Arrow ImagePICU & Rapid Response

Meet the team working across our Older Adult services

Here at St Andrew’s, our on-site, specialist multi-disciplinary teams work across Birmingham and Northampton to support older people with a mental health diagnosis or a neurodegenerative condition who also have complex physical health and mobility needs.

We recognise that within the context of mental healthcare, supporting older people requires specialist clinical and psychiatric knowledge, insight and compassion.  We aim to Sarah Hayes web thumbnailsupport people in their rehabilitation so that they can return home or to a residential setting suitable to their on-going needs. For some of our patients who are unable to make this step our job is to ensure that we help them to maintain the best quality of life and support their end of life care with compassion in an environment that is comfortable and reassuring for them, their family and loved ones.

Our Older Adult Team are key to this care approach so as part of our spotlight on this service we want to share with you some of their insight into the clinical and therapeutic interventions used to support our older adult patient group. 

This week we meet Sarah Hayes, Lead Occupational Therapist, part of our neuropsychiatry MDT and working across our our dementia services.

 “The challenge that we have as health professionals working with older people is to remember the person that is beneath the physical, mental health and cognitive impairments; to get to know who that person was underneath, it’s the sense of ‘personhood’ and recognise that we need to get into the individual’s world.” 

To hear more from Sarah about the unique needs of our older patients and what she most enjoys about her role, click on her video below:

Supporting the physical healthcare needs of older adults

Our older adult services draw from a range of specialisms within our MDT to treat complex mental health conditions whilst also supporting the physical healthcare needs that are a key consideration when supporting an older patient co-hort.

As we get older we know that our bodies become less robust from a physical perspective and there are lots of barriers that our bodies give us to stop us from doing what it is that we want to do. So what we need to do as occupational therapists, particularly when working with those with the degenerative conditions such as dementia, is look at promoting or sustaining people’s level of ability for as long as possible and we do this by compensating and providing equipment for everyday living.

There is nothing more satisfying than assessing someone for a bespoke wheelchair and when you get them sitting in that wheelchair; you get them sitting at a table and their faces and their whole demeanour it changes because they can sit at a table and they can enjoy the meal that they have or they can enjoy even watching television, and I think that's where the greatest joy is, using equipment to be able to promote how somebody interacts with the world around them.” Sarah Hayes, Lead Occupational Therapist

Parul Video web thumbnailWith an on-site Consultant Geriatrician as part of the Northampton MDT we are able to closely monitor our older patient’s physical well-being and ensure that we pre-empt and proactively manage physical health issues with the aim of enhancing people’s mobility and quality of life, whilst reducing the need for acute hospital admissions.

As a specialist Consultant, one of Parul’s key aims is to define a strategy for managing older people’s physical health and identifying their frailty:

 “If we can identify that people are getting more frail, we can put something into practice early on, such as an exercise programme or a lifestyle change which may stop them deteriorating…and if there are no reversible factors, then we need to think about how we can make people more comfortable and involve them in decisions about their best interests.Parul Shah, Consultant Geriatrician

Dementia Care Mapping focus

The process of Dementia Care Mapping 

DCM usually involves one or two trained observers (mappers) sitting in areas such as a lounge or dining area and observing what happens to patients over the course of a typical day. It is only used in public areas of care environments. Care staff and visitors carry on as normal and DCM should not interfere with this.

The focus of mapping is on the patient and their experience.  What is recorded is how patients are responding and reacting to the environment and the people around them.

Each of the seven wards within the Neuropsychiatry pathway dementia and Huntington’s disease sub-pathways and two of the wards within the Men’s Mental Health pathway older adult sub-pathway are currently signed up to DCM. The Women’s Mental Health pathway is also beginning to train mappers.

Participating wards are mapped at least four times a year. The results are fed back to the care team so that care can be developed through multi-disciplinary action plans, and progress is monitored at service level. 

Individualised care and treatment

Individualised treatment programmes incorporate the principles of the RAID (Reinforce Appropriate and Implode Disruptive) model – positive, meaningful engagement and reinforcement.

We use specialist age-appropriate interventions and tools, which address psychiatric symptoms, risk and offending behaviour.

Our commitment to Dementia Care Mapping (DCM)

Structured professional judgement tools, such as HCR-20 and RSVP, are used to assess risk on a regular basis and we use Dementia Care Mapping as an observational means to improve the quality of life and wellbeing of our patients. With a team of mappers, including Advanced Mappers we are able to routinely map on a quarterly basis complementing a holistic approach across services for older adults in our care.

Importantly for our patients their DCM data is presented on the BI Patient Portal and comes up on individual patient's dashboard, and it therefore able to be included in ward round discussions and CPA reports.

Our older age adult service was the first to be awarded the RAID Centre of Excellence, recognising our environment of positive engagement.

Achieving positive engagement

We provide a holistic approach to the assessment, treatment and rehabilitation of mental illness and physical health problems.

With input from over ten disciplines, our approach provides a range of individual and group therapies including index offence work, problematic alcohol and drug use, emotional coping skills and strategies, and cognitive stimulation therapy.

Specialist occupational therapy interventions develop important community skills prior to re-integration. In addition to psychology, psychiatry and physiotherapy inputs, individualised treatment aims to maintain and improve functional independence:

  • activities of daily living: personal hygiene, laundry, budgeting skills, cooking and preparing meals.
  • on-site vocational pathway: activities include woodwork, horticulture, catering, ceramics and office skills
  • individual education sessions: literacy, mathematics and IT skills
  • arts and crafts
  • body image therapy to promote self-care and self-image
  • spiritual support
  • physical health and wellbeing - crucial to our comprehensive care programmes.

We offer dual-trained adult and mental health professionals who work alongside our dedicated physical health team with access to General Practitioner (GP), a geriatrician, a Practice Nurse, dental and podiatry services.

Discharge and ongoing Support

Discharge is considered at admission and our clinical and social work teams will work with local area teams to manage transition into appropriate settings.

Matthew Berridge web thumbnailMatthew Berridge
is the Clinical Nurse Lead on our medium secure, male older adult mental health ward Cranford, he explains the role of the nursing team in supporting patients in their discharge;

“A lot of patients really would like to get out of hospital, but actually when it's coming up to discharge, that can be a challenging time because what they want is on the horizon and they start to think; “am I going to cope with this?” So as a nurse it’s about building their confidence.

In the months leading up to discharge, we look at their access to the community, how their activities of daily living are going and we work with the outside agencies”

St Andrew’s offers highly bespoke community care packages to support very complex patients. This would be discussed and agreed with the commissioner in advance.