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Service user experience in adult mental health services overview

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Service user experience in adult mental health services HAI

About

What is covered

This pathway is about ensuring that users of adult mental health services have the best possible experience of care from the NHS.
Despite initiatives to improve the service user's experience of healthcare, further work is needed to deliver the best possible experience of care to adults using mental health services. This pathway recommends how health and social care professionals and providers can achieve this within the NHS.

Updates

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

27 March 2014 Minor maintenance updates
26 March 2014 Minor maintenance updates
19 February 2013 Minor maintenance updates
29 May 2012 Minor maintenance updates

Short Text

Service user experience in adult mental health services

What is covered

This pathway is about ensuring that users of adult mental health services have the best possible experience of care from the NHS.
Despite initiatives to improve the service user's experience of healthcare, further work is needed to deliver the best possible experience of care to adults using mental health services. This pathway recommends how health and social care professionals and providers can achieve this within the NHS.

Sources

The NICE guidance that was used to create the pathway.
Service user experience in adult mental health. NICE clinical guidance 136 (2011)

Quality standards

Quality statements

Feeling optimistic about care

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People using mental health services, and their families or carers, feel optimistic that care will be effective.

Quality measure

Structure
Evidence of local arrangements to ensure that service users are supported to feel optimistic that care will be effective.
Outcome
Evidence from experience surveys and feedback that service users, and their families or carers, feel optimistic that care will be effective.

Description of what the quality statement means for each audience

Service providers ensure systems are in place to collect feedback on the experience of care from service users and their families or carers.
Mental health and social care professionals ensure they support service users, and their families or carers, to feel optimistic that care will be effective.
Commissioners ensure they commission services that support people using mental health services, and their families or carers, to feel optimistic that care will be effective.
People using mental health services, and their families or carers, feel optimistic that care will be effective.

Source guidance references

NICE clinical guidance 136 recommendation 1.1.1

Data source

Structure
Local data collection.
Outcome
Local data collection.

Empathy, dignity and respect

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People using mental health services, and their families or carers, feel they are treated with empathy, dignity and respect.

Quality measure

Structure
Evidence of local arrangements to ensure that mental health and social care professionals treat service users with empathy, dignity and respect.
Outcome
Evidence from experience surveys and feedback that service users, and their families or carers, feel they are treated with empathy, dignity and respect.

Description of what the quality statement means for each audience

Service providers ensure systems are in place to collect feedback on the experience of care from service users and their families or carers.
Mental health and social care professionals ensure they treat service users, and their families or carers, with empathy, dignity and respect.
Commissioners ensure they commission services that have mental health and social care professionals who treat service users with empathy, dignity and respect.
People using mental health services, and their families or carers, feel they are treated with empathy, dignity and respect.

Source guidance references

NICE clinical guidance 136 recommendation 1.1.1

Data source

Structure
Local data collection.
Outcome
Local data collection. Providers may be able to use questions contained within the national patient surveys available from NHS Surveys. Questions on treating service users with dignity and respect are contained within:

Shared decision-making and self-management

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People using mental health services are actively involved in shared decision-making and supported in self-management.

Quality measure

Structure
a) Evidence of local arrangements to ensure that service users are actively involved in shared decision-making.
b) Evidence of local arrangements to ensure that service users are supported in self-management.
Process
a) Proportion of service users actively involved in shared decision making.
Numerator – the number of people in the denominator actively involved in shared decision-making.
Denominator – the number of people using mental health services.
b) Proportion of service users supported in self-management.
Numerator – the number of people in the denominator supported in self-management.
Denominator – the number of people using mental health services.
Outcome
a) Evidence from experience surveys and feedback that service users feel actively involved in shared decision-making.
b) Evidence from experience surveys and feedback that service users feel supported in self-management.

Description of what the quality statement means for each audience

Service providers ensure systems are in place to actively involve service users in shared decision-making and support self-management.
Mental health and social care professionals ensure service users are actively involved in shared decision-making and supported in self-management.
Commissioners ensure they commission services which actively involve service users in shared decision-making and support self-management.
People using mental health services feel actively involved in making decisions about their care and treatment and supported in managing their mental health problem(s).

Source guidance references

NICE clinical guidance 136 recommendation 1.1.2

Data source

Structure
a) and b) Local data collection.
Outcome
a) Local data collection. Providers may be able to use questions contained within the national patient surveys available from NHS Surveys. The NHS mental health inpatient survey (Q27) collects information on involvement in care and treatment decisions. The NHS community mental health survey (Q5, 10, 25 and 33) collects information on taking account of service user views.
b) Local data collection.

Continuity of care

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People using community mental health services are normally supported by staff from a single, multidisciplinary community team, familiar to them and with whom they have a continuous relationship.

Quality measure

Structure
Evidence of local arrangements to ensure that service users of community mental health services are normally supported by staff from a single, multidisciplinary community team, familiar to them and with whom they have a continuous relationship.
Outcome
Evidence from experience surveys and feedback that service users of community mental health services feel they are normally supported by staff from a single, multidisciplinary community team, familiar to them and with whom they have a continuous relationship.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for service users of community mental health services to normally be supported by a single, multidisciplinary community team familiar to them and with whom they have a continuous relationship.
Mental health and social care professionals ensure that service users of community mental health services are normally supported by a single, multidisciplinary community team and that they maintain a continuous relationship with service users.
Commissioners ensure they commission services in which service users of community mental health services are normally supported by a single, multidisciplinary community team which maintains continuous relationships with service users.
People using mental health services feel supported throughout their care by a team of staff who they know.

Source guidance references

NICE clinical guidance 136 recommendation 1.4.7

Data source

Structure
Local data collection.
Outcome
Local data collection.

Using views of service users to monitor and improve services

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People using mental health services feel confident that the views of service users are used to monitor and improve the performance of services.

Quality measure

Structure
a) Evidence of local arrangements to collect and use views of service users to monitor and improve the performance of services.
b) Evidence of local arrangements to have service user monitoring of services; for example, using exit interviews undertaken by trained service users.
c) Evidence of local arrangements to provide the executive board with reports on acute and non-acute mental health pathways, with a breakdown of the experience of care according to gender, sexual orientation, socioeconomic status, age, background (including cultural, ethnic and religious background) and disability.
Outcome
Evidence from surveys and feedback that service users feel confident that their views are used to monitor and improve services.

Description of what the quality statement means for each audience

Service providers ensure systems are in place to use the views of service users in monitoring and improving the performance of services.
Mental health and social care professionals ensure service users are provided with opportunities to give feedback on their experience.
Commissioners ensure they commission services that use the views of service users to monitor and improve performance.
People using mental health services are asked about their experience of care and this is used to monitor and improve the service.

Source guidance references

NICE clinical guidance 136 recommendations 1.1.20, 1.1.21 and 1.1.22

Data source

Structure
Providers may be able to use questions contained within the national patient surveys available from NHS Surveys. The NHS staff survey for mental health trusts (Q5) collects information on whether staff in acute mental health trusts have been trained on how to monitor and use service user feedback to make improvements.
b) and c) Local data collection.
Outcome
Local data collection.

Access to services

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People can access mental health services when they need them.

Quality measure

Structure
a) Evidence of local arrangements to ensure agreed referral methods are in place between primary and secondary care.
b) Evidence of local arrangements to ensure that people with a non-acute referral to mental health services have a face-to-face appointment that takes place within 3 weeks of referral (or within 2 weeks of any change of date).
c) Evidence of local arrangements to ensure service users are seen within 20 minutes of the agreed appointment time.
d) Evidence of local arrangements to ensure that people in crisis referred to mental health secondary care services are seen within 4 hours.
e) Evidence of local arrangements to ensure service users have access to a local 24-hour helpline staffed by mental health and social care professionals.
f) Evidence of local arrangements to ensure crisis resolution and home treatment teams are accessible 24 hours a day, 7 days a week, regardless of diagnosis.
g) Evidence of local arrangements to ensure that people admitted to a ‘place of safety’ are assessed under the Mental Health Act within 4 hours.
Process
a) Proportion of people with a non-acute referral to mental health services who had a face-to-face appointment that took place within 3 weeks of referral (or within 2 weeks of any change of date).
Numerator – the number of people in the denominator who had a face-to-face appointment that took place within 3 weeks of referral (or within 2 weeks of any change of date).
Denominator – the number of people with a non-acute referral to mental health services.
b) Proportion of service users who were seen within 20 minutes of the agreed appointment time.
Numerator – the number of people in the denominator who were seen within 20 minutes of the agreed appointment time.
Denominator – the number of service users with an agreed appointment time.
c) Proportion of service users in crisis referred to specialist mental health services who were seen within 4 hours.
Numerator – the number of people in the denominator who were seen within 4 hours.
Denominator – the number of service users in crisis referred to Quality standard for service user experience in adult mental health 13 of 31 specialist mental health services.
d) Proportion of people admitted to a ‘place of safety’ who were assessed under the Mental Health Act within 4 hours.
Numerator – the number of people in the denominator who were assessed under the Mental Health Act within 4 hours
Denominator – the number of people admitted to a ‘place of safety’.
Outcome
a) Evidence from experience surveys and feedback that service users with a non-acute referral had a face-to-face appointment that took place within 3 weeks of referral (or within 2 weeks of any change of date).
b) Evidence from experience surveys and feedback that service users with an agreed appointment time were seen within 20 minutes of that time.
c) Evidence from experience surveys and feedback that service users are able to access a local helpline 24 hours a day.
d) Evidence from experience surveys and feedback that service users in crisis referred to specialist mental health services were seen within 4 hours.
e) Evidence from experience surveys and feedback that people admitted to a ‘place of safety’ were assessed under the Mental Health Act within 4 hours.

Description of what the quality statement means for each audience

Service providers ensure systems are in place to provide access to mental health services when needed.
Mental health and social care professionals ensure services users can access mental health services when they need them.
Commissioners ensure they commission services that provide access to mental health services when needed.
People can access mental health services quickly and easily when needed.

Source guidance references

NICE clinical guidance 136 recommendations 1.2.1, 1.2.3, 1.3.6, 1.5.5, 1.5.6, 1.5.7 and 1.8.8

Data source

Structure
a) to g) Local data collection.
Process
The outpatient commissioning dataset contains the data needed for calculating waiting times for non-acute appointments. More information available at HES Online.
b) to d) Local data collection.
The NHS staff survey for mental health trusts (Q5) collects information on whether staff in acute mental health trusts have been trained on how to monitor and use service user feedback to make improvements.
b) and c) Local data collection.
Outcome
a) and b) Local data collection.
c) Providers may be able to use questions contained within the national patient surveys available from NHS Surveys. The NHS community mental health survey (Q36 to 39) contains questions on the accessibility of out-of-hours phone numbers.
d) and e) Local data collection.

Definitions

The Mental Health Act 1983 (amended 1995 and 2007).

Information and explanations

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People using mental health services understand the assessment process, their diagnosis and treatment options, and receive emotional support for any sensitive issues.

Quality measure

Structure
Evidence of local arrangements to ensure that service users assessed by mental health services are provided with explanations and information so they can understand the assessment process, diagnosis and treatment options, and receive emotional support for any sensitive issues.
Process
Proportion of service users assessed by mental health services who were given explanations and information about the assessment process, their diagnosis and treatment options.
Numerator – the number of people in the denominator who were given explanations and information about the assessment process, their diagnosis and treatment options.
Denominator – the number of service users assessed by mental health services.
Outcome
a) Evidence from experience surveys and feedback that service users assessed by mental health services understand the assessment process, their diagnosis and treatment options.
b) Evidence from experience surveys and feedback that service users assessed by mental health services received emotional support for any sensitive issues.

Description of what the quality statement means for each audience

Service providers ensure systems are in place to provide information so service users can understand the assessment process, their diagnosis and treatment options.
Mental health and social care professionals ensure they provide service users with explanations and information so they can understand the assessment process, their diagnosis and treatment options, and emotionally support them with any sensitive issues.
Commissioners ensure they commission services that provide explanations and information so service users can understand the assessment process, their diagnosis, their treatment options and are emotionally supported with any sensitive issues.
People using mental health services understand the assessment process, their diagnosis and treatment options and receive emotional support for any sensitive issues.

Source guidance references

NICE clinical guidance 136 recommendation 1.3.3

Data source

Structure
Local data collection. Providers may be able to use questions contained within the national NHS staff survey available from NHS Surveys. The NHS staff survey for mental health trusts (Q5) collects information on whether staff in acute mental health trusts have been trained to give information to service users.
Process
Local data collection.
Outcome
a) Local data collection
b) Local data collection.

Care planning

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People using mental health services jointly develop a care plan with mental health and social care professionals, and are given a copy with an agreed date to review it.

Quality measure

Structure
a) Evidence of local arrangements to ensure that service users can jointly develop a care plan with mental health and social care professionals.
b) Evidence of local arrangements to ensure that service users are given a copy of their care plan.
c) Evidence of local arrangements to ensure that service users have an agreed date to review their care plan.
Process
a) Proportion of service users who have a jointly agreed care plan.
Numerator – the number of people in the denominator who have a jointly agreed care plan.
Denominator – the number of service users.
b) Proportion of service users given a copy of their care plan.
Numerator – the number of people in the denominator given a copy of their care plan.
Denominator – the number of service users with a care plan.
c) Proportion of service users with an agreed date to review their care plan.
Numerator – the number of people in the denominator with an agreed date to review their care plan.
Denominator – the number of service users with a care plan.
Outcome
a) Evidence from experience surveys and feedback that service users jointly developed a care plan.
b) Evidence from experience surveys and feedback that service users were given a copy of their care plan.
c) Evidence from experience surveys and feedback that service users have an agreed date to review their care plan.

Description of what the quality statement means for each audience

Service providers ensure systems are in place to jointly develop care plans, share copies with services users and agree review dates.
Mental health and social care professionals ensure service users have a jointly developed care plan, that they share copies with service users and agree review dates.
Commissioners ensure they commission services that jointly develop care plans with service users, share copies with service users and agree review dates.
People using mental health services jointly develop a care plan with mental health and social care professionals, receive a copy of the care plan and agree a date to review it.

Source guidance references

NICE clinical guidance 136 recommendation 1.4.2

Data source

Structure
a) to c) Local data collection.
Process
a) to c) Local data collection.
Outcome
a) Providers may be able to use questions contained within the national patient surveys available from NHS Surveys. Questions on involvement in care plans are contained within the NHS community mental health survey (Q23, 24, 25 and 26).
b) Providers may be able to use questions contained within the national patient surveys available from NHS Surveys. A question on provision of a written copy of the care plan is contained within the NHS community mental health survey (Q29).
c) Providers may be able to use questions contained within the national patient surveys available from NHS Surveys. A question on whether a care review was held in the past 12 months is contained within the NHS community mental health survey (Q30).

Definitions

Care plans should include the needs of the individual service user, activities promoting social inclusion such as education, employment, volunteering and other specified occupations, such as leisure activities and caring for dependants.

Crisis planning

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People using mental health services who may be at risk of crisis are offered a crisis plan.

Quality measure

Structure
Evidence of local arrangements to ensure that service users who may be at risk of crisis are offered a crisis plan.
Process
a) Proportion of service users who may be at risk of crisis offered a crisis plan.
Numerator – the number of people in the denominator who are offered a crisis plan.
Denominator – the number of service users who may be at risk of crisis.
b) Proportion of service users accepting an offer of a crisis plan who have a crisis plan.
Numerator – the number of people in the denominator who have a crisis plan
Denominator–- the number of service users accepting an offer of a crisis plan.
Outcome
Evidence from experience surveys and feedback that service users who may be at risk of crisis are offered a crisis plan.

Description of what the quality statement means for each audience

Service providers ensure systems are in place to offer a crisis plan to service users who may be at risk of crisis.
Mental healthcare professionals offer a crisis plan to service users who may be at risk of crisis.
Commissioners ensure they commission services that offer a crisis plan to service users who may be at risk of crisis.
People using mental health services who may be at risk of crisis are offered a crisis plan.

Source guidance references

NICE clinical guidance 136 recommendations 1.1.11, 1.1.12 and 1.4.5

Data source

Structure
Local data collection.
Process
a) and b) Local data collection. The mental health minimum dataset contains data on creation of crisis plans for people on a Care Programme Approach (CPA) only. More information available at HES Online.
Outcome
Local data collection. Providers may be able to use questions contained within the national patient surveys available from NHS Surveys. A question on crisis planning is contained within NHS community mental health survey (Q28).

Definitions

A crisis plan should contain:
  • possible early warning signs of a crisis and coping strategies
  • support available to help prevent hospitalisation
  • where the person would like to be admitted in the event of hospitalisation
  • the practical needs of the service user if they are admitted to hospital (for example, childcare or the care of other dependants, including pets)
  • details of advance statements and advance decisions
  • whether and the degree to which families or carers are involved
  • information about 24-hour access to services
  • named contacts.

Assessment in a crisis

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People accessing crisis support have a comprehensive assessment, undertaken by a professional competent in crisis working.

Quality measure

Structure
a) Evidence of local arrangements to ensure that service users accessing crisis support have a comprehensive assessment.
b) Evidence of local arrangements to ensure that professionals who assess people in crisis are competent in crisis working.
Process
Proportion of service users accessing crisis support who have a comprehensive assessment.
Numerator – the number of people in the denominator who have a comprehensive assessment.
Denominator – the number of service users accessing crisis support.
Outcome
Evidence from experience surveys and feedback that service users accessing crisis support were asked about their relationships, their social and living circumstances and level of functioning, as well as their symptoms, behaviour, diagnosis and current treatment.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for service users accessing crisis support to have a comprehensive assessment undertaken by a professional competent in crisis working.
Mental health and social care professionals ensure service users accessing crisis support have a comprehensive assessment by a professional competent in crisis working.
Commissioners ensure they commission crisis support services in which professionals competent in crisis working undertake comprehensive assessments.
People accessing crisis support have an assessment in which they are asked about their living conditions, how well they are managing in everyday life, their relationships, symptoms, behaviour, diagnosis and any treatment they are having.

Source guidance references

NICE clinical guidance 136 recommendation 1.5.3.

Data source

Structure
a) and b) Local data collection.
Process
Local data collection.
Outcome
Local data collection.

Definitions

A comprehensive assessment includes details of the person's:
  • relationships with others
  • social and living circumstances
  • level of functioning
  • symptoms
  • behaviour
  • diagnosis
  • current treatment.

Inpatient shared decision-making

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People in hospital for mental health care, including service users formally detained under the Mental Health Act, are routinely involved in shared decision-making.

Quality measure

Structure
Evidence of local arrangements to ensure that service users in hospital, including service users formally detained under the Mental Health Act, are routinely involved in shared decision-making.
Outcome
Evidence from experience surveys and feedback that service users in hospital, including service users formally detained under the Mental Health Act, feel routinely involved in shared decision-making.

Description of what the quality statement means for each audience

Service providers ensure systems are in place to routinely involve service users in hospital, including service users formally detained under the Mental Health Act, in shared decision-making.
Mental health and social care professionals ensure they involve service users in hospital, including service users formally detained under the Mental Health Act, in shared decision-making.
Commissioners ensure they commission services that routinely involve service users, including service users formally detained under the Mental Health Act, in shared decision-making.
People in hospital for mental health care feel involved in making decisions about their care, even when they are formally detained under the Mental Health Act.

Source guidance references

NICE clinical guidance 136 recommendation 1.6.3.

Data source

Structure
Local data collection.
Outcome
Providers may be able to use questions contained within the national patient surveys available from NHS Surveys. A question on involvement in decisions is contained within the NHS mental health inpatient survey (Q27).

Definitions

The Mental Health Act 1983 (amended 1995 and 2007).

Contact with staff on wards

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People in hospital for mental health care have daily one-to-one contact with mental healthcare professionals known to the service user and regularly see other members of the multidisciplinary mental healthcare team.

Quality measure

Structure
a) Evidence of local arrangements to ensure that service users in hospital can see a mental healthcare professional known to the service user on a one-to-one basis every day for at least 1 hour.
b) Evidence of local arrangements to ensure that service users in hospital can see their consultant on a one-to-one basis at least once a week for at least 20 minutes.
c) Evidence of local arrangements to ensure that service users in hospital are given an opportunity to meet a specialist mental health pharmacist.
Process
a) Proportion of service users in hospital who saw a mental healthcare professional known to the service user on a one-to-one basis every day for at least 1 hour.
Numerator – the number of people in the denominator who saw a mental healthcare professional known to the service user on a one-to-one basis every day for at least 1 hour.
Denominator – the number of service users in hospital.
b) Proportion of service users in hospital who saw their consultant on a one-to-one basis at least once a week for at least 20 minutes.
Numerator – the number of people in the denominator who saw their consultant on a one-to-one basis at least once a week for at least 20 minutes.
Denominator – the number of service users in hospital.
c) Proportion of service users in hospital who saw a specialist mental health pharmacist.
Numerator – the number of people in the denominator who saw a specialist mental health pharmacist.
Denominator – the number of service users in hospital.
Outcome
a) Evidence from experience surveys and feedback that service users in hospital see a mental healthcare professional known to the service user on a one-to-one basis every day for at least 1 hour.
b) Evidence from experience surveys and feedback that people in hospital see their consultant on a one-to-one basis at least once a week for at least 20 minutes.
c) Evidence from experience surveys and feedback that people in hospital know they can meet a specialist mental health pharmacist.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for service users in hospital to have daily one-to-one contact with mental healthcare professionals known to the service user and regularly see other members of the multidisciplinary mental healthcare team.
Mental healthcare professionals ensure service users in hospital can have daily one-to-one contact with mental healthcare professionals known to the service user and regularly see other members of the multidisciplinary mental healthcare team.
Commissioners ensure they commission services that provide service users in hospital for mental health treatment and care with daily one-to-one contact with mental healthcare professionals known to the service user and the opportunity to see other members of the multidisciplinary mental healthcare team.
People in hospital for mental health care have daily one-to-one contact with mental healthcare professionals known to them and regularly see other members of the multidisciplinary mental healthcare team.

Source guidance references

NICE clinical guidance 136 recommendation 1.6.6.

Data source

Structure
a) to c) Local data collection.
Process
a) to c) Local data collection.
Outcome
a) and b) Local data collection. Providers may be able to use questions contained within the national patient surveys available from NHS Surveys. Questions on time to discuss conditions and treatments are contained within
c) Local data collection.

Definitions

One-to-one meetings should not be undertaken as part of the multidisciplinary ward meetings which are for the clinical administration of the ward.
Recommendation 1.6.6 states:
Offer service users in hospital:
  • daily one-to-one sessions lasting at least 1 hour with a healthcare professional known to the service user
  • regular (at least weekly) one-to-one sessions lasting at least 20 minutes with their consultant
  • an opportunity to meet with a specialist mental health pharmacist to discuss medication choices and any associated risks and benefits.
Daily one-to-one sessions with healthcare professionals known to the service user need not be one session that lasts an hour. The hour contact could be made up of shorter sessions and spread throughout the day.

Meaningful activities on the ward

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People in hospital for mental health care can access meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm.

Quality measure

Structure
Evidence of local arrangements to ensure that service users in hospital have access to meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm.
Outcome
Evidence from experience surveys and feedback that service users in hospital feel they can access meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for service users in hospital to access meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm.
Mental healthcare professionals ensure service users in hospital have access to meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm.
Commissioners ensure they commission services that provide service users in hospital with meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm.
People in hospital for mental health care feel they can join in with a range of activities, including creative and leisure activities and exercise, 7 days a week and throughout the day and evenings.

Source guidance references

NICE clinical guidance 136 recommendation 1.6.9.

Data source

Structure
Local data collection.
Outcome
Local data collection. Providers may be able to use questions contained within the national patient surveys available from NHS Surveys. The NHS mental health inpatient survey (Q31 and 32) contains questions on the provision of activities on the ward on weekdays and at the weekend.

Definitions

Meaningful and culturally appropriate activities should include creative and leisure activities, exercise, self-care and community access activities (where appropriate). Activities should be facilitated by appropriately trained health or social care professionals.

Using control and restraint, and compulsory treatment

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People in hospital for mental health care are confident that control and restraint, and compulsory treatment including rapid tranquillisation, will be used competently, safely and only as a last resort with minimum force.

Quality measure

Structure
a) Proportion of professionals using control and restraint, and compulsory treatment including rapid tranquilisation, who are trained to do so.
Numerator – the number of professionals in the denominator who are trained to use control and restraint safely and as a last resort.
Denominator – the number of professionals using control and restraint, and compulsory treatment including rapid tranquilisation.
b) Evidence of local arrangements to ensure control and restraint, and compulsory treatment including rapid tranquillisation, are used as a last resort with minimum force and only after all means of negotiation and persuasion have been tried.
Outcome
Evidence from experience surveys and feedback that service users in hospital feel control and restraint, and compulsory treatment including rapid tranquillisation, are used as a last resort with minimum force.

Description of what the quality statement means for each audience

Service providers ensure systems are in place to train professionals in the safe use of control and restraint, and compulsory treatment including rapid tranquillisation.
Mental healthcare professionals using control and restraint, and compulsory treatment including rapid tranquillisation, ensure they are trained in its safe use and use it as a last resort with minimum force.
Commissioners ensure they commission services that train professionals in the safe use of control and restraint, and compulsory treatment including rapid tranquillisation.
People in hospital for mental health care who need to be controlled or restrained or have treatment without their agreement (such as medication to calm them quickly) receive them only from trained staff. They are only used as a last resort, using minimum force and making sure that the person is safe.

Source guidance references

NICE clinical guidance 136 recommendation 1.8.10

Data source

Structure
a) The NHSLA risk management standards contain requirements on the processes in place in mental health and learning disability organisations for managing risks associated with rapid tranquilisations (Standard 4, criterion 8). Providers may be able to use questions contained within the national NHS staff survey available from NHS Surveys. The NHS staff survey for mental health trusts (Q5) collects information on training to prevent or handle violence and aggression to staff and service users.
b) Local data collection.
Outcome
Local data collection.

Combating stigma

This quality statement is taken from the service user experience in adult mental quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statement

People using mental health services feel less stigmatised in the community and NHS, including within mental health services.

Quality measure

Structure
Evidence of local arrangements to ensure that a strategy is developed with other local organisations to combat stigma in the community and NHS that is associated with mental health problems and using mental health services.
Outcome
Evidence from experience surveys and feedback that service users feel less stigmatised in the community and NHS, including within mental health services.

Description of what the quality statement means for each audience

Service providers ensure strategies are in place to work with other local organisations to combat the stigma in the community and NHS that is associated with mental health problems and using mental health services.
Mental health and social care professionals ensure they work to combat the stigma in the community and NHS that is associated with mental health problems and using mental health services.
Commissioners ensure they commission services that work with other local organisations to combat the stigma in the community and NHS that is associated with mental health problems and using mental health services
People using mental health services feel less stigmatised in the community and NHS, including within mental health services.

Source guidance references

NICE clinical guidance 136 recommendations 1.1.7 and 1.1.9.

Data source

Structure
Local data collection.
Outcome
Local data collection.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Pathway information

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

27 March 2014 Minor maintenance updates
26 March 2014 Minor maintenance updates
19 February 2013 Minor maintenance updates
29 May 2012 Minor maintenance updates

Supporting information

Glossary

The Equality Act 2010 replaces all previous anti-discrimination legislation and includes a public sector equality duty requiring public bodies to have due regard to the need to eliminate discrimination and to advance equality of opportunity and foster good relations between people who share certain protected characteristics and those who do not. The protected characteristics are age, disability, gender reassignment, pregnancy and maternity, race, religion or belief, sex and sexual orientation. The Act provides an important legal framework which should improve the experience of all mental health service users, particularly those from black and minority ethnic communities.

Paths in this pathway

Pathway created: March 2012 Last updated: March 2014

© NICE 2014

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