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Claire Lussignea, Lead Psychologist from the Norfolk and Suffolk NHS Foundation Trust – Question and Answer Document

© Copyright 2012 Anastacia Tohill and Claire Lussignea from the Norfolk and Suffolk NHS Foundation Trust. Yessica’s Journey Blog. All rights reserved. Please do not copy, duplicate or download text.

Norfolk and Suffolk NHS Foundation Trust Website

I attended the Service User Redesign and Communication Group meeting in January (see earlier blog). Service Users from Hellesdon Hospital – the Norfolk and Suffolk NHS Foundation Trust and other organisations were invited to the meeting to discuss two pathways – the Non Psychotic and Psychotic disorder and the Wellbeing Service.
This is the question and answer document which Claire and I produced which I am very proud of. I hope that this helps towards a positive and a greater involvement of Service Users working in partnership with the Trust to help one another and to learn from each other and to improve services and care as well as acknowledge the services which are working well. The document has been sent to the Redesign group which Claire requested and the Service Users Council and I hope that it has been helpful and encourages other service users to actively get involved in helping to shape, redesign and improve the NHS.
Thank you to Claire Lussignea, Lead Psychologist, and the Norfolk and Suffolk NHS Foundation Trust Marketing Department for kindly giving me permission to publish this document.

27th January 2012

Anastacia Tohill  |  Service User Council Member | Service User Redesign and Communications Sub Group Member.

Here are some of the questions I wanted to ask but we ran out of time at our Redesign meeting on 26th January with the Non Psychotic and Psychotic disorder Pathway Staff. If you need further clarification about the questions or more details please do not hesitate to contact me.

These are my own questions that I wanted to ask but I will pass this information onto the rest of the group who may also find it useful.

I would like to thank Claire Lussignea who is the lead Clinician and lead Psychologist at the Norfolk and Suffolk NHS Foundation Trust and was one of the members of staff on the Psychotic Disorder Pathway panel who has kindly taken the time and trouble to answer my questions. I also want to thank any other staff who also contributed to the answers. She said that we are still in the early stages of working out the Radical Redesign process and there is still a lot to be worked out and it is hard to capture complex issues. She has encouraged me to get back to her to discuss anything further from her answers. Thank you I do appreciate it and I have found it extremely helpful and encouraging.

I hope other service users and staff find it helpful and useful and I hope it encourages and helps to formulate new ideas, discussions and ways of improving the NHS system.

  1. If hope is central to recovery how will you use Service Users lived experiences to show hope to people who are experiencing Psychosis?

How will you use Service Users stories of hope?
How will you monitor the process?
How will you make sure the process is fair?

Answer: ‘Hi – we haven’t yet worked out all the detail around how we will use people with a lived experience within the service. We will be asking the service user redesign and communications group for some ideas as to how you think this would best work. However my personal thinking is that using people’s personal stories is usually a very powerful tool.’

How will you safeguard vulnerable adults who are feeling unwell and ensure they receive the right advice and message of hope? Would you provide professional training for Service Users and what would this be?

Answer: ‘There are formal training programmes which include supervision and coordination roles. There are different models used throughout the country. We will be looking at these and plan to use a tried and tested approach.’

How will you select suitable candidates for the role?

Answer: ‘Please see above’

  1. Have you thought about using creative activity as a way to help people who are experiencing Mental Health problems and creating useful projects which actually enhance peoples wellbeing and confidence and helps them to explore their own mental health?

Answer: ‘This is a very good idea. In an ideal world I would like to see such projects being service user led but with the required support and administrative support provided by the mental health service. Do you have any particular ideas? There is no barrier to us helping get these off the ground.’

  1. Research is very important in understanding Mental Health. Have you thought about using ‘Service User’ Research to enhance the Trust’s understanding of Psychosis. Using service users stories of experience, specific case studies, questionnaires, interviews. monitoring, recording and analysing the results to help improve the understanding of Psychosis?

Answer: ‘The Trust has a Research Dept which I know is supportive of Service User Research. The Early intervention Service is also very active in undertaking research into psychosis. I can provide contact details for you should you wish.’

Are you involved with other organisations with research into psychosis?

Answer: ‘Yes some of the research undertaken is collaborative with other organisations.’

  1. How will you ensure that Service Users are treated as individuals and recognise that each person has a unique experience of Mental Health? Are you going to move away from the typical tick box system and one size fits all way of thinking?

Answer: ‘I think what you are talking about here is a change in culture and in attitude of staff members. Norfolk and Suffolk Foundation Trust has joined up to support IMROC which is a project looking at changing the culture and approach of mental health services to recovery. It is very focussed on putting the service user at the centre of the work. Would you like more information on this?’

The organisation is also in the process of revising its CPA paperwork. We will ensure service users participate in this review to ensure any new paperwork does not lead to a tick box system.

  1. Often personal qualities, experience and skills are equally as important as qualifications. What personal qualities and skills will you be looking for in staff.

Answer: ‘I think looking at some of the information coming out of the IMROC project will answer this better than I can. I will forward you some of the information on my return from leave and then we can have a chat if this does not answer your questions.

On every job description there is a list of personal qualities we are looking for from the staff member doing that job. We are also hoping to increase the number of job interviews that service users are on the panel for so that you are the people helping to determine who is employed.’

How will you make sure that you find the right staff with the right attitude and skills to help people experiencing mental health problems?

Answer: ‘See above.’

How will you monitor the effectiveness of staff?
How will you make sure that your staff receive proper training and guidance, support and time to ensure they give a good effective service. If staff are unhappy this sometimes reflects badly on the very people they are trying to help.

Answer: ‘All staff have clinical supervision and managerial supervision and also an annual appraisal of their effectiveness. These are the systems that are in place to support the above. However we are currently looking at Suffolk’s clinical supervision system to see if there are things we can learn from it.

The Trust’s training dept runs lots of courses and workshops for people. Some of which are mandatory. Staff are also supported to attend external courses. All this training is designed to ensure staff are receiving the necessary training and guidance to do their job effectively.’

  1. How will you ensure that you provide a fair system for everyone who experiences mental health problems. What will you do to ensure this? In a tick box type system often many people are left out from being helped as certain criteria can go against them.

Answer: ‘I am hoping that when the Payment by Results system comes in for mental health this will help for a fairer system. People will be allocated to a care cluster and each care cluster has a package of care attached to it that describes exactly what someone should get and options of things that should be thought about and discussed with them. This should mean less of a lottery about what help someone receives.’

  1. How can you ensure that assumptions are not made about what someone experiencing Psychosis says? How will you ensure that they are listened to properly? Sometimes people may have delusions but sometimes in amongst the delusions there may be some real events happening which are true. How will you differentiate this and how will you offer reassurance to someone?

Answer: ‘I think this is about the skills of the staff (so comes back to appropriate training and knowledge) and attitude of the staff (which comes back to the IMROC work and effective recruitment and supervision and appraisal).’

  1. Medication is important in helping someone to get well but talking therapy is equally as important especially in helping people to understand what is happening to them, why it is happening and how they can help themselves. It also opens the doorway to TRUST and HOPE. What talking therapies are being offered as a service by the Trust for people who are or have experienced psychosis?

Answer: ‘The care packages describe what should be offered to people with psychosis depending on which care cluster they are in. However as standard anyone with a new presentation of psychosis should be assessed for whether they are likely to benefit from CBT. However other therapies are also available depending on need. The trust provides a range of therapies including CBT, CAT, IPT and EMDR as standard.’

Is the Trust actively seeking out new and old therapies, researching therapies and trying out therapies to find out which ones work best and also find out good professional organisations and therapists which work and work well? Sometimes what works for one person will not work for others so it is important to offer a wide diverse range of therapies and therapists. It the Trust using Research to formulate ideas?

Answer: ‘The Trust is not doing all the research itself. This type of research involves many hundreds of people and therefore some people in the Trust are involved in big national studies looking at this. The National Institute for Clinical Effectiveness also periodically reviews the research evidence base for the treatment of different conditions and the Trust endeavours to follow these guidelines.’

Is this something Service Users could be involved in helping with – surveys, questionnaires etc. Monitor and recording of information perhaps so there is a database of good therapists and therapies. Could service users help the Trust in researching therapies in some way?

Answer: ‘I believe that the Trust’s Research Dept is keen to involve Service Users in research. I can provide a contact for you should you wish?’

  1. What do you think of the idea about psychiatry becoming like other medical specialities where there is a range of tests including imaging tests of the brain functions, blood tests and psychological tests to find out about susceptibility factors to mental health problems, help with diagnosis and enable help in a different way?

Answer: ‘I think this already exists for some conditions but not for others. This is not something I have discussed with colleagues but my own personal view is that we should make use of whatever is useful out there to help us understand our experiences.’