cycle Gibbs ( 1988 ) . This theoretical account is a recognized model for my contemplation. Gibbs ( 1988 ) consists of six phases to finish one rhythm which is able to better my nursing pattern continuously and larning from the experience for better pattern in the hereafter.

During the first hebdomad of arrangement I was encouraged to work closely with my wise man. This gave me the chance to orientate myself to the ward and acquire an overview of the demands and demands of the service users. This besides provided me with the opportunity to detect how the nursing squad worked on the ward. During this clip I had learned that if the construct of inter-professional working is to win in pattern, professionals need first-class squad working and communicating accomplishments. Good communicating, as we have staged in our group work theory, ( accomplishments for pattern 3 ) is important in the effectual bringing of patient attention and hapless communicating can ensue in increased hazard to the service users. I have learned the valuable accomplishments required for good communicating and will reassign these into pattern by accommodating to the local communicating processs ( expand ) . The NMC advices that at the point of enrollment pupils should hold the necessary accomplishments to pass on efficaciously with co-workers and other sections to better patients care ( NMC, 2004 ) .


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