Jasmine Snowdon Hello, and thank you for  watching my presentation today. This will   be on the importance of mental health  nursing in child and adolescent mental   health services. My name’s Jasmine Snowdon.  I’m a Registered Adult and Mental Health Nurse,   and a Senior Teaching Fellow in the  Mental Health Nursing Teaching Team,   at the University of Southampton. I also look  after the dual field programmes at Southampton,   so that’s adult mental health and  child mental health programmes. Okay, so a little bit about me is that I trained  as an Adult and Mental Health Nurse a while ago,   and that really inspired me to move into eating  disorders, because I felt I could use my physical   health nursing skills and my mental health nursing  skills. What I noticed while I was there was that   there was quite a lot of older people, or people  that were in, kind of, middle ages of 20 to 50,   that had had repeat admissions into the inpatient  eating disorders unit, that hadn’t received the   support, and the family support, that they  could have had when they were younger. So, after seeing this, and becoming quite attached  to the people that I was working with, and wish I   could have helped them at a younger age, I moved  into child and adolescent mental health services.   So, first off, I worked in an inpatient service,  which was a mix of eating disorders and general   psychiatric. So what means is all your other  psychiatric conditions, such as depression,   anxiety, that were more severe, and psychosis  was more the predominant one that we saw and,   also, sometimes emotional dysregulation and  trauma, where people were a risk to themselves. And then, from that experience, I really  wanted to help people in the community,   ‘cause I felt it was better for young people  to be in the community, and to work with their   families more closely, and be in that role  of an educator to prevent hospital admission.   Hospital admission can be really traumatising  for young people, and they can build a sense   of community within the inpatient service, but,  also, from my clinical experience, it was not   necessarily helpful for them to be out of school,  away from their family for long periods of time.   So, I wanted to be that Community Practitioner  that would help young people in the community. So, move now. And then I was interested  in educating Student Nurses, ‘cause what   I noticed is that a lot of my colleagues  became more anxious around managing risk,   which at times, sometimes, made  their practices restrictive,   and we know this from the literature, that  restrictive practice can be quite common. So, what I want to do is install that level of  confidence and ability to adapt in the care that   they were delivering, by teaching Student Nurses  through case scenarios, and my own clinical   experience, on how to manage a person safely in  the community, by also seeking to help – some help   from your team members, and knowing when admission  is needed, because it’s not always avoidable. But   it’s what you do in terms of discharge planning  and how to support that young person so that   admission is useful, rather than prolonged over  a period of time when they don’t need to be there   for different reasons. So, for example, we few  – we saw a few people for social care reasons. And then I was interested in research into the  impact of skill mix in child and adolescent   mental health services, and that’s what I’ll  be talking in part about in this session.   Okay, so just to give some background, there’s  different fields of nursing within the UK,   so I know this is an international platform. So  mental health nursing in the UK is a profession   grounded in empathy, advocacy and empowerment,  and it’s walking alongside the individual in   their journey with their mental health and  working with their fluctuating mental health. It’s also about working with the person in  promoting recovery focused models and reducing   stigma, and help the individual build and to  adapt with different life situations they may   encounter. We also do integrated – integrating  therapeutic relationships, and fulfilling lives,   so that helps us have a greater understanding of  reducing restrictive practices, ‘cause we want   to keep people in the community, and we want  us all to be working together collaboratively,   in the hope that they can begin to make  some positive changes in their life. So, child and adolescent mental health nursing,  in particular, we work in a restorative way with   the family. So it’s not about if the parent has  maybe, for example, hurt the child in some way,   or has maybe not been the best parent  on paper, we want to work with them,   to help keep that child in the family, within  safe restrictions. So, we work very safely and   effectively with social care services, and we  make sure that they’re always involved in the   meetings that we’re having, to make sure the  child at the centre of the care is safe, but,   ultimately, we want to be able to work with the  family as a whole. And Mental Health Nurses play   a really critical role in that, because  we sit within the biopsychosocial model. So, in child and adolescent mental health  services, we use more of a psychosocial model,   because where they’re less physically unwell, and  that’s de – different in eating disorders, but we   try to work with the family collaboratively, using  those psychosocial interventions. So, what we   might do is educate the parent on how to manage  risk, how to communicate with the young person,   and seeing the young person as their own person,  and, also, working within the i-THRIVE model.   So making sure that the young person’s  thriving and gets help when they need it. So, under the Nursing and Midwifery Council,  there’s four fields mental health, child,   adult, and learning disabilities.  Okay, so, what made me passionate   about looking at research in this area  was that from my clinical experience,   I noticed there was a significant gap in-between  the literature from my adult nursing counterpart   in my other registration and my mental health  registration. So, it meant that I was noting a   lot of restrictive practices while I was in  a clinical setting, and it means that young   people were sometimes kept in hospital when they  weren’t necessarily mentally unwell at the time,   but they were struggling to get housing, which  then had a significant impact on their mood. Also, the staffing ratio, sometimes they’re  understaffed, but there was also a lack of   insight into the importance of the role of  the Mental Health Nurse, because sometimes   the work that we’re doing – and it’s hard  to quantify what mental health nursing is.   So there is an element of sitting down with  people and having a cup of tea, but there’s   also the elements there that we have a greater  understanding of the law, how to manage risk,   and those therapeutic interventions, and how  to apply them on a lighter or heavier level. There was quite a divide between psychology and  mental health nursing, in terms of the young   person might go and see the Psychologist, and then  we wouldn’t necessarily get the best handover,   and then they’d be onto the ward, and potentially  have an incident, ‘cause we had that breakdown   in communication around what the young person  had just spoken about and why they were upset. It’s also how incidences were managed,  so we’d have a lot of people on the ward,   but not necessarily a lot of people engaging  the young people in activities. And that was   partly to do with the skill mix of people  knowing what they needed to do, but that’s   just from my personal experience. So that’s  what made me passionate about it originally,   so not everywhere will be like that, but  that was my experience of inpatient care. I also noticed that people were – had delayed  discharges, so it meant that they could be in   the community, but they had been in inpatient for  so long that they felt like that was their home,   rather than the home they were going to  go to. So, they’d built up a network,   they had regular meals, there was people caring  for them, in a safe and warm environment,   and sometimes that’s not the environment they’re  living in before being admitted into hospital. This is what we don’t know about skill mix in  inpatient care. So, as you can see, there’s a   significant gap in the literature since COVID-19.  So a lot of what I’ve looked at in researching   this was that the literature hasn’t been updated.  So there was a significant increase in admissions   of children and young people, and especially  children and young people that had a diagnosis of   autism as well as a mental illness. So, those were  the people that were more likely to be admitted,   but there was very limited literature on what’s  going on for them and what’s changed since 2019. There’s an overall lack of research globally  around quality and safety in mental health care,   so I was hoping to build on that. There’s a lack  of understanding of difference between the care   of adults with mental illness and the care of  children and young people with mental illness,   and why those important – differences are so  important. ‘Cause there’s completely different   legal frameworks that you’re working under,  children have less ability to make decisions,   but still need to be involved in decision-making  and understand, to the maximum of their age range,   what is happening at what times, and  they need to be involved in their care. Adults have more autonomy, overall, but, also, in  terms of how we work with children, there is more   resource. So it means that the wards do tend to be  better staffed and the community teams are better   staffed, but that’s because of the volume and  the amount of care that we’re able to provide,   and there’s more laws in place to protect  children than there is with adults. So,   if an adult doesn’t consent to care,  then they’re able to refuse the service,   if they have capacity. Whereas, a child, you  would – sometimes, they don’t understand what   they’re declining, or what the treatment is,  so we’ll work with them for a bit longer to   build up that rapport, which is so important. So,  those differences aren’t necessarily understood. And the need to involve in the – or the existing  workforce for appropriate measures for quality,   so we need to work with service providers,  in our current workforce, to be able to do   that. We have done a questionnaire  that looks at workforce wellbeing   and, hopefully, that will feed into that, but we  don’t have anything concrete yet. There’s a lack   of understanding of how the service user feels  while they’re in an inpatient setting in CAMHS,   so we don’t have their experience and their  side of things of what they felt at the time. There’s a lack of understanding of the links  within incident data, so we collect it and we   see trends to react to them immediately. So, when  we’re looking at it from a Trust perspective,   we will look at trends in terms of how many types  of incidents are happening at one time and if   there’s a type of incidents happening at one  place, quite often that will be looked at,   but it’s not all linked together, in terms  of what was the skill mix on that day? Has   any intervention been helpful? Did that  young person get their one-to-one support   that day that they’re supposed to have? And all  of this isn’t taken into account in the current   way we collect incidences, and there’s limited  quality monitoring of incident data, as a whole. So, there’s a significant gap. So the  National Quality Board looked into this   and said it was a research need, that we  urgently need a commissioned programme   for this empirical research in mental  health multidisciplinary settings.   Particularly in linking staffing requirements  and outcomes for people with mental illnesses,   and it’s a priority area that currently there is  – so, there’s guidance, but there’s no plans to   implement this or evaluate this currently,  from the literature that I’ve looked at. So, the idea that’s in place is, “How do  different nursing services delivery models,   including skills mix, specialise and interventions  offered, affect the experience and outcomes of   patients with mental illness based on the  incident data and staffing experience?” So,   this is the question that we are looking at in  the United Kingdom, and my particular question   will be focusing around child and adolescent  mental health services and that staff and skill   mix that we have here. Because there’s a lot  of unknowns, and what we might see from the   incident data is the more staff that you have on  shift, the more incidents you have. But that’s   because you might plan for that incident in that  day, and without a Mental Health Nurse doing that   research in child and adolescent mental health  services, it’s very easy to misinterpret the data. So, that’s where mental health nursing  is so important in CAMHS, where we sit   within the biopsychosocial model, so can take  the psychosocial part, so work with families.   But we can also do the research and add the  context to it, from our clinical experience,   rather than looking at the numbers and  not understanding the context of those. So, thank you for listening to me  today, and I hope you enjoyed this talk.