Thursday, 14 September 2017

Back to the Floor: Superintendent Jon Cummins at Felindre Ward

Superintendent Jon Cummins, Staff Nurse Melanie Fletcher, Dr Frank Medford
Years ago there was a BBC TV documentary series called Back to the Floor, where bosses returned to the shop floor to find out what life was really like as a worker in their company. This turned out to be both intriguing and extremely useful for the managers who took part.

Here in Powys the approach has been adapted by the Powys Mental Health Planning & Development Partnership* to give Chief Officers, Service Directors and other high level staff the opportunity to experience a day in the life of a member of staff at the operational end of a service. They have chance to find out what is really happening on the ground, and what consequences strategic decision making can have on people who are in receipt of a service. For someone experiencing mental distress in Powys, that service could be provided by a voluntary organisation such as a Mind centre or Kaleidoscope, or the statutory sector such as the NHS or the police, for example.

Every couple of months I attend the PMHPDP’s Engage to Change sub-group which focusses on enhancing the Partnership’s communication, participation and engagement activity to support delivery of the Powys strategy Hearts and Minds: Together for Mental Health. The great thing about this role is that it gives me the opportunity to participate in some of the Back to the Floor activity as an observer (I make notes, take photographs and feed back to the Partnership). The Partnership has identified three clear learning opportunities for the exercise: 1. Are we meeting our purpose? 2. What gets in the way? 3. What can we do better?

So it was that in mid-August I observed Powys Divisional Commander, Superintendent Jon Cummins, who is a member of the PMHPDP, go Back to the Floor at the mental health inpatient unit in Powys, Felindre Ward at Bronllys Hospital. Towards the end of our visit Jon also had chance to meet staff from the South Powys Crisis Resolution and Home Treatment Team. It was a brilliant opportunity for both of us to find out more about the workings of the ward and the CRHTT, and for the agencies to build stronger and better working relationships.

Felindre Ward, Bronllys Hospital

Before the visit: Jon’s view

I had been to Felindre Ward before during a Section 136 three years ago when I had a different role in Dyfed Powys Police. At that time I didn’t see beyond the S136 suite. The person was compliant and of no trouble to police or health partners, but in spite of this I could see that the joint working at the time was not quite there. I am keen to see how things have changed.

Throughout my career I’ve only been fleetingly in mental health secure and non-secure units across both England and Wales purely from a policing perspective and they all appear broadly the same. I have an image of rows of beds and people receiving care and attention in a stuffy unwelcoming environment.

I did not make such a visit to a mental health ward during my induction as a newly appointed student police officer a number of years ago when I entered the service. However, I would expect Dyfed Powys police staff to have some understanding of what goes on in Felindre Ward – it is important to have this understanding as part of their training and is something that we are currently working on with partners to implement. As only 11% of demand of what Policing is currently dealing with is crime related, it is even more important today for officers to have that rounded knowledge and perspective on mental health and vulnerability than when I first joined the police service as the nature of our work has changed.

The barriers to this that I am aware of are often around knowledge, training and the sharing of information between partners. Although we are consciously improving, we can be quite parochial and not always create opportunities for joint training and provision of services. And we can sometimes 
have misunderstood expectations about what the other agencies can do for us and us for them. 

There are also challenges around available resources in the right place at the right time. Powys is such a huge geographical area and the public rightly need the right resource dealing with them. For instance we were once asked by health colleagues to attend the home address and check on an admitted patient’s cat! It’s the little practical things which can make a significant difference, ensuring that both the community and our partners have an understanding of what the police can and should be doing to protect our communities.

When it comes to strategic issues, I am aware that all mental health services in the county have recently returned to be managed by Powys Teaching Health Board, having previously been outsourced to neighbouring health boards. A move to a single place of safety for S136 into Powys is one strategic issue that we will be working on over the coming months.

And I know there are current service gaps around the mental health provision for children – unbelievably they can still currently end up in police custody and then there will be headlines in the media and scrutiny on the police from a number of external partners such as HMIC (Her Majesty's Inspectorate of Constabulary) and the IPCC (Independent Police Complaints Commission). Policing feels that this can be a significant burden to carry when there are service gaps from other partners.

The perception is that people often using services at Felindre Ward are from certain aspects of the community. As we know children are ruled out due to age. I think the profile of service users differs across Wales. Here in Powys we don’t see the high volumes of abuse of drugs/alcohol as in other parts of Wales. Well, people may have a dependency, but they are often more willing to engage with their community as they are smaller and generally known to each other, this also provides services with opportunities to identify people earlier.

And people are less transient in Powys. They are often either from Powys or have moved here. It feels that the majority of service users are unemployed and from the 25 – 40 age group. There seem to be more men than women who are suffering from mental health and who will be engaged with the police and health partners.

Many men who are subject to a S136 have self-harmed, either at the point of contact or previously in their history. There are also some women who are repeat service users who are also very well known to the police, they are smaller in number as a group, but often have a higher individual demand on police and partners' services.

90% of those calling the police around mental distress do so themselves when in crisis. If they are making the call to the service themselves it is often a cry for help and we strive to put the appropriate intervention in place. It is not unusual for people to call police 20 – 30 times and say they are going to kill or seriously harm themselves. What is more concerning is those whom are not known to police or other partners and are suffering in silence, not being comfortable to tell someone they are not ok.

Back to the Floor exercise

Jon and I were shown round Felindre Ward by Staff Nurse Melanie Fletcher. We saw nearly every nook and cranny from laundry rooms to bedrooms, common room to garden space, clinical room to nurses' station. 

En route Melanie introduced us to colleagues and some of the people currently staying on the ward and happily answered our many questions. She explained that staff can voice their opinions at regular team meetings and she felt that there is a “good listening ear”.

We then met and spent a considerable time talking to three members of the South Powys Crisis Resolution Home Treatment Team.

After the visit: Jon’s view

Well, I had hoped to learn more about mental health services and I have absolutely done that! I have made some great contacts within the Mental Health services at an operational and tactical level which mean that I can put processes in place around information sharing, across all of Powys, but particularly in the South Powys area. There is a real opportunity for information sharing and problem solving meetings to be set up between the different services – ambulance/police/mental health.

I learnt that people aren’t necessarily admitted on any form of section, but do need support and that there is problem-solving going on around these individuals which is something police officers will be unaware of.

There appears to be a gap around providing support and/or services for those people who are distressed but have not committed a criminal offence and are not on the ward, but are regularly coming to the attention of police. There needs to be a problem-solving forum around these people who are regularly in contact with police officers but have not passed the threshold for admittance to the ward on a form of section, which is something that I will take forward with the police management team in Powys.

Jon with Sharon Stinson and Laura Charles-Nelson
from the South Powys Crisis Resolution Home Treatment Team

I also now have a much greater understanding of the work of the CRHTT. They seem to act in much the same way as a mental health triage team that operate in other areas of Dyfed Powys. So there is the opportunity and willingness for officers to put in a call to the staff about people we come into contact with and see if the person is known to them and what solutions can be provided or advice given.

Seeing the inner workings of the ward was also very useful. There are a quite a few activities going on in the ward. Everyone currently on the ward seemed happy. They are getting the care and attention that they need and no issues were raised. They seem to have made the ward home, so it was a positive experience in that regard.

The main barrier to service delivery, as it always has been, is around communication. One thing I didn’t realise we had finalised until today was that student police officers are having work experience with mental health staff on the ward, which is hugely positive. And information sharing is starting to happen now with the joint mental health training which takes place.

Following on from the Back to the Floor session I want to put some formal structures in place and circulate information about the various mental health teams and what they can offer to colleagues – what they do and where they are. And finally I would just like to say that it would be extremely useful for all managers within policing to do a similar exercise themselves. Thank you to the staff and all at Felindre Ward for their warm welcome, allowing me to experience what they do and how they do it to benefit the partnership working approach with Dyfed Powys Police.

And finally

Many thanks to Jon for taking part in this Back to the Floor exercise at Felindre Ward. All of the learning from this and subsequent BtTF visits will be fed into the Powys Mental Health Planning & Development Partnership* to share with others and to help with future planning and delivery of the Hearts and Minds: Together for Mental Health Strategy. Over the next six months a number of other members will also be visiting partner agencies to recognise the excellent work staff do and to talk to people using services so watch this space for future blog posts.

*The Powys Mental Health Planning and Development Partnership brings together key stakeholders including Powys County Council, Dyfed-Powys Police, Powys Teaching Health Board, Powys Community Health Councils, Powys Association of Voluntary Organisations, and representatives of people using services and those close to them.

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