
The following illustration may help:
I started work with J about a year ago when her GP referred her to my team (Community Mental Health Team). She was 56, from Ireland and lived alone in a one bedroomed flat. She had a history of schizoaffective disorder, was largely uncommunicative and would sometimes fail to look after herself to the point where she would put herself at risk of dying. When I first met her I was conscious of my being younger than her and of a different ethnicity (I am black Caribbean). I also realised that the professional network around did not appear to recognise the risks to her health and safety posed by her mental health problem. I took the time to really listen to what she had to say, including how she experienced her mental health problem, by drawing on motivational interviewing skills I had learned (Treasure, J (2004) Motivational Interviewing Advances in Psychiatric Treatment 10. 331-337). I then worked with the Community Psychiatric Nurse on the team and later with her GP, showing them how to mirror what she said so that she knew she was being understood. This approach led to Jennifer telling the nurse and GP more about her condition. As a team we met from time to time to reflect on Jennifer's state. We considered together the implications of her condition and lifestyle, and this proved a useful route through which to explore further the risks she posed to herself. In my statutory role, I had to inform Jennifer what my duties were, particularly as an Approved Mental Health worker. She needed to be aware that I could apply for her liberty to be restricted if the risk to her health and safety worsened. That early engagement from the team was really helpful when later it became evident that her mental health problem was deteriorating. My task was to coordinate the support and protection from the team by ensuring she always had someone to turn to, helping her to make as many decisions for herself as possible but stepping in when she needed protection. She would often not answer the door when a member of the team visited so I knew she was struggling to engage. After a couple of attempts, I eventually applied for Jennifer to be compulsorily admitted to hospital where should could receive more specialist and intensive help.