Welcome to Cary Ward

The entrance at Fromeside

Information for relatives and friends of service users resident on Cary Ward, Fromeside

Welcome to Cary Ward

This booklet is for people who have a relative or friend on Cary Ward at Fromeside. It includes information about learning disabilities and autism spectrum disorders and the criminal justice system, as well as information about where to go for more help and advice. We appreciate how difficult it can be when someone you care about is admitted into hospital and we hope that this pack will provide you with useful information. Please do not hesitate to talk to any members of the Cary Ward team if you have any questions or would like more information.

Contents Page number

Introduction 3

What is Cary Ward like? 4

Staying in touch & visiting Cary Ward 12

Security and safety 14

Care provided by Cary Ward 15

Being involved in your relative or friend’s care 17

Information about learning disabilities 19

Information about autism spectrum disorders 21

Information about Mental Health Act sections 24

A checklist of questions 25

Understanding the jargon 28

Other sources of support 31

Useful contact names 38

How to get here 39

Introduction

Fromeside is a medium secure hospital with 80 beds. It is based in the grounds of Blackberry Hill Hospital in Bristol. The hospital provides care within a medium secure environment for men and women between the ages of 18 and 65. Service users can be admitted from court, from other hospitals or from the community. The hospital is enclosed and service users need permission to go outside the building. There are 8 different wards at Fromeside: Cary Ward, Bradley Brook, Ladden Brook, Wellow, Kennet, Avon, Siston and Teign. This information booklet provides information about Cary Ward. Cary Ward has 8 beds and provides care for men who have a learning disability and/or autism spectrum disorder who require care in a medium secure setting.

There are different information booklets available for the other wards, which provide care for people who have mental health problems like schizophrenia but who do not have a learning disability or autism.

What is Cary Ward like?

All service users have their own bedroom with an ensuite bathroom.

There is a sensory room. This has been designed to provide a relaxing place for people with autism and learning disabilities

There is a main lounge where service users can watch TV. This is also where meals are served.

Service users can play table football in the education room.

Service users can exercise using the exercise bike or rowing machine.

All main meals are provided. Service users can also use a small kitchen on the ward to make hot drinks and snacks. There is also a vending machine in the main hospital so service users can buy snacks.

There is a café in the main hospital that can be used by service users and staff. Service users can work in this café to gain work experience.

Cary Ward has its own garden which service users can use.

The Malago Centre

Service users can also go to the Malago Centre. This is a place in the main hospital where they can do activities such as art, music and drama therapy, occupational therapy, woodwork, metalwork and cooking, as well as having a gym and recreation hall for a variety of sports. There is also a small library in the Malago Centre.

The metal workshop in the Malago.

The arts and crafts room in the Malago.

The Malago garden.

The wood workshop in the Malago

The gym in the Malago

Staying in touch

Can I phone or write to my friend/relative? You are very welcome to telephone or write to your relative or friend. There is a payphone that can be used to make and receive calls. The telephone number and address for Cary Ward is at the end of this booklet. Mobile phones are not allowed on the ward but service users can use their own mobile phones when they are out on leave.

You are welcome to send letters and parcels. Parcels are checked before they are given to service users to make sure that they do not contain any prohibited items. Please see the section on security for a list of items which are not allowed in the hospital.

Visiting Fromeside

Can I visit my relative/friend? Visits from family and friends are very important to many service users. Visits usually take place on the ward. They generally last up to an hour, but some people prefer shorter visits. There are board games and other activities available if you and your relative/friend would like to use them during the visit, please ask a member of nursing staff.

A member of staff will always be present in the room for initial visits. This is to make sure that everyone is safe and so that someone is available to provide you and your relative with support. This will be reviewed on an ongoing basis. Where possible, visits will move to being unsupervised. However if you would prefer to have a member of staff with you when you visit please ask.

How do I arrange a visit? If you would like to visit please telephone the ward to book a time. It helps to give the ward as much notice as possible. This means that we can make sure that the visit does not disrupt your relative or friend’s daily programme and that there is a room available. If you don’t let the hospital know your plans in advance, sometimes it may not be possible for you to have your visit. Generally only two visitors are allowed on the ward at a time. More visitors may be able to visit under special circumstances; please contact the ward to discuss this.

When you visit for the first time you will need to bring ID that includes a photo, for example a passport or driving licence. When you arrive please go to the hospital reception. Staff will

provide you with a visitor’s badge. A member of ward staff will then collect you. You will be asked to place any prohibited items in a locker before you go on to the ward.

Directions to Fromeside are provided in the ‘How to Get Here’ section.

Can children visit? Special arrangements have to be made before a child under the age of 18 can visit Fromeside. Visits must be arranged several weeks in advance. Children visiting Fromeside have to be accompanied by an adult and visits will take place in a family room away from the main wards. Visits usually need to be supervised.

If there is concern for the safety of the visitor or service user, then we may have to cancel or rearrange a visit at very short notice. We always try to avoid this where possible.

Can I bring in a gift for my relative/friend? You are welcome to bring in gifts for your relative or friend. A member of staff will need to check the items before they are given to the service user to make sure that they are permitted. If the gift is wrapped a member of staff will need to be present while it is being opened. Some items are not allowed on the ward for safety reasons. Please see the section on security for more information.

Security and safety

Because Fromeside is a secure unit, some things cannot be brought onto the wards. This is for your safety and for the safety of staff and service users. The following is a list of items that are not allowed in the hospital.

 All drugs and medicines  Alcohol  Solvents  Lighters and matches  Umbrellas  Metal combs  Aerosol sprays, perfumes and after shave lotions  Glass objects and containers  Cameras  Knives or sharp implements  Mobiles, modems, portable recording devices  Any other item at the discretion of the nurse in charge

You are welcome to bring in other items for service users, however these will need to be checked by the ward security nurse to make sure they are safe and are allowed on the ward. Lockers are available for visitors. Please contact Cary Ward if you have any questions about what you are allowed to bring in or if you have any other queries about security arrangements.

Care provided by Cary Ward

We aim to care to the greatest of our ability. We respect human rights and work within the law at all times, maintaining dignity, privacy and confidentiality. We actively support service users to express their views and to be involved in care planning. We encourage the use of advocates.

The Multi-Disciplinary Team All service users at Fromeside are cared for by a Multi-Disciplinary team (MDT). On Cary Ward the Multi-Disciplinary team includes a consultant psychiatrist, nursing staff, clinical psychologists, arts psychotherapists, occupational therapists, social workers and adult education tutors. Information about these roles is provided in the ‘Understanding Jargon’ section.

Assessment When someone is admitted to Fromeside the first thing we do is to assess their needs. We think about every individual as a whole person. This means that we assess many different things, including their mental health, how well they are able to look after themselves, and how good they are at getting on with other people. We also assess their risk to themselves and other people. We try to get to know all service users as people, and part of this is working to understand their cultural and religious needs.

Treatment and Rehabilitation When we understand more about a service user’s difficulties we can identify what treatment they need. On the ward service users are looked after by a team of nurses and healthcare assistants. Every service user has a ‘named nurse’ and ‘co-worker’ who are responsible for planning their care with them. They work with service users to develop ‘care plans’ which are plans of how to deal with a particular difficulty. Each person has a consultant psychiatrist, who also acts as their care coordinator.

All service users have a timetable of activities for the week. This usually includes occupational therapy, arts psychotherapy, education and psychology sessions as well as leisure activities. These sessions are designed to help service users understand their strengths as well as the things they find more difficult, and to help them develop the skills to live safe and fulfilling lives.

Having leave to go out into the grounds and into the community is an important part of rehabilitation. Most people begin with escorted ground leave, and if this goes well then they

may begin to have escorted community leave. People use their community leave for a range of activities; including learning how to access community facilities, engaging in leisure activities and doing work placements.

Moving on from Fromeside Our aim is to help everyone who comes to Cary Ward to become settled and safe enough to move on to somewhere more independent and with fewer restrictions. We plan any discharge or transfer carefully with the service user and the Multi-Disciplinary Team. Everyone who leaves Fromeside to live in the community will have support from community services, including a community forensic nurse, when they are initially settling into the community. Service users moving to another hospital will be cared for by the MDT based at their new hospital. If a service user is moving to another hospital the team will be able to provide information about the new service and will try to answer any queries you may have. The FIND Team (Forensic Intellectual and Neuropsychiatric Disorders Team) are responsible for overseeing the care of service users who are from the West of England (Somerset, Bristol, South Gloucestershire, North Somerset, Bath, Gloucestershire, Swindon and Wiltshire) who move to other secure hospitals, and will participate in CPAs (Care Programme Approach meetings in which the service user’s care is regularly reviewed) where possible.

Being involved in your relative or friend’s care

Many service users benefit from the support of family and friends. We aim to make the most of these supportive relationships through being open and promoting partnership between our service users, their family and those of us who provide specialist support.

We encourage service users to share information with their family or other carers. However, sometimes service users prefer not to share information with people outside their care team. We have to abide by the law when it comes to sharing information. This means that if the service user has given their consent (said “yes” to sharing any information), we are able to discuss their care with you. If they have not given their consent (said “no” to sharing any information), then we have to respect their wishes and will not be able to discuss their care with you. We will be able to give you general information about how care is provided on Cary Ward but we will not be able share any specific information about your relative or friend. We know this can be difficult or frustrating, so the team will continue to discuss these issues with your relative or friend and encourage them to re-establish links with you when the time is right.

Service users can invite relatives and friends to attend Care Programme Approach meetings (CPAs). These take place every 6 months. The purpose of CPA meetings is to have a detailed review of the service user’s progress and to make plans for the next 6 months. It is also an opportunity for relatives and friends to share their views. CPAs generally last about an hour.

Before you attend a CPA or a meeting with the care team, you may want to look at the ‘Checklist of Questions’ section later on in this booklet. This may help you to prepare for the type of conversation that might take place, including the diagnosis, treatment and care plan of your relative/friend.

Mental Health Review Tribunals are also a way of reviewing a service user’s care and deciding whether they still need inpatient care.

The way we aim to work with service users and their carers is outlined in 'The Triangle of Care - Carers Included: A Best Practice Guide in Acute Mental Health Care' which is available on the AWP website (http://www.awp.nhs.uk/advice-support/service-users/carers-families/).

Relatives and friends can often provide information about service users which can help us to fully assess their needs and identify the most appropriate treatment options. We welcome the opportunity to meet with relatives and friends in order to discuss this.

Working with friends and family of service users is often an important part of assessment and treatment for service users, but it is also important for us to consider your needs. We

can arrange for you to receive a ‘Carer’s Assessment’ which will identify your own support and information needs so that you are able to continue to provide support to your relative or friend. If you would like a Carers’ Assessment please let a member of the care team know.

Information about learning disabilities

A learning disability affects the way a person understands information and how they communicate. This means they can have difficulty:

 understanding new or complex information

 learning new skills

 coping independently A learning disability can be mild, moderate or severe. People with a mild learning disability are usually able to hold a conversation and communicate most of their needs and wishes. They may need some support to understand abstract or complex ideas. People are often independent in caring for themselves and doing many everyday tasks. They usually have some basic reading and writing skills. Most people on Cary Ward have a mild learning disability. People with a moderate learning disability are likely to have some language skills that mean they can communicate about their day to day needs and wishes. Some people may need more support caring for themselves, but many will be able to carry out day to day tasks. People with a severe learning disability have much more significant difficulties and generally require high levels of support.

Everyone with a learning disability has different strengths and abilities, as well as needs.

A learning disability is not the same as a learning difficulty or mental illness. The term learning difficulty is used in educational settings in the UK to include those individuals who have ‘specific learning difficulties’, such as dyslexia, but who do not have a significant general impairment of intelligence. Mental health problems can affect anyone (including people with learning disabilities) at any time and may be overcome with treatment, which is not true of learning disability. A learning disability is a lifelong condition. However, with the right support, people with learning disabilities can learn and develop new skills and are able to live very fulfilling lives. Some people with a learning disability may also have an autism spectrum disorder. More information about this is in the next section of this booklet.

Approximately 1.5m people in the UK have a learning disability. A learning disability occurs when the brain is still developing - before, during or soon after birth. Before birth things can happen to the central nervous system (the brain and spinal cord) that can cause a learning disability. A child can be born with a learning disability if the mother has an accident or illness while she is pregnant, or if the unborn baby develops certain genes. A person can be born with a learning disability if he or she does not get enough oxygen during childbirth, or is born too early. After birth, a learning disability can be caused by early childhood illnesses or head

injuries. A learning disability can be diagnosed at any time. A child may be diagnosed at birth, or a parent or professional may notice a difference in their development during early childhood. For some people it may be many years before they receive a diagnosis – while others may never receive a diagnosis at all. Even with a diagnosis, it is often not possible to say why someone has a learning disability.

Information adapted from www.nhs.uk/Livewell and www.mencap.org.uk

Information about autism spectrum disorders

Autism is a developmental disability that affects how a person communicates with, and relates to, other people. It also affects how they make sense of the world around them.

It is a spectrum condition. This means that, while all people with autism share certain difficulties, their condition will affect them in different ways. Some people with autism are able to live relatively independent lives but others may have accompanying learning disabilities and need a lifetime of specialist support. Asperger syndrome is a form of autism. People with Asperger syndrome are often of average or above average intelligence. They have fewer problems with speech but may still have difficulties with understanding and processing language.

Approximately 1 in 100 people have an autism spectrum disorder. People from all nationalities and cultural, religious and social backgrounds can have autism, although it appears to affect more men than women. It is a lifelong condition: children with autism grow up to become adults with autism. The exact cause of autism is still being investigated. However, research suggests that a combination of factors - genetic and environmental - may account for changes in brain development. Autism is not caused by a person's upbringing, their social circumstances and is not the fault of the individual with the condition.

The Triad of Impairments The three main areas of difficulty which all people with autism share are sometimes known as the 'triad of impairments'. They are:

1. Difficulty with Social Communication People with autism have difficulties with both verbal and non-verbal language. This can include:  Having a very literal understanding of language, and thinking people always mean exactly what they say. This can make it difficult to understand jokes and sarcasm or phrases like 'It's cool', which literally means that it is a bit cold, but which people often say when they mean something is good.  Finding it difficult to interpret facial expressions or tones of voice.  Finding it hard to understand the give-and-take nature of conversations, perhaps repeating what the other person has just said (this is known as echolalia) or talking at length about their own interests.

It helps if other people speak in a clear, consistent way and give people with autism time to process what has been said to them. Many people with autism also find pictures helpful when reading written information.

2. Difficulty with Social Interaction People with autism often have difficulty recognising or understanding other people's emotions and feelings, and expressing their own, which can make it more difficult for them to fit in socially. Difficulties may include:

 Not understanding the unwritten social rules which most of us pick up without thinking: for example they may stand too close to another person or start an inappropriate subject of conversation  Appearing to be insensitive because they have not recognised how someone else is feeling  Preferring to spend time alone rather than seeking out the company of other people  Not seeking comfort from other people  Appearing to behave 'strangely' or inappropriately, as it is not always easy for them to express feelings, emotions or needs.

Difficulties with social interaction can mean that people with autism find it hard to form friendships: some may want to interact with other people and make friends, but may be unsure how to go about this.

3. Difficulty with Social Imagination. Social imagination allows us to understand and predict other people's behaviour, make sense of abstract ideas, and to imagine situations outside our immediate daily routine. Difficulties with social imagination mean that people with autism find it hard to:

 Understand and interpret other people's thoughts, feelings and actions.  Predict what will happen next, or what could happen next.  Understand the concept of danger, for example that running on to a busy road poses a threat to them.  Engage in imaginative play and activities: children with autism may enjoy some imaginative play but prefer to act out the same scenes each time.  Prepare for change and plan for the future.  Cope in new or unfamiliar situations.

The world can seem a very unpredictable and confusing place to people with autism, who often prefer to have a fixed daily routine so that they know what is going to happen every day. This routine can extend to always wanting to travel the same way to and from college or work, or eat exactly the same food for breakfast. Rules can also be important: it may be difficult for a person with autism to take a different approach to something once they have been taught the 'right' way to do it. People with autism may not be comfortable with the idea of change, but can cope better if they are prepared for it in advance.

Difficulties with social imagination should not be confused with a lack of imagination. Many people with autism are very creative.

Special Interests Many people with autism have intense special interests, often from a fairly young age. These can change over time or be lifelong, and can be anything from art or music, to trains or computers. Some people with autism may eventually be able to work or study in related areas. For others, it will remain a hobby. A special interest may sometimes be unusual, for example collecting parts of hoovers.

Sensory Differences People with autism may also experience over- or under-sensitivity to sounds, touch, tastes, smells, light or colours. For example, a person with autism may find certain background sounds, which other people ignore or block out, unbearably loud or distracting. This can cause anxiety or even physical pain. People who are hypo-sensitive may not feel pain or extremes of temperature. Some may rock, spin or flap their hands to stimulate sensation, to help with balance and posture or to deal with stress. People with sensory sensitivity may also find it harder to use their body awareness system. This system tells us where our bodies are, so for those with reduced body awareness, it can be harder to navigate rooms avoiding obstructions, stand at an appropriate distance from other people and carry out 'fine motor' tasks such as tying shoelaces.

Information adapted from the National Autistic Society (http://www.autism.org.uk)

Pathways into forensic services

Most people with a learning disability or autism spectrum disorder are looked after by their GP, sometimes with support from a learning disabilities or mental health team in the community. Sometimes people have to come into hospital (a psychiatric ward) when they are not able to cope in the community or things have become unsafe. Although some people choose to come into hospital, some are detained under a Section of the Mental Health Act 1983. A person can be detained on the order of a judge or following an assessment by two doctors and an approved mental health professional (usually a social worker). A person may be detained to assess their mental health and work out what help they may need, or they may be detained for treatment. Treatment may include therapy, medication, nursing support or work on coping skills and life skills.

The word “forensic” simply means “to do with the law”. Forensic units care for people who have a learning disability, autism or serious mental health problem and who have been in trouble with the law or have done very dangerous things. Forensic units include low secure units (like Wickham Unit), medium secure units (like Fromeside) and high secure units (like Broadmoor Hospital).

Most service users who come to Fromeside will be transferred from prison or from another hospital. The crimes people have committed can include anything from more minor offences (such as driving offences) up to more serious violent crimes. Fromeside also care for some people who not have committed any crimes (or who only have a very minor criminal record), but have had problems coping in general psychiatric units. Sometimes general psychiatric wards cannot cope with lots of difficult behaviour, and so a service user may move to a forensic unit where they can receive extra support.

The length of time that people remain in a forensic unit varies. Some people will stay on the unit for several years, and some people leave after only a few months. There are a number of pathways on from Fromeside, including low secure units, supported accommodation or independent living in the community.

Most people who are discharged into the community will be supported by a CFN (community forensic nurse) or by a CPN (general community psychiatric nurse) or a community learning disability nurse. Sometimes service users who live in the community have to conform to certain restrictions, such as taking medication, living in a certain place, and seeing mental healthcare professionals (usually a psychiatrist and a social worker) on a regular basis. These restrictions are to help them keep mentally well and to avoid further criminal offences. There will be regular reviews of the support the person is receiving in the community to make sure it is the right support for them.

Information about Mental Health Act sections

Most people who have a learning disability or autism spectrum disorder receive treatment in the community, either from their GP or, if they need more specialist care, through their community mental health or learning disabilities team. There are also a small number of people who require treatment in hospital. Some of these people may refuse treatment despite having been clinically assessed as needing it.

The Mental Health Act (1983) is the legal way care can be given to an individual who does not wish to consent to it or is not able to understand the need for treatment. This is normally referred to as being “sectioned” or being “on section”.

Fromeside is a forensic unit and most service users are detained under the Mental Health Act 1983. Service users may be detained under different sections of the Mental Health Act, depending on the circumstances of their admission. The Ministry of Justice is involved in some of these, for example section 37/41, 47/49 or 48/49, but not others such as section 2 or 3.

The Mental Health Trust must ensure that the law is followed and that the individual service user and their nearest relative understand their rights. In order to do this we have a Mental Health Act Administrator who makes sure that the service user has the appropriate information on their particular section and that they are represented by a solicitor through the legal aid scheme.

The most common sections of the Mental Health Act that are used at Fromeside are:

Section 2 (Admission to Hospital for Assessment followed by Treatment): Two doctors, including a doctor who is a specialist in the diagnosis and treatment of mental disorder must make recommendations to an approved mental health professional (AMHP). The AMHP then decides whether the person needs to be treated under section. If so, the person may be detained for up to 28 days. This section can not be extended but it can be converted to a section 3 (see below).

Section 3 (Admission to Hospital for Treatment): Two doctors, including one who is a specialist in the diagnosis and treatment of Mental Disorder must make recommendations to an AMHP. The AMHP decides if the person needs to be treated under section. If so, the person may be detained for up to 6 months. This section can be extended firstly for another 6 months and then yearly. This section is for people who have a diagnosis of a mental disorder already. The term mental disorder includes autism spectrum disorders and learning disability if the learning disability is associated with abnormally aggressive or seriously irresponsible

behaviour. The person may be detained for a very short time or for a longer time depending on their illness, risks and response to treatment. The service user’s Responsible Clinician (usually their consultant psychiatrist) can end the detention when the service user is ready for discharge, they do not need to wait for the end of the period of detention.

Part III of The Mental Health Act: Part III of the Mental Health Act is specifically concerned with service users involved in criminal proceedings or who are under sentence. It includes Section 37, 37/41, 38, 45a, 47, 48 and 49.

Section 37 (Hospital Order): This section of the Mental Health Act is sometimes used by the courts to send a person to hospital for treatment instead of prison. They will eventually be discharged from hospital to the community when they are well enough.

Section 37/41 (Hospital Order with Home Office Restrictions): This is the same as a Section 37 but the Home Office are involved in applications for leave and discharge. On discharge the tribunal may apply certain restrictions (for example about where people can live). If the person does not follow these conditions of discharge, or they become unwell, they can be recalled to the hospital.

Section 38 (Interim Hospital Order): This section allows a court to send a person to hospital for a temporary period to decide if a hospital order (Section 37) should be used.

Section 45a: This can be used by the Crown Court to order a person with a mental disorder to be detained in hospital at sentencing. It is expected that they will return to prison once treated to complete their sentence.

Section 47 (Transfer of Prisoners to Hospital for Treatment): This section is used to transfer a sentenced prisoner suffering from a mental disorder to hospital.

Section 48 (Transfer of People in Prison, on Remand, to Hospital for Treatment): This section is used to transfer a remand or un-sentenced prisoner to hospital from the prison service.

Section 49 (Restriction Direction, Following Transfer from Prison to Hospital): This section is a direction by the court and is often used together with Sections 47 and 48. It has the same effect as a section 41.

Section 117 (After-Care Arrangements): This section applies to people who have been detained under the Mental Health Act under Sections 3, 37, 37/41, 47 and 48. This means that the Care Team has a duty to make arrangements for a person’s continuing support and care in the community.

Section 17 (Planned / Organised Leave): This section allows the Responsible Clinician to give leave (for example ground leave or community leave) to a person detained under the

Mental Health Act. If the service user is on a section 41 or section 49 then community leave also requires the permission of the Ministry of Justice.

Mental Health Review Tribunal (MHRT): This is a mini court system, which gives people who are kept in hospital (detained) under the Mental Health Act the chance to appeal and get discharged. An appeal may be refused (so their section continues) or they may be discharged. Service users with restriction orders may receive a conditional discharge, which means that the discharge may have certain conditions (for example about where they live) attached to it. The service user can be present with their solicitor and/or advocate and talk to the tribunal panel members. The Responsible Clinician (usually the consultant psychiatrist), a member of nursing staff and usually a social worker have to give evidence.

Solicitors and Legal advice: It is a person’s legal right to have access to a solicitor who can help with legal issues including representing them in court and helping with Mental Health Act appeals. Most service users at Fromeside and Wickham Unit are entitled to legal aid. Nursing staff can liaise with the Mental Health Act administrator to help service users find a solicitor for their tribunal.

Right to a second opinion: Solicitors will sometimes instruct an independent consultant psychiatrist to assess the service user and give a second opinion when there is a dispute as to the appropriate diagnosis or treatment.

Consent to treatment: Once a service user has been taking medication for 3 months whilst detained under the Mental Health Act, consent to treatment procedures apply. This means that the Responsible Clinician needs to talk to the service user, explain about the medication and check how much the service user understands. If the service user can understand enough about the medication and gives consent, the Responsible Clinician fills out a form T2. If the service user cannot understand enough or does not consent, then the Responsible Clinician will ask for a Second Opinion Approved Doctor (SOAD) to assess the service user. The SOAD will then decide whether the service user should be given the medication and if so, will fill out a form T3.

A checklist of questions

There may be lots of things you would like to know about your relative or friend’s care. The following is a checklist of questions which you may find helpful when you meet with the Cary Ward Multi-Disciplinary team.

About the diagnosis  What is the diagnosis or problem?  If a diagnosis has not yet been made, what are the possibilities?  Why has this happened to him?  Will he get better?

About the assessment  What assessments have been done?  Will any more assessments be needed?  What are the results of the assessments? How will these be acted upon?

About care and treatment  What are the aims of the care and treatment?  What part will the care co-ordinator play in his care?  Who else will be involved in the treatment?  How often will you see them?  What is your plan for treatment? How long will it last?  Would psychotherapy or psychology (talking treatments) of any sort be helpful?  What happens if he refuses treatment?

Care Programme Approach  When will there be a care programme approach (CPA) meeting and will I be invited to it?

Sharing of information  Have you asked them about how much information he is happy to share with me?  Will I be informed about important meetings concerning his care and treatment?  Can I see members of the MDT on my own?  Would you like to ask me for any other information about him or the family?

 Can I tell you things that will not be shared with the service user or other members of staff?  Are his views on confidentiality clearly marked in their notes?

The family and the treatment  Will I be involved in discussions concerning my relative/friend’s treatment?  What can I do to help?  Can we be referred for family work?  Are there any local self-help or carers’ groups?

Getting help  How do I arrange to see you?  Who do I contact if I’m worried about something?  How can I get in touch with you?  Who do I contact in an emergency?  How can I get a second opinion? (you are entitled to this)

Medication  What medication is to be used?  Is the lowest effective dose being prescribed?  Can a low dose be taken at first and increased if necessary?  What are the possible short term/long term side effects of this medication?  Why have you chosen this particular medication?  How long will he need to take this medication?  Are there any other medications that could be used if this one does not work?  What signs/symptoms might mean that the medication should be changed?  What will happen if he stops taking the medication?  How often will the medication be reviewed?

Hospital treatment  How long will he need to stay in hospital?  What arrangements will need to be in place for him to leave hospital?  If he gets leave will I be informed?  Can he start to receive his due benefits immediately on discharge so financial security/housing does not become a problem?  Who will inform utilities etc that he has been admitted/discharged so that there is no danger of non-payment summons being incurred?

Discharge from hospital  Where will he live when he leaves hospital?  What arrangements will be made for his care and monitoring after discharge from hospital?

[This section has been adapted from a list provided by the Royal College of Psychiatrists and the AWP Carers Pack]

Understanding the jargon

Hospitals are full of abbreviations and unfamiliar terms. This list aims to provide some useful explanations of the most common of these, but never be afraid to ask for an explanation if someone is using a phrase you don’t understand, as it is easy to forget that most people are not familiar with this sort of language.

Absent without leave (AWOL): Service users are considered AWOL if they go beyond the defined boundaries/leave areas for Fromeside without permission or fail to return from escorted or unescorted leave.

Antipsychotic medication: These are medications used to treat psychosis such as schizophrenia. Atypical Antipsychotics are the more recently introduced medications and may have less severe side effects. Some of the more frequently prescribed are Amisulpride, Olanzapine, Risperidone and Clozapine.

Approved Mental Health Professional (AMHP): AMHPs are specifically trained and approved by the local authority under the Mental Health Act (1983). Their role is to assess people for hospital admission and if they consider there is no alternative, to authorise admission and make the necessary arrangements. This is an enhanced role and different from the usual remit of social workers.

Autism spectrum disorder (ASD): An autism spectrum disorder is a condition that affects social interaction, communication, interests and behaviour. It includes Asperger syndrome and childhood autism.

Avon and Wiltshire Mental Health Partnership NHS Trust (AWP): This is the NHS trust responsible for Fromeside and Cary Ward.

Care co-ordinator (or key worker): This is a member of the team who will co-ordinate the care programme approach (CPA) and act as the link contact for the service user, carer/s and other team members. In Fromeside this is usually the consultant psychiatrist.

Care Programme Approach (CPA): This is a means of planning and monitoring the care of someone in secure hospital and who is considered to be a vulnerable member of society. The central features of CPA are assessment of need, involving the service user and carer/s, the allocation of a Care Co-ordinator and an agreed care plan, which is reviewed at regular intervals.

Clinical psychologist: A person with a degree in psychology and a specialist degree in clinical psychology. They use psychological knowledge and techniques to help in understanding and treating psychological and psychiatric problems.

Community forensic nurse (CFN): Community Forensic Nurses provide support to clients returning to the community from Fromeside. They become involved with individuals prior to discharge in order to develop a therapeutic relationship and to help ensure that there is a smooth transition into the community. They have several roles including monitoring and supervision of clients as part of the statutory requirement, but they are mainly concerned with supporting individuals to successfully reintegrate back into the community. The degree and level of support provided is very much geared to the individual’s requirements.

Depot injection: Long acting medication often used where people are unable or unwilling to take oral medication regularly.

Mental Health Act (MHA) (1983) as amended in 2007: Sections under the Mental Health Act that admit people compulsory to hospital, where they are thought to be at risk to themselves or others, or in danger of serious deterioration if compulsory intervention is not taken.

Ministry of Justice: The Ministry of Justice is the Government department responsible for internal affairs in England and Wales. It oversees the movement, transfer, and leave of people held under forensic sections of the Mental Health Act.

Multi-disciplinary team (MDT): This is the team of professionals who provide care for every individual at Fromeside. It consists of a psychiatrist, an SHO (Senior House Officer), nursing staff, psychologist, OT, therapist and social worker.

Nursing team: This is made up of nurses, some of whom are qualified in psychiatric or learning disability nursing (Ward Manager, Charge Nurse, Staff Nurse), and some without formal qualifications (Health Care Assistant).

Occupational therapy (OT): OTs are trained to work with people to help them improve their ability to cope with daily living as independently as possible. They not only help with practical tasks, but can improve coping strategies as well as helping to encourage participation in recreational, educational and vocational activities.

Patient care review (PCR): Once a fortnight the MDT meets to discuss the treatment and progress of each service user. The service users themselves are also encouraged to attend. This is usually when decisions about changes in leave status or medication are made.

Positive response plan: A document created to help care staff understand people who have learning disabilities or autism and display behaviour that others find challenging. It should include both proactive and reactive strategies. Proactive strategies are intended to make sure the person has got what they need and want on a day to day basis and also includes ways to teach the person appropriate communication and life skills. Reactive strategies are designed

to keep the person and those around them safe from harm. They provide a way to react quickly in a situation where the person is distressed or anxious and more likely to display challenging behaviour. On Cary Ward we are moving towards a version that is developed collaboratively with service users and carers called a Collaborative Safety Plan.

Prevention and management of violence and aggression (PMVA): This is a special technique to safely hold individuals when it becomes necessary to physically intervene in a situation. It is only used as a last resort and for as short a period as possible. Nurses who use PMVA undergo extensive specialist training and attend regular updates to maintain their skills.

Psychiatrist (Consultant): A doctor who has completed specialist training in Psychiatry. They have overall responsibility for service users’ psychiatric care. The medical team may also include specialty doctors, core and advanced trainees. These are all qualified doctors who may have different levels of experience and roles in the service user’s care.

Responsible clinician (RC): Most Responsible Clinicians are consultant psychiatrists and take overall responsibility for the service user’s care. Each service user who is detained under the Mental Health Act will have one Responsible Clinician.

Seclusion: The supervised confinement of a service user alone in an enclosed environment without means of leaving that area, when the service user’s behaviour places the safety of other service users and staff at risk.

Social worker: Social workers may be involved as part of the care team to provide advice and help on suitable housing, appropriate benefit claims and generally giving support in the community.

Therapy: This can include Art, Music, Drama, Psychological Therapy and Psychotherapy, which may be offered by specialist therapists, occupational therapists, psychologists or clinical nurse specialists.

Other sources of support

The following organisations may be able to provide you with further support and information. Please note, the listing of a service does not mean that we recommend it. You should ensure that a service is suitable and safe before using it.

1. ACAD – Advice and Counselling on Alcohol and Drugs Provides free confidential advice, information and counselling for people and concerned about their own or someone else’s drinking or drug use. Tel: 0117 929 3028 www.acad.org.uk

2. BASS - Bristol Autism Spectrum Service BASS runs advice services for adults with autism diagnoses in Bristol, Bath, South Gloucestershire and North Somerset. Carers of adults with a diagnosis of autism from these areas are also welcome to use the service. Telephone or email to book an appointment. Tel: 01275 796200 Email: [email protected] www.awp.nhs.uk/services/specialist/autism-spectrum/advice-service

3. Bristol Black Carers Project A Bristol based organization which offers support, advocacy, advice and information to carers of African, African Caribbean, Asian, Chinese and Vietnamese origin. Tel: 0117 9415303 www.bristolblackcarers.org.uk

4. Bristol Drugs Project Bristol Drugs Project offers free, confidential help if you are concerned about your own or someone else’s drug use. Tel: 0117 987 6000 www.bdp.org.uk

5. BILD - British Institute of Learning Disabilities BILD provides support and information for people supporting those with learning disabilities. Tel: 0121 415 6960 www.bild.org.uk

6. Carers Trust Carers Trust is a charity working to improve support, services and recognition for carers of those with disabilities, mental health problems, and addictions. Tel: 0844 800 4361 www.carers.org

7. Carers UK Carers UK offers a telephone advice, support and information service if you want to talk about caring. Helpline: 0808 808 7777 Contact number: 020 7378 4999 www.carersuk.org

8. Carers Direct Helpline A national helpline for carers that can give you information about what you're entitled to and the help available in your area. Tel: 0300 123 1053

9. Foundation for People with Learning Disabilities A charity working with people with learning disabilities, their families & carers, local authorities, and service providers, to help make things better for people with learning disabilities. Contact number: 020 7803 1100 www.learningdisabilities.org.uk

10. Mencap The Learning Disability Helpline is an advice and information service for people with a learning disability, their families and carers. Tel: 0808 808 1111 Email: [email protected]

By post at: The Learning Disability Helpline, Mencap, 3rd Floor, Delta View, 2309- 2311 Coventry Road, Birmingham, B26 3PG

www.mencap.org.uk

11. Mental Health Foundation The Mental Health Foundation is a mental health research, policy and service improvement charity. www.mentalhealth.org.uk

12. Mental Health Matters A charity committed to partnership and collaboration with other service providers, carers, and their families. Email: [email protected] Tel: 0191 516 3500 www.mentalhealthmatters.com

13. Milestones Trust Supports around 1000 people in the Bristol area with learning disabilities, mental health problems and dementia. Email: [email protected] Tel: 0117 970 9300 www.milestonestrust.org.uk

14. Mind You can call Mind if you need someone to talk to, information or advice about mental health issues. Tel: 0300 123 3393 Text: 86463 www.mind.org.uk

15. National Autistic Society A charity for people with Autism (including Asperger’s Syndrome) and their families, providing information, support as well as pioneering services. Helpline: 0808 800 4104 www.autism.org.uk

16. National Self Harm Network Provides information and support to people who self harm and those who care for them. Tel: 0800 622 6000 www.nshn.co.uk

17. Nilaari Offers confidential services to individuals who are affected by the misuse of drugs and/or alcohol. Support is also available for family and friends. Tel: 0117 952 5742 www.nilaari.co.uk

18. Organisations Supporting Women Offers a list of further websites specialising in women from different cultures and backgrounds. www.bristolwomensvoice.org.uk/disabled-and-bame-women

19. The Care Forum Provides support and advice to carers and has a number of local carers’ groups. Tel: 0117 965 4444 www.thecareforum.org

20. Rethink Call the Rethink helpline if you need someone to talk to, information or advice about mental health issues. Tel: 0300 5000 927 www.rethink.org

Rethink also run a number of carers groups across the country. To find out about carers groups in Bristol, please contact: 0121 522 7007

21. Revolving Doors A charity which supports people with mental health problems who have been arrested or imprisoned. Tel: 0207 407 0747 www.revolving-doors.co.uk

22. Sane line A national out-of-hours helpline for anyone coping with a mental illness whether they are sufferers, carers or concerned relatives or friends. Tel: 0300 304 7000 www.sane.org.uk

23. Scope A charity existing to promote equal opportunities for those with disabilities. Their hotline provides free, impartial information & support on issues that matter to disabled people and their carers. Hotline: 0808 800 3333 Email: [email protected] www.scope.org.uk

24. Victim Support An independent charity helping people cope with the effects of crime, by providing free and confidential support and information. Tel: 08 08 16 89 111 www.victimsupport.org.uk

Useful contact names

Consultant Psychiatrist

…………………………………………………………………………………………………………

Named Nurse

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Associate Nurse

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Ward Manager

…………………………………………………………………………………………………………

Social Worker

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How to get here

Address

Fromeside Blackberry Hill Stapleton Bristol BS16 1EG Tel 0117 3784012

 Fromeside is located approximately 2 miles off the M32 in Bristol.  Limited car parking is available.  Bus Service 5/5A from Bristol Centre to Downend. This route travels via Blackberry Hill Hospital.

Please use the postcode BS16 2FB to find the location of Blackberry Hill Hospital, Bristol.

BY RAIL:

Main Rail Station: Abbreviations Address Postcode Bristol Temple Meads BRI Bristol (Central) BS1 6QF Bristol Parkway BPW Bristol (North), Stoke Gifford. BS34 8PU

Bristol's main stations are Temple Meads (city centre) and Parkway to the north (near M4/M32). Both stations have bus links to Bristol centre and surrounding areas. A taxi journey from Temple Meads to the hospital should take 25 minutes, and from Parkway 15 minutes. Train tickets are available to purchase from the booking office at the stations, self service machines or online at www.thetrainline.com. The train service for most trains in Avon & Wiltshire area will be First Great Western.

Bristol and Blackberry Hill Location

DRIVING DIRECTIONS

From the M4:

 Leave the M4 at junction 19 signposted - M32 - Bristol

 Leave the M32 at junction 1 signposted – Filton, A4174 Ring Road

 At the traffic lights take the first exit, left, onto the A4174 Ring Road.

 At the traffic lights turn right onto Bristol Road, B4058 signposted Frenchay Hospital

 Continue forward over mini roundabout on the B4058

 Continue forward through traffic lights on the B4048

 At mini roundabout turn left onto Broomhill Road

 Continue forward onto Manor Road until you reach Blackberry Hill (on your left)

 Enter Blackberry Hill Hospital via the white entrance.

 Turn right at the roundabout

 Press the button to gain access through the barrier

 Once through the barrier you are then within the AWP site. Follow the road past Wickham Unit. Fromeside are visible on the map below.

Car parking is free; however spaces are very limited and not guaranteed. If you cannot find a space, then there is available parking on Manor Road outside of the hospital (the main road which runs alongside the front of the site). Please note that there is wheel clamping in operation; always park within AWP specified car parks.

Disabled Parking Bays are available directly outside of the Fromeside, Wickham and Lansdowne

Site Map

You are welcome to contact us at any time and we will try to help. If the person we feel can help you the best is unavailable or it is out of hours a message will be passed on to them.

Cary Ward Fromeside Blackberry Hill Hospital Bristol www.awp.nhs.uk

Fromeside Main Reception Telephone Number: 0117 3784012 Cary Ward Office Telephone Number: 0117 3784045 Cary Ward Residents’ Telephone Number: 0117 965 8382

PALS

To make a comment, raise a concern or make a complaint, please contact the Trust’s Patient Advice and Liaison Service (PALS). Tel: 01249 468261 Freephone: 0800 073 1778 Email: [email protected]

Other formats or languages

If you need this information in other formats (such as large print, audio, Braille) or in another language, please call the PALS number.

Lead: Clinical Psychology Leaflet code: Jan 2017- 512 Approval date: 09.01.17