Introduction

Family, friends and carers play a critical role in looking after people with mental health problems (in this document referred to as service user) and supporting them with their recovery.

We understand that recovery can be complex and unpredictable and there are times when being a family member, friend or carer can be challenging and stressful.

The purpose of this leaflet is to provide information about the Forensic Mental Health Service and sources of support available to families and carers.

There are also opportunities for families and carers to get involved with the service.

If there is anything you don’t understand or are concerned about please ask.

If you have any questions after reading this leaflet please ask a member of staff who will be happy to help in any way they can. If you have any caring related enquiry or feedback you can contact us at forensiccarers@oxfordhealth.nhs.uk

What is the Forensic Mental Health Service?

Men and women may enter our service when there are concerns about mental health needs and levels of risk to self and others.

Our aim is to look after people in the least restricted environment possible and support people to recover and return back to the community in a safe and supported way.

People may come to us:

• From court
• From prison
• From the community
• From general psychiatric hospitals and units
• From other secure hospitals around the country

We operate from a number of sites across the Thames Valley.

Marlborough House

This is a medium secure unit for men at Milton Keynes Hospital site. There are two wards:

• Watling, for new admissions and for men whose mental health and risk needs are acute;
• Chaffron, for those progressing towards lower levels of security and the community.

Woodlands House

This is a low secure unit for men on the Whiteleaf Hospital site in Aylesbury. Buckinghamshire.

Forensic Community Mental Health Team

The service has a community mental health team (CMHT) specifically for those who have moved into the community from the inpatient wards. The team consists of nurses, social workers, occupational therapists, psychologists and psychiatrists. They visit service users in the community across Oxfordshire, Berkshire and Buckinghamshire.

A number of inpatient units are situated at the Littlemore Mental Health Centre, Oxford.

The Oxford Clinic

This is a medium secure unit for men. There are three wards:

• Kennet, for new admissions and for men whose mental health needs and risk needs are acute;
• Glyme, for men who are progressing towards lower levels of security and the community;
• Evenlode is for men with additional learning needs.

Wenric House

This is a low secure unit for men.

Lambourn House

This is a pre-discharge unit for men and women. Residents here have a greater level of independence which includes budgeting, shopping and cooking for themselves.

Thames House

This an enhanced low secure unit for women on the Littlemore Mental Health Centre site in Oxford. There are two wards:

• Kestrel, for admissions and for individuals whose mental health and risk needs are acute;
• Kingfisher, for individuals who are progressing towards lower levels of security.

Admission to a Forensic Mental Health Unit

We try to admit service users to a ward where their needs are best met, including the opportunity for visits from friends and family.

However, transfers between wards are necessary and can occur when a person’s levels of risk are higher than can be managed on a particular ward (movement from lower to higher security) and when a person is progressing towards discharge (movement from higher security to lower security). This can mean a transfer from one hospital site to another. We have several sites across the Thames Valley.

How does the service work with families & carers?

The Forensic Mental Health Service aims to work positively and inclusively with families and carers, encouraging involvement and offering support in a variety of ways.

We are only able to share detailed information about your family member or friend if they give their consent. However we will always be happy to provide general information about the service.

Welcome meetings

This will give you the chance to attend a meeting with your family member’s clinical team. It’s an opportunity for you to receive information about the service and the ward, and ask any questions. If you cannot attend, you can always call the ward and talk to the staff who will provide you with the information.

When you are going to be attending a meeting write down questions you have beforehand so you don’t forget to ask.

Other meetings

Clinical Team Meetings (CTM) and Care Programme Approach Meetings (CPA)

If you are a family member then it may also be helpful for you to attend these meetings if your relative consents for you to do so.

During these meetings your relative’s needs are assessed and a care plan is developed in response to the needs identified and agreed. CTMs are held fortnightly or monthly depending on the ward, and CPA meetings are held every six months to see that your relative’s needs are being met and to agree any changes.

Who are the Clinical Team?

Members of the Clinical Team work together to care for the mental and physical wellbeing of the patient with the aim of reducing risk and supporting their recovery and independence. The team is made up of a number of health professionals and you may hear it referred to as the ‘multi-disciplinary’ team (MDT).

The Key Nurse is a registered mental health nurse responsible for co-ordinating the service user’s care on the ward for the duration of their stay. They may also be known as a care coordinator.

The Responsible Clinician (RC) is a consultant psychiatrist who takes overall responsibility for care and prescribes and monitors medication.

The Modern Matron is responsible for ensuring the quality of nursing care on the ward.

The Ward Manager runs the ward and works with the other professionals to ensure any concerns are dealt with. The are in charge of all the ward’s nursing and care staff.

The Occupational Therapist focuses on life skills and runs therapeutic groups. They will also work with your friend or relative on an individual basis to engage in meaningful activities; such as cooking, work skills, self-care and hobbies.

The Psychologist uses a range of approaches, sometimes called ‘talking therapies’. They help a person explore and understand strengths and difficulties, including thoughts, feelings and actions, relationships, and risk and protective factors, with the aim of enabling the person to make changes. They may work with the individual, in a group, or involving family members and other significant people in a person’s life. Other key members of the inpatient teams include Health Care Assistants, Fitness Instructors and reception staff.

The Forensic Community Mental Health Team (FCMHT) includes community psychiatric nurses (CPNs), social workers, occupational therapists, psychologists and consultant forensic psychiatrists. They are based in the community and provide care post discharge, but also link to the inpatient wards where necessary.

Difficulties with Confidentiality and Sharing Information

We know that as a family member, friend or carer you will want information about the care your relative or friend is receiving.

We need to have the consent of the patient to share information about their care with you. Sometimes, when someone is unwell, they might change their minds about whether or not we can do this.

We understand how frustrating and worrying it can be if consent is not given. If this is the case we will always listen to you, so please continue to share information with the clinical team.

We can always give general information about the service, as well as generic information on mental health conditions or medications.

We will regularly review the issue of consent with patients.

Legal Matters

Involuntary admission to secure services is governed by the Mental Health Act (1983/ 2007). This is a complex piece of legislation with more than 100 different sections. The most common used are:

Section 3: a civil section for individuals who are detained by two doctors and one approved mental health professional if they are deemed to present a risk to their own health and safety, or others, and if treatment can’t be given unless they are detained in hospital.

Section 37: or “hospital order”, is imposed by a court instead of a prison sentence for individuals who have committed an offence but where the presence of a mental health problem makes it appropriate for them to be detained in hospital for treatment.

Sections 3 & 37 of the Mental Health Act give particular rights and duties to the ‘nearest relative’. For further information speak to a member of staff.

Section 41: or “restriction order” is given to someone with a Section 37 when the court decides it is necessary for the protection of the public. The Ministry of Justice has to agree to the transfer or discharge of the person and, once discharged, it means the person can be more easily re-admitted to hospital if needed.

Section 47: allows for a sentenced prisoner to be transferred to hospital if this is necessary to receive mental health treatment.

Section 49: is a restriction order for individuals transferred from prison. It means that the Ministry of Justice must agree to a person’s discharge.

Forensic Mental Health wards

A forensic mental health ward is a place where people are given the care and treatment they need to recover. We aim to offer an environment which is as comfortable and as least restrictive as possible whilst maintaining the safety and security of both patients and staff.

All of our wards, apart from Lambourn House, are secure which means they are locked and access both on and off the ward is restricted. For this reason family and friends of service users are not able to access the ward. Visits will usually take place in meeting rooms or family rooms located separately to the ward.
Each of our wards have their own leaflet with specific information about that location. If you have not been given a copy of this please ask a member of the staff team.

Routine and activities

On all wards patients are encouraged to fit in with the routine and be an active part of the community of patients and staff. This means attending daily planning meetings, regular community meetings and participating in activities that will enable mental health recovery. Physical health is also important and there is a focus on promoting healthy eating and physical activity.

Leave

All service users in our care are detained under the Mental Health Act and can only leave the ward if leave has been granted. Leave always needs to be approved by the Clinical Team and in some cases by the Ministry of Justice. This is called Section 17 leave and will be given with some restrictions in place about how it will be used. For example often the patient will need to be escorted by staff before unescorted leave is given or the leave will be only permitted to a particular place or area. There will always be a specified length of time over which the leave can take place.

Leave is often a good time for family and friends to meet with a patient. If leave is escorted by a member of staff you might like to discuss with them what level of observation is required to manage any risks while giving you and the patient privacy and space.

Transfer between services and discharge

As a patient’s needs change they may need to transfer to another ward. Wards have varying levels of security and are set up to support patients at different stages of their recovery.

Patients will always be placed in the best available service to meet their needs. This can mean being placed further away from home. We try to avoid transferring patients to wards outside of the service or region if at all possible.

Transfers are carefully planned and will be discussed at the Clinical Team Meeting (CTM). Staff from the ward which the patient is moving to will meet with the patient, and staff from the sending ward to ensure the transfer is well managed.

Discharge from the service is carefully planned by the Clinical Team and families and carers will be involved in this process. Patients will continue to be supported by the Community Team after they have been discharged from the ward.

Visiting your friend or relative

Visiting times

All our wards welcome visitors however there are a number of procedures that must be followed.
All wards have protected times when visits cannot take place. This includes meal times, when medication is given and therapeutic time where service users are encouraged to engage with various therapies.

Arranging a visit

The nursing staff on each ward will explain to you when visits take place and how you can book them in advance. The patient must request or give their consent for you to visit them on the ward. This will be discussed with members of the clinical team to make sure that your safety and that of others is considered. The clinical team will communicate all decisions with you.

Bringing gifts and other items to the ward

We understand that family and friends want to bring gifts and other useful items into the ward. In order to maintain a safe environment all items need to be risk assessed and approved by the ward staff.

Items which are generally approved include stationery, books, magazines and toiletries.

Items that are always banned include alcohol, tobacco, illicit drugs, more money than needed for routine purchases, smart phones and other devices that connect to the internet, devices that can record audio or video, plastic bags, glass bottles, drink cans, sharp objects such as knives and scissors, chewing gum and Blutac.

Each ward will make you aware of what you can and cannot bring onto the ward and any banned items will need to be placed into a locker prior to the visit. Please note visitors and their bags may be searched prior to a visit.

Bringing food to the ward

Although we understand that sharing food is important to families, we cannot accept home cooked food onto the wards for staff to reheat for health and safety reasons.

In order to maintain good physical health in all our patients we discourage visitors and patients to bring unhealthy food that is high in fat or sugar. Each ward has guidance which includes suggestions of healthy alternatives.

If you’re not sure about what items or food you can bring onto the ward then just ask a member of staff beforehand for guidance.

Family and carer involvement within our services

We value feedback from family and carers and we want to ensure that we involve our patients’ families when we consider developments in our service.

We believe that family friends and carers have a unique perspective and a lot to offer in helping us continue to meet the needs of our service users and their loved ones.

There are several opportunities to get involved.

The Family and Friends Forum

This is a quarterly support group that meets to consider the specific needs of friends, family and carers of service users within the forensic service.
There is generally a speaker and a topic along with some informal time where carers can gain support from facilitators and each other.

Friends, family and carers who attend are aware that this is not a group for sharing specific information about their loved one and information received is of a generic nature, therefore protecting patient confidentiality.

The Family and Friends Forum is a great way to meet other carers, find out information about the services and get more involved.

Carers Council

The council offers family, friends and carers a chance to provide their feedback on their experience of our service, and to be actively involved in shaping the care and services the Trust provides.

The Council is attended by senior clinicians and managers, who represent all wards within the service.

The quarterly meetings offer a range of topics including policy, changes to service provision and carer experience of the service.

Support for Family and Carers

Carer Assessment

A carer assessment is an assessment focused on the carer as an individual, their caring situation and needs. It enables an individual to be formally recognised and supported in their role as a carer and is a time for them to express their needs and concerns arising out of their caring role.

You can have an assessment no matter what your level of need, the amount of care you provide or your financial means. An assessment can help you feel more supported, less isolated and more aware of the help available to you. Your carer’s assessment should cover:

• Your caring role and how it affects your life and wellbeing
• Your feelings and choices about caring
• Your health
• Work, study and training
• Relationships and social activities
• Housing
• Planning for an emergency

The assessment will provide you with information based on your needs, such as:

• Details on specialist carer’s organisations who can help with your health and wellbeing, housing, benefits, employment, training and leisure opportunities.
• Carers’ support groups.
• Help to plan for an emergency.

A carer’s assessment is free and available to anyone who is in an unpaid caring role, including young carers under 18.

Accessing a Carer’s Assessment

The process varies across the Thames Valley region. In the first instance, contact the local authority for your area.

Sources of support to families and carers

Oxfordshire

Carers Oxfordshire is a free service which offers information, advice and support to adults looking after someone 18+ in Oxfordshire, who could not manage without this help.

• 0345 050 7666
• carersoxfordshire@oxfordshire.gov.uk
• www.carersoxfordshire.org

If you are a young carer (aged under 18) further information about support for you can be found by visiting www.oxfordshire.gov.uk and searching for young carers.

Rethink Mental Illness
Rethink Carers Hub offers advice, support and information for carers. The national site below will help you find a local support group in your area.

• Oxfordshire Carers Support Service. Monday-Friday, 9am-5pm
• 0300 5000 927 or 01865 904499
• www.rethink.org

Oxfordshire Mind provide support to people who are caring for someone with a mental health problem.

• 01865 247788
• info@oxfordshiremind.org.uk
• www.oxfordshiremind.org.uk

Buckinghamshire

Carers Bucks supports the health and wellbeing of unpaid carers and supports unpaid carers of all ages and in different caring roles.

• 0300 777 2722
• mail@carersbucks.org
• www.carersbucks.org

Buckinghamshire Mind provides support to people who are caring for someone with a mental health problem.

• 01494 463364
• info@bucksmind.org.uk
• www.bucksmind.org.uk

Carers Milton Keynes provides support for young and adult carers.

• 01908 231703
• mail@carersmiltonkeynes.org
• www.carersmiltonkeynes.org

Berkshire

Berkshire Carers Hub (Reading and West Berkshire): free, personalised support to make things easier.

• 0118 324 7333
• ask@berkshirecarershub.org
• www.berkshirecarershub.org

Other useful resources

Info on different mental health conditions can be found here: www.rcpsych.ac.uk/mental-health

A NHS carers toolkit, developed with carers and professionals, to provide support and guidance can be downloaded from:
www.england.nhs. Just search for secure-carers-toolkit-v2.pdf