I want the Mental Health Service, in all their guises, to start treating their patients in a more holistic way. So, perhaps I’ll start off by saying what I mean by holistic.
Simply, it is by not only treating the patient, but also by treating the carer/family and involving them in the team treating the sufferer.
In my experience, holistic treatment of patients is unheard of in the hospitals, though here I do have to make an exception in the case off the Willows Unit, which is a treatment and recovery centre, a specialist facility, who are an absolutely wonderful unit, who fully understand and apply the principal of holistic care.
It has to be said that the Willows unit, being a specialist, has a higher staff to patient ration, so that it is easier for them, but if the other units would embrace the philosophy, they would find their workloads and stress levels reduced, as well as providing better care for everyone involved.
We can split the service into three primary stages, being pre-admission, in-patient and community care post discharge.
We will start by looking at the pre-admission stage. Generally the first step is to visit the GP who , depending on the situation, may offer one of a number of solutions, ranging from “keep away from the stressors” via medication, cognitive behavioural therapy and referral to a psychiatrist. Often the first visit will be in the relatively early stages, and the doctor will treat the patient as for a physical illness.
However, once the problem has reached the stage where the patient needs a professional to keep an eye on them, involving either the County Crisis team or support from Social Services, it is important to fully involve the carer and the extended family if appropriate.
The professionals must remember that they have been trained to deal with mental illnesses, that they only see the patients for a short period. The carer, be it husband, wife, parent, child, has not been trained, has the situation to deal with around the clock, 24 hours per day, seven days a week, there is no break and they do this caring with no support, no real advice and no training. This is an all but impossible situation. The carer doesn’t know how to cope, how to deal with the patient, and can get no respite.
If the professionals could understand this, at the first appointment they should get to know the patient and the carer, to learn what skills and knowledge they have, and to understand the needs of both patient and carer, and provide the support and training to help the carer as well as the patient.
The implication of the professionals not engaging with the carer is that the carer becomes stressed, has a reduced tolerance to the symptoms of the patient and cannot help them properly. This leads to the patient not being properly cared for and to the carer becoming exhausted, frustrated and struggling to cope with the situation. Holistic treatment will give pointers into how to deal with the patient, and give the professionals a much better idea of the circumstances of the illness and care as well as the medical details. This can only benefit everyone concerned
Proper support for the carer at this stage will do many positive things. It will give the carer some real input into the treatment, educate them and allow them to support their patient much more effectively.
If the situation does not improve, or deteriorates, the next stop is likely to be admission to one of the acute wards in hospital.
On the ward, the way forward is to ensure that everyone is working towards the same goal, the recovery of the unfortunate patient. The way to do this is to involve the family, that is the primary carer and the close family in the treatment. If they know what is happening, and if the ward staff consider their health, both physical and emotional, as well they will get more support from them, confidence and rapport can grow and a great deal of work can be taken off the shoulders of the ward staff.
I think this is rather easy to achieve. When a person is admitted, there is a fair chance that their carer will be with them. Do the initial admission documentation, explain to the patient and carer ward protocols, who is who, who will be involved in the treatment. That way everyone knows what is going to happen
Show the patient and carer around the ward, there could be some issues of confidentiality and dignity in the case of a mixed sex ward, but these can be overcome with thought.
The carer has a wealth of knowledge and experience of the patient, both when they are well and when they are ill, they will know the likes and dislikes, it is important to have an easy dialogue with the carers to extract this knowledge, don’t forget the carer is not a specialist in Mental Health Care and may well not know what is relevant, what is important and what is irrelevant, so it is important to have these discussions, and record the answers.
There is a major question I believe around the protected meal time issues. I have been on the ward during the protected meal time and seen a patient Take a dinner, throw it all into the bin untouched only to be told at a ward round next morning that they had eaten a good meal and left nothing on the plate. This is simply not acceptable as for many patients eating is a crucial component of the care and treatment. We cannot, however, blame the nurse in question. When there is a ward of 18 people, it could be that 9 or 10 have eating issues, but there may be only two or three staff to supervise them, in which case they cannot be expected to be able to oversee everyone, but of course that is no help to the patient, and is very upsetting to the carer.
By all means have protected meal times, but at present it looks as though they are protected purely so that carers are not aware of the shortcomings, simply invite the carer to stay with the patient to assist with meals.
Most carers will be glad to do that, and there are so many benefits, including better supervision of patients at meal time and inclusion of the carer.
For a carer, regular visiting of a patient on a psychiatric ward is incredibly draining, and incredibly distressing. If the carer feels they are not included in the process the situation is even worse. If the carer becomes ill as a result, which is not uncommon, their support of the patient deteriorates, putting more pressure on the ward staff.
It would not be difficult for the staff to simply welcome the carer and assess their well-being in a short conversation. The staff can then help to keep the carer as well as possible, which will also in the longer term, help them in their work.
Carers should always be invited to Ward Rounds, they will often not be able to attend because of work commitments of course, but the invitation shows a desire to include them, which is important. The ward round itself should be open, honest and effectively run. The medical staff should be able to draw on the knowledge and views of the carer in support of the patient, and should be willing to be sure that the carer understands the current situation and the future plans for treatment, as far as they are known. It is no help to the carer to be told, as I have been, that we would rather make something up than say I don’t know, and to ask me questions about the patient that they should be telling me.
This simply undermines the carers confidence and respect for the medical team, and of course does not help their emotional or physical health, as it simply causes frustration and stress.
Finally, we need to consider the care after discharge. The discharge plan must be for the benefit of the patient but crucially must also take account of the carers condition and circumstances. If it doesn’t the carer is put under more pressure, more stress, and their health can suffer, and have an adverse effect on the carer, in the worst case, both could end up back in hospital.
It is so important that the carer is fully involved in the treatment of a patient. The carer is a crucial part of the team and if not included, can feel abandoned, suffer severe stress and end up as a patient. Not only that, but when not included the patient will lose confidence in the medical team, lose respect for them and this can lead to tensions and stress that make things more difficult for patient, carer and service provider. This makes everyone’s job, and life, so much more stressful and difficult, and is very negative.
In the best run wards, as with industry, mistakes will be made as we are all human, none of us is perfect. When things do go wrong, whether in reality or in the perception of the patient/carer it is important that the staff should listen to the issues, and either reassure and explain why the perception is wrong, or they should accept the criticism, highlight the problem to the staff concerned and do all possible to ensure that it doesn’t happen again. When the staff are defensive, and refuse to listen to and accept the criticism, it further undermines the carers confidence and trust.
I have seen this holistic approach in action in the unit on which my wife currently is. I have seen how effective it is, and how much more relaxed the patients, carers and staff is at all times. It is wholly conducive to everyone working together, a fully supportive network working for the improvement of the patient.
I have also seen the opposite, where carers are viewed as a nuisance, disregarded and generally treated with contempt. I know which approach I prefer, and I am sure that the staff would agree.
It is not much to ask…please treat the patient as well as you can, by fully involving the carer and family in the treatment, and developing a fully effective team to help the patient
No comments:
Post a Comment