Transcript Stress Vulnerability & Early Intervention

Engagement with
Young People and their
Carers
Manchester Mental Health &
Social Care Trust
1
Aims & Objectives
For participants to gain an understanding of
the importance of therapeutic relationships.
To enhance an awareness about the key
ingredients of successful engagement
which lead to effective therapeutic
relationships
To investigate the skills needed to
communicate effectively with clients
exhibiting a range of psychotic symptoms.
2
Engagement with Young People
Experiencing Psychosis
Engagement can be considered in two parts:
1. The ability to be flexible and opportunistic
when offering intervention to young people
who may be reluctant to want to talk to you
2. The ability to establish and maintain SAFE
& CONSISTENT ways of communicating with
the young person, their carers / families and
their wider social networks
3
Engagement with Young People
Experiencing Psychosis
The principles that underpin engagement
with this group are:
Being able to work collaboratively
Being empathic and non-judgmental
Being prepared to give accurate and honest
information and feedback
Taking time to engage according to the
client’s needs rather than your own
4
What stops young people
engaging with services?
If the client has a long period of untreated
psychosis
If their first contact with services is through a
a service which does not seek their
engagement but enforces them to cooperate.
This is often in a crisis such as A&E, contact
with criminal justice system.
Services which insist on imposing
assessment and treatment on young people
who disagree that they need them
5
Skills of Good
Communication
What are the essential skills to
good communication?
6
What helps?
Hang on in there! Try to keep meeting up with
the young person, if only for a cup of coffee but try to make this a regular event
Address the needs that the client is telling you
she has - benefits, housing, transport,
relationships issues
Be flexible enough to offer to ‘pick up the
pieces’ should a crisis occur
BE THERE when and if they eventually
request help with their psychosis
7
Important skills
The relationship skills of individual workers are
critical (Smith 2003):
You need to be A good communicator
Able to be at ease and relaxed
Able to display a good sense of humour
Able to keep an optimistic & hopeful outlook
Respectful of differences in others and nonjudgmental
Able to see clients as ‘normal’ people coming
to terms with the effects of psychosis
8
Developing rapport &
trust
Give plenty of time initially
Spend time talking to clients about their
interests and give something of yourself
Be as flexible as possible
Give notice if you are late or need to
rearrange appointments
Always use the same room or a room that is
familiar to them
Avoid bleeps and telephone calls
9
Talking to people who
are paranoid
Evidence suggests that people who are
psychotic are unable to interpret discrete
body language cues. More overt non verbal
cues such as smiling frequently might help
Ensure that you tell the clients about the
respect that you have for them
Do not start by asking too many questions
Distance yourself from threatening situations
Look for practical ways of assisting clients
10
Empathise With Feelings
Look at the feelings behind unusual beliefs.
Try to imagine what it would be like if what
they are telling you is in fact true.
Imagine the situation afresh when you see
someone who has ongoing unusual or
strange beliefs.
Be cautious of using humour to test out a
belief.
11
Try to talk naturally
Try not to ask questions that imply doubt.
Consider the tone or stress put on significant
words.
Try to hold onto your own ideas and disbelief.
Your body language gives it away if you do
not believe something they tell you.
When you don't understand what is being
said, ask them to try and explain what they
want to tell you in a different way.
12
Know when to back off!
Don’t be confrontational
Be cautious when recapping as the strength
of convictions or beliefs can change over
time
Strong challenges can cause clients to look
for more arguments to support their belief
Avoid too much eye contact
Consider changing the environment
13
Giving a Rationale
Giving a reason why you want to talk with
someone helps them to feel more in control
Try to make sure that the person is fully
aware of what is happening
Giving people reasons or rationales for
interventions helps maintain the atmosphere
of empowerment and collaboration
This process should also allow for the person
to discuss any misconceptions or
misunderstandings or ask questions
14
Developing Trust
In groups of three, use the
accompanying exercise sheet.
The object of this exercise is to
encourage someone who is psychotic
to visit their GP
15
Engaging families and
carers
Relatives of clients are often suspicious
of mental health services and reluctant
to take ‘on board’ the onset of a serious
mental illness.
It is important to engage with relatives/
carers by providing appropriate
information and to give them the
opportunity to ask questions.
16
Carers Assessments
All carers have a right to an assessment
of their own needs according to the
Carers Act 1995
The National Service Framework for
Mental Health (DOH 1999) states that
carers should have an assessment of
their own needs and access to a wide
range of support systems
17
Engaging families and
carers
Families need to be taken seriously and
informed of the illness, the issues concerning
the problems that arise when the illness is left
untreated and the treatments available
It is often helpful for ‘first time ‘ carers to have
an opportunity to meet others. Putting them in
touch with carers groups can be very helpful
Parents have referred to the acceptance of
severe mental illness as almost like a ‘grief
process’
18
Conclusion
Working with people with mental health
problems is challenging and requires good
communication skills.
The environment in which the therapy takes
place is an important consideration.
Specific skills can enhance the process of
engagement.
It is essential to provide reasons or rationales
when trying to engage with people
It is essential to engage with both the young
person and their carers
19