Respected, Included & Supported. Listening to Patients in Forensic Services

By Michael Salter – Involvement Volunteer

 My journey in this whole process began three years ago when I developed excessive anxiety and became significantly depressed.  I retired from the teaching profession, but I had too much time on my hands.  I moved house but felt increasingly isolated.  Life was a drag. 

There was so much I wanted to enjoy but I needed help to get out of my Doldrums.  I couldn’t understand the physical symptoms that accompanied my mental turmoil.  Incidents that I would normally shrug off.  

I was fortunate that my GP directed me towards Cognitive Behaviour Therapy (CBT) provided by Let’s Talk, Well-being. Other things that helped? Support from friends, a mindfulness course, time plus my own efforts and eventually Fluoxetine gradually helped me back to a much more happy mental state. 

Most important was the introduction that I was given to the Involvement Team and volunteers at Rosewood Involvement Centre which is one of the Trust’s bases in New Ollerton.

I was rapidly welcomed, accepted, DBS checked, approved, encouraged, trained, included, supported and introduced to some of the challenges and opportunities within Mental Health Services where I could make a difference.

Rosewood usually has a wonderful atmosphere.  We are a community and something of a family, though we don’t bicker all the time!  ‘Welcome home’ seems to sum it up.  At meetings and events in various hospitals I was quickly accepted and appreciated. I soon found out that I really enjoyed interacting with patients who had experienced traumatic and chequered lives. They are fellow human beings and they have feelings like anyone else.  They may have complex needs but they too want to feel better, to recover and to have more self-respect and interact meaningfully and to have a present and future with a positive aspect.

Initially I was able to shadow experienced Involvement Volunteer ‘buddies’.  I attended patient forums and helped with staff interview training. I was encouraged to support some of the events held in forensic settings such as sports and carers events and the Sense of Community project at Rampton High Secure Hospital. 

Through this I got to know some of the patients and found some common ground and interests. I was accepted and frequently welcomed into their restricted world.  As volunteers we build up a sense of trust with many patients.  We can enjoy each other’s company too.

As an Involvement Volunteer, I find myself frequently meeting patients (mostly in forensic settings) and asking them to express their thoughts, feelings, concerns, opinions and suggestions about the services they receive.  A major concern is that this should not be a stressful experience nor a frustrating one, for each and every patient.  There is a real risk of feedback fatigue particularly in secure hospital settings where patients can be resident for several years. Here, meaningful interaction may be much more important to patients than continually covering old ground with negative gripes, complaints and frustrations. This image has an empty alt attribute; its file name is picture1.png

Gathering information is most important in progressing the care and treatments for all patients but if the process is too hard for patients who are unwell and if nothing is seen to improve or if patients are surveyed too frequently (and by people who are not in tune with their particular circumstances or stages of recovery) it can be counter-productive.  If nothing is done with the feedback that is gathered, then it simply adds to the frustrations of patients.  For that reason, official action plans are developed from the surveys and these are regularly reviewed in Patient Forum meetings and in management settings within each forensic service. 

Any concerns, ideas and initiatives are considered as openly as possible.  By doing this any outdated restrictive practices may be modified and patients say they feel more empowered in their everyday lives and recoveries. 

Care Opinion (an independent and public online forum) is another way in which patients (and carers) can have a say and share their stories.  It is often used in a positive way, reflecting on special events (such as patients’ OSCARS) any care received, and thanks for staff that ‘go the extra mile’.  At other times it can be a way to raise concerns anonymously.

This image has an empty alt attribute; its file name is careopinion_logo_2_colour_rgb_72dpi_with_strapline-2.png Most importantly, these stories get an online response from staff within two working days.  Within Forensic services, stories and responses are printed and displayed on wards or communal patient areas. (Patients have no access to the Internet at Rampton High Secure Hospital).  This transparency is essential. It helps to bring about changes and reminds patients that they are not forgotten by society.

The approach offered by Feedback Involvement Volunteers is supportive.  We are not judgmental.  We accept patients as we find them on the day. Some are receptive and happy to communicate but some may be unwell or affected by their medication.

We have found that the most meaningful sessions are those where we can chat informally but we mostly listen. We make notes that are approved by patients and find out what they feel is really important. Sometimes we have the opportunity to share a joke and appreciate each other’s company.

Communication skills are phenomenally important. 

Everyone needs continuity in communication both staff and patients alike.  Patients need to be kept in the picture and to feel valued and included.

We try to listen effectively and acknowledge other people’s opinions even if we don’t agree.  The settings in which patients live are their homes for the time being.  Do we give patients the respect they would like? Are they being kept safe and does any concern they raise mean that their privacy is compromised? How can improvements be made bearing this in mind.  How can each patient have the best possible input into their Care Plans and what are the issues that rise from living in such close proximity to other patients who have their own concerns to deal with?

We often stress that we are not staff and that our lived experience of mental health issues gives us some common ground with patients.  In most settings staff are trusted, liked and appreciated by their patients.  This is something we as volunteers must not undermine but it may be easier for some patients to feedback honest opinions, views and criticisms to us.  Except in serious safeguarding circumstances, this anonymity is something we aim to protect.

Good staffing levels are critical to safe, positive, recovery-orientated treatment in mental health settings. Crises will inevitably arise and be managed and subside BUT, happy, top-quality, motivated and well-trained staff are absolutely essential too. I’m pleased to say the feedback that we get (usually) reflects this!

Michael in Colorado

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