Recommendation
Trusts should ensure that new CPA guidance is or has been implemented and that this is fully understood by staff and supported with intensive training.
Recommendation
Where there are several agencies involved with a patient and one of those agencies (be it health, social care, probation, or police) has implemented or considered implementing a ‘lone worker’ or ‘home visit’ policy in relation to that patient, this …
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Where there are several agencies involved with a patient and one of those agencies (be it health, social care, probation, or police) has implemented or considered implementing a ‘lone worker’ or ‘home visit’ policy in relation to that patient, this should be communicated to the other agencies involved, either through the care coordinator, or through public protection arrangements.
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Recommendation
Staff dealing with patients whose behaviour is clearly risky or potentially risky, who have a history of detention in hospital as offenders, or have had dealings with the criminal justice system for violent offences, need to know when, and how, …
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Staff dealing with patients whose behaviour is clearly risky or potentially risky, who have a history of detention in hospital as offenders, or have had dealings with the criminal justice system for violent offences, need to know when, and how, it is appropriate to refer to MAPPA. The criteria and MAPPA referral procedures, external and internal to the particular organisation, should be made crystal clear to all mental health professionals, including doctors, working in front line services, should be part of any induction programme and a regular and compulsory part of ongoing training. The training need not be burdensome, lengthy or expensive.
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Recommendation
Similarly, staff should be made aware of the potential for referral to MARAC, and to MAPVA, and clear about the criteria and procedures as set out above.
Recommendation
The panel recommends that the question of continuity of care is addressed; where possible, care should follow the patient, and where a patient moves within a reasonable distance, there should be no undue haste to enforce changes of service provider.
Recommendation
Trusts should take the opportunity to review the joint working arrangements within teams, to determine whether appropriate opportunities exist for clinical supervision, peer and case review, and to instigate procedures if not.
Recommendation
The panel recognises the pressure that may force psychiatrists to rapidly admit a patient to hospital where there is an urgent need for treatment. However the appropriateness of the placement should be kept under close review, and the trust should …
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The panel recognises the pressure that may force psychiatrists to rapidly admit a patient to hospital where there is an urgent need for treatment. However the appropriateness of the placement should be kept under close review, and the trust should ensure that the responsible psychiatrist is supported in finding an alternative placement when clinical need, or the safety of staff, is an issue. The trust should also ensure, wherever possible, that choice of hospital is motivated not by expediency but by matching the patient’s need to the care that can be offered.
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Recommendation
Trusts should review clinical practice to ensure, in relation to psychometric tests, that they are only regarded as an adjunct to clinical judgement to inform diagnosis. They should not, on their own, be regarded as diagnostic instruments.
Recommendation
Trusts needs to be clear where the remit for working with people with personality disorders falls. It needs to be recognised that personality disorders can be as serious as illnesses such as schizophrenia in terms of their negative impact on …
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Trusts needs to be clear where the remit for working with people with personality disorders falls. It needs to be recognised that personality disorders can be as serious as illnesses such as schizophrenia in terms of their negative impact on the individual and the society around them. Appropriate, ideally specialist, services need to be provided for such patients, and the professionals working with them need specific training and support.
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Recommendation
Whilst not all patients who have been in medium secure hospitals require ongoing support from forensic services, mechanisms should be put in place to ensure that such patients are discussed with the local forensic services when they are discharged into …
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Whilst not all patients who have been in medium secure hospitals require ongoing support from forensic services, mechanisms should be put in place to ensure that such patients are discussed with the local forensic services when they are discharged into the community. Ideally, the forensic services should be invited to attend the pre-discharge care planning meeting, but if this is not possible, then the treating community team should subsequently discuss the case with their local forensic team.
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Recommendation
Trusts should endeavour to improve the joint working between the addiction services and the adult mental health services, with sharing of information and collaborative care coordination.
Recommendation
Trusts should ensure that all patients subject to CPA have a designated care coordinator who should be responsible for following the patient throughout stays in hospital whether locally or further afield, within the NHS or within the private sector. It …
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Trusts should ensure that all patients subject to CPA have a designated care coordinator who should be responsible for following the patient throughout stays in hospital whether locally or further afield, within the NHS or within the private sector. It should be the responsibility of the treating hospital to ensure that care coordinators are invited to care planning meetings, and that they are kept informed about any impending significant changes to the plans. Where the patient has been placed outside the locality, the care coordinators should, in turn, ensure that other relevant professionals in the locality are informed of all developments.
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Recommendation
Alcohol services often stress that patients need to engage with them on a voluntary basis. However, this does not preclude the need for these services to make every effort to motivate the patients to engage. Staff working with this client …
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Alcohol services often stress that patients need to engage with them on a voluntary basis. However, this does not preclude the need for these services to make every effort to motivate the patients to engage. Staff working with this client group should to be trained in such techniques, and to receive regular supervision.
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Recommendation
Trusts should review the provision and availability of “talking therapies”, including dialectic behavioural therapy in the trust area and encourage clinicians to actively consider whether the needs of a patient should be addressed by psychotherapy or psychology. This is particularly …
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Trusts should review the provision and availability of “talking therapies”, including dialectic behavioural therapy in the trust area and encourage clinicians to actively consider whether the needs of a patient should be addressed by psychotherapy or psychology. This is particularly important where a patient (such as Louisa Ovington) has suffered some form of extreme childhood trauma.
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Recommendation
Trusts should ensure that all mental health professionals and staff across the various services are clear about who can make referrals to any other branches of the services, including psychiatrists, psychology, forensic, CMHT services, CRT, AOT and what the mechanism …
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Trusts should ensure that all mental health professionals and staff across the various services are clear about who can make referrals to any other branches of the services, including psychiatrists, psychology, forensic, CMHT services, CRT, AOT and what the mechanism for referral is.
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Recommendation
Trusts should disseminate across the services the criteria established by each branch of the service for acceptance into, and exclusion from that service.
Recommendation
Trusts should review all policies, formal or informal, that prescribe general rules for discharge from services, and ensure that they are not applied in a formulaic way. Discharge should be dictated not by non attendance per se, or by self …
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Trusts should review all policies, formal or informal, that prescribe general rules for discharge from services, and ensure that they are not applied in a formulaic way. Discharge should be dictated not by non attendance per se, or by self evaluation, or by rigidly applying service criteria, but by clinical need and an up to date assessment of risk. If a patient has repeatedly failed to attend appointments, careful consideration should be given to whether more active steps should be taken to ensure engagement. The care coordinator’s opinion should be sought, as he or she is likely to have a broader knowledge of the patient.
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Recommendation
There should be programmes in place to ensure those working with patients with personality problems are appropriately trained in motivational interviewing and engagement techniques.
Recommendation
Trusts should ensure that appropriate channels of communication are set up between mental health services and all other agencies working with patients. Care programme meetings could be a forum for this. GPs should be invited to attend all such meetings. …
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Trusts should ensure that appropriate channels of communication are set up between mental health services and all other agencies working with patients. Care programme meetings could be a forum for this. GPs should be invited to attend all such meetings. Where criminal justice professionals are involved with a patient, the CPA meeting should be used as an opportunity for liaison with and sharing of information between all the different agencies.
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Recommendation
Trusts should ensure that all policies include the production and review dates; the author; the organisation to whom it relates and are archived in a system, preferably electronic, where easy access is available.
Recommendation
Trusts should ensure that all professionals keep up to date, contemporaneous notes that are organised methodically and in such a way that they are readily accessed (by those authorised to do so) and easily understood.
Recommendation
A comprehensive, regularly updated chronological history should be maintained which is accessible by all those (authorised to do so) who are dealing with the patient.
Recommendation
Formal care planning meetings, involving current and future care providers, must be held prior to a patient being discharged from hospital, and prior to any event that is known to have the potential to result in the patient being discharged …
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Formal care planning meetings, involving current and future care providers, must be held prior to a patient being discharged from hospital, and prior to any event that is known to have the potential to result in the patient being discharged ( in this case, the expiry of the Section 38 order).
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Recommendation
Where trusts are commissioning services from independent sector providers, trusts should ensure that the practice of those providers complies with those recommendations.
Recommendation
The panel is concerned that many of the above conclusions and recommendations echo those made in other investigation reports, therefore consideration should be given to the use of such reports for training purposes. Additionally, the panel hopes that this report …
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The panel is concerned that many of the above conclusions and recommendations echo those made in other investigation reports, therefore consideration should be given to the use of such reports for training purposes. Additionally, the panel hopes that this report is widely disseminated across agencies.
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Recommendation
If a patient is admitted to an independent hospital outside the local area, progress reports are sent to the care coordinator and the funding authority at least every three months.
Recommendation
Care coordinators may leave their posts at short notice. The panel accepts that this, and difficulties in replacing staff, may militate against good handovers between care coordinators. However, trusts should ensure that transfers of care are agreed to in writing, …
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Care coordinators may leave their posts at short notice. The panel accepts that this, and difficulties in replacing staff, may militate against good handovers between care coordinators. However, trusts should ensure that transfers of care are agreed to in writing, that the new care coordinator accepts that he/she is taking on responsibility for the patient, and that CPA documentation includes a full and up to date historical summary that can be handed over to the new care coordinator.
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Recommendation
Trusts should give serious and urgent consideration to implementing a unified computerised record keeping system on which all entries relating to the day to day working with a client are recorded, by all mental health professionals.
Recommendation
Trusts should ensure that a thorough needs assessment is carried out for both carers and “significant others” to properly inform risk assessments and care plans.
Recommendation
Trusts should ensure that accurate and regularly updated risk assessments, using a reliable tool, are carried out, and that the results of these are incorporated into risk management plans. This should be supported by training and regular audit.
Recommendation
Trusts should review policies and ensure that there are up to date ‘lone worker’ or ‘home visit’ policies in place in each part of the front line services, that staff are aware of such policies, and aware of the procedures in place to implement them.