Prepared to Care: Training to increase support for mental health patients with palliative needs

Categories: Care and Education.

Karenann Spicer, Director of Education and Research at the Hospice of St Francis in Berkhamsted, writes about leading a recent project for healthcare professionals to increase their knowledge of supporting patients with both mental health and palliative care needs.

Following a successful scoping session in 2017 in which mental health and palliative care professionals came together to look at how we can best support patients with dual needs, three common themes were highlighted.

  1. All professionals wanted education in both the mental health and specialist palliative care arenas
  2. There is a stigma surrounding the specialism of both in mental health and palliative care
  3. There is a lack of understanding of the service provisions from the respective disciplines

Such a need for education has previously been emphasised. There is also a call for increased collaboration in this area.

As a result, a study day was designed and delivered with the purpose of bringing both disciplines together to learn from each other.

A proposal was brought to the local hospice education consortium covering five hospices. Funding was sought and granted to support design and delivery costs, and four bespoke study days were created with the aim of delivering these across the county. Co-facilitation was agreed from the mental health team services to educate on the day with Specialist Palliative Care Educators.

The four sessions were delivered free of charge to all mental health and palliative care professionals with an interest in supporting patients with the dual needs of end of life care and mental health. The target audience was 50 per cent mental health professionals and 50 per cent palliative care professionals.

The day was planned to create break out sessions for both disciplines to learn the theory behind the practice from each other. In addition, two separate sessions brought the groups together to learn from one another. A pharmacist gave a separate session on medication use for patients with mental health and specialist palliative care needs.

The content and discussion

The primary objective of each session was to learn from each other, understanding the challenges when caring for a patient who is palliative with mental health needs and working together to provide end of life care to seldom heard and disadvantaged groups in the local community.

Both disciplines met to discuss learning objectives and the content to be covered. Each one-day course was divided into the two disciplines with activities and topical discussions relevant to mental health and palliative care. For example, “What does a hospice do,” “Recognising dying” and “Tools used in palliative care;” “What is mental health care,” “Drugs used to support patients mental health and palliative care needs” and “Understanding mental health services and how to refer.”

Overall the delegates valued the content and delivery highly as documented on our evaluation forms. Participants were asked to indicate their confidence for seven key objectives pre and post session, with 1 being not confident and 5 being very confident. All objectives scored 1-3 pre-session and 3-5 post session. Comments included:

“I will be more aware to listen and look for different signs with mental health patients, take time to consider how they may be feeling, discuss with other members of the team and phone the single point access,” and “Giving me an understanding of mental health medication and how it interacts with palliative medication. The importance of making sure the patients’ mental health problem is controlled by medication and not just stopping their medication if they become palliative unwell”.

Palliative care professionals now understand the implications of long standing mental health problems among patients and their families, and mental health professionals understand the additional issues faced by their patients at the end of life.

The study days provided an opportunity for each discipline to learn together. This was a clear benefit to all delegates, and the outcomes for the participants included:

  • Having a better understanding of services and referrals
  • Having an improved knowledge of how to support patients with dual needs
  • Being more confident to care for patients with dual needs

Our primary beneficiaries were the 124 local Mental Health Professionals (MHPs) and Palliative Care Professionals (PCPs) who attended the study days. Each day was repeated twice to engage as many staff as possible from North/ East Herts and West Herts. The delegates shared their learning with their clinical teams when they returned to their workplace, including learning materials and resources.

The PCPs included nurses, clinical nursing specialists, medical staff, physiotherapists, social workers, specialist doctors, and nursing support assistants. The MHPs included community psychiatric nurses, well-being practitioners, nursing heads, and support workers.

As a group of local hospices, the ultimate beneficiaries will be those people with mental health problems and their families and carers who have a palliative diagnosis. However since the series of study days finished in January 2019 the broader success of this education collaboration will be highlighted throughout the coming year, where the topic of mental health will be embedded in the palliative care education programmes.

People with severe and enduring mental health problems who require palliative care should have access to the same quality of treatment as the rest of the population. This is an overlooked and disadvantaged group of our community whose needs can be better supported and cared for with greater training, understanding, and effective referrals and liaison between MHPs and PCPs. We are confident that these education sessions have achieved the objectives set out in our application for funding, the main themes of which were:

  • To alleviate the stigma attached to mental health and palliative care
  • Improving the awareness of the available services for patients by the other discipline
  • Confidence in the language used when making patient referrals to either team to ensure the required response, and the need for further education for both disciplines.
  • Increase appropriate referrals made to the respective services by greater liaison and development of innovative ways of linking the services, and phone calls made between the hospices and NHS partners.

The local hospices and Hertfordshire Partnership Foundation Trust and NHS colleagues collaborated to deliver the training sessions and educated each other in the challenges and opportunities faced by each service provider. We were able to explain the technical language used by each team and to increase the confidence of service providers in raising safeguarding issues earlier in a diagnosis.

By establishing good communication and effective partnerships we will be able to serve more patients in our community, helping them to live well for longer from an earlier point from diagnosis by accessing relevant services when needed.

In the future, we hope to continue to deliver education to our mental health colleagues. We have had offers from our counterparts in HPFT to continue the delivery of education to our palliative care colleagues, to ensure we sustain the momentum to be “Prepared to care for all patients”.

The challenges

This project aimed to be innovative in terms of its content and delivery. It had many strands of education which needed to be disseminated to the attendees in a logical and clear format, and this was time consuming and challenging.

However, we were able to mitigate this by clear guidance to the other hospices and the HPFT team on the structure and content expected for each education day, and by working collaboratively we achieved our aims.

The arrangement of the tables at certain venues did not allow for mixing and networking opportunities, yet the larger venues meant attendees could walk about and sit with different groups during the day. These breakout sessions allowed members from each discipline to learn the theory behind the practice from each other.

Additional challenges were sourcing the most appropriate practitioner to deliver content on the day, however we managed to find the right people and the collaboration with senior practitioners was rewarding for all attendees.

In conclusion

We are working towards professionals improving collaboration and ensuring we are prepared to care for all patients. Such education helps reduce the fear and stigma created when caring for such patients. Four study days have been delivered to 124 attendees – 114 female and 10 male.

Each study day has been well evaluated and the consensus from the participants was that having both disciplines together created valuable learning and increased awareness of the importance of collaboration when supporting patients.

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