An inpatient CAMHS lockdown

"Young people and their families will continue to be supported by the teams and, as far as we can under these circumstances, we will operate as usual."

CAMHS Service Manager, Nathan Crimes, gives a detailed account of the effect the lockdown has had on his service and what it looks like for both staff and patients.

Topics covered in this article

Introduction

Life in CAMHS impatient service - how has this changed?

How have the YP responded?

How have the teams responded?

Supporting the staff

What next?

Introduction

The reality of COVID-19 has hit us all in some way or another.

I have colleagues who have been critically unwell and a former colleague who has lost their life to this terrible disease.

This is the picture nationally, not only for healthcare workers, but for families up and down the country who have been devastated by this pandemic.

The response to this crisis has been nothing short of astonishing; observing how, nationally, NHS trusts, local communities, Community Response Teams (CRT), private care providers, the older persons care sectors (to name but a few), have responded to this national crisis has reinforced the existing immense sense of pride across all sectors of the care profession.

The constant change and escalating concerns are being met head-on by staff who, despite being anxious, are motivated and determined to do whatever is necessary to support the immense pressure on services both locally and nationally.

Life in a CAMHS inpatient service – how has this changed?

The start of the escalating concerns saw changes in the way the Young People (YP) could access education.

Local authorities correctly withdrew teaching staff from the service, as an alternative the YP are being set work by teachers remotely.

This is a significant change to the daily routine of the service, something that can, and has previously, during periods such as school holidays, caused a great deal of disruption and can see YP responding in a manner of different ways.

Next to come was the introduction of social distancing and the limiting of visits from family, carers & additional support staff which eventually gave way to a total ban on visits, in-line with Infection Prevention and Control (IPC) principles.

To ensure that government guidance is adhered to, an end to leave off the unit with family, carers and staff also occurred.

The YP that could access extended periods of leave safely have been supported to do so.

The YP have observed staff cleaning areas of the ward with increased frequency.

They have seen non-clinical staff wearing uniforms; signs being placed in highly visible areas; extra hand sanitiser strategically placed to ensure it is used effectively; and these are just the first few changes.

These changes naturally caused concern within the staff teams that form the service, with staff feeling increasingly anxious about the management of risks and potential changes to YP behaviour.

How have the YP responded?

The YP have responded with patience, resilience and understanding.

All YP clearly recognise and support the change to processes within the service.

Staff have proactively shared information and created a forum for frequent open and transparent discussions.

Families and carers while understandably anxious, have also supported the process, the teams are in regular communications to ensure that families are up to date with progress and able to collaboratively take part in decision making relating to care.

The YP are proactively supporting each other and offering their peers kind words of encouragement and support, displaying a capacity to motivate their peers to take part in activities, particularly the daily online PE sessions knowing that being physically active helps support good mental health.

The YP have shown strength and compassion during this difficult time while dealing with existing Mental Health issues, this fortitude has been acknowledged by the care teams, reinforcing the positive, mature behaviours.

How have the teams responded?

Changes to operational procedure have meant that the care teams within the service have been required to change many practices, ward-based and community colleagues have been issued with tablets to virtually meet with YP unless a face to face visit is clinically indicated.

Service-wide daily safety huddles are key to understanding the broader picture relating to safe staffing levels in both CAMHS and acute services.

Staff are attending ‘back to the floor’ training to refresh their clinical knowledge in the event that they will be redeployed to support our colleagues in acute care or one of the newly-erected field hospitals.

Staff are actively volunteering to support the system however they can.

Extending the offer of both inpatient and community services has been a priority to ensure that capacity can be created in other parts of the system to manage the ongoing challenges.

Support teams such as administration, domestic support, housekeeping, catering, pharmacy, estates teams and porters are under immense pressure to meet the increasing demand placed on them.

Each and every team has risen to this challenge while displaying a positive ‘can-do’ attitude.

Our colleagues in education have given their time in the holidays to provide vital support to services by offering education to the children of care workers, freeing staff up to ensure that they are able to continue to deliver vital services.

Health visitors and school nurses are playing a vital role in observing the health of at risk YP living in the community.

The community response has been incredible, the YP have received items from well-known supermarkets, local business and staff to ensure that their needs are met and spirits remains high.

These kind, small gestures have made a notable difference to how the YP have been feeling.

Supporting the staff

Ensuring that the staff are supported to maintain good mental well-being is vital in making sure that services can continue to operate in a safe effective way.

All staff have access to local staff support sessions, the health board are providing targeted support sessions led by our colleagues in psychology to ensure that staff concerns can be addressed, supporting to optimise the mental well-being of staff within the service.

Daily corporate briefings play a significant part in ensuring that all staff are up to date with changes across the health board.

What next?

The service will continue to provide the existing high standards of care under the current restrictions, and changes will take place when national guidance is revised/updated.

The staff will meet the challenges and changes with continued enthusiasm and motivation.

YP and their families will continue to be supported by the teams and, as far as we can under these circumstances, we will operate as usual.

As a whole care system, we realise now, more than ever, the power of strong, compassionate team work.