Priory Hospital Burgess Hill Elizabeth Anderson ward Carer Handbook 2020
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Priory Hospital Burgess Hill
Elizabeth Anderson ward
Carer Handbook 2020
1
Contents
Contents.................................................................................................................................. 2
Your role as a carer ............................................................................................................ 3
Introduction to the ward: Elizabeth Anderson ........................................................ 3
Our aims for patients ......................................................................................................... 4
Our aims for carers ............................................................................................................. 4
Contact information ........................................................................................................... 5
The Patient experience ..................................................................................................... 5
Safety and Security ............................................................................................................ 6
Restricted and contraband items .................................................................................. 6
Legal information, advice and advocacy .................................................................... 8
The triangle of care ............................................................................................................ 8
Care and treatment ............................................................................................................ 9
Discharge and transition ................................................................................................ 10
Information on mental health conditions ................................................................ 11
Glossary ................................................................................................................................ 12
2Priory Hospital Burgess Hill is a specialist site, set in attractive grounds in a rural setting in West
Sussex, providing Secure Service for females with mental illnesses and personality disorders in a Low
Secure care environment. This hospital also has two Psychiatric Intensive Care Units (PICUs) – one
male and one female, an acute male-only service and a specialist Dialectical Behaviour Therapy (DBT)
ward for female patients with Personality Disorders. The hospital is a spacious, purpose-built
environment, which is set in attractive grounds in a rural setting, with good links to local amenities.
The hospital offers clinical therapy, physical exercise, education and other meaningful activities for
patients.
Burgess hill provides a wide range of therapies to help rehabilitate our patients and equip them with
the skills needed to return to the community, where possible.
Your role as a carer
A carer is considered to be anyone who provides support by a range of means for an individual
who is under the care services. This may include emotional support or being a representative
to act as their advocate. The role of carer is also implied if the individual no longer resides
with you or is admitted to hospital at the time.
The term carer in this booklet is used to describe all family and friends who have a significant
role in providing support or input into the care of a patient. This is the official term used in
government policies, in the law and by professionals, therefore it may be beneficial to
recognise that the term may apply to you even if you chose not to use it yourself. In some
cases, it may be that as a carer you have additional needs yourself such as having mental
health needs wherein you require support, you are a young carer, have young children or are
caring for other relatives. Please inform us if this applies to you, so that we can ensure your
individual needs as a carer are met.
If someone you care for is admitted to hospital it can be a difficult and confusing time. You
may be unsure of what to expect, who to contact or your involvement in the patient’s
treatment and care planning. The purpose of this handbook is to provide general information
about what you can expect, how to request help and any further information regarding an
admission to provide clarity. Details of the team involved directly in the patient’s care planning
and how they can be contacted will also be included.
As a carer you may want to provide information which you do not wish to share with the
patient. While it is not a breach of confidentiality for a healthcare professional to listen to and
acknowledge the concerns of carers, the healthcare team may need to disclose information
received from others (including carers) to the patient in some cases – for example, if it has
influenced the assessment and treatment of the patient. We will also require the patient’s
consent in order share information.
We hope this booklet provides an overview of the services we deliver and what you may expect
for the person you care for.
Introduction to the ward: Elizabeth Anderson
Elizabeth Anderson ward is a female PICU (Psychiatric Intensive Care Unit) ward.
We are a 10 bedded unit that admits adult females (aged 18-65) with a mental disorder and
associated challenging behaviour or aggression. The goal is to progress recovery to a point
3where community care can either be considered or delivered. We aim to deliver the care in a
personalized manner, and in the least restrictive way. We understand that many of our
admissions are precipitated by service user’s experience of crisis in the community. We aim to
support them (and their families) through that crisis and help achieve a move back towards
ongoing community based recovery usually via a step down procedure with an interim return
to acute inpatient services in the patient’s own locality.
Each ward has a multidisciplinary team. These
are groups of staff with different areas of
Our aims for patients The Multi-disciplinary team
expertise and training. Some staff work across
different wards. We have a variety of staff that
• If patients are out of their own locality area we aim
all have a role in supporting recovery. Our team
to work with them and their cares and community
teams to return them at the earliest opportunity
on Elizabeth Anderson ward include:
• Comprehensive assessment and treatment with Dr. Amitabh Chatterjee
equality in service delivery. Consultant psychiatrist
• Reducing length of stay in hospital to the minimum.
Natasha Uff
• More timely, streamlined and supported discharge Speciality Doctor
planning.
Role currently being recruited to
• Provider Collaborative working together to create a
regional approach for patients with very specialist Psychologist
needs which cannot be met locally.
Ian Brown
Lead Social Worker
Mark Smith
Lead Occupational Therapist
Our aims for carers Nicholas Holland
Ward Manager
• An inclusive and welcoming approach by all staff and
providers. John Breen
• Identifying the multi-disciplinary team with their main Charge Nurse
task being direct liaison with family and carers.
• Recognition within the Provider Collaborative, of the Bonnie Segwagwe
‘Triangle of Care’ (Patient / Provider / Carer) and the Charge Nurse
significant role of family and carers’ within this.
4Contact information
Our location
Priory Hospital Burgess Hill, Gatehouse
Lane, Goddards Green, Hassocks, West
Sussex, BN6 9LE
Telephone: 01444 231 000
Email: info@priorygroup.com
Web: www.priorygroup.com/burgesshill
The Patient experience
Referrals
This is a request by a person or organisation on behalf of the patient when they believe that a
placement in a secure hospital is the best way to meet their needs. The referral is discussed by all
Providers at a weekly referrals meeting and the most appropriate unit is asked to undertake an
assessment.
Assessment
Admission to Elizabeth Anderson ward will usually follow a process where referrals are screened
by a central triage service.
Carers may be entitled to a carer’s assessment under the provisions of the Care Act (2014). Carers
can have different needs based on their circumstances. A carer’s assessment will assess these
needs and oblige local authorities to provide relevant support depending upon meeting eligibility
criteria. Such support might include assistance for a carer’s own health and wellbeing needs or
help with travel. It is worth noting that visitors to service users detained for an extended period
may not necessarily be deemed a carer under Care Act definitions, until the point that the service
user is about to be discharged into the community.
When Patients are First Admitted
It can be a very difficult time when a patient is admitted to hospital. Whilst we are a hospital, as
a secure hospital we have restrictions designed to ensure the safety of all people. Our hospital
social work team endeavour to get into contact with carers of someone admitted to the hospital as
soon as possible after admission.
5Following admission the patient will usually be subject to one or more assessments. Initially, these
assessments are normally about fact finding i.e. talking about symptoms/anxieties, stressors, the
patient’s life story and ways that the staff can offer help and support. These assessments will also
include physical observations, evaluating occupational therapy needs, psychological needs,
benefits/finance and establishing a support network of communication for the patient.
Safety and Security
Being a secure hospital means we offer care to patients who are liable to be detained under the Mental
Health Act (1983) and whose risk to harm others, themselves or to abscond from hospital can no longer be
safely managed in other mental health settings.
There are specific standards, determined by NHS England, of physical and procedural security that low secure
hospitals are required to meet. The Priory Hospital Burgess Hill aims to meet these standards whilst
implementing reductions in restrictive practice. Physical security includes aspects such as airlocks
throughout the hospital and secure furniture. Procedural security includes an adept authorised leave
recording process and facilitating visits safely. Safety measures ensure the safety and security of patients
and the public and ensure appropriate treatment can be offered.
Restricted and contraband items
For the safety of all patients and staff, some items (often referred to as ‘Sharps’) are restricted.
Patients’ access to items defined as ‘Sharps’ such as those used for arts and crafts and razors for
personal care may need to be supervised by ward staff. This will be decided in the regular reviews
conducted by staff with the patient and documented in the patient’s care notes. It may also be
dependent on the individual ward.
Certain items are contraband on the wards and others are restricted. This is to keep everybody
safe. Some items are restricted on the ward and in the bedrooms due to potential risk and the use
of them is considered on a case by case basis.
BANNED AND RESTRICTED ITEMS
The following items are banned in all healthcare units
Alcohol • Plastic bags in communal areas e.g. for
Explosives including fireworks household waste
Illicit drugs • Psychoactive substances
Knives - excluding cutlery provided and managed by staff • Weapons or replica weapons
Non-prescribed medication • Wire coat hangers
6The following items are restricted in all healthcare units
Adhesive tape of any kind (e.g. Cellotape)
Aerosol containers
Any mirrors, including make-up sets
Bath oil/bubble bath
Batteries including lithium batteries
Cables/wire with particular reference to wire bound notebooks
Cans and tins
Cigarettes, e-cigarettes and vaping devices
Curling tongs/Hair Straighteners
Dental floss
Devices with access to the internet and/or a recording/camera
facility
False nails
Glass and metal nail files
Glass bottles
Hair dryers
Herbal remedies
High caffeine e.g. energy drinks
Lighters, matches
Magnets
Mobile phones and SIM Cards
Nail clippers
Nail polish remover
Plastic bags for personal use e.g. carrier bags
Razor blades
Scissors
Sewing and knitting needles
Sharp items
Solvents/glue
Wire bound books
Wool/string
The following clothing may also need to be restricted dependent on the patient’s risk assessment and
type of service being provided
Clothing with draw strings Loops in clothing
Hoodies Scarves
Shoelaces Tights
Belts Dressing gown cords
Any wrapped gifts e.g. birthdays and Christmas will need to be opened in front of a staff member.
Partially used or open food items cannot be brought in to the Centre.
7Legal information, advice and advocacy
All patients who have been detained in hospital under the Mental Health Act are informed about what
the specific section means and are told why they have been detained. Solicitors and Independent Mental
Health Advocates are available and visit the wards regularly. Mental health advocates work alongside
service users and carers to support the individual admitted, provide information and help them
understand their rights. An advocate is independent of any person who is professionally involved with
the service user’s medical treatment and works for a separate organisation.
General advocacy – NYAS
Provided by NYAS (national youth advocacy service). Our advocate is currently on site Monday from
9.30am – 4.30pm and Thursdays from 9am – 2pm and are available to provide support with general
patient advocacy requirements.
Helpline – 08088081001/ help@nyas.net/ Freepost NYAS
IMHA – Independent mental health advocates
Provided by MIND and the local authority. This is suitable for patients who have been detained and
require input regarding rights, treatment and tribunals etc.
Helpline - 01243642121
Free legal advice and support for Mental Health Tribunals is available and legal aid may be available for
appealing to the Hospital Managers. A summary of the sections and their meanings is contained at the
back of this handbook.
The triangle of care
This is a therapeutic alliance between carers, service users and professionals.
It aims to promote safety and recovery and to sustain wellbeing in mental
health by including and supporting carers. The Priory Burgess Hill has
committed to applying for Triangle of Care accreditation. If you require further
information, please ask the ward manager.
The Triangle of Care was initially developed to improve mental health acute
services by adopting six principles. It is widely accepted that these key
principles can be applied to all service areas.
The six key principles:
Carers and the essential role they play are identified at first contact
or as soon as possible thereafter.
Staff are carer aware and trained in carer engagement strategies.
Policy and practice protocols re confidentiality and sharing
information are in place.
Defined post(s) responsible for carers are in place.
A carer introduction to the service and staff is available, with a
relevant range of information across the acute care pathway.
A range of carer support services is available along with a self-
assessment tool.
8Care and treatment
The care pathway is the plan which sets out the journey each individual patient will go through. Patients
will progress at different rates so it is difficult to be specific about how long patients will remain as inpatients.
The wards are staffed twenty four hours a day and patients are allocated a multidisciplinary care team,
including a primary nurse to oversee care and support.
Family, friends and supporters are encouraged to be involved in the Care Pathway with the patient’s
consent. However, you may share information or concerns with staff even if staff cannot disclose personal
information about patients to you.
Every six months (3 months following admission) a Care Programme Approach (CPA) review will be held.
This is an opportunity to review progress with the MDT. Relatives, friends and supporters are welcome to
be part of discussions about care and treatment with the patient’s agreement.
Therapeutic Activities and Treatment
A wide range of therapies will be available that may include
- Psychological therapy (individual and group)
- Art Therapy
- Music Therapy
- Cooking
- Gardening/Allotment
- Facilities
- Gym
- Cafe
- Sports
- Recreation room
- Day trips with Occupational therapy team
Risk Assessment
Risk assessment is an important way that we can show how the work patients have done has reduced the
risks posed to themselves and others. Risk management plans help patients test themselves and recover
more quickly. We do this in collaboration with patients so that everyone understands the concerns and what
needs to happen to reduce the risks. Each patient has a risk meeting every 6 months where they can work
with the team on formulating updated risk assessments. There will be opportunities in between these
meetings as well, as part of the care planning.
De-escalation, Restraint and Seclusion
Patients may rarely require a period of support away from the main ward and some wards have a de-
escalation area, where staff can spend time with a very distressed or angry patient in a low stimulus
environment. Seclusion is supervised confinement, isolating a patient from others when the patient presents
an immediate risk of attempting an assault. The MDT makes a decision to locate a patient in a de-escalation
area or seclusion if it decides this is necessary to prevent more serious harm. Seclusion runs for the shortest
period possible. There are strict procedures about how this is managed and reviewed on a regular basis.
9Being nursed in seclusion may mean that patients do not have immediate access to a telephone to maintain
contact with their family and friends.
Therapeutic hold (restraint) is rarely used on the wards. Where there is considered to be an immediate and
serious risk to a patient or others, staff may use authorized methods to restrain someone to prevent harm.
As soon as it is considered safe to do so, staff will release the hold. Staff will try methods other than restraint
first, wherever possible, such as talking to the patient in an attempt at de-escalation, or offering medication
to reduce an angry emotional state.
Leave
There are different levels of leave:
Escorted on the grounds of the hospital
Unescorted on the grounds of the hospital
Escorted outside of the grounds
Unescorted or shadowed outside of the grounds
Leave is individually risk assessed prior to being granted.
Discharge and transition
From the moment of each patient’s arrival we are considering their future care pathway and planning
treatment to work towards recovery.
We want patients to be able to move on and live as independently as possible. When a decision has been
made at a CPA meeting or Recovery Review that a patient is ready to move on, there are a number of
different factors which affect where this move will be to and how quickly it takes place. Locked and open
rehabilitation services provide a step down between hospital and community living for those patients who
need a longer period of rehabilitation. With patients’ permission we aim to fully involve carers/family in
discharge planning.
Discharge to the Community
Throughout all patients’ admissions, the MDT maintain links with the relevant community mental health
teams in the patient’s home area. As patients approach discharge, the relevant community team will attend
meetings with the patient and start getting to know them if they did not know them prior to admission.
Patients may be discharged to a variety of different placements or accommodation when they leave hospital.
This will be dependent on their individual needs, their home area, any exclusion zones and available options
in the relevant area.
Funding Decisions
When patients move on from hospital they may need support for a variety of different needs. Depending
on what support is needed, this will effect where the funding for the care comes from. It may also depend
on where the patient’s home area is. Different Local Authority Departments (for social care) and/or Clinical
Commissioning Groups (for health care) may need to fund moving on and locating the right services to
meet people’s needs.
Section 117
This is often referred to as Section 117 (S117) aftercare and is the specific section of the MHA which relates
to aftercare. Aftercare is the help someone may need in the community after leaving hospital. This can
cover a variety of health and social care needs. Entitlement to s117 after-care applies following
hospitalization under sections 3, 37, 45A, 47, or 48 of the Mental Health Act 1983. Entitlement to S117
10aftercare will be reviewed periodically by the NHS Trust and Local Authority that have joint responsibility
for the patient.
Compliments and Complaints
We welcome feedback about the Service we deliver as this helps us make improvements. Please let a
member of staff know where there are aspects of the service you would like more information about,
disagree with, have valued, or wish to share your feelings about. Discussing issues with the relevant Primary
Nurse, Social Worker or Ward Manager initially may well solve the issue most quickly.
In addition, you can put any concerns you may have in writing to the Ward Manager or Hospital Director.
You can give feedback at any point, however there will be occasions when you will be contacted and asked
to complete a short survey so that we can be sure everyone’s views are considered.
Visiting
All units welcome approved visitors and value the role friends, supporters and relatives play in an individual’s
recovery. All visits are individually risk assessed and all visitors are contacted by the ward directly to arrange
the visit. Please contact ward nurse in charge or ward manager to arrange and book visits.
The safety of children is very important to us and if children or young people under eighteen are planning
to visit, special arrangements and agreements will need to be made. There is a separate approval process
for children visiting and the relevant Social Worker will discuss this with the parents if appropriate. All people
holding Parental Responsibility must give consent and Children’s Services will be contacted to check that
there are no specific concerns about the child that may affect whether they can visit.
Information on mental health conditions
If you would like information on diagnoses or medication or general treatment options, then please speak
to the ward staff. They will be happy to arrange an appointment with the Consultant or other members of
the MDT who may be well placed to give you information. With patient agreement the care team may be
able to provide more specific information about the diagnosis, treatment received and to discuss options
and future care needs.
There are many different mental health problems and patients may be given one or more diagnoses.
Sometimes the diagnosis can change over time as the multi-disciplinary team make further assessments
or gather more information.
If you would like further information regarding diagnoses, we recommend these websites:
Improving Carers Experience http://iceproject.co.uk
Mind For Better Mental Health https://www.mind.org.uk/about-us/contact-us/
NHS England have developed “The Carers Toolkit” Please follow the link for this:
https://www.england.nhs.uk/commitment-to-carers/carers-toolkit/
Royal College of Psychiatrists https://www.rcpsych.ac.uk/
11Glossary
Capacity: in mental health, this is the term used to establish whether someone is able to make their own
decision about something at a particular time. If someone lacks capacity then they have been assessed as
being unable to make a decision about a specific issue at a particular time. It is designed to protect patients
and could include decisions about clinical matters, such as treatment (including medication) or other issues,
such as relationships or finances.
Code of Practice: Both the Mental Health Act and the Mental Capacity Act have codes of practice which
are guidelines staff are required to follow in order to observe the law.
Contraband: is a term commonly used to refer to items that are restricted or prohibited within the hospital.
Detained: A person is detained if they are being kept in hospital under a section of the Mental Health Act
and are not free to leave. This is also sometimes referred to as ‘sectioned’ or ‘compulsorily admitted’.
Hospital Managers: Hospital managers are a panel appointed specially to look at whether people should
be discharged. They are independent of the hospital, Clinical Commissioning Group, Local Health Board or
any organisation that runs the hospital, because they cannot be officers or employees.
Independent Mental Health Advocates: An IMHA is an independent advocate who is trained to work
within the framework of the Mental Health Act to support people to understand their rights under the Act
and participate in decisions about their care and treatment.
Mental disorder: is a specific term and is also used in the MHA. It can include any ‘disorder or disability
of mind’.
Mental Health Act: (MHA) is the law in England and Wales which allows people under certain
circumstances to be detained in hospital. It can only be used if certain criteria are met.
Mental Health Tribunal (officially ‘First-Tier Tribunal Mental Health’): (MHT) is a panel which you
have a right to apply to (under certain sections) so you can be discharged from your section. Tribunal
hearings usually take place in the hospital where the patient is sectioned and detained, but they are totally
independent of the hospital.
My Shared Pathway: is an approach that emphasises outcomes and improves collaboration between
patients and the MDT, with a focus on recovery under eight headings: mental health recovery; harm-related
behaviours; insight; problems with substance misuse; nature of future plans; physical health status; life
skills; relationships.
Nearest Relative: This is a legally defined term under the MHA and describes a relative who has certain
responsibilities and powers under certain sections of the MHA. It gives the right to information and to
request discharge in some situations for patients under certain sections. It is not the same as next of kin.
The law sets out a list to decide who will be the Nearest Relative and it can be changed under certain
circumstances. The rights of the Nearest Relative are reduced or stopped if people are subject to certain
sections of the MHA.
Nearest relative rights vary depending on which section of the MHA the relative is detained under.
Responsible Clinician: (RC) is the Approved Clinician who has been given overall responsibility for a
patient’s care. Certain decisions such as renewing detention under the MHA, granting s17 leave or decisions
regarding Community Treatment Orders can only be taken by the RC.
12Section 17 leave: (s17) this section of the Mental Health Act (1983) allows the Responsible Clinician (RC)
to grant a detained patient leave of absence from hospital. It is the only legal means by which a detained
patient may leave the hospital grounds/secure perimeter.
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