My third week working with the Community Mental Health Team

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I have now completed the third week of my placement with the Community Mental Health Team, and I am pleased to report that it has been another fantastic week of learning.  Of all the different things that I have experienced this week, there were two things in particular that I really enjoyed.

One day I accompanied a client to have a look around a local arts project scheme which helps people who have had various health problems.  This particular client has been suffering with poor mental health for many years, and is now at the stage where she is ready to move on independently and further develop her confidence.  The client expressed a wish to engage in some activities outside her home, and so getting out a couple of times each week, to a suitable group, is probably exactly what this client needs.  The lady in question is very artistic, and paints and draws in her spare time, and so the arts project seemed perfect for her.

Looking around the arts project we were shown a variety of different activity rooms.  The centre caters for pottery, painting and drawing, textiles, woodwork, photography and music.  The facilities there are absolutely brilliant, and I was really excited for the client.  The client was asked which groups she would like to join, and she happily signed up for the painting and drawing, and the pottery class.  The client is able to start with immediate effect, so I was so very happy for her.  I feel sure that the groups will be of such great benefit to her, as well as being personally enjoyable and satisfying too.

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It is great that projects such as this exist, and there should be more of these types of opportunities in various parts of the country.  Stimulating the mind is of benefit to us all, and moreover, is especially important when recovering from mental illness.  An active mind that is engaged in enjoyable pursuit is incredibly therapeutic.  Suitable physical activity is also really good for helping with conditions such as anxiety and depression, as the release of endorphins is good for the brain.  Gardening, for example, would be a great activity for this purpose.        

Another day I was involved in a training day for risk assessment.  My mentor was actually teaching part of the session, so this is how I came to get a place on the course.  Risk assessments are a central part of being a mental health nurse, and when anything changes for a client, we always need to update the assessment.  Many of my recent patients have just had annual reviews, and so I have been involved in carrying out new risk assessments alongside the client; like a care plan, the client should be involved in the risk assessment too.  When working on risk assessments, I often found them quite difficult, and it is so important to look at possible risks from all possible angles.  Therefore, as I was struggling a little, the training day was incredibly useful.

The teaching explained how risk needs to be considered from three main views: current, historic and future.  Historic risk is not always relevant, and the main focus should be on the ‘here and now’.  Risk assessments also need to look at the risk to self (i.e. the client), the risk to others, vulnerability and exploitation, self-neglect, as well as safeguarding of children. 

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When thinking about risk in more detail, consideration of the following is also relevant: nature, severity, frequency, imminence, likelihood, risk reducing and risk enhancing.  When applied to a fictitious risk scenario, for example, the nature of the risk may be an overdose by paracetamol.  The severity may be that in 1994, the client made a serious attempt on their life.  The frequency is that it was a single attempt.  Given that it was 20 years ago, it therefore seems unlikely that the client may make a similar attempt at present.  For the risk to be reduced, the client needs to take their medication and to engage with their CBT treatment.  For the risk to be enhanced, the client would need to stop taking their medication, there would be increased mental stresses and a failure to engage with the CBT support.  Finally, any strong protective factors, such as a supportive family network, should be identified, along with any early warning signs of deterioration, such as the client withdrawing in isolation.

I now feel much more capable in carrying out risk assessments, and my mentor has already noticed that they have markedly improved.  Next week will be my last chance to practise my newly acquired skills for a while, as my placement is due to finish next Friday.   I will provide a final update on the community next week, and then it is back to university again.

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