AIBU to think mental health SWs on a PD ward should think about the timing of telling patients they are leaving?

[UndertheCedartree]

Part of Emotionally Unstable P.D is that you tend to get attached to some of your carers and when they leave the symptom 'feelings of abandonment' are triggered.

I wish they would take it more into consideration. Don't tell us on a Friday leading to patients not being allowed to go on weekend home leave. Don't tell us in the evening meaning there is less support and therefore incidences more likely to happen. Don't tell us only a few days before so no chance of a transition and proper 'goodbye'. Tell us a while before in the day time when psychology support is available and with a proper transition period and time for a 'leaving do'.

Frankly, that should be the case for all patients. Making the transition from inpatient care to being "alone" in the community is daunting and emotional for anybody, whether it's been an admission for mental or physical health.

But absolutely if any individual has known needs likely to make that adjustment even more challenging the discharge should be planned and managed with appropriate care and consideration.

The issue is poor care and inadequate discharge planning, which isn't acceptable.

YANBU unless it’s because a last minute long term home has come up and it’s urgent e.g. supported living or council housing.

@user - you're not wrong. But I was refering to the SWs leaving for a new job.

Sounds upsrtting. But it isn't always possible to individualise care in this way. I guess tolerating distressing feelings is what those clients will be working on in treatment and the staff do have reasons for leaving or moving at short notice. Treatment is unlikely to be focussed around ensuring clients don't experience difficult feelings, and avoiding those situations ever happening because learning to tolerate and survive them is the only way to manage reality. It is hard and staff do take long term therapeutic relationships into account when they can, but their jobs are tough and ever-changing and of course they have their own private lives which can affect their work. Sounds like the impact of this shows these were good relationships which is to both your credit and the staff's... These memorable and positive connections are part of recovery and trust and actually staff get attached too. I worked in that field and still think of long term clients from years ago and wonder how they are doing.

@cactus2020 - we are learning to tolerate distress but we need support to do it. So if the announcement is made on a weekday morning meeting the support is there. If you make the announcent at debrief - the support is not there. And if you do it on Fri debrief you upset weekend plans. Seems a simple adjustment to make to just announce it it the morning. The SW are always aware they are leaving for quite a while before it is announced (I know occasionally this may not be the case) so I think there could be a better transition. And not just SWs, Psychologists & OTs too.

Sorry, I misunderstood. I see your point about the timing but perhaps the workers don’t want a leaving do or a big fuss made. I would think that’s quite usual.

My experience is that the discharge process from a mental health ward is routinely poor. If there is a plan, then handover to the community teams regularly doesn’t work and patients fall through the cracks, ending up with either no support of something very different to what was planned.

Patients deemed not to be benefitting from the ward environment will often be discharged with no warning. The nature of mental illness is that many patients do not have stable accommodation to go home to, and the short notice means nothing can be arranged in time. I’ve also seen binge drinkers, who mainly did it when watching sport, discharged alone the morning of a their team’s big game.

Oh, and minor issue, but given the psychological challenge of discharge, being discharged by your doc at 9am and then having to wait 7 hours for pharmacy is not exactly ideal.

I have no doubt that discharge planning is just as poor for physical illness wards.

@Schuyler - it's not about making a big fuss but allowing the patients to be able to say goodbye. The times we've managed to do one has been really appreciated by the staff and patients. If there is some time between knowing the staff member is leaving and then leaving - it means those feelings can be explored and dealt with, skills learnt and there is time for a transition to new staff and finally a time for patients to say goodbye and put in practice their work on their sad feelings in the transition.

Op I know this doesn't help your situation but it's not always the SW's decision when to tell you. It's not unusual for staff to be told that they can't tell people they are leaving until their last shift because it's assumed that patients can't/won't work with someone once they know they're leaving.

I've been a nurse in a similar setting. My experience was that much thought was given as to when to share info about leaving (trying to find a not too early but not too late compromise, howbthr news would be delivered, whether it would be helpful to mark the transition etc).

But there were times when our plans didnt work out due to things outside our control. One time a nurse from another ward mentioned a staff member leaving to a patient on the ward, and knowing they would likely tell other patients we had felt it was better to tell them face to face but not at the ideal time. Quite often staff were moved by managers with very little warning and little opportunity for planning.

There were also times when we called it wrong - gave a long period of notice that let a patient's anxiety build up to being sky high, or when it came as too much of a shock.

You are completely right about what should be happening, but it may be a genuine error, or it may be that staff don't have full control of the situation.

I'm assuming that SW is support worker rather than social worker?

If this is happening regularly then it suggests the ward might be poorly managed or using a high proportion of agency staff that have little control over their contracts. You need to discuss that with the ward.

But if they are support workers then they might only have 1 week notice, so between giving notice and actually leaving there might be very few appropriate opportunities to end the professional relationship with patients.

My experience is that the discharge process from a mental health ward is routinely poor. If there is a plan, then handover to the community teams regularly doesn’t work and patients fall through the cracks, ending up with either no support of something very different to what was planned.

Derailing, I know and I'm sorry, but this really hit home for me. My son 'fell through the cracks' and died a month after discharge. Procedures were tightened up at that hospital, but I am deeply saddened to hear that this is widespead.

To go back to the original point. Yes, I am sure you are right. Patients need time to adjust.

@Swimtobreathe - in the current situation she was told to tell us only a few days before. However after doing so she says she would give more notice next time. I gave her the example of one of the therapists who gave us a months notice. We were able to explore all our feelings together and there was a transistion to the new therapist aswell as a time to say goodbye. It worked really well.

@Stompythedinosaur - I understand things aren't always under your control. We had an OT moved ward with little notice but at least we still get to see him around the hospital and at inter ward groups. It is when they leave for good that is so devestating.

@hatgirl - It's not happening regularly and I'm refering to permanent staff rather than agency. They have to give more than 1 weeks notice. However even if the do have such a short notice period it doesn't stop them choosing to say they are leaving in the morning and not on a Friday.

@Biber - I'm so sorry It must be so hard losing your son. It is just terrible that a proper discharge plan wasn't put in place and followed through.

Luckily my ward seems pretty good at discharge planning but I'll have to see as I get nearer being discharged.