© PROMISE 2016 - All Rights Reserved | Em@il:promise@cpft.nhs.uk


PROactive Management of Integrated

Services & Environments


Relational Security

Ann Marie Paul, Ward Manager, George Mackenzie House (Low Secure Unit)

As a low secure unit we very much work with the concept of relational security.  To me proactive management is relational security.


That’s about having a clear understanding of your patient, getting to know everything about the person, understanding who they have outside of the ward, understanding their therapy and being alert to any changes in what we know as their usual pattern of behaviour.  If somebody is on the phone more often than usual then we want to know why.  Are they being bullied by somebody?  Relational security prevents incidents through the 3 steps See, Think, Act: seeing something, thinking about it and then acting on it.  This comes down to simple things.  When you see there’s a towel lying on the floor, think about it, why is it there? Act -do something about it, remove it.  That’s what prevents incidents from happening.  If the patient, for example, is continually walking over wet towels, that’s an irritant to them, it’s not just about the CQC might not like it, actually it could be an irritant to their behaviour.  We think about everything we do and know the person as a whole so that we can make the ward as pleasant as possible.  I think what we find from any Serious Incident is that there actually was something leading up to it that could have been a warning sign.  Somebody always says ‘I knew that was going to happen, she was a bit funny this morning’.  What we try to do is avoid that.  Relational security is something we’ve been using for some time and that we continually think about, train staff on and review.  We talk about relational security but we could easily talk about proactive management.  It’s uppermost in our working day and part of the bread and butter of what we do.

Meaningful Activity and Community Links

Ann Marie Paul, Ward Manager, George Mackenzie House (Low Secure Unit)

At George Mackenzie House we believe it is crucial for patients to have a structured day.  Patients take part in a lot of therapeutic psychological work, skills work, recoveries and outcomes groups and physical activities.  It’s about keeping people occupied, giving them the time and opportunity to reflect on how they’re feeling and to talk about their future.  We also do an awful lot of activities in the community and involve patients in community links as soon as they are able to get their leave.  For example, going to the gym at Kelsey Kerridge, a long walk at the local Country Park, bowling, visiting museums or the Raptor Centre (bird sanctuary) – whatever’s of interest to them.  The hope is that before they leave, the structured day that they have here will be replicated in the community to suit their changing needs.  The community team then follow up and support them to continue in this.  For example, they might enrol in a college course, attend community activities or take on voluntary work.  

We believe that meaningful activity and a structured day are crucial to preventing relapse in the community.  It’s really noticeable that when people don’t have community activities or structure in their lives, that’s when things get really bad for them and it often leads to relapse and readmission.  Activity and structure to living is the key for patients but it’s the key for us as well.  We all like to have some kind of meaningful activity in our lives.  By the time people come here they very rarely have meaningful activity in their lives.  Usually, by the time they come here they’ve been through the system a lot and things have got really bad.  Sometimes people will look on them differently.  We start right from the beginning and offer them as much as support as we can.  When they leave here our patients will have a full structured day and this is something they can take with them when they go.  We would like to think that when they come here they get a new start.  

 InDovations from GMH