CPA – Managing Informal Service Users’ Non Compliance With Treatment.

Issues and points raised by the Reading group:

·      The first issue raised by the group was with regards to DMHST trying to meet the cultural and religious needs of the patients that it serves, for example some medication may contain alcohol and animal ingredients such as gelatine and these should be notified to the patient and alternative medication allowed as it is not permissible for certain groups for example Muslims and vegetarians. It was believed that within the policy rationale there should have been a mention with regards to this topic and the choice given to these patients to decide if they would take the medication that has been offered to them or if they could possibly be given another type of medication which does not contain the non permissible ingredients. The main emphasis being on ‘giving the service receiver the relevant information and choice’.

·      The group felt that there would be difficulties of individual needs clashing with risk management for example the policy states that service users have the right to refuse treatment but then on the same hand, treatment can also be given without consent from the service receiver.

·      In relation to the statement of policy the group felt that although it mentions that the service receiver should be involved within the treatment plans process it does not state what would happen if the service receiver was unable to speak, read or understand English. Would they be given someone to interpret for them? Documents produced in differing languages? As this can lead to misunderstandings from a service receiver point of view.

·      The group felt that the font used in the policy was a bit too small and that there should have been an abbreviations sheet which should contain an explanation of some of the terminology used within that particular policy document for example what is assertive outreach, management plan and what makes a service user high and low risk? Can more understandable phrases be used?

·      The group felt that the flowchart for non-compliance was a bit too simplistic and rigid to follow. The group felt that the needs of the service user should be put first rather than the trust following a specific plan or flow chart as not all service users would follow the procedure for non-compliance.

·      The group felt that the service users needs should be looked at holistically and not just the needs of the service user within the hospital environment. The group specifically talked about how a stay in hospital could alleviate some of the issues and anxieties that a service user came in with but the stay in hospital would not look at other issues that they face such as issues with drug use, housing or benefits.

·      The group felt that although the policy states that DMHST will provide treatment which reflects the needs and preferences of the service user this does not happen fully in real life, they believed that their needs are only really listened to if they refuse treatment and if they had received treatment without questioning it then their needs and preferences are never really looked at.

·      It does not mention within the policy that care and treatment plans should be communicated to the service user and it is vital for the service receiver to have a say in how their treatment and care plans are changing.

·      The group felt that some service users might willingly comply to their care plan whilst they are in an unwell state, but once they are well they can decline or not follow. It does not state what would happen if they decided to question their care plan at a later stage.

·      The final point that the group raised was one which service users could have a real problem with. The group suggested that rather than them having to tell everyone their story over and over again to all the professionals, they would much rather the professionals share the relevant information with each other rather than having the service user repeat their story, which could lead to some service users becoming very anxious because they have had to revisit memories that may not have been very pleasant for them.

Physical Examination – Policy for Physical Examination of Patients on Admission.

·      Within the policy document it does not state what happens during a Physical examination exactly. This needs to be added to the policy so that professionals are aware of what to expect and what to carry out. There is no reason given from the trust as to why a physical examination needs to take place.

·      It does not state within the policy whether a service user can refuse to have a physical examination. Also it does not state if the service user can request a doctor who would be suitable to meet their race, gender or religious beliefs and needs.

·      Within the policy it does not state if a patient has a right to allow a family member or friend to stay with them whilst the examination is carried out. 

·      The group felt that in most cases the service user is going through a lot of trauma with having to be admitted to hospital. This means that it probably wasn’t an appropriate time for staff to carry out an physical examination and that they should wait for at least 24 hours before the examination is carried out unless it is deemed to be imperative for the patient. The group also felt that if an individual is being transferred from another department or hospital then surely the service user would not need another examination if records have been kept of their previous examinations within the other departments and then passed on to the new department.

·      The group felt that care should be taken (where staffing levels allow) not to carry out the physical examination during meal times, personal hygiene or prayer times and that similarly as much dignity, privacy and reassurance should be given to the service user as is possible. The group also felt that the examination should be deferred if a service user is admitted during the evening or night as it can make a potentially volatile situation worse.

·      The group felt that whilst previous diagnosis’s should be taken into account, it would be beneficial to start each examination with a ‘blank slate’ and not just look for injury / illness relating to predominantly known condition. A patient’s illness may have taken a different course or new symptoms may be missed if this becomes a tick box exercise based on information or unintentional prejudices held.

·      The group felt that service users could view the policy very negatively as it concerns physical examination, which service users may view as an invasion of their privacy. The group did not know how the trust could tackle the physical examination policy but felt that it could be carried out in a non-threatening and informative manner.  

Locking of Doors on Open Wards:

·      The group felt that there is a huge risk that the trust would use this policy unofficially through action by stealth and that it would become a routine procedure to keep control of service users and to make the professional staffs job that much easier.

·      The group felt that it was good of the trust to acknowledge within the introduction how difficult of a decision it was to lock patients up on open wards.

·      The group suggested that their was a possibility that this policy could be abused by overstretched staff to try to keep tabs on the patients by way of locking the doors.

·      The group suggested that where the doors have been locked on open wards staff should highlight the reason why this has happened and also countersigned / witnessed by another independent members of staff which would restrict the possibly of this policy being misused by overstretched members of staff.

·      The group felt that the trust should have security staff so that the doors could be left open on open wards.

·      The group felt that it was not fair on vulnerable service users to have to share or be locked up on wards with potentially volatile service receivers who needed to be locked up so they could not pose a risk to themselves or anybody else.

·      The group felt that there should be notices on doors so that service receivers would be aware that they are entitled to leave the open wards but they would need to ask a member of staff to leave, also these notices should be in the different languages that are spoken by the service receivers.

·      The group felt that the rights of the service receivers especially those who smoke and practice their religious duties such as praying needs to be incorporated within the policy document so these individuals could practice what they wish to do when they needed to.

·      In conclusion the group felt that the policy document seems to balance the human rights of the service user with the MH code of practice well in theory but not as well in practice.