Partnership Working

Fiona Couper and Debbie Spain Department of Mental Health

Florence Nightingale School of Nursing & Midwifery

Learning Outcomes

By the end of this session, you will be able to • Discuss the meaning of ‘partnership working’ in

mental health services• Critically examine factors that may prevent and

promote partnership working• Identify implications for clinical practice• Have opportunities for reflection

Background

• Individuals in contact with mental health services typically benefit from involvement with more than one health professional and more than one agency

• Partnership working: “any situation in which people are working across organisational boundaries towards some positive end’ (Huxham and Vangen, 2005, p.4 in Tait and Shah, 2007)

Shared Knowledge, Skills and Values

• Pulling Together (SCMH, 1997) promoted collaborative teamwork while retaining separate professions

• Ten Essential Shared Capabilities (DH, 2004): broad domains of competency for all workers

• Clinicians may not have full awareness of other disciplines in terms of scope of practice, values, codes of conduct and organisation

Group work

In small groups identify the :-

1.Benefits of team working

2. Barriers to team working

Ten Essential Shared Capabilities (DH, 2004)

1. Working in partnership2. Respecting diversity3. Practising ethically4. Challenging inequality5. Promoting recovery6. Identifying people’s needs and strengths7. Providing service-user centred care8. Making a difference9. Promoting safety and positive risk taking10. Personal development and learning

Shared Knowledge, Skills and Values

How do members ofyour team conceptualisepresenting difficulties ?

Do all professionalsshare ideas about thetreatment plan ?

Some benefits of team working

• holistic approach to care and support • reflects the need to offer Recovery-focused interventions • increases efficiency, reduces duplication • shared knowledge and expertise• better use of resources, value for money• improved communication and engagement• stimulates creativity • combined influence• distinct conceptualisations of symptoms / treatment• anything else ?

(e.g. DH, 2006; SCMH, 2000; Tait and Shah, 2007)

Factors affecting partnership working with service-users

• attitudes / perceptions• nature / severity of mental health symptoms• MHA status• withholding information• relationship dynamic• unclear expectations• inconsistency • resistance • staffing levels / retention• resource constraints(e.g. McCloughen et al, 2011; Simpson and Brennan, 2009)

Barriers to working with professionals

• perceptions and attitudes• no common shared

language• inequalities in relationship• accountability and

responsibility not clear• conflict of interests /

agenda • power struggles• resistance • ‘a blame culture’

• end points / outcomes not clearly identified

• different organisational policies, priorities, IT structures

• disagreements re cost• bureaucracy • reluctance to share• team dynamics• poor support mechanisms

Triangle of care

The Triangle of Care. National Mental Health Unit(2010)

This document provides a guide to the views of users, cares and professionals about best practice. Their view about what constitutes a mental health crisis can differ. Consider some one you have cared for recently and note how:- •The user described the crisis•The carer described the crisis•The Professional described the crisis

Barriers to inter-agency working

Five significant obstacles to inter-agency working between health and social services:

1.Structural 2.Procedural 3.Financial 4.Professional 5.Status and legitimacy (Wistow and Hardy, 1991 in Holton, 2001, p.431)

Group work

• Consider one of the five Barriers and find examples in practice.

Improving partnership working with service-users and their families

• recognising need• being prepared to work together • listening • acknowledging service-user expertise • adopting a collaborative, goal-orientated approach• promoting open and reciprocal conversation• developing a shared understanding • facilitating self-management skills and self-efficacy • providing information in accessible formats

Improving partnership working with service-users and families contd.

• encouraging service-user feedback• named / designated nurse / team• providing choice• evidence-based decision making• signposting to PALS and advocacy service as needed• emphasising relapse prevention techniques • using advance directives / crisis planning when appropriate

Working in partnership in day-to-day clinical practice

Strategies include:

• clear communication: a shared language• effective leadership• making time• meetings ! (need to specify when, where, how often)• inter-agency training

Working in partnership in day-to-day clinical practice contd.

Strategies also include:

• identification of individual strengths and resources• joint assessments• sharing of information / ideas / experience• mechanisms for providing feedback• willingness to manage change

Enhancing partnership working

• leadership skills • negotiation skills• assertiveness• flexibility / creativity • feedback• responsiveness• trust

• motivation • skills-based intervention• familiarity with policies • shared resources• clarity in aims • clinical supervision

Is there one thing that you could change in yourself to encourage more cohesive partnership working with others ?

Summary and some considerations

• A need to consider a whole-systems approach to care

• Service-user involvement in design, delivery and evaluation of services

• Increasing emphasis on evidence-based practice – we need to develop broad systems for evaluating inter-agency interventions

ReferencesAudit Commission (1998). A Fruitful Partnership: Effective Partnership Working. Audit Commission.Department of Health: NHS Modernisation Agency, NATPACT. Working separately together: A guidebook for successful partnering between organisations within the NHS. Leeds: HM Government. Department of Health (2006). From Values to Action: The Chief Nursing Officer’s Review of Mental Health Nursing. London: HM Government.Department of Health (2009). Putting People First. Working together with user-led organisations. London: HM Government.Department of Health (2011). No Health Without Mental Health. London: HM Government.National Mental Health Unit(NMHDU)(2010) The Triangle of Care. London. NMHDUHolton, M. (2001). The partnership imperative. Joint working between social services and health. Journal of Management in Medicine, 15(6), pp.430-445.Involve: www.invo.org.uk

ReferencesMcCloughen, A., Gillies, D. and O’Brien, L. (2011). Collaboration between mental consumers and nurses: Shared understandings, dissimilar experiences. International Journal of Mental Health Nursing, 20, pp.47-55.Rethink. www.rethink.org Sainsbury Centre for Mental Health (2000). Using opportunities for inter-agency partnership in Mental Health. Taking Your Partners. London: SCMH.Sainsbury Centre for Mental Health. (2004). The Ten Essential Shared Capabilities. London: Sainsbury Centre for Mental Health.Simpson, A. and Brennan, G. (2009). Working in partnership. In P Callaghan, J Playle and L Cooper (eds). Mental Health Nursing Skills. Oxford : Oxford University Press.Tait, L. and Lester, H. (2005). Encouraging user involvement in mental health services. Advances in Psychiatric Treatment, 11, pp.168-175.Tait, L. and Shah, S. (2007). Partnership working: a policy with promise for mental healthcare. Advances in Psychiatric Treatment, 13, pp.261-271.