Mental health duty caseworker post

[SillyBridget]

Quite a specific topic so unsure if posting in right place, but has anyone worked in this type of role before and if so can they tell me what it was like? The role I'm interested in involves 4 days casework as an AHP and 1 day duty in a CMHT. I've done MH casework before in a different setting but never duty and I'm a bit unsure what it involves. Do duty workers generally deal directly with crisis and manage risk during working hours, or refer to crisis team?

Hopeful bump - unsure if I should have posted under health instead?

I think you need to talk to someone directly about the role and what it involves.

And I will do but hoping to hear some experiences in the meantime while I decide whether to apply 😊

.

Giving it one last hopeful bump before I give up 😊

I'm a CMHN by profession and have done Duty a lot.

It tends to be a Marmite part of the role but personally I loved it, I could have happily done it full time!

It involves taking calls from service users, GPs, relatives, occasionally concerned members of the public. Sometimes you get service users dropping in. Basically you have to triage the phone calls/visits. Some of them may involve just an email to the care coordinator to follow up. You might have someone walking in saying their broke, needing a food bank referral, depending on where you are you might be able to top up was or electric cards. You may need to contact the council/HA if there's an issue with their housing. You may at times need to raise a safeguarding alert if you're concerned about their safety.

Occasionally, it may need a consideration for hospital admission. In the trust I was in this was decided with the HTT who were the "gatekeepers" for admission.

Some days are really busy, other days are busy-ish in that you may get only 1 or 2 tasks that take a long time, other days you get very little.

You have to be good at prioritising and thinking on your feet, but I always enjoyed the mixture you got. I hate doing casework cos I hated doing things like Care Act assessments and budgets for care package where I often felt like a cross between a social worker and an accountant! I prefer the face to face contact with clients to all the paperwork you have to deal with now!

HTH x

Thank you so much this is so helpful!

Can I ask when you were considering hospital admission or dealing with crisis - did you visit them in the community to assess this or was it more that you got a worrying call then contacted the crisis team etc? One thing I was also wondering was, if you put on a visit and were doing the caseload part of your job and were worried about someone - again would you act as the duty worker in this respect and sometimes have to cancel other appointments?

I've worked in mh before but only in acute so not sure how it all works in community (I'm an OT so also mainly focused on the therapy part whereas I think this will be more handling risk on my own than I'm used to. I'm definitely up for the challenge though).

It sounds incredibly varied and interesting, I think I would enjoy it. Thank you again for taking the time to reply.

It can be either following a phone call or dropping into the office. I would also consult the notes and talk to those who know them, eg the family and/or the care coordinator. The duty worker doesn't usually do home visits, as they're often the only ones there. In a real emergency we can utilise 999 if say the patient has said they've od'ed. We used to be able to get the police to do a welfare check but this is harder now as the police have started a Right Care, Right Person model in some partsof the country. We can usually liase with care coordinator, HTT to go out or get Ambulance to take to a&e to see psych liaison.

Sometimes yes in a crisis we need to rearrange appointments because of a crisis. If you are worried you may need to try and get hold of the person by phone-if you can't you may be able to speak to a family member. It's best if you can get their permission before speaking to a family member....but if, say, the patient always brings a certain family member to appointments and they sit in with the patient I would contact that family member but document in notes 'I spoke to John's mother. As she has always attended with him, and appears to be acting as his carer, I felt consent was implied' or something along those lines. You can normally get the client in for an appointment in the next couple of days (it's useful to have some space in your diary for this, if no-one needs it there's always admin to be done). If they DNA or you can't get hold of them and you felt the risk was high, yes you may need to do an urgent HV.

Most community appointments are in the team base but it can be useful to do home visits to see what their living conditions are like as it can say a lot about people's mental health, eg is it clean and tidy or is there hoarding. Don't judge them though, if they've got small kids for instance some untidiness is normal as long as it's generally clean. Also some homes are really poor through no fault of the patient eg overcrowding, damp/mould etc which obviously affects their mental health. There's not a lot we can do except let housing providers know if it's social housing, or direct them towards agencies which can help them like Shelter. Strictly speaking we can write supporting letters for rehousing but the lack of social housing means it has little impact.

Of course there will be clients who don't want a home visit. They're usually those living in shared housing or if they don't want family members to know. You can usually assess the risk to see if this is OK, usually it is.

Duty is generally just picking up crisis work if the cco isn't in or busy. Or emergency type stuff and communicating with seniors. Sometimes referral type meetings etc. Sometimes emergency home visits. Nurses might pick up missed depos etc. Any disturbances in the building. It really varies and sometimes nothing at all. I'm assuming you're a social worker?

An OT. So I'd be doing my therapy casework but one day per week duty from what I can make out from the job spec.

Thank you again for such a helpful detailed reply. I think I'm starting to work out how it all fits together more!

Sorry I read AHP as AMHP 😂
So you'll be a cco 4 days and duty 1?
We don't do offical duty that often maybe once or twice a month if that but there's a large workforce in the building and also each team has their own kind of duty but we call it something else.

Official duty would be attending a&e if crisis cannot, attending referral meeting, dealing with building emergencies, assisting the seniors or consultants and signposting really.

Team duty is arranging initial assessments and talking to patients if they call and cco is not in. Also just helping out if needed but this alongside your usual work. And sometimes there's nothing to do.

Haha easy mistake to make! I think the service also has cco, so I would be doing OT casework but 1 day per week duty. It mentioned triage of referrals and risk management but it was the risk part I wasn't clear on - whether it was coordinating care and crisis intervention from the "office" base or whether it was also things like home visits, taking to A&E etc....but I think a pp said you need to be at the base all day so perhaps more the former I'm not sure.

I think team duty may be more like what it is

Oh ok so you'll have a more OT based workload. That makes sense. Love our OT's. Everyone has the same basic job but then patients are given more on our speciality. So if someone needs more OT input, allocated to OT, on a depo, allocated to nurse etc etc.

I would contact the team manager and ask as ime every teams set up can be vastly different.

That makes sense. Thank you so much, I'll do that 😊 thanks for all your helpful advice.

Hey, I'm a mental health nurse in an older adult CMHT and regularly work duty.

In older people's services, the duty worker triages referrals and deals with any incoming clinical calls from patients. I do go on urgent visits/joint visits with the crisis team, but a lot of it is dealing with referrals.

If there is a crisis that happens, chances are it will be you dealing with it, e.g. calling bed managers, involving crisis teams, etc. I also sometimes attend MDTs as duty, if the regular CPN isn't available.

I honestly spend a lot of time trying to gather more info for referrals, arguing with GPs about delirium, and grading referrals based on risk. A lot of them get marked as urgent when they aren't.

I personally either find duty tends to be manic, or it will be dead and it's a chance to catch up on paperwork.

How does it work if you are on an urgent or crisis visit if you are the only one manning duty from the office/clinic - I think that's what I couldnt get my head around - say if a visit took a long time or a hospital admission was warranted etc - does someone else then cover the duty phone? I think the more I learn about it the more interested I am.

Thank you so much for everyone's helpful responses it's really giving me insight in to the type of role it could be. It'll be a change for me if I do apply but I think possibly a good one. Those of you who have worked in CMHT's, what did you enjoy/not enjoy. Was the lone working ok - did you always feel safe? I like the idea of working more autonomously so community appeals in that respect.

I think that will work differently in every team and it will be scenario dependent. Personally my team is small (5 band 6 CPNs, 1 OT, and the band 5 who can't do duty anyway), but most people work part time. We've had a lot of long-term staff sickness/struggle recruiting until recently, so there were weeks on end I was the only qualified at all most days. We try our best to have back up duty, but staffing doesn't always allow it. We do have a clinical lead, so I'd personally be chatting to them or my manager anyway in the event of a potential mental health act admission anyway. If it's a there and then emergency you'll be ringing 999 anyway. For me, it's more common that we'll get a referral that sounds like a crisis, but the crisis teams (also being short staffed) will request a joint assessment with us so we can make sure the patient ends up under the right team. Our crisis teams don't like it if we refuse this, and it's just the done thing in my team.

Generally in my team patient care takes precedent over non-urgent duty work. Either another member of staff briefly covers, or our manager/clinical will keep an eye on referrals to make sure they're not urgent. If they're not, they can just be left until the next day.

What I can handle over the phone, I definitely will though! I only go out as duty if absolutely necessary for crisis work.

I'd say spend a good couple of weeks shadowing duty, and don't hesitate to ask your colleagues and manager when unsure. You have to think on your feet and make it up as you go a lot. Sometimes you end up dealing with multiple urgent things at once. It's important to prioritise but also know when to ask for a bit of help if you're overwhelmed with duty work!

Brilliant thank you, some great info and advice.

Enjoyed:
-you get far more time to sit and get to know patients, and I feel you end up building some really good therapeutic relationships
-some clinicians will meet patients in cafes or etc, and this isn't frowned upon, at least where I work!)9
-you get to do a lot more therapeutic work compared to wards and have time to think about preparing materials to help with anxiety management etc
-I like managing my own diary and planning my own week. It's very flexible in terms of if you need a dental appointment or etc. If you need to finish 30 mins early it doesn't really matter, you can always log back on later that night and finish up a bit of paperwork
-I personally enjoy driving around as it gives you downtime between patients and space to think
-It's a good hybrid role in terms of working from home Vs office time
-I personally enjoy thinking on my feet, relying on my own decision making, and managing cases independently

Don't enjoy:
-recruitment and retention is very poor in CMHT. You get a lot of sickness due to stress
-can be very hard managing a caseload alongside duty, students etc
-there is A LOT of paperwork, and quite a lot of pressure to do it right, a lot of the time when I'll be honest there's no real benefit to the patient
-you need to plan time for admin or you'll end up on your laptop until 7pm and never take your lunch break. Most nurses I know do this. I used to do it, but now make a point of turning off my laptop at 5 and taking 30 mins for lunch. I'll only stay on if it's related to safeguarding/risk, or if it's something I couldn't avoid e.g. being sat with a patient waiting for an AMPH
-You carry the risk alone a lot, which can feel hard. If you have a complex/risky case, don't be afraid to bring it to every MDT. People won't have solutions, but it will make you feel less alone, and you'll feel more secure having the backing of the MDT for whatever your plan is
-I think when you first start, you do miss some of that team bonding time as you're not all in the office together

Lone work:
-I personally like lone working as I don't like being watched or micromanaged. You can always teams/ring your colleagues for advice, which I do often!
-There will be some kind of lone working policy around checking in with people
-I've always felt pretty safe, but I work with older people's and many of our patients are frail haha. If anyone has violent risk history, you will be attending in pairs. If anyone gives you a bad vibe, go in pairs. If someone is psychotic and paranoid about professionals, go in pairs. Just use your common sense. I've been verbally abused by patients before. The only physical thing I've had is someone with dementia trying to get me with a walking stick 😭🤣 I'm more commonly shouted at by stressed family members than I am patients!! You will have some secret code word to use if you need the police or etc.

How was the lone working element of working in the community, be it casework or duty? I think I would really like the autonomy of it as opposed to being on the wards but equally wonder if I would always feel safe. I know people who have worked in the community and loved it but it was about 10 years ago so keen to hear any recent experience

@Ladamesansmerci cross post! Ignore me you've answered that question perfectly thank you!

I definitely don't like being micromanaged and like autonomous working, while I've always worked in really lovely teams. I think this could be a good potential move (if I get it 😂)