Working with volunteers

Monday 1 October
Today I spent the day with the volunteer to work (V2W) scheme. This scheme enables Oxleas service users to gain voluntary, part time employment within Oxleas. This experience can help service users to build confidence, gain experience and aid future employment as well as give back to the service they had previously used. The relationship seems to work well for both the volunteer and the employer as the employer can have access to someone who can provide the perspective of a patient and who may have a very valuable skill set that can be utilised within the service.

In the morning I observed two interviews for positions within the trust. The interviews were very informal and the employer and volunteer negotiated hours of working and the job role to suit both parties. It was important the role was flexible enough to ensure it fitted in with the volunteer and would be enjoyable and beneficial for them without becoming too much of a commitment. Additionally that once an agreement had been made expectations were set and the employer could rely upon the volunteer's contribution and the scheme could truly mimic employment.

I think the scheme is a fantastic initiative in terms of being a mutually beneficial relationship for all those involved. It improves patient experiences and outcomes whilst also being a cost effective way of improving the workforce for Oxleas.

Tuesday 2 October
On Tuesday I spent the morning with the Psychological Therapies Team in Banbury House. Firstly I sat in on a meeting with the rehabilitation team and then the assertive outreach team. Both teams spent a lot of the time discussing individual cases and forming action plans. I found it very interesting to observe how many professions came together and utilised their knowledge to form the most effective and appropriate action plan for the patient. Both teams used a 'traffic light' system to code each patient to a risk level. All patients in the red zone would be discussed by the team and then anyone could raise particular concerns about other patients they may want to discuss - this would often include patients in green or amber zones who someone feels may need to move into the red category. Every patient in the red zone would also be assessed as to their need to stay in this zone at the end of the discussion.

I think this system worked well as an effective way of managing risk. Every patient was displayed on a large white board under their care planners name and within the correct coloured area. This meant it was quick and easy to see visually how many risky patients each person was managing and the spread between each red, amber and green category.

In the afternoon I attended a more general meeting with senior psychologists. This gave me more of an insight into some key management tasks such as workforce planning. I also gained a better understanding as to how the sub-teams within adult psychological therapies were structured and managed within Oxleas.

Wednesday 3 October
I spent Wednesday at the Maudsley hospital which is part of the South London and Maudsley (SLAM) trust. It was really beneficial to see another organisation that deals with mental health and to see the kinds of services the Maudsley provides as I know Oxleas patients can sometimes be referred to SLAM.

The Maudsley is a huge organisation that is very research driven and renowned. SLAM offers community services to approximately 39,000 people as well as providing 68 inpatient wards across 4 sites. At first glance it seems the advantages of being so large are that SLAM can offer a variety of services and can be hugely impactful in terms of the progression and thinking within mental health services. However being so vast, changes can be harder and take longer to implement across the trust as a whole.

In the morning I attended an informal meeting regarding a new incentive to reduce violence and aggression on the wards. This involved many approaches which included identifying triggers for people's aggression, monitoring their levels of arousal and recording the best ways to deal with individuals when they are frustrated. Violence levels are very high within the inpatient wards at the Maudsley given the nature of the population and situation. It was seen as very important to test initiatives like these with the view to them being rolled out across the wards if successful as high levels of violence and aggression can have a very detrimental effect on staff and patients alike.

I then went to visit the eating disorders day centre where I was told about a recent on-going project named 'the invisible man'. This project came about based on consultations with patients who felt that coming to the waiting rooms in the eating disorder clinic could be very uncomfortable if they had problems that were more unusual for example binge eaters or males with anorexia. Staff had taken this feedback on whole heartedly and through many consultations and within a limited budget had made lots of changes. Previously the waiting room displayed almost exclusively leaflets and posters relating to anorexia and bulimia. They now had files that contained information on a range of eating disorders. Arranging the information in files also meant that patients could view information relating to them in private without others seeing what leaflets they had picked up. The centre had received hugely positive feedback from patients about the changes and had even been invited to speak on the BBC radio regarding their initiatives.

I then visited an adult acute assessment ward for addictions. Here, I attended a group with the patients where we spoke about 'ambivalence'. The ward was for people who had self-referred for treatment regarding their addiction problems. This meant there was a very realistic and positive attitude towards treatment and rehabilitation amongst the group. The group talked about times they had relapsed in the past, how they could avoid exposure to certain substances or people when they re-entered the community and what they felt had led them to their addictive behaviour in the first place. I found the group conversation very frank, inspirational but also realistic in terms of how difficult it can and will be to 'cure' an addiction and how you will always be an addict and will have to control your addictive behaviours.

Over lunch I attended a brief meeting amongst lead people who wanted to create a quality improvement group by getting together all those involved in service improvement and quality standards across all departments within the Maudsley. This was seen as a potential way for people to discuss and share ideas as well as share advice and best practice in terms of implementing quality improvement measures.

In the afternoon I attended a meeting with the executives at SLAM. This was a large group of people including executives with clinical and non-clinical backgrounds. It was very interesting to see how a meeting of approximately 25 people each with their own agenda was chaired and managed to ensure everyone could make their points but a strict time schedule was kept. Some very important and complex issues were discussed and in most circumstances actions were agreed. It was important the agenda remained relevant to all or at least most attendees so in some circumstances it was agreed that a smaller more relevant team would meet separately to discuss certain issues. I found it very valuable to be at such a highly important and influential meeting and to witness important decisions being made whilst considering patient experience, logistical issues and financial issues.