Mental Health Services. Hertfordshire Partnership. The Hertfordshire Partnership NHS Trust is committed to eliminate racism,

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1 The Hertfordshire Partnership NHS Trust is committed to eliminate racism, sexism and all forms of discrimination Produced by: Hertfordshire Partnership NHS Trust 99 Waverley Road St Albans Herts AL3 5TL Ref MHS Service Users Booklet AH Hertfordshire Partnership NHS Trust Mental Health Services Acute Inpatient Units Information Booklet For Service Users

2 If you would like us to explain more about the contents of this booklet please ask a member of staff. Tear Off and Return Comments Slip Name of Inpatient Unit: Date booklet received: Your name and address: (optional) Comments: 1 18

3 Produced by : Contents Hertfordshire Partnership NHS Trust with service users October Acute inpatient units 2 What happens when you arrive for admission? 3. Assessment by the Doctor and Nurse We aim continually to improve the ways in which we provide information to users of our services and their carers. 4. Risk Assessment 5. Reviewing your medication If you have any comments on this booklet, please write them on the tear-off page and return it to: Jo Burnham User and Carer Involvement Lead Hertfordshire Partnership NHS Trust 99 Waverley Road St Albans Herts AL3 5TL Tel: Personal property and valuables 7. The professionals providing your care 8. Daily Routine 9. Weekly Ward Round/Clinical Review 10. Individual Care Plan 11. What is the Care Programme Approach? 12. Your Rights 13. Your Health Records 14. Advance Directives 15. Confidentiality 16 Observation Levels 17 Leave 18 What is the Mental Health Act? 19 Alcohol and Drugs 20 Smoking 21 Compliments and Complaints 22 Advocacy 23 User Involvement 24 Spiritual needs 25 Glossary of Terms and Abbreviations 26. Telephone Numbers 17 2

4 1. Acute inpatient units Useful Telephone Numbers Hertfordshire Partnership NHS Trust is the main provider of mental health care to the county population. Whilst we aim to provide an increasing amount of our services to people in the community, acute inpatient care remains a central feature of our services, ensuring that safe and effective care and treatment is given to those who are acutely mentally unwell. This booklet describes the general features of our acute inpatient care for adults of 16 and above, which is provided on a range of sites across the county. It should be read together with the leaflet which describes your particular unit. Hertfordshire Partnership NHS Trust Head Office Carers In Herts Another booklet for carers is also available. All inpatient units aim to provide an holistic approach to treatment and care, getting to know service users as individuals, meeting their mental and physical health care needs and social needs. On the unit, the multi-disciplinary team consists of psychiatrists, junior doctors, registered nurses, healthcare assistants and administrative staff. The team may also include a psychologist, occupational therapist, and art and drama therapists. Viewpoint Advocacy - POhWER Head Office HAPAS - alcohol advisory service There are other teams and voluntary agencies who work with the unit team in providing treatment and care. In particular, Crisis Assessment and Treatment Teams, (C.A.T.Ts.) work very closely with inpatient units, assessing service users at home to see if they might accept care and treatment at home where appropriate, thus avoiding unnecessary admissions to hospital. Herts County Council - HertsDirect Herts Domestice Violence/Abuse Line What happens when you arrive for admission? Rethink Severe Mental Illness When you first arrive you will be welcomed by a nurse who will invite you onto the unit. The nurse will explain what will happen in the Admission Procedure. The Samaritans You will be shown where your room is and then round the unit so that you know where the essential facilities are located. Cruse Manic Depression Fellowship Saneline

5 Personal Notes 3. Assessment by the Doctor and Nurse The Admission Unit will have had prior notice of your admission. The Doctor and Nurse will have been given any available information about you from your GP, the Crisis Assessment and Treatment Team, the Community Mental Health Team (CMHT) or the Specialist Mental Health Team for Older People ( SMHTOP). It is important for you to be assessed when you arrive. The Doctor and Nurse will want you to tell them about the problems and difficulties you are experiencing. To help you do this they will ask you questions that will help them get a better picture of your problems. With your agreement, a member of your family or friend will be able also to provide important background information about you. This may take a while but the Doctor and Nurse will be sensitive to how you are coping with this and you can stop for a break. A physical examination by the Doctor is necessary to find out about any physical problems you may have. The Doctor may need to take a blood sample and you will be asked to provide a urine sample for testing. The reasons for this will be explained to you. Other physical investigations may be necessary. You are free to ask any questions you may wish during your assessment. 4. Risk Assessment In order to make sure that inpatients remain as safe as possible, all take part in a risk assessment when they are first admitted. The Doctor and Nurse will use information from the assessment and ask you some specific questions about risk. They will refer to past case notes and will often find it useful to speak to your carer or relative. Completing a risk assessment helps us determine with you what your immediate care needs are, and is an essential part of the care plan which describes the.services you should receive during your inpatient stay. The risks that your mental health problems cause for you, and possibly for others, will be regularly discussed with you and monitored during your inpatient stay. 5. Reviewing your medication It would be helpful if you, a relative or carer brought in medicines you are currently taking. This helps the Doctor when prescribing medication for you while you are in hospital. Your medication, if it remains unchanged, will be returned to you if unused upon discharge. When there are changes you will usually be given a one-week supply of medication to take home. 15 4

6 6. Personal property and valuables Named Nurse The person with responsibility for the service user in hospital. Also known as a primary nurse or key worker. Checking your property: When the time comes for your property to be checked a nurse will explain the procedure to you. Your property will always be checked in your presence and in the privacy of your room. OT/ Occupational Therapist A person trained to work with the service user on social and life skills, evaluating the impact of the mental health problems on those skills and setting up individual or group programmes to help their recovery. For your security and that of others it is necessary to check through all the possessions you bring in with you. Pharmacist Someone with expert knowledge in medicines who works closely with the unit team. They can help with advice about side effects. Keeping a record of your property: PRN Medicines which are not for regular use but which are to be taken only when necessary. Details of your valuables such as jewellery, money and credit cards will be recorded in the property book. These items if you wish can be placed in the ward safe. You will not be denied access to your valuables. If you do not wish to use the safe you must sign a disclaimer form. Sharp implements ( except for disposable razors), belonging to you will be recorded in the property book. To protect you and other service users from harm it is our policy not to allow you to keep these with you. We will put them in a safe place. When you need to use them please ask a nurse. On rare occasions if there is a risk to yourself or others you may temporarily only be able to use them under supervision. Knives and other sharp objects, which could be deemed to be weapons, are not allowed on the ward. If you have brought any in they will be removed. You may agree that a member of your family should take such items home. They remain your property and so the unit team, if they have kept them, will return them to you on discharge. Please try to limit the number of possessions you bring on to the unit. Psychotherapy/ psychotherapist Someone trained to provide in-depth psychological treatment for emotionally distressed people, either individually, in groups or with families. SHO /Senior House officer The junior doctor who works with the consultant. Service User Other terms used are client and patient Social Worker/ SW/ ASW Someone who assesses your social needs and suggests a package of care to support the service user and family. An ASW or approved social worker has had specific training in mental health and will be involved when the Mental Health Act is used. A copy of your listed property will be given to you to keep. TTA/TTO Tablets to take away/ tablets to take out. Medicines that are supplied by the unit when a service user goes out on leave or is discharged. If you are unsure about any of this information please ask a nurse MDT/ Multi disciplinary Team Consists of doctors, nurses, ot, social workers. All those involved in your care. Mobile phones are allowed on the unit ; however, they may only be used in the designated areas, so that other service users are not disturbed. They must not be used during ward rounds or in therapy sessions. Charger's may be removed for safe-keeping and can be accessed through staff. CATT/Community Assessment and Treatment Team This team may be the service user's first contact with mental health services and may support the service user for a time after discharge from hospital 5 14

7 25. Glossary of Terms and Abbreviations 7. The professionals who will be providing your care SOME TERMS HAVE ALREADY BEEN EXPLAINED Staff on the unit will be wearing identification badges. Advocate A trained independent person who can help you speak up for what you need Carer Someone who provides you with regular support Title Consultant Psychiatrist. This Doctor has overall responsibility for your treatment while in hospital. For patients detained under the Mental Health Act, he/she also has the role of Responsible Medical Officer (RMO). Care Co-ordinator The person who co-ordinates your care outside hospital under CPA. This person is likely to be a CPN, Social Worker or OT Other Doctors This may be a Specialist Registrar, Senior House Officer, Associate Specialist, or Staff Grade. They are all medically qualified, and are supervised by the Consultant. Care Plan A written plan detailing treatment and care completed with named nurse. CPA The name for the way services for individual service users are organised in the community. CPN Community Psychiatric Nurse Modern Matron This is the most senior nurse in the local service. He/she will address any concerns you have during your stay on the unit, and will meet your relative or carer if you or they wish. Ward Manager/Team Leader This is the person who is in overall charge of the unit. He/she will ensure that you are receiving adequate care and will deal with immediate problems and concerns of yourself, and your carers and relatives. Consultant Psychiatrist The doctor who has overall responsibility for your treatment and care in hospital. Formal patient/service user A person who is detained under a Section of the Mental Health Act GP /General Practitioner The doctor seen at the surgery Health care assistant/associate Nurse Someone who is there to support the qualified nurses in providing care. Named Nurse Everyone has a named nurse who co-ordinates your care on the unit. The nurse ensures that you have a care plan. Associate Nurse This nurse works with and supports the named nurse to implement your care plan. Care Co-ordinator This staff member is responsible for your care when you are at home, organised under the Care Programme Approach (CPA).They will keep in touch with you in hospital, and are closely involved in your discharge planning. Informal patient/service user A person who is in hospital on a voluntary basis Mental Health Act A government Act that states the conditions that must be met before someone is compulsorily detained in hospital Mental Health Act Commission The government department that is responsible for monitoring through visits the welfare of detained service users. Mental Health Act Managers Independent persons who ensure that the Mental Health Act is being properly administered. Occupational Therapist/ Activity Nurse These staff provide individual and group activity. Occupational therapists evaluate the impact of your mental health problems on what you are able to do, and set up individual and group programmes to help you recover skills. Psychologist, Art and Drama Therapist You and the team may decide that these types of therapy are needed, in which case a referral will be made to one of these staff ( they are unlikely to be based on the inpatient unit). Pharmacist These staff help the doctors and nurse give you the correct medicines, and help ensure that you have good information about drug treatments. 13 6

8 8. Daily Routine 21. Compliments and complaints Meals: Menus are generally provided on tables in the dining room. In addition, the menu for each day is on the notice board in the dining room. If you require a special diet please tell us. You are welcome to bring in your own food and make your own drinks. We appreciate your comments about the services we provide. "Having Your Say" forms are available on all units, for you or your carer to complete if you wish. These are responded to by the modern matron if you wish, but are also used to gather information across the county about what service users think of inpatient care, so that where we can we can put things right. If you are concerned or upset by a specific situation please talk it through with the ward manager or modern matron first. Medication: We will be pleased to give you fact sheets that tell you about your medication. Please ask your named nurse. Your doctor will be happy to talk to you about any concerns or questions you have about your medication. Visiting: Prior arrangement is necessary when children are visiting. Children must remain in the children's visiting area. If you wish to pursue a formal complaint, the 'Complaints Booklet' will tell you how. You may also wish to ask an Advocate for help to make a complaint. 22. Advocacy An Advocate is a trained, independent person who you can turn to for information and advice, and who can represent you in ward rounds, with any problems or complaints you may have. You can contact an Advocate on: POhWER Arrangements with the nurse in charge to visit outside of the usual times can be made. For details of mealtimes, medication times and visiting times, please see your unit leaflet. West Herts: East Herts: pohwer@pohwer.net Unit Therapy and Social Activity The Occupational Therapist or the Activity Nurse provide activities on the unit. They can arrange to see you and assess which activities would help overcome or manage your problems better. A copy of the activity programme is on the notice board, and in our own leaflet provided with this booklet. If there are activities you would like that are not on the programme please discuss this with the OT or your named nurse, to see if your suggestion can be met. Therapy Activities are important to your treatment and recovery. We aim to provide a full therapeutic programme on all inpatient units, and would welcome your comments on what might be improved. 23. User Involvement Viewpoint are the independent user involvement organisation who work with the Trust to ensure service users' views are heard. They also provide representatives to sit on interview and selection panels. They are always looking for new members, and they provide training and support. They can be contacted on or via info@hertsviewpoint.co.uk 24. Spiritual needs You may wish to arrange for your religious representative to visit you while you are in hospital. Please ask the nursing staff for a contact number, and do discuss any particular requirements you may have in order to have your spiritual needs met 7 12

9 17. Leave Our aim is for you to become well enough to return home as soon as possible. As you get better leave to the shop, to community facilities, such as drop in or day care centres and to your home will increase. Leave will form part of your detailed care plan, and increasing periods of leave away from the unit are seen as an important aspect of helping you prepare for a successful return home. 18. What is the Mental Health Act? The Mental Health Act 1983 sets out when and how someone can be detained in hospital. It ensures the rights of the service user and nearest relative are protected. Someone can only be detained in hospital in the interests of their health or safety or for the protection of others. This is generally when two doctors and a social worker have assessed that the risk to the service user or the risk the service user poses to others is too great for them to remain at home or in hospital as an informal patient. If you are detained in hospital under a Section of the Mental Health Act your nurse and doctor will explain this to you and give you a rights leaflet to help you understand what it means. 9. Weekly Ward Round/Clinical Review The ward round, which is sometimes known as the clinical review, is held to review your progress with you. Some people become anxious about the clinical review and forget what they want to say. It may help if you discuss this with your named nurse and write down what you want to say before going in. If you want an advocate to support you, please speak to your named nurse. If you wish, your carers or relatives may attend by prior arrangement with the nursing staff on the unit. Your care plan will be updated after the clinical review, and you will be given a written copy of this. You do not have to attend the clinical review. If you choose not to, your views can be represented to the clinical review by the nurse and the discussion can be reported back to you. Service users generally prefer to be directly involved and our aim is to help all service users feel able to do this. You have the right to appeal against detention and the leaflet tells you how you can do this. 19. Alcohol and Drugs 10. Individual Care Plan Alcohol and illicit drugs are not permitted on the unit. Any visitors arriving on the unit intoxicated or who bring alcohol onto the premises will be asked to leave. It is possible that in very rare cases on older people's units an exception could be made in the clinical interests of a particular service user; however, you should expect this rule to be strictly enforced. When you first arrive the nurse admitting you will devise an initial nursing care plan for your first two days in hospital. Whenever possible you will be asked to contribute to it. The aim of this is to address your immediate needs. Service users arriving on the unit intoxicated or who bring alcohol and/or drugs onto the premises may be promptly discharged if clinically appropriate. When it is suspected that there are illicit drugs on the unit the police will be called to search the premises. These rules are essential in order to maintain a safe and therapeutic environment on the unit, so that the most effective care and treatment can be provided. - Observing and monitoring the signs and symptoms of your illness. - Ensuring your safety - Monitoring your sleep, appetite and self-care needs - Having routine investigations such as blood tests. - Steps to help you adjust to the unit - Time to get to know your named nurse 20. Smoking Within two days your priority needs should have been identified and your named nurse will then sit down with you to work on a detailed nursing care plan. You will be asked to sign it and be given a copy to keep. Your care plan will be reviewed at each clinical review or as necessary. In the interests of everyone's physical health, there is a very strict smoking policy on the unit. You may only smoke in the designated smoking room or in designated areas outside the building. SMOKING IS STRICTLY NOT PERMITTED IN ANY OTHER AREAS Your named nurse will arrange to meet you regularly during your stay to discuss your progress and in the absence of the named nurse the associate nurse will see you. 11 8

10 9 Acute Inpatient Units 11. What is the Care Programme Approach? The care programme approach or CPA was introduced to make sure that people with mental health problems receive care and resources to meet their changing needs under an agreed framework. The CPA involves: - Assessing your health and social needs - Agreeing how those needs will be met in a care plan - Everyone under CPA has a Care Co-ordinator. The Care Co-ordinator will arrange regular meetings with you to check out how your care plan is working. There are leaflets on the unit telling you about CPA. Please ask a nurse if you have difficulty in locating one. 12. Your Rights Everyone on our acute inpatient units has a right to be treated fairly and with dignity and respect. Discrimination of any kind either to service users or staff will not be tolerated within Hertfordshire Partnership NHS Trust. Sometimes service users can be verbally or physically aggressive because of their mental health problems, to other service users or to staff. We are committed to doing all that we can to manage such incidents effectively, with the aim of making our units safe places for all. We believe that it is not acceptable for you to be bullied, sexually harassed or abused. You have a right to say no. If this happens to you no matter who the person is please speak to the advocate or a member of staff to support you and help you make a complaint if you wish to do so. Whatever the state of your mental health or legal status, you retain the right to report any conduct which compromises you on the unit, and you can expect it to be fully investigated. Informal service users These are service users who do not require to be compulsorily detained in hospital. They are the majority of inpatients. If you are an informal service user, you have a right to an explanation about your proposed treatment. You have the right to refuse treatment and to discharge yourself from hospital, although we would recommend that you listen to advice from the nursing and medical staff. You can change your mind about your treatment at any time. If you are thinking of stopping your treatment please discuss your concerns with your doctor or nurse first. Treatment can be given in an emergency where there is an immediate risk to you or others. Self Discharge As an informal service user you are free to discharge yourself. If you decide to take your discharge you will be asked to sign the 'discharge against medical advice' form. If the unit team believes the legal grounds to be met, you can be held temporarily for up to 72 hours under Section 5(2) of the Mental Health Act, whilst the staff ask for an assessment to see if you should be detained in hospital for a longer period under the Mental Health Act Your Health Records You may wish to see your case notes when you are in hospital or when you have been discharged. You have a right to see your notes. Only in special circumstances can information be withheld. The 'Your Health Records' leaflet will explain what you need to do. 14. Advance Directives An Advance Directive is a written document, which can enable a service user to give instructions to staff about their treatment and care in case they are unable to make such decisions for themselves at the time. This is usually when you are admitted to hospital. You can do this by completing an Advance Directive form, which you can obtain from your named nurse or the nurse in charge. 15. Confidentiality So that you can develop strong, trusting therapeutic relationships with the team providing your care and treatment, they are bound by rules of confidentiality, which means that staff need your agreement before they share details of your care and treatment with your carers or others. The only exception to this would be in those rare instances where there was an immediate risk to the safety of those people. We are confident that you will understand that it is generally in your interests for carers and others who will be aiming to help you get well and stay well to be kept informed about your treatment. This is why in most cases service users are happy to give permission for such information to be shared. However, we appreciate that this can be a sensitive area for you, so that we will be careful to respect your rights. 16. Observation Levels When you are admitted and throughout your stay, the medical and nursing team will discuss with you the level of nursing observation that is needed to ensure your safety. For example, it may be necessary for a nurse to check on your well being a certain number of times every hour. The nurse will explain this to you and can give written information about the observation process. Usually when admitted service users are asked to remain on the unit for the first day for assessment purposes. 10