London mental health models of care competency framework

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1 London mental health models of care competency framework

2 Foreword It is important that non-specialist mental health services and professionals do not exclude people with mental health needs. 2 London Health Programmes

3 Foreword Foreword The London mental health models of care seek to improve the quality and outcomes of services for those experiencing a mental health crisis, and to support those with a long term mental health condition to better manage their own mental and physical health in line with a recovery approach. Both models concentrate on refocusing existing services and those who work in them rather than creating additional services and interfaces between services. The nature of support and services for people with mental health problems in London has evolved rapidly in recent times, and is likely to change even more in the coming years. In future, a wider range of organisations and staff are likely to become further involved, to varying degrees, in providing such support for people with mental health problems. Many will not work in the health sector, nor will they be specialists in mental health. Successful implementation of the models of care will require staff from an increasingly wide and diverse range of backgrounds, sectors and services to have the right knowledge, skills and behaviours to work positively and effectively with people with mental health problems. The framework aims to indentify the key competencies which will increase the expertise and confidence of the full range of staff that support people with a long term mental health condition or in a crisis, thereby improving patient experience and the quality, effectiveness, productivity and sustainability of services. This new competency framework does not seek to replicate or replace the range of welldeveloped frameworks providing detailed coverage of the competence and capability requirements of different professional groups, but to reflect the knowledge and skills which will support successful implementation of the mental health models of care. David Jobbins Associate Director, Mental Health This competency framework is not aimed exclusively at specialist mental health staff, but at everyone who comes into contact with people with mental health problems and those who are responsible for commissioning and developing services. A competency framework for all those working with people with mental health problems in London 3

4 Executive summary Executive Summary This competency framework has been developed to support the implementation of the two mental health models of care; for people with long term mental health conditions and people experiencing a crisis. The models of care require development of the skills and practices of the workforce, identifying best practice in London and building upon it. This competency framework will help to identify training needs within and across the health and social care workforce enable organisations to design and provide training to a consistent model help employers to draw up job descriptions support in group training Part two: setting out further competencies for staff who are not mental health specialists, but who work with a wider client group including people who may have a mental health problem, and/or people who may be experiencing a mental health crisis. Part three: setting out additional competencies for staff working with people with mental health problems either as a main client group, or as a significant part of a wider client group, for example mental health clinicians and GPs. Clinicians, managers and commissioners should aspire to see all individuals within their organisations gaining part one competencies. For part two and part three competencies however, the requirements will differ according to factors such as the nature of the team, service or organisation, its functions, ways of working and overall skill-mix. support individuals self-assessment of their own development needs function as a guide for designing local care pathways and commissioning services. The competencies are organised into three parts, with each part of the framework building upon the preceding parts. Part one: setting out universal competencies relevant to everyone who may, as part of their day-to-day work, come into contact with people with mental health problems; 4 London Health Programmes

5 To assist workforce leads, commissioners and training managers the competency framework is designed to be used on a number of levels - at an individual level, at a team level or at an organisational level. Executive summary At an individual level, the competencies can be used by individuals across a very wide range of services, professions and roles for self-development, to reflect on work and practice, and to identify development and training needs in discussion with their managers. At a team or organisational level, the competencies can be used by providers, clinicians, managers and commissioners to consider requirements within a given team, service or organisation, and identify collective development and training needs. The competency framework is designed to help clinicians, commissioners, employers and managers when designing local care pathways and commissioning services, to identify training needs within and across workforces; to inform the development of job descriptions and training and development plans and to support individual self assessment and development. A competency framework for all those working with people with mental health problems in London 5

6 Introduction and background Introduction and background The London mental health models of care are concerned with better supporting those with a long term mental health condition in managing their own mental and physical health more effectively in line with a recovery approach and raising the quality and outcomes of services for those experiencing a mental health crisis. Both models were driven by the case for change which highlighted the challenges for mental health services in London and seek to refocus existing services and those who work in them rather than creating additional services and interfaces. This framework uses the same terminology as used in the models of care. For more detail see Appendix 1. The model of care for long term mental health conditions seeks to strengthen the quality and capacity of provision in primary care, and how primary and secondary care work together, to enable more people with a long term mental health condition to receive their healthcare support through professionals in a primary care setting, working in partnership with user self management groups, informed carers and families and third sector organisations offering home based personalised care support. Key to this is improving the ability of individuals and services to prevent crisis occurring, improving the availability of specialist advice, highly skilled expert assessment, and interventions available in primary care. Particularly for people with long term mental health conditions, attention is given to recovery, appropriate care settings, partnership working and shared care. For people experiencing a mental health crisis, the emphasis is on appropriate and timely responses and recognition of the wide range of professionals and others who may be a first point of contact - people should receive a response based on the principles of right place, right time, right person, right assessment, first time. Rather than redesigning services, the models of care focus on improvements to four key elements of typical care pathways: How people access help when they or someone they care for needs it. What happens when people ask for help. How the response from the NHS and partners can be improved. The model of care for people experiencing a mental health crisis describes a care pathway that should be in place consistently and systematically across London, offering consistent, appropriate and timely responses. The availability of alternative services and information about them. 6 London Health Programmes

7 A key objective of the models of care is to enable more people with mental health problems to be supported appropriately within primary care and community settings, thereby reduce unnecessary secondary care admissions. Such an approach should lead to better, more person-centred care, while at the same time enabling secondary care services to provide better quality care for those who need that level of support. The models are intended to contribute to the delivery of the government s mental health strategy, suicide reduction strategy and quality, innovation, productivity and prevention (QIPP) plans for mental health. Several national policies and programmes are aimed at reducing variation and ensuring continuous improvement in quality, productivity and innovation within health services, including mental health. These create the operational context in which large numbers of staff - within and outside the NHS - will support people with mental health problems, and will impact on the way many services are commissioned and run. The key policies and developments that are driving these changes are summarised in Appendix 2. Staff across a range of health and public and voluntary sector services need to develop the skills, knowledge and confidence to work in different ways if QIPP benefits are to be realised and this framework defines what individuals and teams need to do in order to support service users more effectively. The mental health models of care can be downloaded at tinyurl.com/d7vs967 The London population and the mental health of Londoners London is home to some 8.17m people 1 with an extremely diverse and transient population. It is the UK s most culturally diverse city; more than 300 languages are spoken in London and over 40% of the UK s Black and Minority Ethnic population live in the capital. London has high levels of deprivation, with significant variation across the city: more than half of London s boroughs are within the 30% most deprived areas in England, and ten boroughs are amongst the most deprived 10% 2. Significant numbers of people come to London and leave London each year, with many inner London boroughs having particularly transient populations. An estimated one in four of the UK population will experience a diagnosable mental health problem at some point in their lives 3. At any given time, around one in six adults are experiencing a mental health problem, and for half of these people the problem will last for over a year 4. Within London the levels of mental health need and demands on mental health services are greater than the UK average 5. Prevalence is greatest in the most deprived parts of London, with social and economic factors affecting the incidence and duration of 1 GLA Intelligence Update demography team, 2010 mid-year population estimates, estimates for June 2010, based on data issued by the Office for National Statistics, and published June Mental health services case for change for London, London Mental Health Models of Care project, London Health Programmes, June mental_health_ pdf 4 New Horizons: a shared vision for mental health, Department of Health, Mental health services case for change for London, London Mental Health Models of Care project, London Health Programmes, June 2011 Introduction and background A competency framework for all those working with people with mental health problems in London 7

8 Introduction and background mental health problems, and worsening health inequalities 6. Dementia is more common in outer London due to its older population. London has higher than average numbers of people with complex needs including refugees, asylum seekers, homeless people and people with a dual diagnosis of mental illness and drug or alcohol problems 7,8. The nature of the London population, and the needs of this population is dynamic and will continue to change in future years. 6 ibid 7 ibid 8 In March 2011 London had 35,920 statutory homeless households in temporary accommodation, out of a total of 48,920 in England, Live Tables on Homelessness, Department for Communities and Local Government, last updated March 2012 The London mental health models of care core pathway To support the models of care, the project team at London Health Programmes, supporting the project clinical leads, has, with a range of other stakeholders, developed a core pathway, setting out the five essential functions that staff working with people with mental health problems need to carry out: l Assessment l Effective referral to appropriate services l Planning l Implementation (intervention and treatment) l Evaluation 8 London Health Programmes

9 Training needs pathway flowchart Planning Implementation Evaluation (Intervention & Treatment) Function The effectiveness of all interventions /periods of care and support should be evaluated from the service and the service user s perspective People should access and use evidence based interventions, which are built around them and their needs, and the needs of family members, in the context of their lives. Person, family, friends and workers agree needs to be addressed, goals to achieve them, and ways of achieving those goals in the context of a person s life Introduction and background People access the most effective source(s) of help/ support Evaluation of individual outcomes Holistic person centred assessment of health and social care needs in the context of their lives Support implementation of wellbeing and crisis plans Agree personal goals and monitor progress towards achievement Make/ accept referrals according to locally agreed protocols (seeking specialist advice as needed) Provide specialist advice to those health workers who might require it Make appropriate onward referrals to specialist mental health services, local authority services & other community agencies Maintain local directory of services to meet mental health need, including those for wider determinants of health (including how to access them) Evaluation of quality of services Work in partnership with users, carers, other services Provide personalised care, taking account of diverse needs (including ethnicity, gender, sexual orientation etc) Support access to and effective use of personal health budgets Deliver evidence-based physical & mental health interventions (including medical and psychosocial interventions) and interventions with families Enable self management of physical and mental health Support the use of health promotion information/ advice and services Monitor & review progress, and act when setbacks occur Discharge safety/risk and statutory duties/ responsibilities effectively Assessment of mental health, physical health, risk, functioning (including work, social life, relationships, self care, spirituality etc) Ensure that carer s assessments are carried out and implemented Evaluation of cost benefit and service efficiency Collaboratively develop living well/wellbeing and crisis plans Agree risks with individuals and family members/friends etc and how they will be managed Description Assessment Complete care plans which meet relevant statutory requirements as needed (including Care Programme Approach) Effective referral to appropriate services A competency framework for all those working with people with mental health problems in London 9

10 The London MHCF The London mental health competency framework How the competency framework was developed The process of developing the competency framework was very inclusive, as was the process for developing the models of care. Significant input was harnessed from mental health specialists in the field including the core professional groups of nursing, occupational therapy, psychiatry, psychology, and social work and in addition a wide range of other stakeholders were engaged including people using mental health services, their families, friends and carers, GPs, pharmacists, mental health charities and voluntary and community sector providers, employer and workforce organisations, and non-mental health staff. Through a series of focus groups and interviews, over 100 people were involved. This wide-level engagement has made a substantial contribution to the rigour and relevance of the framework. In developing this competency framework, it has been important to be mindful of the potential linkages with existing frameworks, but also of the complexity of trying to map a large number of links to many different documents. The aim of such mapping should always be to assist those using the frameworks, not to confuse them. Appendix 3 (Related competency frameworks) summarises the competency frameworks (in chronological order) that are relevant to the broadest range of staff working with people with mental health problems in London 9. This competency framework is not aimed exclusively at specialist mental health staff, but at everyone who comes into contact with people with mental health problems. Thus, it has been explicitly linked most closely with those existing frameworks that have the widest reach and application the Ten Essential Shared Capabilities 10, and the NHS Knowledge and Skills Framework (KSF) 11. However, there is, quite rightly, a great deal of consistency and congruence with the other competency frameworks mentioned in Appendix 3. An accompanying document is available which maps the London mental health competencies and NHS Knowledge and Skills Framework (KSF), linking the competencies in the framework to the dimensions in the KSF. This document is available at tinyurl.com/cn4azcm 9 It is also worth noting that the Social Care Institute for Excellence (SCIE) has produced a suite of briefings, guides and other materials that are useful to those working with people with mental health problems. See 10 The Ten Essential Shared Capabilities A Framework for the Whole of the Mental Health Workforce, National Institute for Mental Health England, Sainsbury Centre for Mental Health, NHS University, Department of Health, August The NHS Knowledge and Skills Framework (NHS KSF), Department of Health, Oct London Health Programmes

11 Rationale for the competency framework The models of care promote a refocusing of existing services and the roles of those who work in them. They introduce new roles and ways of working. Implementing the models will require people to do things differently in different settings; this competency framework identifies the knowledge and skills required to support them. The competencies identified in each of the parts of the framework will support and bring about some of the changes proposed within the models of care: Refocusing existing services to do things differently so as to promote recovery and enable people who no longer need specialist services to control the planning and delivery of their own care. Introducing shared care approaches for many people with long term mental health conditions: this means a transfer of clinical responsibility from secondary to primary care, with the active support and collaboration of secondary care, and enhanced information exchange. Creating navigator roles to help people access services that can support them with a range of issues, such as employment and housing, which may be integral to their recovery. Enabling better partnership working and drawing on the expertise of individuals, family members, friends and carers, and a range of relevant professionals, especially in developing the most appropriate plan for an individual s care. Sharing of expertise by specialists to help build capacity in non-specialist services, and to ensure the holistic needs of individuals can be met without the need for them to be managed in secondary care. Reforming secondary care services to provide swifter access to people who need their input, and improve their capacity to develop the specialised mental health services that only they can provide. The competency framework also articulates the means by which the aspirations of the models of care can be achieved - improving communication between primary and secondary care, the voluntary and community sector, clinical commissioning groups and local authorities; ensuring that physical health needs are properly assessed and addressed by all services and the physical health inequalities suffered by people with mental health problems are minimised; promoting a personalised recovery approach, involving people s family, friends and carers where appropriate; reducing the stigma associated with mental health problems, as more people receive support in non-stigmatising settings; promoting the routine use of outcome measures in relation to mental health; and contributing to the delivery of the government s mental health strategy, suicide reduction strategy The London MHCF A competency framework for all those working with people with mental health problems in London 11

12 The London MHCF and quality, innovation, productivity and prevention (QIPP) plans for mental health. Changes across health and social care organisations and systems are such that commissioning, partnership and governance arrangements are still developing. However, clinical commissioning groups (CCGs), local education and training boards (LETBs) and health wellbeing boards will provide opportunities to lead service and professional improvement. Further considerations include an increasingly mixed provider market supplying health services to NHS patients and potentially greater choice for patients. There will be on-going challenges in ensuring sufficient integration of services and continuity of care for people with long term mental health conditions. The competency framework is designed to: framework was that it is also important to consider the competencies required to support and work with people outside of the core pathway for example, people who may not have had any formal assessment or diagnosis, or those who have had a diagnosis but seek most or all of their support independently, and not through formal referral and care planning processes. The focus groups and interviews identified a need for specific competencies required to effectively support people experiencing a mental health crisis. Such competencies are important in supporting people in crisis irrespective of whether they have had a formal assessment and diagnosis, have been referred to other services, or have a care plan. help to identify training needs within and across the health and social care workforce enable organisations to design and provide training to a consistent model help employers to draw up job descriptions be useable in group training support individuals self-assessment of their own development needs function as a guide for designing local care pathways and commissioning services. One aim of this competency framework is to identify the competencies needed to deliver the five functions in the core pathway effectively. In addition, the clear feedback from the focus groups and interviews held in developing this 12 London Health Programmes

13 How the framework is structured The competency framework is presented in three parts: Part one sets out universal competencies relevant to everyone who may, as part of their day-to-day work, come into contact with people with mental health problems. Part two sets out further competencies for staff who are not mental health specialists, but who work with a wider client group which may include people with a mental health problem, and/ or people who may be experiencing a mental health crisis. Part three sets out additional competencies for staff working with people with mental health problems either as a main client group, or as a significant part of a wider client group for example mental health clinicians and GPs. This new competency framework does not seek to replicate or replace the range of well-developed frameworks providing detailed coverage of the competence and capability requirements of different professional groups. Rather the intention is to articulate a set of knowledge, skills, attitudes and behaviours that are desirable and appropriate for everyone who comes into contact with people with mental health problems. Very specific or technical frameworks for certain mental health professionals are placed at the top of the diagram below. These are not examined in detail here, as they have their own rigour and legitimacy. Nothing within this London mental health competency framework is intended to contradict or replace these existing frameworks. Competencies for specific professional groups The London MHCF Structure of the competency framework Part three competencies Part two competencies Part one competencies A competency framework for all those working with people with mental health problems in London 13

14 The London MHCF How to use this competency framework The competencies in this framework are necessarily generic enough to apply across a wide and diverse range of people. Each part of the framework is additional and complementary to the previous parts: people with part two competencies should also have part one competencies; they are further competencies, not alternative ones. The competencies in this framework are intended to be developmental: it would not be realistic to expect all staff, across such a wide range of services and organisations, to have all these competencies as a minimum requirement. Rather, they are intended as competencies that clinicians, commissioners, managers and staff will aspire to, and will support staff to work towards through training and development. In considering these competencies, it will also be necessary to think about an individual s scope of practice the areas where a person has the knowledge, skills and experience to work safely and effectively. An individual s scope of practice is likely to change over the course of their working life, and may expand as they develop new skills, for example through training or education. When using this framework, individuals and their managers should pay attention to their existing scope of practice, what an individual is currently feeling confident and competent to do, and what impact it would have were they to gain some of the other competencies in this framework. organisational level to assist workforce leads, commissioners and training managers. At an individual level, the competencies can be used by individuals across a very wide range of services, professions and roles for selfdevelopment, to reflect on work and practice, and to identify development and training needs in discussion with their managers. At a team or organisational level, the competencies can be used by managers and commissioners to consider what competencies are required within a given team, service or organisation, and identify collective development and training needs. The competencies in part one should apply to everyone who may come into contact with people with a mental health problem as part of their day to day work, and therefore managers and commissioners should aspire to see all individuals within their organisations having part one competencies. For part two and part three competencies however, the requirements will differ according to factors such as, for example, the nature of the team, service or organisation, its functions, ways of working and overall skill-mix. The competency framework is designed to be used on a number of levels - at an individual level, at a team level or at an 14 London Health Programmes

15 How might evidence of the competencies be provided? There is no single right way to use these competencies as part of an assessment or appraisal process. As they apply across such a broad range of staff and professional groups, they will be assessed in different ways in different organisations and situations. It will be up to individuals, line managers, senior managers and commissioners to determine, in any given situation or service, which specific competencies are required, and what evidence they draw on to determine whether a competency is being met, however the following may provide useful examples of ways in which evidence might be gathered: Learning and reflections from: informal or formal study and reading; training courses (including accredited courses); attending events or conferences; watching programmes, videos or DVDs; shadowing other staff or visits to other services; conversations with people with mental health problems and/ or relatives and carers; networking and conversations with colleagues and others, membership of groups or forums; use of directories, toolkits and other resources. Using the competency framework Reflections on one s own work and practice and on interactions with others. Feedback from line managers, informally and/or more formally e.g. through one-to-one meetings, supervisions, appraisals and performance reviews. Feedback from colleagues, informally through discussions and/or more formally, including through reviews if these are available. Feedback received formally or informally from people who use the services or the public, about individuals or the service/place of work. A competency framework for all those working with people with mental health problems in London 15

16 Using the competency framework Using the competency framework The competency framework is designed to be used on a number of levels and settings; at an individual, team or organisational level. It will be for local consideration as to how the framework could be most usefully applied in different settings The table below provides an overview of a range of possible roles and how they might apply the framework. It is not intended that either the list of possible roles nor the potential applications should be considered exhaustive; they are included to provide guidance. Group definition Possible roles Part Part Part Application People who may come into contact with people with mental health problems as part of their day to day work Staff who are not mental health specialists, but who work with people who may have a mental health problem, and/or people who may be experiencing a mental health crisis, as part of a wider client group Primary care receptionist A&E receptionists Housing department staff Employment staff Voluntary sector staff Practice /district nurses Health visitors /health trainers A&E staff /general hospital staff Police London Ambulance Service staff Housing support workers Advice services Pharmacists Substance misuse workers Social care staff 4 Identifying areas for personal development Increasing mental health awareness Identifying individual training needs Preparing for appraisal 4 4 Personal development Increasing mental health awareness Indentifying individual training needs Preparing for and providing staff appraisal Informing policy development Service development Developing training programmes 16 London Health Programmes

17 Group definition Possible roles Part Staff working with people with mental health problems either as a main client group or as a significant part of a wider client group Mental health clinicians Police officers with particular mental health responsibilities GPs Voluntary sector mental health workers Mental health advocacy workers London Ambulance Service Navigators/peer support workers 1 Part 2 Part 3 Application Indentifying areas for personal development Identifying individual training needs Team training needs analysis Developing training programmes Informing and developing job descriptions and person specifications Service design and redesign Mental health strategy and policy development Using the competency framework Developing outcomes frameworks Local education and training boards (LETBs) Clinical commissioning groups (CCGs) Local HR, workforce and training leads Healthcare providers, education and training providers, and professional advisory bodies. Collectively commissioning education and training according to locally determined need. Healthcare providers, clinicians and professional advisory bodies. Collectively commissioning clinical services according to locally determined need. Individually or collectively designing policies and tools for organisations and health communities, to support recruitment, training, professional and team development and appraisal processes. A competency framework for all those working with people with mental health problems in London 17

18 Part one universal competencies Part One: Universal competencies One in four people experience mental health problems; it is likely that we will all encounter people with mental health problems at some point as family, friends, neighbours, work colleagues, and in our professional roles. Mental illness can affect all aspects of a person s life, including employment, family life, and friendships. There is a recognised need to improve basic understanding of mental health (also known as mental health literacy ). This can make a significant difference to how well people are supported formally and informally, and by many different staff and professional groups. Staff in first point of contact roles, such as reception staff in GP surgeries and accident and emergency departments, are key. valuable within organisations and agencies such as housing departments, education and advice centres. The competencies in part one are about having a basic awareness and understanding of mental health. They are not about diagnosis or treatment but will support staff to feel more confident in supporting those with mental health problems to manage their own lives and to access appropriate and effective help and support. Some staff need awareness; some staff need expertise. The competencies in part one also underpin the development of part two and part three competencies. The part one competencies are universal, and apply to all people who may come into contact with someone experiencing a mental health problem as part of their day to day work. They are fundamental to promoting positive mental health and have a significant impact on an individual s wellbeing. In particular, a focus on part one competencies may be particularly valuable for individuals and organisations with little experience or knowledge of mental health problems. They provide a framework to identify the knowledge and skills needed to respond appropriately to someone with a mental health problem and may be particularly 18 London Health Programmes

19 1. Personal orientation and interpersonal skills Domain and Competency heading Empathy Being able to understand the thoughts and feelings of other people, to see things from their perspectives, and to give sensitive and appropriate responses to other people's emotional states. Respect Interacting with other people with courtesy and respect, irrespective of their status (e.g. health, social, professional status). Not acting in ways which are rude, belittling, patronising, dismissive, or consciously hurtful. Nonjudgemental them. Accepting and valuing other people as they are, without judging attitude Evidence could include being able to Demonstrate an ability to reflect on own work and practice, including interactions with others (and possibly be able to describe changes in own behaviour or ways of working as a result). Part one universal competencies Holistic approach Self awareness Communication Being able to see the 'whole person' rather than seeing someone just in terms of 'a problem' or 'a diagnosis'. Self awareness of the impact of one's own behaviour, language, and body language on others, including people with mental health problems. Being able to communicate clearly, sensitively and effectively; this includes communicating both verbally and in writing, and sharing relevant information appropriately. A competency framework for all those working with people with mental health problems in London 19

20 Part one universal competencies 2. Awareness and knowledge Domain and Competency heading Awareness of Awareness of the prevalence of mental prevalence of health problems, and the likelihood that mental health many people may have experience of mental problems health problems. Awareness of Awareness of the main kinds of mental mental health health condition and symptoms (e.g. conditions and depression, anxiety disorders, bipolar symptoms disorder, schizophrenia). Evidence could include being able to Demonstrate an awareness of the range and prevalence of mental health problems. Demonstrate an understanding of the potential impact for people experiencing a mental health crisis. Awareness of concept of mental health crisis Awareness of concept of long term mental health condition Understanding of mental health stigma and discrimination Awareness of the concept and possibility of mental health crisis, and the potential impact on people's behaviour, feelings and perceptions when experiencing such a crisis. Awareness of the concept and possibility of long term mental health conditions, and the potential impact on people's behaviour, feelings and perceptions of living with a long term mental health condition. Understanding of the stigma and discrimination faced by people with mental health problems. Demonstrate an ability to reflect on whether there are gaps in own awareness and knowledge of mental health problems and how these might be addressed. Demonstrate an ability to apply own mental health awareness and knowledge in real-life situations, and to identify whether this knowledge was adequate for the situation(s). 20 London Health Programmes

21 3. System knowledge Domain and Competency heading Signposting people Knowledge of appropriate with a range of sources of help and mental health support for people with problems a range of mental health problems. Ability to signpost people to appropriate support. Evidence could include being able to Demonstrate knowledge of mental health resources including sources of information used to support people experiencing a mental health crisis (local resources and services). Demonstrate an ability to identify what additional resources could be drawn on. Part one universal competencies Seeking support to ensure the immediate safety of someone in mental health crisis Signposting people in mental health crisis Knowledge and ability to seek necessary help and support to ensure the immediate safety of someone experiencing a mental health crisis. Knowledge and ability to signpost people experiencing a mental health crisis to appropriate sources of help and support. Identify any gaps in knowledge of mental health system and resources, include: non-statutory as well as statutory services, specialist mental health services and non- mental health services. Demonstrate an ability to reflect how own mental health knowledge has been applied either formally or informally, whether that knowledge was adequate for the situation and what further knowledge would be useful. A competency framework for all those working with people with mental health problems in London 21

22 Part one universal competencies 4. Proactive behaviour Domain and Competency heading Non-discriminatory Non-discriminatory behaviour towards behaviour people with mental health problems. Evidence could include being able to Demonstrate ability to reflect on individual work and practice, including any situations where this competency has been demonstrated. Understand the nature of discrimination in mental health. Demonstrate the ability to challenge inequality and discrimination in own role. Taking responsibility Willingness to take responsibility for positively addressing a situation where somebody with mental health problems needs support. Demonstrate ability to reflect on individual work and practice, including any situations where this competency has or has not been demonstrated. 22 London Health Programmes

23 Applying part one competencies in practice How do these competencies support implementation of the core pathway and London mental health models of care? These competencies should support staff to recognise that a person may be experiencing a mental health problem, to offer an empathetic and sensitive approach, and to signpost them to appropriate support. The competencies in part one will support staff to have the self-awareness to understand the impact of their own behaviour, language and body language, provide a good understanding of the stigma and discrimination faced by people with mental health problems, and to demonstrate non-discriminatory behaviour themselves. They should help staff in developing a good knowledge of local resources both to refer people formally, and also to signpost people to other sources of support, including nonstatutory services. This should help people access support beyond statutory health and social care services, for example housing or employment advice, education or training, self-help groups, support from mental health charities, or volunteering opportunities. Stigma and fear of discrimination can lead to reluctance to engage with mental health services. It is important that people involved in any part of the pathway understand this as it can fundamentally shape the quality of people s experience of mental health care, treatment and support, and willingness to seek appropriate ongoing help. If staff demonstrate self awareness and an understanding of the stigma and discrimination faced by people with mental health problems, they are more likely to build relationships of trust and engage in ways that enable people to play a full and active role in determining and achieving their own care goals. Whilst support and signposting are not identified as a part of the core pathway, they are key to reducing stigma and helping people to access the right support. For some this will mean entering the care pathway through an assessment, and for others getting support through wider community resources. Without empathy I don t believe there can be a change in attitude and behaviour. Highly developed empathy, a respectful and non-judgemental attitude, and a holistic approach are all important competencies for anyone carrying out any function on the pathway: the pathway makes clear that assessments should be done in a holistic, person-centred way, and include a person s physical health as well as mental health These same competencies remain core for all the other functions in the pathway: effective referral to appropriate services; planning and Part one universal competencies A competency framework for all those working with people with mental health problems in London 23

24 Part one universal competencies It makes such a difference when someone treats you as a normal human being. development of care plans (and living well, wellbeing and crisis plans, as appropriate); intervention and treatment, and evaluation. They are fundamental to building strong, positive and trusting relationships with people with mental health problems, and with their families, friends and carers. of mental health crisis and of long term mental health conditions will enable staff to feel more confident to support people experiencing mental health problems more effectively, in a range of different settings. In some cases, these will be covered by people s professional training and the clinical and profession-specific competencies required to perform these functions. An appropriate awareness of the prevalence of mental health problems, of conditions and symptoms, and of the concept and nature The best doctors are nonjudgemental, compassionate, kind and take you seriously. 24 London Health Programmes

25 Part two competencies These are competencies for staff who are not mental health specialists, but who work with people who may have a mental health problem, or who may be experiencing a mental health crisis, as part of a wider client group. There are a large number of roles whose main focus is not on mental health, but where staff need a good knowledge of mental health issues and to be able to engage supportively and effectively with people with a range of mental health problems. It is likely that increasing numbers of staff who are not mental health specialists, or who work outside traditional mental health services, will become more involved in providing support, care, treatment and services to people with mental health problems. Some non-mental health staff work with people with mental health problems and require the skills and knowledge to respond and provide appropriate support. In addition, staff in certain roles are likely to encounter people experiencing a mental health crisis and need to have the knowledge or training to know how best to respond as safely, effectively and supportively as possible. They need to recognise when people may be experiencing a crisis and have the confidence and competence to help respond appropriately to that crisis and enable the person to get the care and support they need. It may not necessarily be their role to provide these themselves. The focus of part two competencies is on building skills and knowledge of mental health issues, to increase the confidence of staff in a variety of settings and to improve the support provided to people with mental health problems. Competencies in this part of the framework may be particularly valuable in relation to services/organisations in which there is a need to have a good level of mental health knowledge to be able to recognise and respond to people with mental health needs and be able to recognise and respond to people experiencing a crisis. This may include primary care staff, police, ambulance and A&E staff as well as staff in a range of other settings including some housing support and employment staff. It will be for commissioners and managers to decide what proportion of staff, and which posts or roles, should have these competencies within a given team, service or organisation. It is important to note that people with part two competencies should also have part one competencies - these are additional competencies, not alternative ones. Part two competencies A competency framework for all those working with people with mental health problems in London 25

26 Part two competencies Part two For staff who are not mental health specialists, but who work with people who may have a mental health problem, and/or who may be experiencing a mental health crisis, as part of a wider client group 1. Personal orientation and interpersonal skills Domain and heading Working sensitively with people in distress Working collaboratively, including in a crisis situation Competency Ability to work empathetically and sensitively with people in distress, in a way which is calming and reassuring, and seeks to reduce their distress. Interacting with other people with courtesy and respect, irrespective of their status (e.g. health, social, professional status). Not acting in ways which are rude, belittling, patronising, dismissive, or consciously hurtful. Evidence could include being able to Demonstrate an ability to reflect on own work and practice, including interactions with others (and be able to describe changes in behaviour or ways of working, as a result). Demonstrate understanding and appreciation of the role of others involved in providing support, care, treatment and services to people with mental health problems. 26 London Health Programmes

27 2. Awareness and knowledge Domain and Competency heading Awareness of Ability to recognise that someone the signs that may be experiencing a mental someone may health problem and to respond be experiencing appropriately a mental health problem Awareness of Awareness of the concept and possibility of possibility of mental health crisis, mental health and the potential impact on people's crisis, and behaviour, feelings and perceptions potential impact when experiencing such a crisis. on people's (This requires a more detailed level behaviour, of awareness than in part one, and feelings and is linked to the ability to identify perceptions immediate symptoms of possible mental health crisis, below.) Identifying Ability to identify the immediate immediate symptoms and behaviours symptoms of that indicate a person may be possible mental experiencing a mental health crisis, health crisis and to respond appropriately Evidence could include being able to Demonstrate an ability to recognise the signs that a person may be experiencing a mental health problem Demonstrate an ability to respond sensitively, safely and appropriately to a person with a mental health problem Demonstrate understanding of the potential impact of a mental health crisis on people s behaviour, feeling and perceptions. Demonstrate an ability to identify immediate symptoms and behaviours that indicate that a person may be experiencing a mental health crisis. Demonstrate an ability to respond sensitively, safely and appropriately to a person experiencing a mental health crisis. Part two competencies Understanding concepts of risk, risk assessment, and risk management Understanding of concepts of risk, risk assessment and risk management in relation to mental health crisis and in relation to long term mental health conditions. Ability to apply these concepts by making judgements about risk in the immediate situation when dealing with and supporting a person experiencing a mental health crisis, and/or when dealing with and supporting a person with mental health problems who is not in crisis. Continued u A competency framework for all those working with people with mental health problems in London 27

28 Part two competencies Knowledge and ability to provide support to ensure immediate safety of someone experiencing Knowledge and ability to provide necessary help and support to ensure the immediate safety of someone experiencing a mental health crisis. Demonstrate understanding of the concepts of risk, risk assessment and risk management in relation to mental health problems and mental health crisis, and ability to apply these concepts in own judgements and actions. mental health crisis Demonstrate the ability to apply a range of De-escalation skills Ability to apply a range of skills and learnt techniques including both verbal and non-verbal communication skills with the aim of reducing a person's anger, aggression, agitation, hostility or skills and learnt techniques including both verbal and non-verbal communication skills with the aim of reducing a person s anger, aggression, agitation, hostility or distress and preventing disturbed, unsafe or violent behaviour. Suicide intervention skills distress and preventing disturbed, unsafe or violent behaviour. Ability to recognise the signs of distress, including suicidal thoughts and intentions, and to provide an appropriate response to support a person at risk of suicide to remain safe. Ability to recognise the need Demonstrate the ability to recognise signs of distress, including suicidal thoughts and intentions, and to provide an appropriate response to support a person at risk of suicide to remain safe; and the ability to recognise the need to seek further advice/ support as required. to seek further advice/support as required. Understanding Understanding that people can Demonstrate understanding of the different different kinds experience many kinds of crisis that kinds of non-medical and non-health crises of crisis that can are not health or medical crisis, that people can experience, and of the ways affect mental but that can affect people s mental in which these can affect people s mental health health (e.g. social crisis, housing health. crisis, financial crisis, etc). Demonstrate ability to respond to people experiencing such crises in ways that are sensitive to the potential impact on mental health. Understanding Understanding the relationship Demonstrate an understanding of the need to the relationship between mental health and physical exclude physical causes for mental health. between physical crisis and the need to exclude and mental health physical health problems (for crisis example impact of infection and pain in the elderly). Continued u 28 London Health Programmes

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