carrying out social assessments at an acute psychiatric ward a practice research charlotta hallén...
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Carrying out Social Assessments at an Acute Psychiatric Ward
A Practice ResearchCharlotta Hallén 5.8.2009
Education in Social Assessment
• Jorvi hospital psychiatric social workers
• Anna Metteri, Associate Professor in social work, Tampere University
• 2007-2008
• A tool tailored in collaboration for psychiatric social work with adult patients
Social Assessments 1.
• Gathering information about the patients´ life spam, living conditions, social network and family, education and work, income and social security benefits and matters that might be important around these themes.
• Based on information given by the patient and on documents.
Social Assessments 2.
• The social workers conclusion consists of:
• Assessing changes in the patients capacity to manage his social network, working, income, family ties and living, that are caused by the illness
• Possible alternatives and suggestions
• The patients motivation and own assessment on his situation
Social Assessments 3.
• Several meetings with the patient, 3-5• Time to gather and process the
information, and finally produce the report • The last meeting is personal feed back on
the report, which the patient can comment on or make changes or corrections
• The report and the information is used within the treatment, separately or as a part of a multiprofessional treatment plan
Why gather information?
• The sooner the patient gets a good and realistic plan, the better the outcome in recovery
• By gathering information of a patient you get a picture of what kind of rehabilitation a patient needs and what is possible for him to get.
Treatment at the Acute Psychiatric Ward
• Short term treatment, average duration 2008 was 18,5 days
• Aims at minimizing the patients symptoms• A team consisting of a psychiatrist, psychiatric
nurses, and if needed a social worker, a psychologist and an occupational therapist, is formed for every patient
• The social workers role is to keep in mind that the patient has a life outside the ward, and that he is returning there.
Symptoms and deficits
• Paranoia
• Lack of insight in illness
• Lack of reality insight
• Deficits such as distractibility, memory problems, lack of vigilance, attention deficits
• Limitations in decision making and planning
The theme for my research
• Difficult and challenging to carry out social assessments with patients in acute ward treatment
• To find out what makes it difficult and why???
• During 1 month I systematically evaluated every patient treated at the ward
Facts
• Totally 37 patients, 22 men and 15 women
• 11-19 patients treated at the ward per day
• The age range was 18-59, and one clearly elderly
• The treatment duration varied from 1 day to over 4 months
Three categories of patients
• Patients who have suffered from mental illness or are in treatment at a ward for the first time in their lives (10)
• Patients who have been in and out the ward several times, or have suffered of mental illness for a long time (18)
• Patients whose treatment clearly is supposed to be somewhere else (9)(severe abuse problems, elderly patient)
What I did
• Daily meetings where I evaluated every patient• The evaluation was based on information from
patient files given by a psychiatric nurse, and on my own perceptions from situations at the ward during the day or patientmeetings
• Claryfying questions when needed• The patients got a no, yes or maybe - in being
ready to engage in a social assessment
The results of the evaluation1. Reasons depending on the
patient• Too early: The patient has recently been admitted to acute
treatment/symptoms are that severe that any kind of action is impossible
• The patient is distracted, changes the subject all the time, interrupts others and talks at same time as others, gets stuck in subjects with no relevance/doesn´t talk/is manic/ is unobtrusive/is tense
• The patient already has program for the day, and two programs would be too much
• The patient doesn´t want to/ non-receptive to treatment/lacks insight in illness
• The patient doesn´t want/economically self-sufficient/no need
The results of the evaluation2. Reasons depending on the
wards practices• There is no time. The treatment is ending/others matters
at work take forehand• The patient is repeatedly at the ward/has ongoing
treatment elsewhere/the situation is known and under control
• The patient is not at the ward/is visiting home/is on some introductory visit/is attending a group
• The patient is temporarily at another ward(somatic)• The patients problems indicates that the treatment
should be somewhere else, and he will be transferred within a couple of days
Patients that were maybe ready
• Patients I thought would gain from a social assessment, both personally and as a part of the multiprofessional treatment
• Not yet ready
Patients that were ready
• Some patients I considered ready• Booked myself to the next meeting• In two cases I was told that the meaning of the
meeting is ending the treatment• In two cases I got this information at the meeting• In one case I considered a patient ready when
the treatment had lasted for 4 months, and this was 3 days before ending my research. There was no time.
Two social assessments made
• One consisted of one interview, the next day the treatment ended which I wasn´t aware of. The conclusion wasn´t based on very much and this I had to make on note on.
• The other lasted for over a month, with many meatings, constantly evaluating the patients condition to engage.
• We finished it, but the conclusion didn´t sound very accurate to me, with the patients symptoms going up and down.
Conclusions
• Is not something you do automatically with every patient at the ward
• Some patients are automatically out of reach of social assessment, because of the short visit to the ward, before being transferred to another treatment. They probably would gain though.
• Also those in the beginning of the treatment
Conclusions
• The patients who had suffered of mental illness for a long time, usually has a treatment plan done already. Some might gain of renewing the plan
• The patients that might gain the most are those who get mentally ill and those who gets admitted to a psychiatric ward for the first time
Some questions
• How does the fact that most patients at an acute psychiatric ward gets treated against their will affect the willingness and motivation?
• Can you think in motivational perspectives with these patients? Is motivation the base for success?
• Does diagnosis give a direction for when a patient is ready?
• Is being treated for a mental illness acutely in fact a crisis?
Some books on the theme
• Tossavainen, A. (1996) Johdatus kuntoutukseen ja kuntoutujan sosiaaliturvaan
• Farkas et al.(2000) Introduction to Rehabilitation readiness.
• Satka et. al. (2005) Käytäntötutkimus
• Vartiainen, H. (1999) Psykoottisuuden arviointi. Lääkärilehti 54(3) 189-193