Engagement and Communications

Week 4

 Context

Although we have spent some time looking at diagnostic categories, what this course aims to achieve is increasing your confidence and understanding of how to interact and engage with someone who is in a state of distress. Having looked at diagnostic categories and common behaviours, how can that level of understanding help you then think through how best to provide help and support to someone like Carol?

With grateful thanks to the Mental Health team at City University for their help with this week's resources.

 Introduction

This week runs from 13th to 19th October. You will need to:

1. Complete this section
2. Carry out the Assessment exercise (you may want to watch the Video: Journey: Episode 3: Jackie's Visit first)
3. Complete one or both of Risk Management (Universal) and Risk Management (Advanced)
4. If appropriate complete Therapeutic Interventions (Advanced)
5. Watch Video: Journey: Episode 3: Jackie's Visit
   
6. Join Discussions: Week 4 - Assessing Risk

 Content

Communication

Communication is often a major part of the patient's care (especially chronic and palliative care). Sometimes it is all we have to offer. People with good communication skills can help to articulate the issues, that lead to enabling the identification of a person's mental health problems more accurately. There are so many resources available to help you with your communication skills (often referred to as Interpersonal Skills).

Health and Social Care staff with good communication skills have greater job satisfaction and report less work related stress. Their clients are reported to adjust better psychologically and are more satisfied with their care. Skills can be developed - but practicing skills and feedback of performance is needed. Consider spending time talking and listening to a friend who is going through a difficult time. What really helped them, was it you telling them what to do, or was it listening and accepting them for who they are, and guiding them towards finding a way through the problem together?

Time to Change is England’s biggest programme to end the stigma and discrimination faced by people with mental health problems. The programme is run by the charities Mind and Rethink Mental Illness. They are funded by the Department of Health, Comic Relief and the Big Lottery Fund.The Time to Change Links to an external site. campaign has a variety of resources such as: 'blogs about mental health' Links to an external site. and reports such as: 

Evaluation of mental health training for primary care professionals Download Evaluation of mental health training for primary care professionals

: Primary care is the point at which most people with mental health problems access services and support. This project was developed to help primary care professionals make their practice more mental health friendly, in turn this will improve people’s experiences of using primary care for mental health problems and reduce stigma and discrimination.

Children and young people Download Children and young people

: this report summarises the various pieces of preliminary research that were carried out to help develop Time to Change’s first pilot children and young people’s programme. It highlights some of the key findings from all this research, in order to give an overview of the framework behind the Time to Change children and young people’s programme and to share the insights they have gained with others who are interested in tackling stigma and discrimination among this audience. 

Stigma Shout Download Stigma Shout

: a programme that will publicly challenge attitudes towards mental health in England and counter discrimination against people who experience mental ill health. 

Key Tasks in Communication

Visit the Mental Health First Aid Links to an external site. website, an initiative that started in Australia. MHFA came to England in 2007 and was developed and launched under the Department of Health: National Institute of Mental Health in England (NIMHE) as part of a national approach to improving public mental health. In 2009 they became a Community Interest Company (CIC). The MHFA central office is based in Old Street, London with a central team of 15 members of staff.

Awareness of how you communicate with people is key to understanding how best to engage with someone suffering with mental health issues. Do not be afraid to ask questions in a way that shows your concern, but also means you are not embarrassed or ashamed of their situation.

1. Elicit the person's main areas of concern and ask about their physical, emotional and social situation, and whether there are any changes they have notice (i.e impact)
2. Demonstrate support through active listening, and spending time sat quietly with them, despite how restless or agitated they are. Be very conscious and aware of your ability to move aside out of arms length, should they become aggressive. 
3. Offer information. Speak in short sentences. Reinforce the situation as it stands, in terms of what is happening and when. Share any resources you know of that might help. 

Assist in coping

Identify together who and where their support can be found. Plan the next few minutes. Work together to find some solutions, short, medium and maybe longer term plans. Consider the full range of resources that may be available, and utilise family and friends. Encourage elements of problem-solving, scheduling, distraction, focusing of attention, relaxation  

Eliciting problems and concerns

Establish eye contact at the beginning of the interaction and maintain it at reasonable intervals - this shows interest. Respond to verbal and non-verbal clues, and use "active listening" to clarify any areas of concern. Write down anything you think will be of help. Respond to clues about problems and distress by checking and exploring them, summarising information to show the person they have been heard. Mirror words and phrases they use, and be sure to give them an opportunity to correct any misunderstandings by seeking clarification (have i got that right?). Inquire about the effects of their illness (social and psychological impact) - on them and their family/friends - this shows that you are interested in their well being and that of their social situation.

 Offering support-do's and do not's

Avoid offering advice or reassurance before the main problems have been identified, and do not explain distress as 'normal', or tell them to 'just get over it'. Use empathy to show that you have some sense of how they are feeling, and encourage involvement of carers, family and close friends.Be creative in how you allow the person to express themselves and know you are interested in what is happening to them (e.g. undertake an activity such as going for a walk or to a café).

This very short video is from the Time for Change Project, and is 5 tips on how to start a conversation about mental health.

 References and Further Reading

Corry, P. (2008) Stigma Shout: Service user and carer experiences of stigma and discrimination. Download Stigma Shout: Service user and carer experiences of stigma and discrimination.

London: Time to Change 

Kanagaratnam, N. (2012) Children's and Young People's Programme: Summary of Research and Insights Download Children's and Young People's Programme: Summary of Research and Insights

. London: Time to Change

Loughran, J. (2013) Time to Change Children and Young People's Programme Download Time to Change Children and Young People's Programme

. London: Time to Change

Morrissey, J. & Callaghan, P. (2011) Chapter 1: Core communication skills in mental health nursing Download Core communication skills in mental health nursing

. In: Communication Skills For Mental Health Nurses: An introduction. Maidenhead, UK: Open University press