Expert answers from the social worker

My mum has schizophrenia and I have always helped look after her – I am 24 now and still live at home. I had a carer's assessment and they told me about carers groups and respite care, but actually what I really need is more support for my mother when I am out at work and in the evenings. She doesn't go out at all and has no friends. She is very overweight and just sits at home watching TV. I am worried about her physical health. I just want her to have a bit of a life, so I can have a life too and not always be worrying about her and rushing home to be with her. I told the person who did my carer's assessment all of this and they said things were difficult at the moment because of all the cuts in services, and as my mum was quite well – not being psychotic – then there was nothing more they could really do for her.

It definitely sounds like you and your mum could do with some help. It also sounds like the carer's needs assessment you had was really a discussion about the fact that nothing more could be done for your mum, who is one of your main concerns. A carer’s assessment should be looking at your needs as a carer, as well as highlighting any areas of difficulty for you in your mother’s care. You should have a copy of your carer’s plan highlighting what is going to be done, and with your mother’s consent, a copy of her care plan. Your mother is entitled to an assessment of her potential eligibility for a personal budget, and her care plan should have some elements addressing the physical health needs you have identified, as well as any needs around daytime occupation/activity, and any medication needs. A personal budget for example could pay for items or services related to keeping physically fit. All local authorities are stretched at present but that is no excuse for not providing you both with properly thought out plans. Your carer's needs assessment, should look at what is available locally for carers, including the possibility of paying for some home support for your mother whilst you are out, or possibly accessing local volunteering schemes which can provide peer support or a volunteer to visit and support. My suggestion would be that you go back and ask through the local team manager for the above.

 

Can you please tell me what qualifications are required for care assistants working in mental health wards? Do they need experience of working with people with schizophrenia and other serious mental illness and are they trained in this?

There are no specific qualifications required for this role, but many trusts do have specific training programmes for staff on lower grades, which might include courses on how to work with a person who has a psychotic illness. The most important thing, which can be tested at interview, is that a person is interested in the work and has a caring nature. It would certainly help with a job application if a person already had some experience of working in a voluntary capacity.

 

Can a patient be thrown out of a mental health ward and if so for what reason?

Yes, a person can be asked to leave a ward, but the staff responsible for their care would have to be satisfied that the individual did not pose a threat to their own health or safety, or that of others, or that they would receive any care they needed elsewhere. This could mean an internal transfer to another ward in the same hospital, or, less likely, a move to another hospital. This has been most generally used in the past for patients with very disruptive, or assaultive behavior, who have injured other patients or staff, and usually when this is perceived not to emanate from mental illness as such, but more from learned behaviour. Often this is applied to people with different forms of personality disorder, but as personality disorder now comes within the new wider definition of mental disorder in the 2007 Mental Health Act, hospitals have a greater onus of responsibility to treat such individuals. If a patient is detained on a section of the Mental Health Act, a responsible clinician would have to provide evidence that it was appropriate to discharge that person from section before they could be asked to leave the hospital.

 

Can a voluntary patient be sent home from a psychiatric ward against their wishes and against their family's wishes?

This question is not dissimilar to the one before. A trust has an obligation to all patients, although clearly it has greater duties under law to patients who have been sectioned under the Mental Health Act. It is difficult to answer this question as there are a range of reasons why a voluntary patient might be discharged against their own wishes, or against their family’s wishes. If a person was in hospital voluntarily, but not actually accepting the treatment being offered, which can occur for example with a patient who has an eating disorder, then a doctor might discharge the individual, if they didn’t feel a section was appropriate or possible. It is also sometimes the case that an individual is basically well enough to go, but is scared of moving back into the community and is resisting being discharged. The key to this though, is that the clinical staff involved need to explain to the individual why they are taking this decision, and fully document all their actions, in case of any future investigation into what has happened. Above all they must ensure that it is safe for the person to be discharged, taking into consideration possible harm to themselves or others.