Mental Health Familiarisation Policy 2019

Mental Health Familiarisation is a required component of UKCP and HIPC accredited trainings.

Psychotherapists will require awareness, knowledge and understanding that equips them to work within or alongside other mental health professionals and services, with clients who have extraordinary needs and with family members of mental health service users.

Psychotherapists will require an understanding of their role within a system of restoring balance and justice towards better treatment of people with exceptional needs and prevention of additional mental health distress caused by normative social expectation and/or exclusion.

Therefore, trainees are required to understand the wider contexts and considerations of mental health provision to develop sensitive and reflexive practice of psychotherapy appropriate to the needs of people who experience significant mental difficulties and emotional distress.

HIPC believes experiential learning supports in depth engagement, levels of understanding and reflection different from those gained through direct teaching or individual study.  Students are required to undertake an element of direct experience as part of their mental health familiarisation.

1. The Social Responsibility Framework

Psychotherapists need to understand the historical and cultural influences on societal understanding of, and attitudes to, mental health and illness. To develop a capacity to work reflexively within a social responsibility framework.  These can be gained through training input, placement experience, or a combination of the two, including relevant coverage of the following:

a)       Historical and cultural models of mental health, illness and mental health care.

b)       The impact on mental health service users and their families of diagnosis, stigma, normativity and minority experience.

c)       The influence of socio-economics, class, gender, disability, age, culture, religion, race and sexuality on the incidence, definition, diagnosis and treatment of mental illness and mental health.

d)       The intensifying impact of intersectionality (where a person belongs to more than one marginalised group).

e)       Familiarity with the role of minority community organisations and mental health advocacy organisations and how to engage with them.

f)        Practices for non-discriminatory service provision.

2.     Working within a Wider System of Care

Psychotherapists require knowledge, understanding, sensitivity and awareness which equips them to work within and alongside other mental health services in the field. 

a)       Recognition that clients with more complex, significant, enduring or exceptional needs, including how to differentiate between severe mental illness and the range of human responses to life challenge, such as trauma, shock, bereavement and spiritual crisis.

b)       How and when to refer on to appropriate inter-disciplinary professionals and relevant agencies.

c)       When to provide, when necessary, psychotherapy as part of an appropriate package of care including the parameters for keeping therapeutic work safe with severely disturbed people.

d)       The social and cultural context in which service is delivered to understand and empathise with the lived experience of service-users.

e)       The different personal and professional roles in care for people with complex or enduring needs including current knowledge of local services.

f)        An informed and critical awareness of the differences in paradigms between the medical model and a psychotherapeutic approach including the psychotherapists role in collaborative care.

g)       The psychotherapist’s role in the provision of non-discriminatory services.

h)       The role of medication (prescribed and non-prescribed) and its impact.

i)        Ethical and legal consideration pertaining to the above including appropriate familiarity with the Mental Health Act 2007 and the Equality Act 2010.

j)        The basic structure of the mental health services in the UK, and the role of NICE guidelines.

k)       Diagnosis and classification of mental illness within the medical model including a working knowledge of the DSM V and a capacity to reflect on and evaluate its use as a system of assessment.

l)        The types of interventions and treatments used, their rationale and side effects.

m)      Understanding and appreciation of different professional and personal roles in mental health care.

n)       How to work in a client-centred way which safeguards the wellbeing of the client (and their dependents) and ensures that the psychotherapy received forms part of an appropriate package of care.

o)       When and how to make appropriate referrals to other professional agencies.

3. Direct Experience

The developmental process of learning which integrates knowledge and experience can be gained through training input or direct experience, or a combination of the two.  Some element of direct experience is required, as this is likely to be relevant to fully attaining the overall aims of mental health familiarisation process.

Training and accrediting organisations have discretion to require up to a maximum of 120 hours of direct mental health experience within the overall 900 training hours.  They should include their requirements and the reasons for them within policy.

4. Experiential Learning

HIPC believes experiential learning supports levels of understanding and reflection different from those gained through direct teaching or individual study.  Students are, therefore, required to undertake some element of direct experience.  This may be met in a variety of ways including working, volunteering, attending events or otherwise spending time in settings such as the following:

•         community mental health centres,

•         psychiatric wards,

•         day centres or drop in centres,

•         voluntary organisations such as Mind,

•         advocacy services,

•         community services,

•         specialist services such as those of homeless people,

•         attending events held by groups such as the Schizophrenia and Bipolar Foundations, and the Recovery Learning Community.

•         Adult Eating Disorder Clinic

•         Addiction/Rehab Agencies

•         Geriatric Mental Health Services

•         Alzhiemer’s Clinic/Day Centre

This list is meant to be indicative and is not comprehensive.

There may be occasions where students have gained direct experience in their personal lives, professional careers, by undertaking research or in their counselling or psychotherapy practice.  This may be included in students’ experiential learning, however its relevance and currency must be demonstrated within the assessment.

MIP will Provide:

*         A range of training input, such as lectures and seminars, visits by external speakers (including service user groups) to support students achieving the aims of the MHF.

*         Support personal learning by providing access to, or signposting trainees to learning resources such as written materials, documentaries, films and videos.

*         Offer support to help students access appropriate experiential learning opportunities.

*         Make clear to students their responsibilities and limitations in undertaking experience in the field.

*         Manage the minimum requirements for experiential learning which balance opportunities for in depth engagement and learning with ensuring accessibility for a diverse student body.

*         Provide ways for students to evidence their experiential learning activities.

*         Create assessment procedures whereby students can demonstrate their learning.

*         Provide a rational and documentation for the approach taken.

Trainees are expected/required to:

1.       Take responsibility for arranging placements or direct experience elements to meet the Mental Health Familiarisation requirements.

2.       Take responsibility for taking up opportunities to attend appropriate training input provided by their training organisation or other bodies.

3.       Take responsibility for demonstrating that they can meet the requirements of the Mental Health Familiarisation in line with the UKCP HIPC College.

4.       The trainee needs to write a short report, 1500 words, of their experience within the Mental Health placement outlining:

          –         the agency’s mission statement

          –         the service user base

          –         support received by the agency

          –         the student’s internal reflections overall of their experience of the placement.

5.       The trainee must have a minimum of three different and distinct placement experiences in mental health settings, minimum 70 hours in total.  Please note maximum 120 hours in totality.

          There may be occasions where trainees have gained direct experience in mental health settings in their personal and professional careers.  However, if their direct experience is not within the last 5 years from MIP graduation then they would still need to evidence 70 hours of current direct mental health experience.

6.       Trainees will need to evidence their attendance at the mental health placement they work within, and this will need to be evident in their portfolio, with their short reports of 1500 words per placement experience.

Additional Information:

It is important not to confuse the clinical placement that you completed in your 4 year training with the mental health placement for UKCP registration purposes.  If you completed your clinical placement within one of the mental health services it cannot be counted towards the mental health familiarisation direct experience, as this would mean the student would be short of the expected 900 hours overall to complete UKCP registration.

As well as this, the focuses of the two placements are distinctly different in nature and experience.

Approved at UKCP HIC college meeting 12th July 2018. Discussed at and amended after the UKCP ETPC meeting July 20th July 2018.

                                                                              Approved by MIP February 2019.

(Updated June 2019)

All staff, directors and committee members of the Manchester Institute for Psychotherapy will strive to avoid any conflict of interest between the interests of MIP on the one hand, and personal, professional and business interests on the other.  This entails avoiding actual conflicts of interest as well as the perception of conflicts of interest.

The purpose of this policy is to protect the integrity of MIP’s decision-making process and the integrity and reputation of staff, directors, committee members, trainers, supervisees and members of the public.

Examples of conflict of interest include:

1.       A committee member who sits on two committees where one committee may be making decisions which would have an impact on the work of another committee.  Where possible, members of MIP should only occupy a seat on one committee of the organisation or have only one named role.

2.       A committee member who is related to a member of staff and there is a decision to be taken on staff pay or conditions.

3.       A committee member who has a personal relationship with another member which may influence their views of the professional standing of that member, e.g. it would not be appropriate for a Quality & Ethics Committee member to be on an investigating panel of a colleague or friend.

4.       A committee member who has an active role in another organisation which may be in competition with MIP, for example in recruitment of members or funding of posts.

5.       A committee member who has shares in a business that may be awarded a contract to do work or provide services for MIP.

6.       Committee members may attend other committees, however if there is a conflict of interest with regards to specific proposals discussed, the member will step down for that particular proposal and area of discussion.

7.       Any committee member who suspects a conflict of interest should make it known to the chair and be prepared to remove themselves from the role.

Upon appointment, each committee member will make a full and transparent disclosure of interests, such as relationships and posts held, that could potentially result in a conflict of interest.  Such potential conflicts of interest should be reviewed within the committee periodically.

Committee members must be transparent about any transactions or decisions in which there may be a conflict of interest between MIP’s best interests and those of the member, or any organisation the member is involved in.

In such situations, a member will then agree as follows:  “After disclosure, I understand that I will be asked to leave the room for the discussion and will not be able to take part in the decision.”

Any such disclosure and the subsequent actions taken will be noted in the minutes.

This policy is meant to supplement good judgement and staff, directors, management, committee members, trainers and supervisors should respect its spirit as well as its wording.

This policy is regularly reviewed every 18 months an updated a minimum of every 36 months

Revised February 2019

SAFEGUARDING POLICY STATEMENT – ADULTS

The purpose of this policy statement is to protect vulnerable adults who receive MIP services.  Our overarching philosophy is that we expect every therapy to have professional supervision and the appropriate qualifications, including Placement Therapists.  Moreover, all practicing therapists will be expected to provide evidence of their insurance and their CBS check, and membership of a governing body.

All therapists who work from the Institute will have had to go through the above procedure and have the appropriate training background and qualifications to be competent in the services that they are offering.  This is regularly monitored and reviewed by MIP in terms of overseeing their ADL and training programmes and advanced specialisms.   Membership of a governing body such as UKCP, UKATA, BACP with adherence to their stipulations is a requirement for ADL.

A placement student will have discussions with their placement provider regularly on the importance of swift action in case of concerns over potential safeguarding issues with their clinical placements.

Whistle-blowing

MIP has an open culture where people feel able, positively supported, and encouraged to raise their concerns, even when they relate to the practice of their staff.  This includes support for whistle-blowing and any such concern would be referred to and addressed by the Quality & Ethics Committee.

SAFEGUARDING POLICY STATEMENT – CHILDREN

This safeguarding policy was drawn upon the basis of legislation, policy and guidance that seeks to protect children and young people in England.  A summary of the key legislation and guidance is available from: nspcc.org.uk/childprotection

 The purpose of this policy statement is to protect children and young people who receive the Manchester Institute for Psychotherapy services.  We will provide parents, therapists, trainees and staff the overarching principles that guide our approach to child protection.

This policy statement applies to anyone working on behalf of the Manchester Institute for Psychotherapy, including senior managers, paid staff, therapists and trainees.

We believe that:

*         children and young people should never experience abuse of any kind.

*         we have a responsibility to promote the welfare of all children and young people to keep them safe, and to practise in a way that protects them.

We recognise that:

*         the welfare of the child is paramount.

*         all children, regardless of age, disability, gender reassignment, race, religion or belief, sex, or sexual orientation, have a right to equal protection from all types of harm or abuse.

*         some children are additionally vulnerable because of the impact of previous experiences, their level of dependency, communication needs or other issues.

*         working in partnership with children, young people, their parents, carers and other agencies is essential in promoting young people’s welfare.

We will seek to keep children and young people safe by:

*         valuing, listening and respecting them.

*         appointing the appropriate child protection/safeguarding lead.

*         developing child protection and safeguarding policies to reflect best practice.

*         using our safeguarding procedures to share concerns/relevant information with agencies who need to know.  Involving children and young people, parents and carers, appropriately.

*         creating and maintaining an anti-bullying environment, and ensuring that we have a policy and procedure to help us deal effectively with any bullying that does arise.

*         developing and implementing an effective online safety policy and related procedures.

*         recruiting staff and volunteers safely, ensuring all necessary checks are made.

*         support, training and quality assurance measures.

*         implementing a code of conduct for staff, trainees and therapists.

*         using our procedures to manage any allegations against staff, therapists and trainees appropriately.

*         ensuring that we have effective complaints and whistleblowing measures in place.

*         ensuring that we provide a safe physical environment for our children, young people, staff, therapists and trainees, by applying health and safety measures in accordance with the law and regulatory guidance.

*         recording and storing information professionally and securely.

Appropriate MIP safeguarding lead

MIP will provide at least two safeguarding leads for both adults and children.  These individuals are highly qualified clinicians, with experience to provide safeguarding support.

All placement therapists will be provided with the lead contact details and must contact the safeguarding lead with any concerns over safeguarding issues.  Moreover, these safeguarding leads are available for all other therapists.

Should the safeguarding lead not be available, the admin office will signpost an alternative contact and confidentiality must be adhered to.

Contact details:

1. Senior lead for safeguarding:

Name

Phone number/email

2. Deputy lead for safeguarding

Name

Phone number/email

NSPCC Helpline 0808 800 5000

Responding to concerns and disclosures.

The procedural process with regards to MIP lead persons are publicly on the website so that therapists, placement students and clients are aware of these procedures.

Assessment

At MIP, all placement clients that are referred to the placement therapists will have undertaken a “risk assessment” where the above areas will be taken into consideration.  If at the assessment the assessor thinks that there is a high risk in the area of suicide, these high risk clients will not be passed to the placement therapists.  However, that does not mean that the clients’ feelings of suicide or suicidal idealization may not be triggered through the placement.

THERAPISTS PROCEDURES

The therapists procedures outlines what therapists need to do in a range of situations in order to best protect the client within the therapeutic setting.

 As with all these procedures, the first step at a general level is Supervision.

Supervision’s major focus is to help the placement therapist to provide their best services for the client. It is in the supervision hour that the placement therapist brings their anxieties, worries and concerns to the supervisor.

As well as the above, the placement therapist will endeavor through supervision to develop their skills in the area of therapy and therapeutic discourse.  This will include learnings in how to work with clients, techniques and treatment planning towards resolution.

If the client discloses that they are being abused, harming themselves or have been abused in the past:

*         The first port of call is to gently enquire and check out what you have heard to make sure you are understanding correctly – this is not interrogation – though you have to be specific to make sure of the facts this needs to be done in a relational manner.

*         Remember that the information you will be hearing in this context will be very difficult for them to talk about and it will have taken a lot of courage for them to disclose at this level, so it is imperative that you treat the person in an empathic manner with a great sense of integrity, authenticity and respect.

*         It is imperative that you do not lead the client to the conclusion that they were being, or were, abused. For example, do not put thoughts into the client’s head.

*         If there is a risk to the person, or you are not sure if there is a risk to the person, it is imperative you speak to your personal supervisor as soon as possible to discuss the situation fully.  (In specific situations you may decide to contact the safeguarding lead at MIP) – certainly this needs to be recorded in your own notes.

*         If there is a risk you may need to disclose – dependent on level of risk, ie if you think they are of harm to themselves or other people, you will need to disclose this immediately.  If there is no immediate risk, then discuss it at your next scheduled personal supervision.

*         In your personal notes, vis a vis your client, this must be recorded as said above, even if you choose not to take this to your supervisor.  However, it is highly recommended that you do take all considerations to your supervisor.

*         All actions that you have taken have to be noted in your client records and you need to tell your supervisor of these actions, with dates and times against each of the actions.

If the client discloses they are abusing:

 *         Check out gently what you have heard to make sure you have understood them correctly and remind them of the contracting about confidentiality and its limits.

*         Try to get them to take the appropriate action, for example with your support contacting the police.

*         You will need to disclose the information that is being given to you and you must make this clear to your client.

*         If the risk is significant and imminent you will need to disclose it straightaway to the MIP safeguarding lead and/or social services or the police.

*         Offer to continue to support the client through the ongoing therapy if appropriate and safe to do so.

*         If you no longer feel safe to work with the client seek advice from the MIP safeguarding lead and your supervisor.

*         Make sure that you made notes of all your appropriate actions and discussions with your client, supervisor and safeguarding lead.

If the client discloses that a Third Party is Abusing:

*         First of all check out gently what you have heard to make sure you have understood correctly.

*         Try to get them to take appropriate action.

*         Whether or not they are prepared to take appropriate action speak to your supervisor and the safeguarding lead at MIP as soon as possible.

*         In your client notes you need to record all discussions with the client, supervisor and the safeguarding lead.

SUICIDE AND SELF HARM FRAMEWORK

 This document has been informed by the BACP Information Sheet P7 Working With Suicidal Clients, and the Suicide Risk Document produced by Newcastle, North Tyneside and Northumberland NHS as well as the information produced by Beacon Counselling.

 When working with Placement clients who present with a wide variety of issues, such as depression, anxiety, stress, repression of feelings, hopelessness, and a feeling of helplessness in the world and indeed in their levels of functioning, you may well find as the therapeutic sessions evolve that sitting underneath these presenting issues the placement client may report feelings/thoughts of suicide/suicidal idealisation.

Suicidal Idealisation

This is when clients may have fantasies, dreams or even imaginations of the ideas of what it’s like to take their own life and indeed may have whole thought processes on how their suicide may impact other people around them.

More often than not when people report suicidal idealization it does not mean that they are then going to go and take their life. However, their reporting of this to yourself is important and must be taken extremely seriously by yourself.  This is where supervision is imperative.

The Threshold Model

The threshold model shows how different types of risk and protective factors interact to produce a threshold for suicidal behaviour for the individual.  The different types of factors are:

1. Long term predisposing risk factors that can be present at birth or soon after birth – these identify people who are in risk groups.

Genetic or Biological Influences:

(a)      Family history of suicide or attempted suicide

(b)      Family history of depression

(c)      Family history of alcohol or other substance misuse

2. Personality Traits

Rigid thinking characterized by patterns of thought that are difficult to change.

Black and white thinking or “nothing thinking”

Excessive perfectionism, where high standards are causing distress to the person or others.

Hopelessness with bleak and pessimistic views of the future

Impulsivity, tending to do things on the spur of the moment

Low self esteem with feelings of worthlessness

3. Short Term Risk Factors

Environmental Factors:

(a)      Divorced, separated of widowed

(b)      Being older and/or retired

(c)      Having few social supports

(d)      Being unemployed

Psychiatric Diagnosis

The three psychiatric disorders most strongly correlated with suicide are:

*         depression

*         Substance misuse (including alcohol)

*         Schizophrenia

4. Precipitating Factors

These are events that may tip the balance when a person is at risk. They include:

*         High stress/life crises

*         Divorce

*         Imprisonment or threat of imprisonment

*         Recent job loss

*         Recent house move

*         Recent loss or separation

*         Unwanted pregnancy

*         Interpersonal problems

Depression

          Depression is the most common of mental illnesses.  People may often report low mood and lack of energy as criteria for depression.

Depression comes in many forms. Often it is defined as “anger turned inwardness”, repression of feelings, an incapacitation or/and a general sense of worthlessness and lack of purpose.

In a continuum of health you may get mild depression where a person may report the above and will be able to move from this state with relative ease.

If a person reports “at the other end of the health continuum” which we might call “high intensity” depression the person will report “stuck” or “fixed” in that particular state and an inability to move from one ego state to another.

Symptoms:

What follows is a check list of the most common symptoms of depression. If at least three-five of the symptoms below have been present for at least 2 weeks the person is likely to be suffering from clinical depression (high intensity).

1. Depressed mood
2. Loss of interest and enjoyment
3. Increased fatigue or loss of energy
4. Appetite or weight disturbances
5. Disturbed sleep
6. Ideas of self-harm or suicide
7. Reduced concentration and attention
8. Problems with sleep or indeed incapacitation
9. Reduced self-esteem and self confidence
10. Lack of pro-activity
11. Lack of purpose or structure in life

Process of Assessment (taken from Suicide Risk Document- Northumberland NHS)

Key stages in applying the threshold model to suicide risk and assessment are:

1. To establish a working relationship with the placement client. This means developing rapport and a trusting relationship with your client.

This working relationship will provide a container and a secure safe space for the placement client to feel more able to disclose important information with regards to what they are presenting.

The use of empathy, active listening, and genuineness is imperative in this, not only throughout therapy but also particularly important at this first stage of meeting.

2. Phenomenological Inquiry about the person’s presenting issues and narrative is vitally important within the therapeutic sessions.

You will also need to be aware of inquiring about their current mental health, physical health and any substance problems.

3. When listening to their historical and presenting issues you will also be able to assess their previous methods of coping with similar problems within what we call in Transactional Analysis their “Script”.

4. It is imperative to seek information on their support system which would include availability and help provided by families and friends, for example do they live by themselves, with other people, within the family or do they in fact access any other type of service help.

5. Ask about current circumstances, life events and worries. Through this inquiry you will be able to assess any precipitating factors which/could be triggering any suicidal thoughts, feelings or indeed potential actions.

6. Finally, through the above you will have been throughout assessing the potential existence and specificity for any plans for suicide, including any nearby dates that have special significance for the person. Investigating the availability of means to commit suicide is crucial at this stage. This information will help to assess any suicidal intent.

7. After evaluating the placement client’s narrative and information that you will have gleaned throughout the stages above, will help you to judge how close the person is to his or her threshold for suicidal behaviour. This then is your assessment of risk.

8. Having stated the above stages of risk assessment, it is important that you have this framework and information with regards to working in the area of mental health. Please note, as said above, that the MIP initial assessor will also have done their own risk assessment and will have made clinical judgements in terms of the clients that they will be referring to you in terms of the placement.

Managing Suicide Risk

Managing suicide risk in many ways comes with the territory of risk assessment and management techniques will differ depending on the assessed level of risk. For example, if your risk assessment is low then the management techniques will differ from working with a high assessment risk.

Low Risk to High Risk (in Ascendency with 1 being Low risk and 8 being High risk):

1.         If a risk is low, maintain usual contact/sessional arrangements.

2.         A therapeutic approach is useful in promoting contact and encouraging the client to take a shared responsibility for their future care and safety.  (The FRAMES approach to brief therapy is summarized below).

3.         If you are concerned or anxious talk to your colleagues at the placement service and/or contact your Placement Supervisor (do not wait necessarily for your next booked supervision session).

4.         Use the person’s existing support system by encouraging them to engage with their contact/friends/family.

5.         As said earlier, if you believe the risk is more urgent contact your Placement Supervisor and also talking with your colleagues may well be useful at this junction.

6.         If they are the high end of suicide risk Supervisor immediately to work out an action plan with regards to future sessions.

7.         The same as above – immediate contact with your Supervisor and immediate plans may need to be implemented, such as an urgent mental health assessment or even a 999 call.

8.         Please note with regards to point (7) and (8) you will need to notify the Safeguarding Lead person at MIP.

Conclusion

(a)      Always be aware of suicide risk.

(b)      It is vital to keep good and accurate records.

(c)      Use the FRAMES approach as a therapeutic style to promote contact and change.

Feedback to the client

Responsibility for change lies with the client

Advice to change

Menu of strategies for bringing about change

Empathy as a therapeutic style

Self-efficacy or optimism

This mnemonic is a useful technique for memory recall and may be useful if this context.

Click below for Safeguarding Flowchart: 

SAFEGUARDING – FLOWCHART – OVERVIEW