|Contact||Stuart John Chuan, PICT lead and Forensic Psychologist, Camden and Islington NHS Foundation Trust|
|Telephone||020 3317 3500|
|Address||St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE|
The Psychologically Informed Consultation and Training (PICT) service supports frontline workers to work more effectively with people living with complex mental health and challenging behaviours in Islington.
The service supports:
- Families – Islington
- Parents with mental health problems – Islington
- Primary Care services – such as GP and A&E liaison in Camden and Islington
- Crisis Services – in Camden and Islington
- 18-24 year old transitions gangs and serious youth violence – Islington
Understanding the needs of parents with complex mental health problems is essential in supporting them to turn their lives around and ensuring their children thrive and make the community safer. Parents with mental health problems may also display challenging behaviours of aggression, hostility, social isolation, impulsivity, and alcohol and drug abuse.
Relying solely on the traditional approach of referring parents to an Adult Mental Health (AMH) expert to assess, diagnose and provide treatment recommendations to the individual can often fail. This is due to the parent’s poor engagement, fear of mental health stigmas, diagnostic co-morbidity complexity or high threshold eligibility criteria for specialist services. The other approach of relying on a separate dedicated AMH team to provide only direct interventions to parents can lead to problems with caseload capacity, waiting lists and shifting eligibility thresholds criteria.
The PICT solution
Psychologically-Informed Consultation & Training (PICT) is an innovative alternative solution. The PICT AMH team are situated within Children’s Social Care and family support teams. Through staff consultation and training, PICT aims to equip the existing workforce with the knowledge, skills and confidence to identify, understand and work more effectively with AMH and behavioural problems.
Practitioners can then respond in a psychologically-informed way that addresses the parent’s underlying needs, strengthens their capacity to live a life worth living and care for their children appropriately. Practitioners experience an increased sense of personal achievement and emotional resilience in their work, and the approach supports joined-up care and coherent working between adult and children’s services.
The PICT team provides a relatively smaller proportion of joint case working with the family. The aim is not for the PICT team to provide a service that already exists within AMH services. Instead, it is to enhance the skills and capabilities of the practitioner by modelling an approach of working with the parent(s) that is psychologically- informed. Frontline practitioners can then generalise the new skills, knowledge and practice principles gained from the experience of joint working.
Camden and Islington NHS Foundation Trust has provided the following services to date:
Signposting to appropriate AMH services and care pathways, and providing up-to-date AMH service contact details to practitioners
Supporting timely liaison and information sharing with AMH services when urgent risk arises
Providing consultation that increases practitioner understanding of problem behaviours and the impact of parental mental health difficulties on parenting. Consultation also supports the development of realistic goals which take account of parental mental health problems and leads to more informed referrals to the appropriate adult services
Joint home visits with the practitioner as part of an assessment to aid the understanding of AMH difficulties, impact on parenting and ability or readiness of the parent to engage in interventions
Direct work facilitated jointly with the practitioners to improve mental health and wellbeing of the parent and their engagement with services, and increase the confidence and competence of the practitioner to work with common mental health difficulties
Liaison with mental health services, facilitating engagement or re-engagement where appropriate.
A practitioner was having difficulties supporting a family to work towards family intervention goals. The practitioner and team felt the barriers to engagement were due to the mother presenting as withdrawn, lacking motivation, poor sleep and difficulty in regulating emotions. She would fluctuate between extreme anger by shouting, tearful and expressing low self-worth. There were significant interpersonal difficulties between family members and between the family and the practitioners involved.
Consultation with practitioners who were involved with the family enabled them to take a step back and share their experiences and observations of working with the mother. They were able to consider the long-standing nature of her presenting difficulties as well as the multiple contexts in which they occurred. Having a better understanding of the parent’s long-standing and pervasive difficulties in relating to others helped the team to identify more effective ways of working with her. For example, being more transparent about roles, expectations and consequences, and maintaining clear boundaries.
The challenge of working with families with such difficulties was normalised. The importance of practitioner self-care and having a space to reflect upon the work was recognised. Small, practical goals for working with the mother’s mental health difficulties were discussed and an action plan was agreed by the team. The psychologist agreed to provide on-going support in implementing these strategies and reviewed tem with the team at a further consultation.
Signposting and liaison example
After previously been referred to a specialist mental health service, the mother was still not interested in any form of engagement. Due to a change in circumstances, she wanted to get support for her mental health problems. She was unsure who to contact to discuss this further. The psychologist was able to liaise with the AMH practitioner who last had contact with the individual and find out what would need to happen for the client to re-engage with their service. This was fed back to mother’s family support practitioner with a brief consultation about how to discuss the way forward with her.
Working in partnership
Being embedded within Children’s Social Care and family support teams provides easy and timely access to advice and support for practitioners regarding AMH difficulties. The PICT approach recognises the existing expertise of practitioners in their own area of service provision with an aim to enhance and augment practice through the addition of an evidence-based psychologically-informed approach. It is an economically viable solution for high caseload services working with families in which there are complex adult mental health and behavioural problems.