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Facing the facts
The QCS care planning policies and procedures include a number of opportunities to write about the social and life history of a service user newly admitted to a care home setting. Why is it important to write about these individual and social factors, why don’t we just focus on problem areas and their management? Well first of all we need a comprehensive picture to get a view of the whole person. And there’s one further important issue – and that is the impact that social and life history factors have on the person’s physical and mental well-being. I want to use this article to give some examples to make these links and also inform how you might complete these sections of the admission and care planning documentation. I think I should also say it is very important to include something in every section of the form. In a previous job I’ve seen completed assessment forms that have perhaps had a heading such as ‘physical health’ or ‘accommodation’ and the section left blank or marked not applicable, because the person completing the assessment thinks because there is not an obvious problem, then there’s no need to write anything down. That is to misunderstand the nature of assessment and care planning – it’s not just about identifying problems. It’s about identifying strengths, or identifying possible risk, in the past, present or future. There’ll always be something to write!
Writing it all down
Let’s look at the admission pack and some of the headings in admission and care planning documentation, and the issues that are important to focus on. In doing this I’ve made reference to an excellent document of facts and figures which I make a lot of use of. Fundamental Facts: the latest facts and figures on mental health was published in 2007 by the Mental Health Foundation, and includes a lot of concrete evidence linking mental health problems with a variety of social and other factor.
So first of all, the heading of culture. It is important to note that cultural factors are not just about race or religion. Someone’s culture is a way of describing the set of someone’s values, their beliefs, and ways of doing things that are influenced by the cultural background in which they’ve been brought up in. So there’s lots of cultural influences, urban or rural, youth culture, perhaps someone is deaf and has been brought up with the support of people in the deaf community. Oh and let’s not make assumptions about culture – just because some is of a particular cultural background we must not assume their way of life is exactly the same as other people from that background.
Religion is listed as another heading. There’s evidence to show that spiritual support can be very helpful to people with mental health problems.
Major life events
Another heading is Major life events and life course history. Here there’s lots of evidence in terms of links with mental health problems. Adverse life events such as bereavement, loss of a job, divorce, are all major risk factors associated with relapse in mental health.
Under the heading Education and occupation, it is worth noting that the Fundamental Facts document highlights evidence that people with mental health problems are more likely than the rest of the population to live alone, have no educational qualifications, be economically inactive, and have a low household income. They are almost three times as likely to have debt problems, more than twice as likely to be receiving income support, more than four times as likely to have experienced sexual abuse, and twice as likely to report a lack of social support.
For people with severest mental disorders, such as schizophrenia, the statistics are even worse. The Fundamental Facts document draws on a very wide range of sources of evidence to make the links between mental health problems and social factors. If you find some more up-to-date sources of evidence linking social factors with mental health, I’d be keen to hear from you.
The key to good assessments
So how do we use this? It’s not expected you would be quoting pieces of evidence on your assessment form. It’s really for the writer of these assessments to make the links. Why is it important to write about someone’s physical health in an assessment of their mental health? It is because there is a link. Again quoting from Fundamental Facts,’ People with poor physical health are at higher risk of experiencing common mental health problems, and people with mental health problems are more likely to have poor physical health.’ So it is important to record physical health issues in any assessment. If there do not appear to be any physical health problems, it is important to record that too. We want to use this assessment as a benchmark for future changes. We want to maintain someone’s physical well-being, by promoting healthy living. It is important information to note changes or deterioration in the person’s physical health. Might there be stress-related factors causing that?
I’ve written before in these blogs about the importance of identifying current and former recreational activities. The Fundamental facts document quotes evidence that taking part in in social activities, sport and exercise is associated with higher levels of life satisfaction, and that is linked to improved self-esteem. This is an important protective factor in maintaining someone’s mental well-being.
This gets to the crux of a good social and health assessment. What we are trying to identify is a number of key factors that may impact on someone’s mental health. These may well be problem areas that can be identified as risk factors which may trigger a worsening of someone’s mental health condition. As I’ve said previously, an assessment is not just about problem areas, it’s about trying to identify protective factors. These are the strengths that someone has. For some people who are severely disabled by their mental ill-health these will be difficult to identity. They will be there, and these can be built on, to promote well-being, prevent relapse, and promote the person’s own ability to manage their mental health. This is what care planning should be about.