Leanne Taylor

Head above the neck

Background

We would all benefit from accepting that every person has both mental and physical health, and that there should be no shame in properly planning the care of individuals with mental health needs, regardless of their reason for attending hospital. A benefit of this would be a better experience for patients and staff, and a possible reduction in crisis situations or so-called ‘challenging’ behaviour.

This project aims to improve patient care for those with mental health conditions entering a general nursing environment, improve staff experience in these situations, increase understanding, reduce stigma, and remove the ‘taboo’ of mental health. 

 

We would all benefit from accepting that every person has both mental and physical health, and that there should be no shame in properly planning the care of individuals with mental health needs, regardless of their reason for attending hospital

 

My plan is to implement a set of mental health questions to all general/accident and emergency admission forms so that every patient is asked about their current mental health and how it is best managed. The information would help provide them with care that is tailored to their needs. A mental health pathway would be developed for staff to follow if any needs are identified.

I also feel that a mental health passport for patients to complete and have with them during their stay in hospital would be beneficial. Compulsory mental health awareness training for all general hospital staff would help support and embed this by improving communication and reducing any potential stigma towards patients with mental health needs.

Aims and objectives

  • Gather evidence supporting the need for my idea to be implemented. It was felt initially the project was very much a result of my experiences and it was important to understand if other nurses also felt that my project would make a difference to patients and staff
  • Improve patient care in general hospital settings for those with mental health concerns by implementing a national assessment tool and pathway in order to improve care planning, educate staff, raise awareness and reduce stigma
  • Improve mental health awareness training and education for general hospital nursing staff

male nurse with pen

Activity to date

  • Attended the RCN induction day 1 June 2017
  • Drafted a set of four mental health assessment questions to be included in general hospital admission forms. These included past history, current needs, management and medication
  • Worked through the RCN project guidance questions to introduce and explore the idea
  • Researched the subject matter (mental health in general hospitals). Talked to nurses in my working environment, explored people’s experiences on social media, looked at previous research studies, looked at Mental Health charity sites and mental health campaigners
  • Participated in several Skype chats with my RCN mentor, who supported me to develop my idea and advised me on how to build my project and gather evidence to support it
  • Engaged in Twitter chats and contacted the RCN Mental Health Forum chair for advice and discussion about my project
  • Designed a paper questionnaire asking general nurses ten questions about their views on working with patients with mental health needs, their confidence and how prepared they felt to manage mental health. I distributed this questionnaire in the hospital I work in. I gained a number of supportive free-text quotes from the paper questionnaire
  • Designed a survey monkey version of the questionnaire and distributed this online to general nursing staff. Achieved 56 responses from general nurses for the survey, and the responses were overwhelmingly positive in favour of my project, especially of the need to know about someone’s mental health needs before commencing care for them 

elderly asian woman in hospital bed

  • Distributed results of questionnaire to my mentor, the RCN Mental Health Forum chair, to the leadership team at the hospital I work in, and to my social media networks
  • Had a positive response from RCN Mental Health Forum chair about the survey results, which he took along to a RCN committee meeting. Following this, he reported: “This is a great piece of work... We had a good teleconference on 20 October 2017, and we discussed your study further. There are some themes in there which reinforce our previous study and we have agreed to pursue new aspects of stigma and inclusion in our ongoing #OneOfYours project”.
  • Thought of name ‘Head above the neck’ for my project to represent the idea of not ignoring the mental health of someone who has come into a general hospital for a physical problem. This also came out of hearing registered mental health nurses saying they ‘only deal with things above the neck’ I had the idea of developing a project website under this name and discussed this with my mentor, however, due to time pressures this was agreed would be best revisited at a later date
  • Produced a write-up of my survey results
  • Drafted a mental health pathway for staff to follow if needs identified at the admission stage. Had a look at the learning disabilities ‘traffic light’ document I had seen in my work environment for inspiration on how to create a similar document for mental health
  • Drafted a mental health passport for patients to complete and have with them during their hospital stay. The passport identifies a wide number of areas that are important to effectively support patients with mental health concerns 
  • Designed a draft mental health sticker to add to medical notes when significant mental health care needs are identified on admission
  • An article about my project was featured in the October 2017 RCN bulletin for World Mental Health Awareness Day

Outputs to date

  • Paper questionnaire 
  • Survey monkey questionnaire
  • Set of mental health assessment questions for general admission form 
  • A mental health pathway for staff
  • A mental health passport for patients
  • A mental health sticker for medical notes (green ribbon symbol)
  • Article about this project in the RCN Bulletin October 2017 for World Mental Health Awareness Day
  • Survey write-up

Lessons learned

  • The project planning process, as not conducted this previously
  • The importance of time management, especially when managing multiple commitments
  • Not over-committing yourself. This can become overwhelming and result in your own health being affected
  • Not everyone is amenable to change. You can come across hurdles and opposition when trying to effect positive change
  • Looking after yourself. Striving to make a difference can take its toll if you are trying to manage too much at once and not looking after yourself
  • Acceptance that you cannot achieve everything all at once. It is best to break the goal down into smaller steps and focus on one thing at a time and realise when certain tasks would be best left to a later date when more time, support and funding are available
  • Be persistent and do not give up. I came across stigma and lack of understanding of mental health in this process, as well as discouragement and opposition. Getting responses to my survey was initially slow, but I kept sharing it and talking about it in different places in person and online and eventually got there
open book

Any activity that was unachievable and why

I struggled to finish my survey report and project write-ups due to a period of illness resulting from burn-out and over-commitment. I was on a full-time nursing placement, had two university essays to complete, other written work for university and placement, I was working part time as an HCA due to financial issues, I was working on this project and taking part in a Student Leadership programme for the Council of Deans for Health.

Reflections on impact

This project aimed to improve both patient care for those with mental health conditions entering a general nursing environment, and staff experience by adding more support and training and better advanced care planning. This would potentially avoid crisis and challenging situations that occur when mental health care has not been correctly planned by improving staff education, whether this was through mental health awareness training or a mental health first aid course.

The initial survey I carried out, highlighted some key aspects that require particular attention when nursing patients with mental health needs. This supported the need for a mental health passport for patients and a pathway for staff to follow. Conducting the same survey in a bigger platform would provide further confidence in my original survey findings and the importance of the project. 

 

This project aimed to improve both patient care for those with mental health conditions entering a general nursing environment, and staff experience by adding more support and training and better advanced care planning

 

I would evaluate any wider implementation of the passport and pathway by conducting a similar survey to general nursing staff, asking how they felt about caring for mental health patients after the implementation of the new admission questions, mental health pathway and passport. I would also ask them if the level of challenging situations has changed, e.g. hospital staff sometimes resort to calling security or even the police when someone with mental health issues is regarding as being ‘challenging’. 

I would also conduct a patient survey to measure how the new question-set and approach to care has been received, and to ask them to compare this to their previous hospital experiences.

sad patient looking out the window

The way forward

The mental health assessment questions on admission, the mental health pathway, passport and medical notes sticker could be implemented nationally. It would be useful to improve care of patients with mental health issues by having a standardised approach in every hospital. It will help encourage education and understanding, and reduction of stigma. Asking every patient about their mental health would highlight to staff, patients and members of the public that every person has mental health and physical health, and it should not be taboo to talk about it.

Lack of education or appropriate training was also a key point raised in the survey, so working with Health Education England, universities and hospitals to ensure that the level of mental health training provided to nurses or student nurses is adequately important.

Sustaining momentum

So far, I have involved the hospital I work in and been in contact with their leadership team about potential improvements. I also engaged regularly on social media about the project. I would like to develop this project into daily practice by working further with the RCN to obtain additional support to help me develop it to its full potential. I would love to be able to implement this project to make a difference to the care of patients with mental health needs. I have experienced several situations where these patients have not received positive care, and crisis situations of calling security or police to restrain people have been reached, and I think these situations should not only be avoidable but preventable, by improving care planning from the outset.