Nursing in Mental Health

People with mental health problems need therapeutic interventions that increase their independence and/or empower them to manage their condition and recognise triggers that may result in relapse or exacerbation. Their intensive involvement means nurses make a huge contribution to the care of these patients and clients, whether in community or inpatient settings, working in general or specialist mental healthcare services. This award category is open to individuals and teams working in the NHS or independent sector who have developed initiatives that have improved the delivery of mental health care. Entrants should be able to demonstrate the benefits of their work in terms of improved quality of life or increased independence of their patient or client group.

Humber Teaching NHS Foundation Trust
Single point of access – adult forensic mental health services

The Humber and North Yorkshire Single Point of Access (H&NY SPA) takes referrals for Adult Forensic Mental Health Inpatient and Community Services. The SPA opened for inpatient referrals on the 1st of October 2021, expanding to include community forensic referrals on the 1st of June 2023. The community element is potentially a national first due to it being clinically driven, with a regional purpose. The H&NY SPA aims to foster a system-wide approach by unifying referrals for secure beds and the Community Forensic Teams (CFT) across the Integrated Care System (ICS), thereby improving quality, governance, consistency, effective communication, and service user experience. The vision was to create a central hub for receiving and triaging referrals for adult secure inpatient beds and forensic community services across the region. This was a significant development in the provision, as it centralised referrals to ensure equity across the region in relation to gatekeeping criteria. Changing the culture of referrals into forensic services has been a challenge. The team have built relationships with providers, providing education around pathways and triaging community referrals. Centralising referrals has its benefits in oversight of services and a full collection of referral data to provide insight to forensic service development. Plans for this initiative are vastly exciting. The collation of data is growing with each referral, leading to insights into the type of referrals coming into both inpatient and community services. Over time, this will help to shape investment into forensic services and contribute to knowledge on forensic service users and the support they need. The Clinical team is nursing led, with the oversight of an 8b Clinical Lead, an 8a SPA lead and a Band 7 nursing coordinator all of whom are mental health nurses.

Lancashire and South Cumbria NHS Foundation Trust
Trainee senior nurse programme

Staffing shortages within the NHS are well documented, now more than ever with the increased media interest around the issue. As a team, we knew we had a role to play in tackling this. We also recognised that there were gaps in knowledge for our newer members of the nursing team. These combined factors led to us exploring how we could recruit, develop and retain or nursing workforce. We began by exploring nursing development pathways already published and used within the UK and found little that met our needs. Rather than waiting for another service to publish a pathway, we took initiative and created our own. In doing so, we found gaps within the preceptorship programme which led to an overall of this programme too. Abigail Hilton and Emily Richardson met with the existing teams and potential new staff and consulted on how the programme would look. After several months of perfecting the document, we launched the ‘Trainee Senior Nurse Programme’. This is a 6 month development programme for band 5 nurses who wish to develop into band 6 nurses. We managed to agree funding to ensure that all nurses who successfully completed the programme were offered a band 6 post within our inpatient services. This programme has upskilled our nursing workforce and embedded a culture of CPD and growth. We are very proud to say that we have no nursing vacancies (at all bands) within our 3 inpatient sites and have retained all staff who have completed the programme. This programme has diversity and inclusion at the heart, we know from our research many nurses struggle to progress due to difficulties with interview so we have been flexible in our assessment and removed this barrier. We wanted to ensure equal opportunities for all of our diverse workforce.

NHS Practitioner Health
First contact team

NHS Practitioner Health (PH) has provided mental health and addiction treatment to health and social care practitioners (HCP) since 2008. As one of the largest publicly funded providers of its kind globally, PH offers a free and confidential self-referral service in England and Scotland. The current numbers of those accessing primary care services increasing dramatically, necessitating the urgent need to restructure and rethink the service delivery model was essential.PH created a mental health nurse led multidisciplinary First Contact Team to provide initial assessment, early intervention, and onward referral to other parts of the service. This nursing team played a major role in service delivery, developing care pathways, using validated questionnaires to assist triage, conduct assessments and treatment. It helped join the dots between the 200 or so clinicians, ensuring seamless, safe, accessible care during these difficult times (and continues to do so).With the nursing team assessing all new presentations, PH was able to cope with nearly 5000 new presentations in the pandemic year, exceeding the number presenting in the first decade of operation. The team continue to deliver approximately 220 appointments per week to cope with the rapid increase in demand and severity of presentations. The nursing team was also instrumental in creating a suite of online health material available freely to all HCPs across the UK and leading webinars, on-line chat rooms and support groups. The numbers presenting to PH continues to rise, with around 600 new presentations per month. In response, PH has grown its nurse-first-led model, providing care to patients with over 95% of patients improving in mental health outcomes on independent and standardised measures and around 84% who were not at work/training returning after treatment with PH. We hope to replicate our service in Northern Ireland after successfully doing so in Scotland in 2021.

Oasis Community Learning
National mental health team

Following the COVID 19 pandemic there has been an increased focus on the mental health needs of students in education, the impact of well-being on attendance, attainment, and aspiration. The Oasis Mental Health Team was established to support children and families at four levels: creating a trauma responsive whole school environment by training all staff to consider the emotional needs of students, to create a therapeutic response within small groups and dedicated 1:1 support, or top undertake clinical mental health assessment providing a therapeutic program or to facilitate an effective referral to CAMHS teams or GP services. To facilitate this series of intervention the Oasis Community Learning Trust has employed a multi-disciplinary team including mental health nurses, psychotherapist, counsellors, psychologists, experienced nurses, teachers, and primary mental health care workers. All who work with the wider school community including students, parents, and staff to deliver mental health support. The team have developed a matrix approach to map 4 levels of need against 5 criteria that includes impact on self, impact on family, impact on others and impact on learning. This matrix approach is refined to offer classification at primary (4-11yrs), secondary (11-18yrs), and staff. This matrix approach leads to a diverse range of therapeutic interventions that include 1:1 or group work, parenting support groups, particular support following traumatic events such a knife crime incidents or peer suicide. Partnership with local providers is essential and includes CAMHS, GP and local authority and third sector services. Referral to the team is based on a consent model and occurs through 3 distinct routes: self-referral by the pupils, referrals from parents or from the school safeguarding staff. A process of evaluation is in place that focuses on pupil satisfaction to the intervention, parental engagement and support, and the impact of intervention on attendance and attainment.

Rotherham, Doncaster and South Humber NHS Foundation Trust
Neurodevelopment service transformation

Neurodevelopmental Assessments, specifically the differential diagnosis of Autism and Attention Deficit Hyperactivity Disorder in Rotherham, Doncaster and North Lincolnshire for Children and Young People (CYP). Over the past 3 to 4 years, there has been a significant growth in demand for the assessment and diagnosis of Neurodevelopmental conditions which has resulted in a significant waiting list that exceed 2093 children (1072 CYP waiting for screening and 1021 waiting for assessment as of August 2022). RDaSH Children's service and Clinical Commissioning Groups worked closely to understand the demand and capacity issues across the system. Stakeholders from education, early help and social care and health and the voluntary and community sector have all been involved with this work. Successful business cases and funding bids led by service managers (nurses) supported some increased capacity which helped jump start a massive re-design of the pathway to support a streamline offer across three geographical areas, implementing digital support, improve quality and governance, reduce waiting times for CYP, develop resources to support CYP and families (CYPF) whilst waiting for assessment. This was fully supported by a skill mixed team of nurses, AHP's, support workers, administrators and external stakeholders. Challenges:- Recruitment- Knowledge, education and training- Change fatigue for staff and stakeholders (education)- Impact on stakeholders and how health support this- On-going high referral rates - Waiting lists and high wait times (often seen before innovation unfortunately)Outcomes-Implemented a seamless standardised Neurodevelopment offer for CYPF-Implementation of a school based referral process-Reduce referrals rates by one third-Reduced screening waits from 12 months to 4 weeks-Reduced waiting times for CYPF waiting for assessment. Future Plans:-Continue to reduce CYP's wait for assessment-Staff Wellbeing-Share learning

Serco Group, Mental Health Innovations UK and Unify Business Solutions
SHOUT for prisoners

The National Audit Office report on mental health (2017), calls for an urgent ‘step change’ in efforts and resources to support mental health in the community and in prison. In the community, patients are increasingly able to access family and other support in ways that are unavailable to prisoners, e.g. online applications. Now more than ever, being in prison has a major impact on prisoner wellbeing. It is therefore incumbent upon us to support the most vulnerable prisoners with innovative methods and tools. Historically, a text service to support mental health in prison has been impossible as phones/technology are not readily available or have limitations in a custodial environment. However, Serco, alongside Mental Health Innovations and Unify have collaborated to scope, build and develop a technology to enable such access to SHOUT.SHOUT is a confidential mental health text service that supports people in crisis with issues such as suicidal thoughts, abuse or assault, self-harm, bullying and/or relationship challenges. On reaching out to the service, individuals receive help to move from a moment of crisis or distress to a place of calm, and then further support to create a joint safety plan to mitigate future crises. Serco, MHI and Unify developed the service to ensure viability within a prison. Prisoners are able to access the service 24/7 from their in-cell devices. To ensure prisoner safety and access to emergency services when using SHOUT, we developed an Active Rescue Standard Operating Procedure (building on the established MET police process). Through this process, for anybody displaying signs of crisis, an emergency call is placed to the prison to initiate an in-person welfare check on the individual. Due to the success of SHOUT, the pilot has been extended to additional prisons and is now offered to our staff for additional mental health support.

South London and Maudsley NHS Foundation Trust
The learning disability and autism drop-in clinic

People with a learning disability and autistic people (LDA) experience significantly higher rates of mental illness than the wider population (NHS Long Term Plan 2019).This population is also more likely to experience restrictive practices when using mental health services (CQC 2020). Most clinicians do not receive any training about LDA ( BMA 2014) raising important questions about patient safety, quality of care and workforce capability (Health and Social Care Act 2022). To address this need, a nurse-led learning disability and autism drop-in clinic for adult mental health services (the drop-in clinic) was developed. The drop-in clinic provides mental health clinicians with timely access to specialist advice, consultation and support about learning disability and autism. The drop-in clinic was developed in response to novel roles created in the NHS Trust where the authors worked at the time recognising that colleagues in adult mental health servies were working with lots of autisitc people and people with a learning dissability and needed quick and easy access to consultation, advice and support to improve patient care. To the best of our knowledge, such drop-in clinics are not commonplace and constitute a new initiative. Moreover, nursing interventions are notoriously difficult to define and quantify, and nurses are frequently under-represented in teams conducting research, service evaluation and audit. We therefore sought to evaluate the drop-in clinic to establish whether it is having a positive impact on clinical care and clinician confidence, and if so, how.

Tees, Esk and Wear Valleys NHS Foundation Trust
Dual diagnosis project

Watching people with substance and mental health services try and navigate the complexities of these systems prompted the need for change. We set about creating an assertive outreach model that is recovery focused and undertakes joint homeless sweeps ( 5am visits to homeless people) as part of the offer alongside partners (including social care/ recovery connections/ drug and alcohol services) The team were to meet individuals on their own terms rather than in a clinical setting. Patients would have access “Family of services” delivering trauma informed care, joint assessment / treatment between mental health services and substance misuse services. We created a person centred approach led by individual need not organisational criteria. This was supported by adopting joint policies and processes which meet the needs of the individual and allow for a person centred approach. This model would provided quicker access to assessment/treatment. Service would be collocated in community hubs and visits would occur wherever the individual feels most comfortable, its a flexible model to meet the complexity and has a service criteria that is more inclusive to stop people ‘falling between services’ . Its a nurse led, needs led approach, providing support to other agencies working with complex clients alongside offering assessments to support with care planning so people can access treatment. Funding, recording systems, information sharing restrictions and organisational norms all had to be challenged / adapted for the creation of this project. The service has helped a number of people access mental health and substance misuse service that wouldn't been able to access services without this team. We hope to expand this service into different areas of Teesside and then hopefully other areas we have lived experience focus groups from the teams patients that give feedback to help us identify areas we can improve upon.

The State Hospital
Triple jeopardy three years on – Did we make a difference?

Caring for patients living with dementia is extremely rare in our high secure forensic environment. Nursing staff had limited or no experience in this area and were keen to increase their confidence, knowledge and skills. At the time, the organisation did not provide specialist dementia training based on having no previous need for this.The Senior Charge Nurse (SCN) for the area and a Senior Nurse from Nursing Practice Development worked together to establish the learning needs of the nursing team and liaised with Academics from the Alzheimer Scotland Centre for Policy and Practice at the University of the West of Scotland. The team then collaboratively designed, developed, and delivered this bespoke learning programme and sought ethical approval to evaluate the learning outcomes and application to practice.This learning project is the first of its kind in a high secure setting in Scotland and possibly the wider UK.We trained 24 members of nursing staff and several members of the multi disciplinary team over six sessions. This programme was delivered during the Covid-19 pandemic and therefore a hybrid approach required to be taken. Despite the challenges that the pandemic brought, the value of this training was recognised from a senior level and every effort was made to ensure the sessions took place.The effectiveness of this project lies in the collaborative development of the learning by staff who were aware of the particular needs of their patients, and by academics who are experts in the field of dementia care.A shared understanding created by the learning experience about living with dementia in a secure setting provided a new way of seeing the person. Further development and deepening of the knowledge about communication and dementia produced a deeper connection with the person living with dementia.

West London NHS Trust
Highly engaging de-escalation techniques for all with interactive QR coded digital booklet

In the present climate of rising violence and aggression experienced by service users and frontline staff in health and social care, this project is tailored to practically address those pressures and create safer environments for all. The objective of entering this award is to share and celebrate good safe practice, concepts of patient centred care, inclusion and diversity, reduction of violence and aggression by promoting the benefits of the face to face de-escalation programme and easily accessible digital booklet for ALL staff disciplines, in frontline health services. Empowering staff with the empathy, compassion, skills and knowledge to foresee, reduce and prevent violence and aggression and de-escalate potentially harmful and dangerous situations. Fundamentally allowing the opportunity for colleagues to meet patient and service user needs safely and effectively. The author created this innovation following a Qualitative Improvement Project in which he identified staff humanistic factors which led to/supported violence and aggression on inpatient wards. These challenges led the author to look at addressing the humanistic factors from staff that could create the problems and equally defuse them. The author then delivered his first prototype of this programme to nurses of all bandings and experienceas part of a Reducing Restrictive Practice (RRP) day on an innovative induction platform at his host NHS Trust with fantastic results and feedback, using this to build the programme further. Due to its success, the project has been included by the Mental Health Trust as part of a strong ongoing drive for Reducing Restrictive Practice (RRP). It has also been taken up by the local General Hospital multidisciplinary A&E, Emergency Department as training for their staff. The author has now been asked to run a Train the Trainer model to upskill colleagues to spread the training.

Whittington Health NHS Trust
CAMHS dialectical behaviour service

Aim - the aim of our service was to target young people presenting with chronic emotional dysregulation, who are likely to also present with chronic self-injury, unstable relationships and poor sense of self - among other areas of need. A number of these young people are also frequent attenders at A&E, and may also have had lengthy inpatient mental health admissions. NCL did not previously have a service that directly targeted these young people, and we were commissioned to fill this gap. We established a team of 8 staff members, with an identified clinical nurse lead, 2 8a senior nurse therapists and a band 7 nurse therapist. We also had a consultant psychiatrist, a clinical social worker, an assistant psychologist and subsequently employed a clinical psychologist. Initially we completed our training, set our vision, made a joint mission statement as a service, engaged with all local stakeholders across NCL and then launched our service in January 2023. Out initial barriers were around engagement with local stakeholders, ensuring the correct referrals were directed to us and also ensuring we were engaging our young people. An earlier challenge was around drop outs of our treatment programme. To tackle this, we reflected on barriers to our pre-treatment stage, which meant that young people were not committing as truly as we would have liked. We redrafted our pre-treatment process, ensuring that further commitment strategies, as well as engaging skills were used early on. The knock on impact of this was a significant reduction in drop out rates and improved longer term treatment for the majority of our young people. Our vision for next steps is to launch/develop a complex PTSD pathway for young people who have experienced sexual abuse, and cannot currently access conventional trauma work due to their risk profile.