Thriving, not just surviving: award-winning toolkit supports the mental health of student nurses and midwives in Manchester

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Tracy Claydon, PEF

As we highlighted earlier this week, Tuesday 10 October marked World Mental Health Day, an annual, global event recognising the impact of mental health on the lives of many and the importance of showing compassion to those struggling with mental ill heath, as well as looking after our own mental wellbeing. As student nurses and midwives, we may experience a broad range of mental health issues throughout our training as we adjust to our role; juggle placement, academic work and our personal lives; and because of the distressing experiences we may be exposed to on placement. Thankfully, the wonderful team of practice education facilitators (PEFs) at the newly formed Manchester Foundation Trust  (formerly CMFT) have our backs, creating an award-winning toolkit for mentors to enable them to better look out for and support our mental health in practice. We are delighted to share this Q&A with Tracy Claydon (pictured above), PEF for the Division of Specialist Medicine and the Corporate Division at Manchester Foundation Trust and project co-founder. She gives us an overview of the Mental Health and Wellbeing Toolkit and how it aims to support students and mentors in practice.

Firstly, what is the Mental Health and Wellbeing Toolkit?

We identified that there was no specific practical guidance to help mentors in supporting students who may be in emotional distress and/or be experiencing issues relating to their mental health when on placement; the Royal College of Psychiatrists’ (2011) indicated that as many as 29% of students may experience mental health difficulties at some point during their studies, while the National Union of Students (2015) have this figure as high as 78%. The toolkit was developed to support not only current nurses and mentors but also of course to support students to better manage the emotional demands of the role and feel supported to carry out their job confidently.

It is possible and also likely that a significant proportion of the students presenting in distress will not have a diagnosable mental illness but will be experiencing distress related to ‘life stresses’ and will need support to allow them to cope effectively with these rather than seeking to be prescribed an antidepressant or similar medication (NHS Choices, 2016). The provision of a toolkit that would provide a structure and framework for mentors to better support their students was clearly needed. The toolkit includes:

  • Tips for mentors including advice on how to discuss and identify concerns
  • Algorithms for accessing support
  • ‘Having the Initial Conversation’ guidance for mentors
  • Top Ten Tips for students to look after their own mental wellbeing
  • Agency Directory

The toolkit was launched in November 2016 and re-launched in May 2017 to coincide with World Mental Health Awareness Week which had a theme of ‘thriving or surviving’ which reinforced our message… we don’t just want our students to survive, we want them to thrive!

Where did the idea for the toolkit come from?

Students will often experience quite harrowing situations during one single placement that possibly other members of the public will go through their entire lives without seeing.

We talk often about resilience, but how do we build this? And crucially, what can we do when anxiety becomes more than a transient emotion? From a practical guidance we recognised that there were gaps in our support mechanisms within the organisation and also that we had the underpinning literature to evidence this.

The Nursing & Midwifery Council and the Royal College of Nursing recognise the potential for students to experience difficulties in their mental health and yet surprisingly neither agency has/had provided any guidance for nurses or mentors to support them.

At Manchester Foundation Trust (MFT) we wanted to fill this gap and the toolkit was developed as a resource to address this. Equally, it was also incumbent upon us to acknowledge how anxiety or a sense of isolation when not managed in the early stages can then escalate into something more concerning.

The goal was to support our students at the beginning, end and at all points in between on their placement and learning journey, so that they will recognise and regard MFT as a caring and compassionate organisation that enables students to thrive and not just survive and that they would wish to return as qualified staff.

How did you go about developing the toolkit?

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Ant Southin, Specialist Mental Health Liason Nurse

It came as a result of a real life situation where I as a PEF was supporting a compassionate and kind mentor who was struggling to support a student on placement struggling with mental health issues. Myself and my PEF colleague Sharon Green, began working on the toolkit as a resource however, the toolkit only truly started to develop when we were able to access the knowledge and skills of Specialist Mental Health Liaison Nurse, Ant Southin (based at MRI, pictured right) who was able to provide the expertise that we as registered adult nurses by background lacked. This enabled it to have a real MDT approach and became a wonderful collaboration!

How has the toolkit been used in practice so far?

For some students the situations they observe or are involved in will be the most distressing thing they have experienced. It is important that they have a means of communicating and understanding these feelings and recognising that there is help available. The Toolkit has been used in a number of situations where students were struggling to cope emotionally: including supporting students who were affected by this year’s Manchester Bombing.

What are your plans for the future of the project?

Despite having been awarded the MRI Fellowship Award at the recent Nursing and Midwifery Conference and also having been acknowledged as an example of Best practice by Health Education North West (available as an E-Win) we feel this work is still in its infancy; while it is currently aimed at students, we recognise that the messages are important for all of our staff. We hope that we can develop it to be used to support any member of staff experiencing distress. The Human Resources department have requested a meeting to begin discussions around achieving this within the wider organisation. We will be presenting at the upcoming Midwifery Forum at St. Mary’s Hospital and we have also had heard nationally from other NHS Trusts interested in adopting the toolkit within their own organisations.

The MRI Fellowship Award 2017 included a £1000 monetary prize which will be used to support ward areas to develop their own ‘buddy box / soothe box’ resource which they can then continue to develop to meet the needs of their students and staff.

…and finally, what advice would you give to student nurses and midwives to take care of our mental health while on placement?

Student nurses and midwives need to feel prepared and supported for the career they are about to embark upon. The profession is challenging and demanding but with huge personal and professional rewards. Mental health issues can affect any of us at any time in our careers and should be considered a priority for all of us whatever stage of our career we are at. By making them a priority for students it is hoped that they will continue to see this as a priority as they progress through what we hope will be successful nursing/midwifery careers. Using our dedicated #icareforme approach we will continue to maintain the profile of the huge importance of self-compassion for staff working within such challenging and complex environments. It is vital that mental health has the same parity with physical health and we can only achieve this by making it the priority it deserves and needs to be.

Thank you Tracy!! If you’re interested in learning more about the toolkit, you can find it here – in particular, take a look at the ‘Top Ten Tips for Good Mental Health’ on pages 8-9 for simple ideas that we can all use to look after our mental health.

Remember that if you are struggling with your mental health or feeling anxious, worried or depressed then don’t try and suffer on in silence. If you feel confident to do so, speak to your mentor, PEF or academic advisor (AA) or the University of Manchester has a fantastic confidential Counselling Service. Often speaking with your peers can ease the burden – you may find that others are feeling the same – or if you simply want a kind, listening ear then Nightline is another brilliant option, you can find the contact number on the back of your student card.

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World Mental Health Day 2017

World Mental Health Day, founded by the World Federation for Mental Health, takes place each year on 10th October and adopts a different theme each time. The aim is to raise awareness about mental health and encourage people to think about ways to support those who are experiencing mental health conditions. This year the focus is on mental health in the workplace.

imageThe World Health Organisation discussed how depression and anxiety disorders are common and can have an impact upon a person’s work life. Stress is a major factor that contributes towards the development of mental health conditions. With increased demand, funding cuts and staff shortages, there is no doubt that nurses and healthcare services in general are under immense stress. Nurses working in hospitals are said to be twice as likely as the general population to have depression.

For some mental health nursing students, having lived experience of depression and/or anxiety is a big part of what motivated us to choose to study for a degree in this field of nursing. Personally I chose this career because of the platform it can hopefully give me to help improve mental health services that I was involved with when I was an adolescent and to promote awareness of mental health using not just personal experience but professional knowledge too.

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Not many health professionals speak out about their experiences of living with mental health conditions through fear of having their capability to support other people doubted. Mental health conditions affect people in the workplace, and healthcare settings are no exception. To reduce the impacts of stress and workplace pressures on mental health it is important for people be aware of the support services available for employees. The NHS Services Directory is a useful tool for locating local places where psychological therapies can be accessed. Offering support can be as simple as asking a colleague how they’re feeling. If we start conversations, we’re closer to ending the stigma.

Nursing behind bars: Q&A with student nurse, Laura, who shares her prison placement experience

One of the incredible things about nursing is that it is one of the few professions that reaches people in every part of society. This includes prisons which could arguably be considered one of the most challenging environments in which to nurse. Earlier this year student nurse Laura Golightly (pictured) was among a handful of student nurses to be placed at a prison in Manchester. We are delighted to share this Q&A with Laura who describes her experience working alongside the prison nursing team, including the daily challenges but also the huge variety of nursing skills and confidence she gained from this rewarding placement.Laura pic

What originally drew you to applying for a placement in a prison?

I have always had a fascination with prisons since growing up and watching compelling documentaries made by influential documentary makers like Louis Theroux. For many people, and certainly for me, this sub-section of society living their life behind bars in massive secure institutions was really intriguing and something that I felt I could have no real concept of. The reality of life within prison is often something that’s kept very private from the general public, including the mental and physical health problems faced by inmates and the concept of institutionalisation, this threw up some really interesting and thought provoking societal questions about the effectiveness of the prison system as a whole which I really wanted to explore, not only as a health professional, but on a human level also. It had really been a desire of mine to work within a prison, safe guarding very vulnerable members of society, before the opportunity even arose so when I saw the email detailing the placement, I knew I would do everything in my power to secure it.

How did you feel when you arrived for your first day?

I was completely overwhelmed when I first stepped foot into the prison for my first day. Starting a new student placement can be intimidating at the best of times, I’m often left feeling anxious about meeting the staff, performing up to standard, not knowing enough and many of those little worries that seem to occupy your head before starting a new placement. There is certainly plenty to consider turning up on your first day so then to be turning up to a huge Victorian building which seems to dwarf even such vast city centre buildings surrounding it, complete with barbed wire running around the parameter and prison staff greeting you with a sharp eye and a pat-down, well it certainly puts things into perspective. The first day my mentor took me into the grounds and gave me the grand tour, we discussed what general day to day life is working within the prison and he soon made me feel at ease. I have to say though, it did come as a bit of a surprise when we discussed this over a coffee and he pointed out to me that the staff serving us in the café were actually inmates.

What was your daily routine like on placement? Describe an average day.

There was no real average day within the prison, this was one factors I particularly enjoyed about the placement! There are three main areas to work and these are on reception, on the health care unit and on inpatients. The role is vastly different on all three which was fantastic for bringing variety to the role as nurses were rotated throughout the week. On reception we would take care of the medications for all inmates leaving for court or being transferred out and we would medically ‘fit’ them for departure, we would then also take care of all inmates being transferred in, this was the really interesting part. We would conduct an assessment with the patient discussing their past medical history, recording observations, their general contact details, the reason they have come to prison, their mental health, health promotion advice and some screening tools, this was their first point of contact with the medical team so there is usually a fair amount to cover and they would have a follow up within the first 72 hours to once again check in on them and discuss anything they may need to add since their first assessment. A day on the health care unit would consist of giving the meds for a specified wing (which could often take hours with the cocktail of meds some inmates are on) and then reporting back to the health care unit to complete the clinics for the day. There was an afternoon clinic and a morning clinic within this prison and these would often be clinically very similar to a GP surgery clinic. There would be many different health professionals running specialist clinics also such as psychiatric, counselling, smoking cessation, sexual health, BBV, dentistry, optometry and more, just as you’d expect to see in the community. The inpatient unit was quite different all together as these were the extremely vulnerable patients, it mainly consisted of mental health nurses and prison officers who were specialised to deal with the kind of inmate that presented in the unit. It was nothing like what I could have imagined, with huge solid metal doors, no windows, rooms without anything at all inside, no real equipment and it seemed to be constantly deafening with lots of screams and shouts from inmates. On top of all this there was the emergency response radio one nurse would have responsibility for, this would be used to request emergency medical first response. While I was on placement I attended these calls for a range of incidents such as fights, overdoses, inmates high on illicit drugs, cardiac and respiratory disturbances and mental health crises.

What kind of clinical skills were you able to practice with the prison nursing team?

The clinics were fantastic for practicing clinical skills, with lots of hands on experience being available. ECGs, dressings, injections, wound closure, suture removal and observations were all common practice. Every morning and afternoon there was the opportunity to complete the medications round also and due to the vast opportunity for spokes within the prison I also managed to complete a mental health assessment, smoking cessation assessment and observe the work of the specialist drug and alcohol team.

What do you think are the most challenging aspects of prison nursing?

The most challenging aspect of nursing within the prison for me was the prison regime itself. Many individuals within the prison have very low wellbeing for obvious reasons. To prison staff they are inmates, however to medical staff they are patients, this creates a very tricky dynamic when it comes to dealing with their needs. Being unable to encourage patients with activities to promote wellbeing was very difficult, I struggled to encourage patients to be active when they are only entitled to one hour in the yard a day and they are kept locked up in their cell for such prolonged periods of time. I struggled to encourage patients to connect with loved ones when they are only allowed a certain amount of visitation and many of the relationships the prisoners keep are strained due to their absence from home. I struggled to encourage learning when often classes are full up with long waiting lists and staffing levels inappropriate for the level security needed. The problem with prisons is that they aren’t therapeutic environments and this creates a vicious cycle that many vulnerable people fall victim to.

What did you enjoy most about your placement in a prison?

I can honestly say I enjoyed everything about the placement. The staff were all fantastic, great fun, welcoming and always happy to teach, my student colleague on placement with me was lovely, the prisoners were generally very polite and interesting to talk to. Being exposed to all the different healthcare sectors and how they are applicable to the prison community, highlighting the different demands of this small sub-section of the outside population was fascinating and I learnt how to deal with a patient who’s needs were often vastly different than what I was exposed to in my general training so it was fantastic to gain this different and unique experience.

What I really want to get across to nurses that would potentially consider a career within the prison service is that it really is a fantastic and unique experience. Often patients have very complex needs and this can lead to a really exciting and challenging working environment which really allows you to make a difference for your patients. Many of my friends and family thought I was stupid for wanting a placement they perceived as so ‘dangerous’, I really want to communicate how safe I felt in there. The prison officers are very well trained and experienced and look after the safety of the medical staff absolutely superbly. Do not be discouraged by fears of safety as officers are always on hand to assist you and will never leave you alone with a prisoner. Security measures in there are top priority for prison management and you’d never be left to work in an unsafe environment. If you have a keen interest in working with challenging individuals and nursing in a holistic and non-judgmental manner with a particular interest in mental health then the prison environment could be just right for you.

Thank you, Laura! It is fascinating and valuable to hear from other student nurses and midwives working in all kinds of different placement areas. If you have an placement experience or reflection that you would like to share on our blog, please do get in touch! Find us on Facebook @UoMPlacementProject or email studentnurseplacementproject@gmail.com.

Tools of the Trade – Mental Health Nursing

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Assessment or screening tools are key to gathering a whole wealth of information from a client and they can often lead to them opening up about other or underlying issues that may be impacting on their health. How and what they answer can give you insight into their current feelings about things as well as provide a baseline of presentation to record any future changes and used to point towards treatment required. Being able to monitor someone’s recovery progress can help staff encourage and motivate a person, just as being able to monitor someone’s deterioration can help staff adapt treatment and interventions appropriately.

Tools are not always perfect and we have to work with them openly and carefully using them as a guideline to help support the treatment or diagnosis we provide. Below is a short list of the some of the assessment tools you might come across on placement;

The Hospital Anxiety and Depression Scale (HADS) – Used for Anxiety & Depression can be used in community as well as hospital. It is a 14 question Psychological screening tool assessing the severity of symptoms.

Generalised Anxiety Disorder Questionnaire (GAD-7) – Screening tool used to measure the severity of Generalised Anxiety Disorder. 7 questions that can be administrated by a health care professional or self-administrated by the client themselves.

The Mini Mental State Examination (MMSE) – Commonly used short assessment used for screening for any dementia or cognitive impairment concerns are suspected. It measures cognitive functioning, and can be used to monitor change. 11 item tool taking around 10 minutes to administer making it a quick and useful tool to use.

The Addenbrooke’s Cognitive Examination (ACE) –  Well validated assessment tool for clinic setting assessment of cognitive functioning. This measures cognitive domains including language, visuospatial, memory and attention.  Usage is usually in part with other screening tests such as blood test, ECG and MRI scan to inform a diagnosis.

The Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) – Is a self-assessment tool for measuring the side-effects of antipsychotic medications. Red herrings are included to check the accuracy of the results. The 51 questions are based on true side effects with 10 being false  ones aim to help patients Identify, understand and gain awareness of side effects they could be experiencing.

The Alcohol Use Disorders Identification Test (AUDIT) – A basic screening tool used to pick up the early signs of hazardous and harmful drinking and identify mild dependence and highlight if a need for assisted withdrawal is required.

There are many varied tools assessing risk used by health care professionals in all fields and in  a wide variety of settings. It is important practitioners should take care to always explain what is involved,  how long it will last and how they can help a patient and their treatment.

Using an assessment tool can help uncover more information about a patients situation and help to encourage conversation that could provide valuable information to inform their care is more personalised and help reduce risk.

Keep your assessment tool box handy and help patients access all areas in health care support.smile

A moment of CALM: de-stress with new wellbeing workshops for student nurses and midwives

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It’s well known that in order to properly care for others, we must first take care of ourselves. I’m sure many of us have shared that advice with our friends, family, patients or their carers, yet how good are we at following it ourselves?

As the term progresses and the list of assignments builds up, it is tempting to put our health and wellbeing on the back burner. There are so many competing demands, especially as many of us juggle uni work with part-time jobs, family commitments or other personal issues. It can be overwhelming at times: every student nurse I have spoken to has felt the pressure at one time or another, yet you can often end up feeling quite isolated, thinking ‘is it just me?’ Believe me, it’s not.

Don’t fear – help is at hand! After feedback from previous students, a brand new project has been set up to support students throughout the year. CALM has been designed been designed specifically for student nurses and midwives, aimed at tackling some of the regular issues we might face during the course.

On offer is a four week Mindfulness course starting this afternoon which will give an introduction to mindfulness and share techniques to cope with anxiety and stress. Mindfulness is about being present in the moment, switching off from the endless distractions and learning to calmly accept the emotions and thoughts that fill our minds. Over the four weeks you will be given an introduction to acceptance and be taught some simple stress-busting tips including how to carry out a body scan and breathing exercises. You will also learn how to recognise stress cycle and ways to build mindfulness into your everyday routine.

On top of that are drop-in sessions on money management, for practical tips on how to make your bursary and student loan go further, and a session on housing for anyone who wants advice on finding accommodation that fits our hectic schedules. A series of free sport and fitness classes are also in the works, so watch this space!

meditation-1000062_960_720Starting this afternoon, the Mindfulness course will run every Wednesday for the next four weeks between 1-2pm and there are a couple of one-off money management and housing sessions planned for the rest of this semester. You can book a place on any of the sessions here or contact Eve Foster at sso.intern@manchester.ac.uk – and if you’re interested in the Mindfulness course, it’s fine if you can’t make the first session today.

Don’t forget that the university also offer a fantastic counselling service and a massive range of wellbeing and relaxation courses, from daily meditation sessions to longer courses on low mood and self esteem. There are also plenty of online resources and apps like Headspace that can help you unwind and de-stress.

You don’t have to become a incense-burning zen master to build mindfulness into your everyday life. Mindfulness expert Andy Puddicombe says in this TED talk that we only need to spend 10 minutes doing absolutely nothing to feel the transformative effects of mindfulness.

So kick back, switch off and just breath.

Suicide is everyone’s business

There were 6, 122 registered suicides in the UK in 2014 (ONS, 2016).

Today is National Suicide Prevention Day. This got me thinking about my experiences of suicide attempts in placement and what I have learned, which I wanted to share with you.

I am a student children’s nurse… I know, suicide in children’s nursing?! Yes, children and young people take their own lives. Notice I didn’t say ‘commit suicide’? Well-spotted. This was intentional. Now, it’s not easy to break our language habits, but I’ve found that a good start in communicating with people who have attempted suicide (or any vulnerable person, or, well… people) is to think carefully about what I’m saying. The word ‘commit’ is commonly used in reference to criminal activity, which ties it to negativity, so I prefer not to use that word. I recognise I used the word ‘attempt’ above. Is this word associated with failure? I don’t know. I’m still learning.

During my time on placement, I have observed how well staff respond to these children and young people in a clinical sense, and how they are still learning how to provide emotional and psychological support.

My first experience was with a young person with diabetes who intentionally missed insulin doses and miscalculated insulin doses in an effort to end her life. The nurses were open about their discomfort in communicating with her. I respected their honesty and, from this point, made it my objective to build my knowledge of communicating compassion in these situations. I started by sitting and talking with her. More importantly, I listened.

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Fast forward a few months and I am with a girl who has taken an overdose on the ward. This was an emergency. The charge nurse raised his voice and forcefully asked what she had taken. She stayed silent. Another student and I took a different approach. She held her hand and I asked people to stand back.

We introduced ourselves, explained she wasn’t in trouble and that we cared about her.

Somehow, we got to a point where we were singing and dancing to Justin Bieber in her bay, with the curtains closed enough to give her some privacy and open enough for staff to monitor. We listened to her and gave her our time. She disclosed to us what she had taken and she was treated. She was referred to CAMHS (Child and Adolescent Mental Health Service). She thanked us sincerely.

Following this incident, I asked staff which they felt was the best approach, given it was an emergency. Opinion was divided. What do you think?

I could write on and on about suicide prevention, but for now I have listed some of my top tips:

  • Refrain from judgement. If you can admit to yourself that you can be a little judgemental, that shows great level of self-awareness and highlights an area of self-development. For now, try to disguise your judgement. Think about how eye-rolling, tutting and slumping your shoulders whilst turning your back (yes, I have observed these in practice) could make somebody feel – Remember the first standard of the Code ‘treat people with kindness, respect and compassion’
  • Actively listen. Show you’re listening; make eye contact, nod with understanding…
  • Sometimes there are no ‘right’ words, but think about how your language could make someone feel.
  • Don’t be afraid to ask. ‘Are you feeling suicidal?’ ‘Would you like to talk?’ ‘Is there anything I might be able to do to help?’…
  • Don’t make promises you cannot keep. If you feel someone is at risk, make it clear you will need to share information confidentially with appropriate colleagues/services.
  • Know who to refer to and what support is available. You are a student, so at this stage it would be your mentor you would raise concerns with, but learn trust safeguarding policies and national and local services. Here are some resources to get you started:

SamaritansMindStamp Out SuicideMaytree, Male-specific: The Calm Zone,

Young People: Papyrus, Children: Childline

  • Be open to learning ways to help vulnerable people who are considering suicide. One small action you make could save somebody’s life. Keep learning. Keep reflecting. As always, I recommend Twitter as a useful starting point:

#WSPD16 #WorldSuicidePreventionDay #ItsOkayToTalk #TalkThroughTheTaboo

Suicide is everyone’s business and you can make a difference.

Supporting Patients with a Learning Difficulty

 

Between 25 and 40% of people with learning disabilities also suffer from mental health problems, with dementia and schizophrenia showing a higher prevalence. Standards of care for those with an identified learning disability have been under the spotlight since appalling levels of care were highlighted in the media relating to a specialist care home – somewhere that should have been a safe haven for those in need of support. Questions were raised about in-patient services for those with a combination of a learning difficulty and a mental illness who presented with behaviours that were challenging and what care options should be provided. It must be highlighted that not everyone presenting with these combination of diagnoses will present with challenging behaviours. Everyone is different but we all deserve the same level of care.

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In placement as a mental health student I have observed patients being brought onto a general mental health acute ward who have a diagnosed learning difficulty. I have seen both good and poor practice observed. I have seen staff gain a real understanding of a patient’s condition and how the patient see’s and understands the world. I have seen other patients on ward stand up for and support a patient with learning difficulties and sadly seen others exacerbate the patients current mental state. Knowing how to support and care for the patient as an individual in this situation is crucial as well as manage the others in your care in the same way.

Learn more about the patient’s condition just as you would a standard mental health patient. Asking the patient directly can also be a great way to gain understanding of they view their situation. Asking a carer or family for advice, again in the same manner you would with other admissions helps to promote equality and improves the care you can provide. Find out if they have any extra physical or communication needs that need support as it can help relieve some stress and anxiety about settling into the new environment.

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Providing an individualised person centred approach to care during an admission is vital. The Royal College of Psychiatrists (2013) recognise the complexities involved in service provision of this kind and confirm the importance that communication between a multi-disciplinary team plays. Some hospitals have a learning disability liaison nurse so it’s worthwhile finding this out too. It maybe that a learning difficulty is undiagnosed in a patient as cognitive impairment is often found in those with schizophrenia; the consultant should be able to provide support on this when made aware. Either way, care provision should be treated with the same respect, care and dignity as it is to all.

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Reference:

The Royal College of Psychiatrists (2013). People with learning disability. London: Royal College of Psychiatrists