British Psychological Society response to the Commission to review the provision of inpatient psychiatric

The Commission to review the provision of inpatient psychiatric: Call for Evidence

About the Society

The British Psychological Society, incorporated by Royal Charter, is the learned and professional body for psychologists in the United Kingdom. We are a registered charity with a total membership of just over 50,000.

Under its Royal Charter, the objective of the British Psychological Society is "to promote the advancement and diffusion of the knowledge of psychology pure and applied and especially to promote the efficiency and usefulness of members by setting up a high standard of professional education and knowledge". We are committed to providing and disseminating evidence-based expertise and advice, engaging with policy and decision makers, and promoting the highest standards in learning and teaching, professional practice and research.

The British Psychological Society is an examining body granting certificates and diplomas in specialist areas of professional applied psychology.

Publication and Queries We are content for our response, as well as our name and address, to be made public. We are also content for the commission to contact us in the future in relation to this inquiry. Please direct all queries to:-

Joe Liardet, Policy Advice Administrator (Consultations) The British Psychological Society, 48 Princess Road East, Leicester, LE1 7DR Email: consult@bps.org.uk Tel: 0116 252 9936

About this Response

This response was led on behalf of the Society by:

Dr Jo Allen MBPsS, Division of Clinical Psychology

With contributions from: Isabel Clarke CPsychol, Division of Clinical Psychology Anne Cooke CPsychol, Division of Clinical Psychology Dr John Hanna CPsychol, Division of Clinical Psychology Dr Selma Ebrahim CPsychol AFBPsS, Division of Clinical Psychology Dr Julie Fraser CPsychol, Division of Clinical Psychology Dr Lisa Shostak CPsychol AFBPsS, Division of Clinical Psychology Dr Kate Butt CPsychol, Division of Clinical Psychology Dr Pamela Jacobsen CPsychol, Division of Clinical Psychology Dr Anna Ruddle CPsychol, Division of Clinical Psychology Dr Rumina Taylor CPsychol AFBPsS, Division of Clinical Psychology Juliana Onwumere CPsychol, Division of Clinical Psychology Lauren Redrup CPsychol, Division of Clinical Psychology Dr Che Rosebert CPsychol, Division of Clinical Psychology Barney Williams CPsychol, Division of Clinical Psychology Kate Hunt MBPsS, Division of Clinical Psychology Dr David Harper CPsychol AFBPsS, Division of Clinical Psychology Dr John McGowan CPsychol, Division of Clinical Psychology Professor David Pilgrim CPsychol AFBPsS, Division of Clinical Psychology Shirley McNicholas CPsychol, Division of Clinical Psychology

We hope you find our comments useful.

Dr Ian Gargan CPsychol AFBPsS Chair, Professional Practice Board

Call for Evidence Closing Date: 18th March Please complete this consultation and email it to

consultation@CAAPC.info

If you have any questions about the consultation or about the Commission, please contact information@caapc.info

The Commission to review the provision of inpatient psychiatric care for adults in England, Wales and Northern Ireland

Call for Evidence The Commission The Commission to review the provision of inpatient psychiatric care for adults in England, Wales and Northern Ireland has been set-up in response to concerns about whether there are sufficient acute inpatient psychiatric beds and alternatives to admission available for patients and service users. The Commission met for the first time in January 2015, and will be spending the next year gathering evidence and considering care in England, Wales, and Northern Ireland (Scotland is not included, as a separate programme of work is currently being undertaken by other organisations on the same issue). The Commission will produce its final recommendations in January 2016. More information about the Commission can be found at www.CAAPC.info. The Commission receives administrative support from the Royal College of Psychiatrists, but has agreed its own terms of reference and will operate independently.

Our Call for Evidence The Commission is beginning its work by asking all individuals and organisations in England, Wales, and Northern Ireland with relevant knowledge and experience for their help by completing this consultation. This includes all:

Patients/service users

carers and family members

members of staff in mental health services (NHS, independent, or voluntary)

providers of mental health services (NHS, independent, or voluntary)

commissioners or planners of mental health services

individuals and organisations involved in health or social care outside of mental health

primary and secondary care staff (clinical and managerial)

charities or voluntary sector organisations with an interest in this area

individuals or organisations working in the criminal justice system

Local Authority Bodies and individuals working for them

Other relevant bodies or groups

Responses will be used to inform the Commission’s areas of inquiry and final recommendations.

What this consultation covers In this consultation, we use the terms

“mental health inpatient care” to describe:

“a unit with beds that provides 24-hour nursing care, and which can provide care for patients detained under the Mental Health Act. Such inpatient units can be provided by the NHS or by other providers.”

“alternatives to inpatient care” to describe:

“alternatives to admission into an inpatient unit. This can include Crisis Resolution and Home Treatment Teams, Crisis Houses, Acute Day Services and other services.”

What this consultation does not cover The consultation does not cover (a) services for children or adolescents or (b) services for people with dementia. The consultation does not cover specialist inpatient services, unless the evidence directly relates to the provision of mental health inpatient care/alternatives to inpatient care. An example of this would be an issue relating to the transfer of care between specialist inpatient services and non-specialist inpatient services. Specialist inpatient services are commissioned/provided at the national rather than local level. They include, for example, mother and baby beds, forensic inpatient services, and eating disorder beds.

Please read carefully In completing this consultation, you should understand that your responses may be quoted and used in reports or other outputs from the Commission. If you would like us to anonymise your response (i.e. so that you or your organisation cannot be identified in any reports or outputs), then please tick or mark this box .

Questions Q1. In your opinion, what is the value and purpose of inpatient mental health care for adults?

We are interested in hearing your views on the importance, worth, or usefulness of inpatient care. Please explain your answer (word limit 500 words).

Please explain your answer and give as much detail as possible.

- The Society believes that there is an important role for inpatient care in supporting people with mental health problems,

providing a refuge and temporary retreat from the home environment which may be overwhelming and distressing in a time of crisis. It can provide space and support and an opportunity to break destructive patterns of behaviour by taking oneself out of context and make sense of what is happening for them (McGowan, 2008). It is also an important respite for families and carers (Schizophrenia Commission, 2012).

- Another important function of admission is that it provides the time for an assessment and reflection for the whole MDT and an opportunity to develop a responsive, meaningful care package using a bio-psycho-social model consolidating an assessment and formulation process (Clarke, 2008; BPS, 2012).

- It also allows for assessing and managing risk, providing safety and containment and an ability to promote positive risk from a safe environment (Meaden and Hacker, 2011).

- Basic needs are better able to be met to encourage eating and drinking and clean and warm and safe. It can provide an

opportunity to find more appropriate housing and enable them to connect with meaningful support in the community based on the formulation developed. In addition it can be an opportunity to connect to others in similar situations and develop relationships.

- There are concerns that the purpose of inpatient stays can focus on social control and coercion as the focus is on

preventing risky behaviours and not on supporting therapeutic environments. Risk management can dominate the managerial and clinical norms of the setting when there are limited time and resources and thinking space for clinicians meaning it is impossible to make such a situation therapeutic when it is based on coercion rather than therapeutic intervention (Pilgrim and Tomasini, 2012; Pilgrim, 2014).

Q2. Please can you provide an example of:

‘good’ inpatient care

‘good’ alternatives to inpatient care?

Please explain your answer, and give as much detail as possible about what made the care ‘good’. Please also tell us where and when this example is from (e.g. Manchester, 2012).

Good inpatient care (500 WORD LIMIT)

Examples of good care include Woodhaven Mental Health Unit in the New Forest and Drayton Park in Camden and Islington NHS Foundation Trust and DBT or Mentalisation informed environments such as Chartwell Ward in Maidstone (Clarke, 2008; Mind, 2014). The important elements in good care are clear aims and purpose, voluntary admissions, a safe welcoming environment with engaged, supported and reflective staff, psychologically informed care, access to a full MDT including psychological therapies and family interventions/support with peer support workers, clear links with community staff and positive recovery focused care with good discharge planning.

Clear aims and purpose involves a full assessment of needs, the development of formulation of problems from bio-psych-social perspectives, with good involvement of service user and family’s perspective and needs (Johnston and Dallos, 2013; Summers, 2006, BPS, 2013). The open dialogue approach to care provides an opportunity to hear all members of the family, the service user and staff’s perspectives in order to develop a truly multi-faced formulation that pays attention to the power imbalance in information gathering (Seikkula et al, 2012). Voluntary admissions are favourable and it is beneficial to offer admission earlier to avoid forced admission (BPS, 2012; 2014). It is important even if someone is very unwell to maintain a positive open and honest dialogue with them and their family (Schizophrenia Commission, 2012; BPS, 2012, BPS, 2014). The individual needs to be listened to, non-judgementally and without premature decisions. Their sense of what is going on needs to be taken seriously and they should be given an opportunity to make sense of this in a wider context (Durrant, Clarke, Tolland and Wilson, 2007; Clarke & Wilson, 2008; Araci & Clarke, in submission). Environment is safe, stable and free of illicit substances (Rose et al, 2013) A good example of a positive physical environment is Woodhaven in New Forest new unit which won award for its co-design by service-users and professionals (Clarke, 2008). Good care happens when symptoms are seen as understandable ways to cope with overwhelming experience and staff work according to a psychosocial formulation of a person’s difficulties (Dillion, Johnstone and Longden, 2014). Staff must have a positive attitude and be compassionate with time to sit with service-users and their families and work towards a recovery approach (Rose et al, 2013). When staff are supported by staff support groups and reflective practice groups improvements in patient care can be seen (Berry, Barrowclough and Wearden, 2009; Cowdrill and Dannahy, 2008; Dexter-Smith, 2007; 2010). Peer support workers improve staff’s ability to identify with SU’s and open up (Repper and Carter, 2011). Commissioning and Delivering clinical psychology in Acute Adult Mental Health Care (BPS 2013) outlines how a psychology resource can not only provide valuable psychological interventions but improve quality of care and psychological mindedness throughout the workforce, including particular examples of good practice, e.g. formulation informing acute pathway care, reflective practice for staff groups, using a systemic perspective and narratives on an acute ward (Allie and Whittall, 2011). Therapeutic interventions include OT, Art and Music therapy, CBT, DBT, family interventions, narrative therapy and mindfulness (BPS, 2012; McGowan and Hall, 2009). Working closely with family members has benefits for risk management in the post-discharge period and has the potential to reduce readmissions (NICE, 2014; BPS, 2014). Alternatives to inpatient care (500 words)

Respite homes or soteria houses provide a good alternative when medication is not a central part of care planning. Examples of these include Maytree, suicidal respite house in North London and Leeds crisis house, led by Fiona Venner. Respite care is only works when they are well-resourced and survivor-run like the Soteria project (Fenton, Mosher, Herrell and Blyler, 1998) and the parachutes’ model based on peer supported open dialogue principles (Olson Seikkula and Ziedonis, 2014). Also home treatment teams when they are genuinely used to avoid admission can be a good alternative. They need to have good connections and communication with ward staff and community services (Lloyd-Evans, Slade, Jagielska and Johnson, 2009). They need to hold multiple perspectives and develop rich bio-psycho-social formulation of a persons’ difficulties involving service-users and their networks (families and friends and services) in their care planning. North East London has shown good improvements in their bed management with this model. Using the principles of open dialogue and a needs-based approach allows this to be possible (Seikkula, Alakare, Aaltonen, 2001). Specialist Personality Disorder services have an important role in reducing bed occupancy and in providing more evidence based treatments for PD (McGowan, 2008). Day treatment services also provide support to enable people to remain in their own homes whilst receiving intensive therapies and support.

Well resourced community teams, CMHT’s, EIP and AO teams provide a good alternative to in-patient care when recovery focused built on supporting the whole needs of an individual. Open Dialogue approach in Finland is an example of a service model, which has successfully substantially reduced bed occupancy and eradicated long term hospital admissions. Specific psychological intervention particularly family interventions have a substantial impact on reducing bed days (NICE, 2014; BPS, 2014). Hearing Voices network model supports multiple explanations for psychotic experiences and support people intensively if

The next questions are about your experience of mental health inpatient care, or alternatives to inpatient care. This experience could come from working in health and social care, receiving inpatient or alternatives to inpatient care yourself, or knowing or caring for someone who has.

Q3. Giving as much detail as possible, please can you:

provide an example of ‘poor’ inpatient care

explain how that poor inpatient care could be improved?

Please explain your answer, and give as much detail as possible about what made the care ‘poor’. Please also tell us where and when this example is from (e.g. Cardiff, 2014).

Poor inpatient care (500 WORD LIMIT) Unfortunately although guidance and standards (AIMS) exist in in-patient mental health care (Cresswell, Hinchcliffe and Lemmey, 2010; BPS, 2012), there is substantial evidence to suggest poor care continues (Schizophrenia commission, 2012; Mind, 2011; Rose, Evans, Laker and Wykes, 2013) These include experiences where the focus is solely on medication and the whole person is not considered and the individual’s explanatory model for their experience is rout inely invalidated (Mind, 2011). Dismissing such explanations and insisting on substituting an illness explanation has been shown by much research to be inimical to recovery (e.g. Heriot-Maitland et al 2012, Brett et al. 2009). Service-users can be labelled and stigmatised, and their behaviours not seen as understandable and human reactions to distressing situations and overwhelming emotions (Rose et al, 2013; Mind, 2011). Furthermore service users can experience forced medication as violence leading to traumatic reactions (Rose et al, 2013; Mind, 2011). Lack of focus on empowerment and the individual’s voice is evident in many ward rounds where service users are asked intrusive questions surrounded by other professionals, most of whom they do not know (Mind, 2011). Also often their families are dismissed and ignored and often sent away when trying to visit (Worthington and Rooney, 2010). It can be common that there is no provision for young family members and we know visiting a parent in hospital can have a traumatic impact on a young person (Östman and Hansson, 2002). A pressure on beds can mean poor decisions are made which are not always in the service user and families best interests. There is also a lack of staff to provide adequate support and staff have little time for therapeutic interventions as they focus on medication compliance, observations and paperwork (Rose et al, 2013; Hill, 2011). A high turn over of staff and too many bank staff does not provide consistency. Furthermore nursing staff are not well enough supported. The work they do is traumatic, yet they have very few (if any) spaces to process the material they witness/hear about. Many wards provide ‘reflective practice’ spaces but often this is not enough and staff are not trained to use these spaces effectively – some make excellent use of them but others will avoid them at all costs as they can feel very threatened. When faced with the level of trauma ward staff deal with every day, with no space to process it, the only option, if you are to stay sane, is to detach from it, hide in the office, immerse yourself in paperwork – in short develop the ‘lack of compassion’ so frequently cited following the Francis Report (Paley, 2013). Poor care is seen when overly restricted practice takes place and the focus is solely on risk prevention and no positive risks are taken (Slade, 2009). The fear of litigation and blame culture in society can mean acute in-patient services have set themselves up as the providers of the cure to the distress and this in combination with a hierarchical profession driven system that does not allow creative thinking means service users are not facilitated to recover in whatever way is best for them but both staff and service-users experience powerlessness to know how to move forward (Rose et al, 2013).

How could that poor inpatient care be improved? (500 WORD LIMIT) Commissioning and Delivering clinical psychology in Acute Adult Mental Health Care (BPS 2013) provides ideas to improve the current care provision. The following areas are seen to be important

Good clinical leadership (Cresswell, Hinchcliffe and Lemmey, 2010)

Moving to a new model, ideally a non-medical, non-hospital based one similar to the Soteria project (Olson, Seikkula and Ziedonis, 2014; Gilbert, et al, 2010; Fenton et al, 1998; Lloyd-Evans et al, 2009).

Use of new roles e.g. psychologists & nursing staff as Approved Clinicians providing team with clinical leadership & fostering new ways of understanding mental health problems & recovery within teams (BPS, 2007; Gillmer and Taylor, 2008; Dillion, Johnstone and Longden, 2014)

Shared MDT ownership of the process of formulation & care planning/treatment (BPS, 2012)

Involvement of systemically trained practitioners to support wider culture on the wards (BPS, 2012)

Supporting staff through training and good supervision to focus on listening and helping them to make sense of their crisis in their own terms and using a multi-perspectives (bio-psycho-social) model (McGowan, 2009). Dialogical practice is a good example of this (Olson, Seikkula and Ziedonis, 2014) but reflective practice and staff support groups are important to helping staff reconnect with service users and their compassion for them. We need to provide space for staff to bring difficult experiences in their work so they can bear witness to peoples distress rather than push to dampen down emotions with sedating medication and ignore difficult experiences that led to these emotions. There needs to be a recognition we can’t medicate people out of their problems. Also narrative therapy projects such as the tree of life on the wards project can also help (BPS, 2012; Denborough, 2008). The sort of atheoretical, person centred approach taken by the spiritual crisis network (who run training events for staff) and inpatient programmes that normalize anomalous experiencing (Clarke 2010). Focusing on the person rather than payment by results and thinking about patients as pawns to improve results (Seager, 2006).

More peer workers and a focus on social science graduates and less focus on medical professionals (Repper and Carter, 2011).

Challenge the dominance of the medical consultant so that nursing staff feel able to stand up for their patients and feel they will be listened to and respected. Open dialogue approach has many lessons here (Seikkula, Alakare, and Aaltonen, 2001)

Change to culture so that psychosocial interventions are given equal priority with medical interventions (Mind, 2011).

Q4. Giving as much detail as possible, please can you:

provide an example of a ‘poor’ alternative to inpatient care

explain how that poor alternative to inpatient care could be improved? Please explain your answer, and give as much detail as possible about what made the care ‘poor’. Please also tell us where and when this example is from (e.g. Belfast, 2013).

Poor alternative to inpatient care (500 WORD LIMIT) Alternatives to in-patient admissions will only work if they are properly connected to community and inpatient services and are well resourced and supported. There is sometimes no continuity of care or thoughts of the different elements involved in someone’s care. A poor alternative might also involve home treatment where they have very high thresholds for inclusion and will only be involved as a gateway to admission. It is also unhelpful when they are solely focused on medication and not psychosocial support and do not provide intensive support which is led by a good formulation of the needs of an individual and their families. This care needs to include good support for families and inclusion of them in the care provided but this often does not happen. Service-users often describe finding it difficult with different members of the crisis team visiting each time and struggle to build up trust and rapport particularly at a time of crisis (Mind, 2011). When the crisis teams do not have good connections to the in-patient and community services this can mean it is disconnected and any change is not lasting or supported. Clients are frequently referred to third sector agencies without considering the person’s whole needs and if these services do not have good connections and understanding of the different elements involved in someone’s care. An example is clients who are referred to non-statutory drugs and alcohol agencies who are commissioned to work with preparing people to make change to their substances. These environments are often detrimental to clients with severe mental health needs who have a comorbid substance problem as they are in frequent contact with people are still using illicit substances and, for a number of reasons, they are likely to be vulnerable to suggestibility. A poor alternative to in-patient admission is keeping service-users in the community in community teams where they have high caseloads and are fire-fighting all the time and not able to do recovery focused work.

How could that alternative to poor inpatient care be improved? (500 WORD LIMIT) Adequately resourced, trained and supported community and inpatient resources

Greater user/carer involvement

Integrated with social care, third sector, community and police

Good liaison between all services

All models need to be formulation-led and based on multiple perspectives

Psychologically informed environments –

Use of Open dialogue principles

Q5. In your opinion, what would be the best way of measuring ‘good quality’ care on an inpatient ward, or in an alternative to inpatient care? In other words, what should we measure? And how should we measure it?

Q6. In your experience, do inpatient wards and alternatives to inpatient care services work well for all patients/service users? Or are there some groups (such as adults from some BME communities or other adult groups) that inpatient and crisis services do not work well for? Please give as much detail as possible.

(500 WORD LIMIT)

- The Society questions whether, in the current form, in-patient care works for anyone. However, there are certain groups, which it has been identified to have specific challenges whether this is for the service-users or the staff. Those with a diagnosis of personality disorder, complex trauma histories and attachment difficulties may find in-patient setting superficially containing but may bring up particular difficult emotions around relationships and illicit responses in staff which are unhelpful to them. However, there are examples of inpatient units that work well with such groups when care is taken to understand their difficulties in a therapeutic way (McGowan, 2008).

BME groups and other minority groups (e.g. LGBT) are often over represented in in-patient units (Davies, et al, 1996) and such places are ill-equip to respond to their specific cultural needs (Mind, 2014) and understand the individual experiences. Furthermore people describe racism and discrimination (Singh et al, 2009). They experience a cycle of fear where they continue to be more likely to be brought in under section and experience admission as a traumatic experience (Morgan et al, 2005). However any in-patient unit that truly follows an individualised care approach and pays attention to the service-users and family networks voice should be able to address such issues.

(500 WORD LIMIT) Satisfaction is an important element to measure as this gives some indication of usefulness. However it is not the same as clinical outcome, which is also important. User led research is an important area (Gillard et al, 2010). The VOICE measure (Evans et al, 2012) provides a comprehensive quantitative measure with validity for service-users which helps measure in-patient care experience and includes questions on relationships with staff, having a role in their care and planning etc. Standardised questionnaires may be used but only those specific to the outcome for the client (i.e. relevant to their presentation). Blanket screening tools with all clients are not helpful and it is important to move away from symptoms focused research and more towards recovery focused research. The forensic service in East London is using the recovery star as a tool. Recovery focused tools are also useful, these include (Slade, 2009). Quantitative measures are important, however it is always a challenge to get measures that are meaningful in all settings and increasing qualitative studies are giving us important information about experience of care. Furthermore although there is often a focus on RCT’s, we need to recognise the importance of data from action focus research (Seikkula and Arnkil, 2014). Longititudinal research is very important as it can give a better clearer picture of what is happening and readmission rates and quality of life are important elements to measure. Audits of pathway delivery against guidelines show how well services are delivering certain guidelines but do not show experience or improvements in care and recovery. Staff experience is important, staff morale and staff burnout, levels of staff sickness or staff retention can provide an indication of the organisational culture along with incidents / datex reports and rates of medication, forced admission and forced medication. Katherine Berry has done some interesting research into staff-patient relationships and alliance along with other staff measures (Berry, Barrowclough and Wearden, 2009).

Q7. We are keen to hear about any examples of good practice, service evaluations, research reports, data-sets, or other information that would help the Commission in its work.

Please take the opportunity below to let us know where we could obtain this information, including any contact details of the organisation/person that it can be obtained from.

Important – please turn to the next page and complete your consultation contact details

(500 WORD LIMIT)

Loren Mosher’s Soteria model (Fenton, Mosher, Herrell and Blyler, 1998) has a presence in the UK - http://www.soterianetwork.org.uk/ The Soteria Network is 'a network of people in the UK promoting the development of drug-free and minimum medication therapeutic environments for people experiencing 'psychosis' or extreme states.

Open dialogue is becoming a movement in mental health services that is gaining momentum and several trusts are involved in developing services which are based on dialogical practice. It is a service delivery model where service users and their families/networks are empowered to have an equal voice in all meetings about the person fulfilling the ‘no decision about me without me’ promise (DoH, 2012). Russell Razzaque (Medical Director of North East London NHS Foundation Trust) is heading up an RCT on this approach. Kent and Medway are also investing in training substantial numbers of staff in this approach. There is a peer supported open dialogue project in New York which is providing crisis respite centres and alternatives to in-patient care following the model in Western Lapland that has led to dramatic change in outcomes for people with psychosis. These are an eradication of long term in-patient stays beyond a year, a substantial reduction in length of admissions and 85% no symptoms at 5 years (Seikkula et al, 2009). Contact Russell.Razzzaque@nelft.nhs.uk or see developingopendialogue.com or opendialogueapproach.co.uk and http://www.nyc.gov/html/doh/html/mental/parachute.shtml

Isabel Clarke has also done and published a lot of work exploring the role of psychology and the importance of training and supporting staff in therapeutic interventions and can be contacted through her website http://www.isabelclarke.org/ Pamela Jacobsen is developing the research on a Triage ward developing a group programme for short-stay wards pamela.jacobsen@kcl.ac.uk. Rumina Taylor is researching and developing family interventions including a family ‘awareness-raising’ teaching session for staff and a carers’ clinic on in-patient units at the Bethlem Hospital. She has shown improvements in client and carer distress and well-being as well as carers perceiving their loved ones’ illness as less threatening, meaning they had a greater understanding and felt more in control of symptoms. Client and carer complaints have reduced since implementation of the service.

Narrative therapy based Tree of Life groups (Denborough, 2008) are being carried out on in-patient wards in South London and Maudsley NHS Foundation Trust. These groups are improving relationships between staff and service users as both share their trees, which are a representation of their life, who they see themselves as, their past and their hopes for the future. This project is being delivered by staff and experts by experience in collaboration, showing the importance of co-facilitation. Julie Fraser is leading on this project and can be contacted on julie.fraser@slam.nhs.uk.

East London NHS Foundation Trust has psychologists working on wards who are leading on providing various different psychological approaches including supporting hearing voices network groups (user led) on the wards, open talking groups, mindfulness groups, staff reflective practice groups, consultations and family work - please contact Barney at barney.williams@eastlondon.nhs.uk or Che Rosebert (cherosebert@hotmail.com for further details)

Service user programmes such as those in Wolfson House, forensic recovery service are important (please contact elizabeth.Matias@eastlondon.nhs.uk).

Drayton Park is an alternative to hospital admission for women in mental health crisis in Camden and Islington NHS Foundation Trust. The service was created by women service users and a group of dedicated professionals who were committed to developing a gender sensitive service for women. The service is based on a Systemic Model. This is included in how referrals are taken, assessments are facilitated and how the team understand the context of the women’s lives and the social and political climate the service operates within. Please contact Shirley McNicholas for further details - 0207 607 2777, email shirley.mcnicholas@candi.nhs.uk.

About you (please complete in full)

Q8. Please provide your full contact details below. We will not use these for any other purpose than to understand who has responded to the consultation, and to produce an overall ‘count’ of the different types of respondents. We will not share your details with any other organisation.

Your name:

Your job title (if relevant):

Organisational name (if this applies):

The British Psychological Society

Address: St Andrews House, 48 Princess Road East, Leicester

Post code: LE1 7DR

Email: Consult@bps.org.uk

Telephone number: 0116 252 9936

Q9. Are you replying to this consultation:

* on behalf of an organisation?

as an individual? Q10. Which of these best describes your experience of, or interest in, inpatient mental health care: As a patient, service user, or survivor As a carer or family member As a member of staff in a mental health service (NHS, independent, or voluntary) As a provider of mental health services (NHS, independent, or voluntary) As a commissioner/planner of mental health services As someone involved in health or social care outside of mental health (clinical and managerial) * As a charity or voluntary sector organisation with an interest in this area As an organisation or individual working in the criminal justice system As a Local Authority body (or an individual working for them) Other (please specify)

___________________________

Q11a. Thinking about the answers you gave in this consultation, where has your experience of inpatient services/alternatives to inpatient services mainly taken place? N/A England Wales Northern Ireland

Q11b. And in which region? North East England West Wales/Valleys Belfast North West England East Wales Outer Belfast Yorkshire and the Humber North Wales East of Northern Ireland East Midlands Mid Wales North of Northern Ireland West Midlands South West Wales West and South of Northern Ireland East of England South East Wales London South East England South West England

Q12. Would you be happy for us to contact you to ask for further information about your response? * Yes No

Finally, if you are replying as an individual (rather than as an organisation):

Q13. What is your gender? Male Female Transgender * Prefer not to say

Q14. Please tick your age group 19 or under 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 or over * Prefer not to say

Q15. Would you consider yourself to have a mental health problem?

Yes – I would consider myself to currently have a mental health problem

Yes – I would consider myself to have had a mental health problem in the past

No

*Prefer not to say

Q16. How would you describe the area in which you experienced inpatient care?

City

Rural

Town

Inner city

Suburban

* Prefer not to say

Q17. How would you describe your ethnic origin? Please tick one box only.

White White – English/Scottish/Northern Irish/British White – Irish White – Gypsy or Irish Traveller White – any other White background

Mixed/multiple ethnic groups White and Black Caribbean White and Black African White and Asian Any other mixed/multiple ethnic background

Asian/Asian British Indian Pakistani Bangladeshi Chinese Any other Asian background

Black/African/Caribbean/Black British African Caribbean Any other Black/African/Caribbean background

Other ethnic group Arab Any other ethnic group Prefer not to say

Thank you for your help Please return this questionnaire by 18th March to: consultation@CAAPC.info

If you have any questions about the Consultation or about the Commission, please contact

information@caapc.info

References

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