A week in the life of… a forensic mental health service manager

Tuesday

Our service aims to reduce stays in secure in-patient care, as well as preventing admissions and re-admissions. Our referrals mostly come from secure psychiatric hospitals, and before deciding on assessing an individual, I take into consideration the current dynamics of the customer group staying in the service. We want to create a positive and nurturing relationship between our residents, and I have to be careful about accepting individuals who might initiate a relapse or considerably increase the risks of other customers relapsing.

If the only flat available is right next to a customer currently in recovery from substance use, I will avoid taking on someone known or suspected of dealing substances, for example. I might also look at potential pre-existing relationships between a current resident and an individual referred – the offending world is not that vast, and it happens more often than you’d think.

Once an individual has been identified as a referral with potential, we organise a joint assessment with them and their social worker or care co-ordinator. As much as possible, we prefer letting the individual come to the service so that they can meet members of the team, other customers and see the premises alongside being part of the assessment. Together, we discuss their goals and aspirations and their understanding of their current situation, as well as what they identify as risks to themselves or others.

With every referral, we are provided with a historical and clinical risk management document with a forensic report, which means we already have a lot of information in hand. The assessment enables us to know the person behind the paperwork. Its aim is, first, to understand the person in order to identify the support they need and the risks they might pose and, second, to let the individual see our service, ask questions and decide whether they think it is a good fit for them.

Wednesday

Growing from specialist support worker to team leader and, finally, service manager, I had to leave behind some of the hands-on daily work, but the trainings delivered by our local authority, the NHS and Look Ahead allow me to refresh and update my background knowledge in forensic psychology and criminology, which is one of my favourite things to do.

I always try improving my learning and development to support my growth and upskill myself. Today, I have a training planned on the practices of the mental health act in forensic settings, delivered by our NHS Foundation Trust.

Some of my staff members have booked themselves for the same training, and I am always very proud of my team and their keenness for learning and developing their skills and knowledge, not only to better themselves but also to provide a better support to the customers they look after. This is a quality I always look for when I recruit support workers.

Thursday

On Thursdays, the responsible clinician of the NHS’s forensic outreach team holds a clinic at the service and sees patients – our customers. One of the staff members, generally the individual’s keyworker, attends the meeting with their clinician. This is when they can express any issues or desires around their care, whether it be their medication side-effects or their wish to go on a holiday with their family.

Most of our residents are under Section 37/41 of the Mental Health Act and may have specific restrictions put in place by the Ministry of Justice (MoJ), such as having to spend every night in the service. I sometimes write reports for the MoJ to feed back on the individual’s progress, and with the help of their clinical team, some of the restrictions can be amended to allow the customer to progress in their recovery and move-on pathway.

After meeting the residents, the responsible clinician and care co-ordinators meet with our team to discuss what was said. This allows us to have some reflective practice where we can ask for advice or suggestions if one of our customer’s recovery plateaus. The relationship between the forensic outreach team and our service is close and we work hard to make joint and supportive decisions that the NHS and Look Ahead both agree with.

Friday

Being a service manager can be isolating at times, but fortunately our head of operations organises patch meetings for all relevant managers.

My team and I also try to hold a tenants’ meeting every month to update our residents on any relevant information and to receive any feedback they might have. This is a good occasion for residents to mingle and for us to supervise the group’s interaction. We use a tool to carry out daily monitoring on all our residents’ presentation and behaviour, but seeing them in social situations allows it in a much more organic fashion.

I regularly review each customer’s support plan (a co-produced document about what is important in their life with practical and achievable commitments to making it happen) and risk management plan (also co-produced, this identifies and assesses risk with the aim to put in place a plan to minimise the harmful impact of risks to the customer and others). These are ‘live’ documents, and we ensure that they are up to date every time something happens in an individual’s life.

At the end of my Friday, I make sure to send a quick email to the manager who is on call for the weekend. I mention any current concerns alongside the plans in place, in case an incident happens over the weekend and my staff have to call on-call for support, before finally leaving for the weekend.