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Mental Health

Mental health nurses should be able to issue fit notes

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by James M.
Mental health nurses should be able to issue fit notes
Image: © Monkey Business

The Thriving at Work report suggests doctors are not always best equipped to provide advice to people with mental health conditions.

The Thriving At Work report, commissioned by Theresa May, recommends that mental health nurses alongside other multidisciplinary healthcare professionals be allowed to sign 'fit notes' for patients as the report suggests they can be better equipt to offer advice.

Currently, 'fit notes', commonly known as 'sick notes', can only be issued by doctors. The 'fit note' outlines the support a patient should be receiving from their employer and when they are expected to be able to return to work.

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The Thriving At Work report says;

"There is limited evidence that the current fit note process is effectively encouraging GPs and patients to discuss work and health.

"Currently, only GPs and hospital doctors can sign a fit note, and many think that they are often not best equipped to provide employment advice for people with a mental health condition.

"Many are concerned about the implications of ticking “may be fit for work” when support might not be available to the individual.

"We recommend that the responsibility for completing fit notes is extended to mental health professionals, and that the government considers how to further improve communication between health professionals, employees and employers where appropriate".

The currently 'fit note' system is under review by the government.

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Mental Health

Suicide awareness for nurses is just as important as basic life support

Better education and awareness, both as part of nursing degree courses and afterwards on the job, are vital.

Published on

by James M.
Suicide awareness for nurses is just as important as basic life support

Nurses can play an important part in helping to prevent suicide, but aren’t always being given the training they need to do so at present.

That’s the message from the Royal College of Nursing’s Mental Health Forum as nursing staff debate the issue at the RCN’s annual Congress today as members call for better education and awareness - both as part of nursing degree courses and afterwards on the job.

The debate follows the suicide of one of the male characters in Coronation Street last week, in a harrowing episode watched by over seven million viewers.

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This week is Mental Health Awareness Week.

The leading cause of death for men under 45.

Almost 6,000 people took their own lives in the UK last year, and suicide is the leading cause of death for men under 45.  Only a third of those ending their lives were known to mental health services.  However, many of the other two-thirds will have come into contact with other health professionals such as nurses and GPs – meaning that nursing staff have opportunities to try and help prevent suicides.  But a previous survey by the College found that half of nurses hadn’t received any training in suicide prevention or awareness since starting work, while 60 percent hadn’t received any as part of their nursing degree.

In March, the Nursing and Midwifery Council confirmed that the recognition and assessment of suicide and self-harm should be included in nursing degree courses, partly as a result of lobbying by the RCN.  Now the College’s Mental Health Forum is calling on all higher education institutions to implement this new standard as soon as possible, and for this training to continue for all nurses, not just those in mental health, once they start working.

The 4,000 nursing staff attending the RCN’s annual Congress, taking place this year in Belfast, will today debate ways to improve suicide awareness within nursing.  The NHS's National Director for Mental Health, Claire Murdoch, is also highlighting the importance of nursing in suicide prevention.

An issue every professional will need to deal with.

Tim Coupland, mental health nurse and RCN Mental Health Forum member who is the proposer of today’s debate, said: “At some point during our working lives, every health professional will come into contact with someone who is feeling suicidal.  We all need the confidence to be able to talk frankly and openly with patients about how they are feeling, in order to let them know we can support and help them.  But I know that many nurses are worried about what to say in these situations, what to do, how to phrase their response, when to share and when to step in – realising that someone is suicidal is disturbing, and it often feels easier to play down the idea or perhaps quickly pass it to a mental health professional. 

“In last Wednesday’s Coronation Street, a leading character took his own life.  I applaud the fact that the producers of the programme worked with the charities Samaritans and CALM [the Campaign Against Living Miserably] to ensure that the way the story was told tried to encourage people who hide their feelings of desperation the chance to start a conversation with others. 

“We want all universities offering nursing degrees to include training in this vital area in their courses as soon as possible, and for employers to offer on-the-job training too.  Suicide awareness and intervention should be as fundamental to nursing staff as basic life support – your intervention, your response, could literally save a life”.

So much more can be done.

Claire Murdoch, National Mental Health Director for England, added: “Even though we know suicides overall are reducing, there is so much more that can be done.  We still need to believe that these deaths are preventable, and nurses are ideally placed to be leading the way.  We need high ambitions in our work to significantly reduce deaths by suicide - all of us should be well trained, be able to recognise the signs, as well as support and signpost a person.  In many cases one conversation at the right time, in the right way, could save a life and be life- changing”.

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Mental Health

Body cameras improve inpatient safety and quality of care

In 2016 there were 70,555 recorded episodes of violence and aggression towards NHS staff in England.

Published on

by Sarah J.
Body cameras improve inpatient safety and quality of care

Northamptonshire Healthcare NHS Foundation Trust trialled body cameras as part of their battle against violence and aggression.

The trial, which saw 12 cameras trialled by 60 staff for three months across five mental health wards at Northamptonshire Healthcare NHS Foundation Trust, reduced the need for emergency restraint from 41 incidents to 18.

According to official NHS figures, in 2016 there were 70,555 recorded episodes of violence and aggression – which equates to around 193 assaults on NHS staff every day. However, total numbers are said to be dramatically higher as many acts of violence and aggression go unreported.

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Feedback was positive.

The trust says that feedback from service users, staff and carers was overwhelmingly positive - 90% of staff said they felt cameras prevented confrontational situations and helped to provide an accurate record of incidents.

Body cameras improve inpatient safety and quality of care

A carer said; “My partner is currently being treated as an inpatient at Berrywood Hospital and seeing the body cameras in use has made me feel more reassured and more comfortable that if staff have to intervene their actions are recorded and it is a last resort.”

Improved patient safety and care.

Lindsay Bennett, Manager of the Prevention and Management of Violence and Aggression at Northamptonshire Healthcare NHS Foundation Trust, said; “We wanted to trial the use of BWC’s because we are always looking for ways to improve safety and patient care. We know that working together with service users so we can identify their triggers and what helps them when they do feel angry or frustrated, is the best way to avoid conflict.

“Using the footage from the Body Worn Cameras has enormous potential to help us prevent incidents and improve how we respond when they do occur as it is a really powerful way of learning.”

Alasdair Field, CEO of Calla - the company who manufacture the body cameras, said; “Having seen the results this technology brings in calming volatile situations, we are further encouraged by the results published in this study. We strongly believe the use of body worn cameras can only improve transparency and accountability, which in turn enhances trust and the relationship between patients and nursing staff.”

As a direct result of the trial, the trust has been named as a finalist for the Royal College of Nursing Institute Awards and shortlisted for an HSJ Patient Safety Award.

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Mental Health

Steep rise in reported assaults against NHS staff

There were 18,720 assaults in 2016/17 compared to 15,469 the previous year.

Published on

by Clare Bodell.
Steep rise in reported assaults against NHS staff

Last year in England physical assaults on NHS staff rose by nearly 10% compared to 2015/16, according to new figures published today by UNISON and HSJ.

The figures were obtained following a Freedom of Information request – submitted by HSJ working on behalf of UNISON – to all the 244 NHS trusts in England. Answers were received from 181 organisations.

The biggest increase was in the acute sector, with reported attacks on health workers in hospitals with an A&E department up a staggering 21%, says UNISON. There were 18,720 assaults in 2016/17 in the acute trusts who responded, compared to 15,469 the previous year.

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The data collected suggests that last year NHS trusts struggling to meet their performance targets were likely to fare particularly badly. Trusts who treated 90% or fewer of their patients within 18 weeks of referral saw an average increase in reported assaults of 36.2% in 2016/17, up 1,857 on the previous year.

Similarly, NHS trusts struggling with huge financial deficits were also likely to have witnessed a big rise in the number of reported attacks on staff, according to the data.

The HSJ/UNISON figures suggest that assaults in the trusts that are more than £20m in the red were up 23.1% on the previous year. This compares to an increase of just 1.5% for organisations that were comfortably in the black, and had surpluses in excess of £5 million.

The trusts responding to the FoI request reported physical assaults on staff of 56,435 in 2016/17, a 9.7% increase on the 2016/16 data.

Steep rise in reported assaults against NHS staffIf these figures are extrapolated to cover the whole of the NHS in England, the number of reported violent incidents in 2016/17 is likely to be closer to 75,000, the equivalent of 200 every single day.

When measured per 1,000 staff, the rise in reported assaults was 6% on the 2015/16 figures.

UNISON asked HSJ to carry out the research, as it is concerned that since the abolition of NHS Protect last year, there is no meaningful collation or comparison being made of the data on assaults.

Commenting on the figures, UNISON head of health Sara Gorton said: “Across the entire NHS, staff shortages are harming patient care and helping to create a hostile environment where health workers are increasingly at risk of being assaulted.

“It’s no accident that trusts where the pressures seem the most extreme – where there are huge financial deficits or where it’s a struggle to meet growing demands on services – have seen the steepest rise in the number of attacks. This desperate situation is only set to worsen as the squeeze on resources gets tighter.

“Now that there is no NHS or government organisation collecting data on assaults nationally, the picture is growing increasingly unclear. The safety of staff, who care for us when we are sick or injured, and their patients should be paramount. The government should reverse its ill-thought out decision to axe NHS Protect immediately"

Although staff working in mental health are seven and a half times more likely to be attacked, this was a smaller increase from 2015/16 of 5%. This seems to suggest the sector is having some success in preventing a difficult situation from getting any worse.

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