MENTAL HEALTH
The Planning Process
Peter Marshall, on-site psychiatrist at Exemplar Health Care’s Lakeview care home in Leigh, advises on developing care plans for people with complex mental health needs.
Complex mental health needs can vary dependent on the illness the person is suffering from, their previous coping mechanisms and wider factors that could compound their response to treatment, such as other illnesses, allergies and support network.
Due to the above, the plans for people with complex mental health needs are going to be different, even if two people suffer from the same illness. This means that, when developing the plans, there are no shortcuts and it is imperative that all people involved in the care of the person are involved in developing the care plan.
The aim of the plan has increasingly been focused to make all the care person-led, and this means starting any plan of care from the point of view of the person. Every person with health and social care needs is treated as an equal partner by the wider plan team in developing a collaborative care and support plan.
The group of healthcare professionals caring for the person work to ensure that the information in the plan is meaningful, relevant and accessible to the person and identifies health and wellbeing outcomes. The plan identifies key people, including family, who provide support and notes who will do what and when they will do it. This is particularly important for people with complex health needs, as the dedicated support from the same core team in the long-term can support their independence and ability to care for themselves outside of the care home environment.
Another key element of the plan is understanding that it needs to be fluid. Complex mental health needs can have periods where the person’s needs are more complex than at other times and they might require different support, medication and strategies to keep them safe.
By adapting person-led care, it enables people with a wide range of differing severe mental health problems to be heard, to be treated with dignity and to be actively involved in their care. The benefits of this can be critical for the person with complex mental health needs and this has been highlighted across a number of people in Exemplar’s care.
One example of an individual who has benefited from Exemplar’s Care is 48-year-old Tim. Tim began experiencing mental health problems as a teenager and throughout his life has suffered from anxiety, depression, extreme agitation and symptoms secondary to trauma. In the early 90s, he spent eight months in rehabilitation.
In the following 13 years, Tim’s mental health continued to decline and he was detained under the Mental Health Act, before being moved to a Psychiatric Intensive Care Unit. By May 2015, Tim found support at an Exemplar care home and he received the person-led care he had been missing.
Supported by in-house and external teams, Tim was able to regulate his sleeping pattern and began counselling. Over time his independence and confidence increased, and he began to take action when his moods gave him cause for concern.
As he became more independent, he was able to leave the home and enjoy walking, going to the cinema and attend a maths and computing course. Two years later, Tim was able to move into Exemplar’s OneCare service – an extended pathway of care where he now lives with more independence.
Setting his own goals and timescales, Tim is now living life to the full, and moving closer to his goal of returning to live in the community.
When developing care plans for someone with complex mental health needs, it is helpful to keep the following key points in mind:
• Who is in the wider care group that needs to be consulted to develop the plan?
• Are the people with the complex mental health needs involved and do they have capacity or is there knowledge of preferences made when they had capacity?
• How can you maintain the dignity of the people on a long- term basis?
• What actions do you need to put in place if there needs to be changes at short notice?
www.exemplarhc.com
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www.tomorrowscare.co.uk
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