Mark Higginson, Director, Mark Higginson (MH) Care Ltd
I felt a sense of optimism and hope that after a number of false starts with Transforming Care, on the 7th January 2019 the NHS Long Term Plan was published. It placed a strong focus on improving care for people with learning disabilities and autism and developing new models of care to provide care closer to home, investing in intensive, crisis and forensic community support. This was the latest attempt to develop community services and close inpatient services for people with learning disabilities and autism who display behaviour that challenges.
As someone who is supporting and advising social care providers who are working with the transforming care programme I have a number of concerns. The national plan talks about developing community services for people with learning disabilities and autism who display behaviour that challenges. Very little time and thought appears to have been given to the needs of those who display offending and offending-type behaviours. Where is the mapping out of services for individuals who have histories of serious violence and aggression, fire setting, sexual offending and damage to property? This lack of clarity appears to be confirmed by the findings in the Care Quality Commission Report, Out of Sight – Who Cares? It made for depressing reading, stating that a lack of appropriate housing and support meant that people are more likely to be subject to restrictive practices and readmitted to hospital.
The success of these services is dependent on robust service design, appropriate skills training for staff and reflective practice. Providing these three core elements can go a long way to creating supportive environments that allow both staff and the people they care for to feel psychologically safe. This requires staff to ‘look beyond themselves’ as very often the people they are supporting have had multiple adverse experiences across their life and present with a complex range of symptoms and behaviours related to past trauma, which neither they nor those working with them have linked to this previous trauma exposure.
Engaging with people who have experienced complex traumas is hard and stressful for staff. Recruiting people who are psychologically minded is critical to creating environments that acknowledge what an individual has experienced and seeks to understand how this may impact on how they relate to a service. Providing a secure base that allows positive relationships to grow and facilitates a culture that promotes values that enable and promote self-worth and identity goes a long way to creating a safe environment.
The ability to develop therapeutic relationships is at the heart of our practice. Listening to and hearing the voice of the person we are supporting and knowing the persons history and its impact on how they relate to the world is a critical part of delivering relational security. Dr Sarah Markham, Visiting Researcher at King’s College, suggests that relational security is the knowledge and understanding staff have of the individuals they are supporting and of the relational and physical care environment, and the translation of this into appropriate responses and care. This approach is grounded in four key factors: the care team, the people receiving the care, the internal world of the people receiving the care and the out-side world of the people receiving care.
Incorporating these elements into everyday practice can lead to creating safer psychological environments that foster mutual collaboration. Importantly, the person being supported feels that their participation is integral to the decision-making process.
Mark Higginson (RNLD) is director of Mark Higginson (MH) Care Ltd which provides, advice, consultancy and education to providers operating in Health and Social Care.