What I learned working in mental health

World Health Day 2017

by Christian Ramtale

“When our bodies are sick and people extend their sympathy, bring us soup, offer up solutions. When our minds are sick, people tend to shy away from you, be afraid, or call you outright crazy.” – Anna Akana.

One in four people in the UK will experience a mental health problem each year.

Due to increased awareness of the role mental health plays in our lives, there is a greater acceptance that mental health is of equal importance to physical health. This has enabled patient safety as a discipline to examine previously unexplored areas in mental health.

Before I joined the research team at the NIHR Imperial Patient Safety Translational Research Centre (NIHR Imperial PSTRC) as a research assistant, I worked as a healthcare assistant for two years supporting autistic adults with comorbidities in a 10-bedded inpatient unit. I quickly learnt that as healthcare providers, regardless of the level of seniority, we share the same principle: to uphold the duty of care to the patient.

Being exposed to a 24-hour care environment allowed me to gain insight into the safety culture at the hospital and what it really means to support service users with mental health issues and learning disabilities. There is always a safety element that needs to be considered when delivering a high standard quality of care to the patient. Some examples of everyday care I provided include support in administering medication, escorting the patient out in public to attend a local hospital appointment, and providing assistance in personal care routine.

I gradually became aware of the more complex needs of some of the service users I worked with either by talking to the patient directly or other members of the healthcare team. Some examples of this included ensuring that the correct medication is being administered to a patient with multiple comorbidities, managing aggressive behaviour appropriately with seclusion and restraint, ensuring that the shared physical environment in a locked mental health unit is suitable to accommodate numerous service users with different diagnoses, etc. However, these complex needs were often unmet. More research is needed in order to understand how these needs can be addressed.

Some of the wider issues of patient safety in mental health can occur in different settings e.g. nursing homes, outpatient hospitals, and medical wards in prisons. These wider issues may include but are not limited to misdiagnosis, lack of communication between healthcare providers and patients, delay in referral, and the impact of staff burnout. Understanding the complexities associated with providing care in a safe environment in mental health is a challenging task. So what can we do?

Fortunately, since working at the NIHR Imperial PSTRC, I am involved in several projects that directly tackle some of these patient safety issues. A recent publication entitled ‘A systematic review of patient safety in mental health: a protocol based on the inpatient setting’ aims to synthesise relevant research literature in order to highlight the best practices, as well as gaps in knowledge, in patient safety and mental health to help identify areas for research. Another ongoing project that is in collaboration with West London Mental Health NHS Trust aims to improve engagement with incident reporting amongst hospital staff after experiencing a serious incident, for example, medication error or violence. We have finished carrying out focus groups with staff for this study and will aim to publish the results later in 2017.

When it comes to providing care in mental health a crucial voice that is often lost, which is the voice of the patients themselves. It is vital to involve patients more in their care as this can provide valuable opportunities, for example, empowering patients to self-manage their treatment. This is why involving patients and public in research is at the core of our work at the NIHR Imperial PSTRC. Working in partnership with the patient and the public when developing and implementing research studies is key to ensure we are doing research in the most important areas and designing them in the best possible way.

The future direction of research within this relatively new discipline of patient safety looks promising to improve safety and outcome for patients. However, it is only when we harness our continual efforts to translate our ideas into action that we will see evidence of real change to improve patients’ care and lives. I also hope that with the greater dissemination of research about mental health and more advocacy, we can dispel some of the myths of mental health. This, in turn, could help people recognise systems and seek help sooner with the same level of confidence as perhaps they would do with a physical health problem.

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