The main purpose of this essay is to discuss the role of

The main purpose of this essay is to discuss the role of Mental Health Nurse in relation to the mental health needs of a service user who will be referred to as Mr A throughout due to patient confidentiality (Section 5 Nursing and Midwifery Council NMC 2018). It will discuss the competences that are required by the NMC (2018) for mental health nursing. The essay will discuss the nurses role in relation to the referral and assessment process when Mr A came into contact with mental health services, the function of the Multi-Disciplinary Team (MDT), the different professionals who form part of the team and how this holistic approach to care supports Mr A with his treatment including therapeutic activities and medication management. This essay will discuss the key factors of recovery risk taking, inclusion and relationships and the importance of building therapeutic relationships between the Mental Health Nurse, service user and their family. However other factors that will be explored are the, social, economic, environmental and political factors also known as the SEEP Model introduced by the (Open University’s 2015) mental health programme. It will explore the challenges that Mental Health Nurses face when dealing with challenging behaviour and complex mental health needs who work within forensic meatal health units.The author will discuss the transition from a high secure unit to a medium secure unit, the impact on the service user and their family and how the Mental Health Nurse communicates with the other agencies that are involved in his careAll nurses have to adhere to the regulations set out in the NMC code ( 2018) in section 4 of the NMC code states that all nurses should act in the best interest of the patient, section 7 communicate clearly, section 8 work co-operatively and section 10 Keep clear and accurate records relevant to your practice. The NMC has set competences in relation to Mental health Nursing which include those listed previously and includes “using strategies to enhance communication and remove barriers to effective communication minimising the risk to people from lack of poor communication”.Mental Health nurses who work in forensic settings including police custody, crown courts, high and medium secure units those are referred to as Forensic Mental Health Nurse FMHN. Documentation and observations are vital for all nurses to ensure that accurate and factual information is recorded about service users as documentation can be used in Court proceedings. It is important that nurses are able to recognise the signs of relapse in their patient. Durcan’s chapter (2016) explores forensic nursing and the need for partnership working in order to support the patient as well as ensure that the risk management plans and assessments are updated and can be shared with different agencies.The multi-disciplinary team consist of the following professionals who support Mr A:Forensic Mental health nurses (FMHN) have daily contact over a 24 hour period with Mr A. They monitor the behaviours and interactions between other service users and staff. They administer and monitor medication any concerns they contact the on call Doctor and document accordingly, they monitor and document any physical health concerns. They create and update care plans and risk assessment which contribute to the CPA review. Nurses liase and communicate with family in this case there is no family involvement within the CPA reviews but they do have contact. The nurses update the handover form for all service users in this setting and attend daily handover meetings with other wards to discuss what has happened during a shift with each service user, if there have been any incidents and the actions taken. They liase with other agencies and ensure that all documentation such as section 17 leave are in date for the service user to gain access to the wider community and sessions within the ward. Forensic Psychiatrist- Diagnose the service user the decide they discuss the best option for treatment and explain the treatment that is being offered in relation to medication. Which is then documented and disseminated to the nurses. They ensure that medication charts are completed and signed and any changes are documented and nurses informed. The psychiatrist reviews medication on a regular basis and attends the CPA review. They authorise Section 17 leave and provide reports to the Ministry of Justice regarding Mr A progress. Psychologist offers weekly psychology sessions and dialectical behavior therapy (DBT) (Linehan 2014) which is an evidence-based psychotherapy that began with efforts to treat borderline personality disorder. They attend daily handover meetings and write reports on the progress of Mr A and what areas of psychology need to be addressed. Health care assistants (HCA) have daily contact with Mr A. They document interactions they offer support to attend therapy sessions within the medium secure unit and wider community including appointments. They feedback any concerns to the qualified members of staff.Occupational therapist (OT) provide therapeutic activities such as cooking and woodwork sessions they create risk assessment in relation to use of equipment within the until. They attend daily handovers.Ward manger has the responsibility of managing the ward. Any concerns from staff and service users can be reported to them attend daily handover. They ensure that all staff adhere to the local policies and procedures in relation to risk and security. Therapy assistant (TA) provides an escort for a service user this is a new role. They work in a group activities with the unit. Ward clark is responsible for ensuring that all documentation relating to the service user is uploaded onto the care notes system. Mr A is 33 year old male who is currently on a section 47/49 of the Mental Health Act (MHA 1983 amended 2007). This is explained to a service user by Cygnet health “You are a sentenced prisoner. You have been transferred from prison to hospital on the advice of two doctors, the Secretary of State agreed that you needed to spend time in hospital to have treatment for a serious mental health problem. You are also under a restriction order (Section 49) from the Ministry of Justice. This means that the Ministry of Justice is responsible for granting leave and allowing discharge from hospital. Two doctors, one who is Section 12 approved and has specialist experience in the treatment and diagnosis of mental illness, and a registered practitioner usually a doctor who knows you, such as your GP put you on the section with the agreement of the Ministry of Justice”. Mr A has a diagnosis of emotionally unstable personality disorder (EUPD). This diagnosis can be explained in the book of Classification of Mental and behavioural disorders (ICD 10) this book is used in the UK to diagnose mental health disorders. The USA uses the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) and refers to this diagnosis as borderline personality disorder.The history of Mr A is documented on the Historical Clinical Risk Management 20 (HCR 20) dated 2008. This risk management tool was developed to structure decisions about risk and violence, this was introduced by (Hart et al 1995). There has been further updates the lastest one being version 3 in 2013. It supports a wide variety of practitioners working in various setting including police officers, psychiatrists, mental health nurses, mental health practitioners and social workers. This assessment includes historical information about a service user, their mental health, family history, offending history and the risk they present to the public and themselves all of which well inform a plan of care to support Mr A whilst on section.His needs were identified using the seep model as follows:Social: No contact with family from the age of 10 until adulthood. He reports no positive relationships in his childhood and often reacted with aggression and violence and often felt isolated due to his behaviour (HCR 20). It was identified that some work could be done on relationships. This will involve the daily input from FHMN’s and regular input from the psychologist as he does not feel able to trust others. Economic- Due to being a looked after child (Government policy 2015) he was only able to stay within the local authority until the age of 18 this impacted on him significantly as he then began to offend. According to documentation he has a total of has 68 convictions relating to violence and an offence of Murder. Due to the risk he presented to others he was sectioned and detained at a High Secure Unit.Environmental: Mr A was placed on the children protection register, at age 6 he was removed from the family home and was under the care of the local authority. HCR record that there is a family history of offending behaviour. Mum has a diagnosis of depression and Dad Schizophrenia He has been known to services from a young age and has not developed any skills in order to manage his daily living activities. Care plan dated June 19 Mr A has identified that he wants to learn how to cook. He reports that he was unable to learn these skills due to the violence that he inflicted on others if he became frustrated at not being able to do things. He will be supported by the FMHN, OT and the TA while supervised in order to support him with this task.Political Due to the nature of his offence Mr A is restricted in what he can do and where he can go. The FMHN who is his key worker has to ensure that all areas of his section are adhered to in line with the MHA 1983. They ensure that his section 17 leave clearly states the recommendations of where he can go this includes areas on the unit and outside of the unit , how many staff are needed to accompany him , how long he will be allowed to attend for . To ensure that Mr A returns when he is required to and the policy and procedure if this is not adhered to. All of which has been explained to Mr A he has signed and dated his section 17 leave to confirm his agreement. R A has the right to ask for changes in leave if thereniz something specific he wants to attend but he understand that this will need to be agreed by the Doctor to agree. S17 leave is checked in line with medium secure local and national policies and procedures (Tetley et al 2011). The Psychiatrist and the FMHN need to prepare reports that are submitted to the Ministry of Justice regarding his care and any concerns. If these restrictions are not followed or checked this can have an impact on the wider public the unit will be in breach of these conditions as this would be illegal. Recovery Model tidal It is important the Mr A feels that he can talk to members of the team who are there to support him ensure that this person centred approach meets his needs. Mr A has regular contact with his mother and father no information in relation to when this contact began. He has tried a number of medications that did not work for him he is currently on Clozapine and his words were” he feels like a different man and he is no longer aggressive. It has been recorded that Mr A has been doing well since starting Clozapine and enging with treatment. He attends regular sessions within the unit and is looking forward to the future the FMHN said that the plan is for Mr A is to eventually move to a low secure unit he has engaged with treatment and feels he is listened to and feels that he has contributed to the care he receive he worked with the Nurse who produced a crisis plan of what he would like to be done when he feels that that he is becoming unwell he has agreed for staff to use de escualtion techniques and restraint if required, He aso reports that his family are a great support to him as an adult. Conclusion Nursing has developed over the years to incorporate different ways of Nurses being able to maintain their skills and competences this is evidence by the Nursing Midwifery Council introduction of revalidation. This is a process that requires all nurses to provide evidence have to ensure that they provided evidence over a 3 year period to ensure that they are still competence and this can be evidenced failure to adhere to the NMC revalidation rules can impact a nurse in these sense that they will no longer be able to practice under the NMC as a registered nurse. In this essay the role of the nurse can vary in different settings however service user do not always ask for help and what has been identified if that the skills and the competences that nurses required can be transferrable in Mental health or community Mental health. The introduction of revalidation for nurses.