Working with friends and family
during times of crisis: Islington
Acute/Crisis strategy for carer
Dr. John Hanna, Consultant Clinical Psychologist,
Highgate Mental Health Centre
January 2012
Islington Acute/Crisis
Mental Health Liaison Team
Two Crisis Resolution/Home Treatment Teams
Two Crisis Houses
Assessment Ward
Four Acute Treatment Wards
Specialist Services for Aging in Mental Health Ward
Psychiatric Intensive Care Unit
Access to Women-Only Acute Treatment Ward
Unique challenges for acute/crisis
• Confidentiality
– When paranoia interrupts close, positive relationships
– Assessing service user’s reasons for denying carer involvement
– Confidentiality of carer disclosure
• Sharing information
– Pre-admission advance directives
– Carer disclosure leading to MHA assessment
– Leave, discharge arrangements
– Complex categories: General, personal, personal-sensitive
• Carer expectations of acute admissions
• Separation—temporary and longer term
• Family/social network dysfunction, abuse, absence
• Young carers
• Out-of-area carers
Triangle of Care Self-Assessment
Findings—9 teams within Islington
• Lack of carer-aware training for staff
• Variable “carer champion” support across
• Identified challenges relating to parameters of
confidentiality/information sharing
• Limited service information available to carers
A renewed carer strategy for Islington
• A working party on improving working with carers and delivering the
Trust’s Carer Strategy—representatives from all acute/crisis service line
services, alongside Islington Carer’s Centre, IBUG, BUF, FT’s carers lead
(Set up in early 2011)
• Co-production toward three shared objectives
– Information leaflet for carers, family and friends on acute/crisis service
pathway to support informed engagement—completed and ready for formal
approval and dissemination
– Confidentiality/sharing information strategy for carers, service users and
staff—completed and ready for formal approval and dissemination
– Staff training on working with social networks during crisis—delivered to
service line managers
• Carer champions to be established within each acute/crisis team
– To receive staff training as above (Spring 2012)
• Good practice adherence projects undertaken within each team (Spring
• Working toward concordance with NICE guidance on family work within
Acute/Crisis service line

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