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PROactive Management of Integrated

Services & Environments

PROGRESS PROCESS PROMOTE PROTECT


In 2005 I spent six months on an acute ward at the Cambridge and Peterborough NHS Foundation Trust (CPFT) in 2005 and this gave me the impetus to influence the design and delivery of services. I had some negative experiences and I noticed that other patients were not always treated with compassion and understanding at times of heightened distress, for example when they had absconded or self-harmed. Some had been unable to access the right care at the right time and others were not treated with the dignity and respect they deserved.


Spending time as an inpatient was an eye opener. Although most of the staff had their heart in the right place, they were often overstretched and some had become desensitised. I didn’t always feel safe on the ward and there were many opportunities for things to be done differently. I frequently observed the lack of interaction between staff and patients and the use of coercion and I was aware of the pronounced ‘them and us’ culture. However, it wasn’t until 2009 that I took up the opportunity to train as an Expert by Experience. The E by E programme was a government initiative in 2001 to prepare students to offer their expertise in a range of roles e.g. service development, research or education.  


My hope was that completing this course would enable me to become actively involved in shaping and improving services delivered by the Cambridgeshire and Peterborough NHS Foundation Trust. The course really acted as a stepping stone, because after completing the training I was asked to:

 Work as a service user researcher

 Be a member of Trust working groups and committees

 Co-facilitate staff training sessions

 Join staff interview panels  


This local experience has led to varied roles both within and outside the Trust, including several leadership roles. I work as a trustee of Mind, as a Lay Patient and Public Involvement Advisor to the CLAHRC EoE board. (Collaboration for Leadership in Applied Health Research & Care) and I’m the Service User Advisor to the Safer Care Pathways in Mental Health project.


In 2013 I was selected by CPFT to attend a two-day Patient Leadership course at the Centre for Patient Leadership and became an ‘Expert by Experience with teeth’. Thus when The Mind report on restraint in mental health services across England, was published in 2013, I felt empowered to take the initiative. I was concerned about the figures that had been released under the Freedom of Information Act. The report highlighted the extensive variation in the use of Physical Interventions and in particular the use of prone (face down) restraint which can cause injury to patients.


At a more personal level I still remember the first time I witnessed the use of restraint and the huge impact it had on me. It was during my first inpatient admission when I was 22 years old. The patient concerned was staying with her baby at the hospital was being treated for postnatal depression. However, when her mental state deteriorated and she became psychotic staff decided she was too unwell to stay on the unit and needed specialist treatment. After having been an inpatient for several months it wasn’t surprising that she resisted all attempts to be uprooted from her familiar surroundings. Witnessing this episode was so distressing that it has stayed with me and I remember her name to this day. It also provoked a more selfish fear that this could happen to me.


This experience and the publication of the Mind report made me curious to learn about CPFT’s restraint policy. I wanted to understand the figures that had been released under the Freedom of Information Act and to know how the Trust was planning to reduce the use of physical intervention. It prompted me approach Manaan Kar Ray, Clinical Director of adult services. Manaan is a keen proponent of Recovery and it was this meeting sparked the inception of PROMISE (Proactive Management of Integrated Services and Environments).



Prelude to PROMISE


Sarah Rae, Co-founder of PROMISE, shares her personal story…


Since my late teens I have been on a journey of Recovery, discovery and rediscovery. During the course of my adult life that I’ve been challenged by episodes of severe depression, crippling anxiety and extreme Obsessive Compulsive Disorder. I have always struggled with emotional regulation and have been diagnosed with Borderline Personality Disorder and Bipolar 2. As an adult I’ve dipped out of secondary mental health services and have had to be cared for as inpatient on two occasions. Overall my experiences have mostly been positive. On most occasions, I have received person centred care which has enabled me to reinvent myself and make positive changes to my life. I’ve also been fortunate to have access to psychological therapies and medication has been a life saver. Crucially, I’ve had the support of a loving husband and together we have raised 4 children.