Reflections of influences on mental health placements: these were in Community Mental Health Teams (CMHT) and secure inpatient units.
- Politics removal of benefits
- reduction in PIP* for one lady with severe anxiety reduced her support and reduced access to the community as a result, she felt her MH was worsening
- What? middle aged man with EUPD & psychosis felt it was unfair the cuts to disabled benefits, when he was assessed for his PIP he felt because he could ‘function’ in the interview and speak coherently he was marked up in his ability whereas he felt he could not manage day to day. He said this reflected people often dismissing mental health because it cannot be seen and he looks ‘normal’.
- So what? He felt very angry about this and sometimes this was directed at any healthcare staff even those not responsible for benefits, such as when groups were cancelled due to staff shortages.
- Now what? Reflected at the time that it must be difficult to find an outlet for your frustration and anyone working for public sector could be a symbol of the government, remember to not take anger at service constraints personally.
- Legal Mental Capacity Act; sometimes cannot obtain consent, and this limits ability to provide person-centred care as constrained to hospital environment and restricted with resources. For one young man on secure unit eg he could not have scissors and was restricted to certain areas eg not kitchen, this meant most occupations carried out were contrived to some degree and difficult to provide true meaning when practising life skills.
- Policies cuts to budget do not align with proposed ‘parity of esteem’ policies…ideas to make this work (from Five Year Forward View) include multi-speciality community teams. In practice I saw working in the same building but not TOGETHER, there were still separate referral pathways etc, this needs to be integrated more to be effective. In other teams there was effective MDT working between professions however, they held weekly ward rounds where all professions met and updated each other.
- Trends mindfulness classes given in CMHT; psycho-education to increase understanding and personal control of clients’ anxiety and management of physical anxiety symptoms
- Professional conduct guidelines confidentiality [section 3.4 in RCOT code of conduct] meant OTs on placement were seen to be respectful about clients and kept their details confidential, anonymising information on registers, emails, reports etc, being careful not to discuss clients in front of other clients.
Mental Health Taskforce (2016) Five Year Forward View for Mental Health for the NHS in England online at https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf
Mental Capacity Act
RCOT code of conduct and ethics.