Meet the team working across our Older Adult services

Here at St Andrew’s, our on-site, specialist multi-disciplinary teams work across Birmingham and Northampton to support older people with a mental health diagnosis or a neurodegenerative condition who also have complex physical health and mobility needs.

We recognise that within the context of mental healthcare, supporting older people requires specialist clinical and psychiatric knowledge, insight and compassion. We aim to support people in their rehabilitation so that they can return home or to a residential setting suitable to their on-going needs. For some of our patients who are unable to make this step our job is to ensure that we help them to maintain the best quality of life and support their end of life care with compassion in an environment that is comfortable and reassuring for them, their family and loved ones.

To discuss a referral into our Secure Older Adult Mental Health Services please contact our Admissions team on 0800 434 6690

The importance of relational security

Having nursed for 35 years, Damien Crossan, Nurse Manager on our forensic Older Adult ward in Birmingham, recognises the importance of relational security for patients and it's an approach that he emphasises with his nursing team: 

"Relational security is central to all healthcare and particularly mental healthcare. It's a drum that I beat quite constantly with my staff group; it's getting to know people, getting to know thoughts, getting to know fears and being a comfortable ear and within mental health that's terribly important because sometimes people just want to say something, not necessarily want anything further than that and as long as they know they're heard you have given comfort."

Damien also acknowledges that within the context of older adult care, supporting end-of-life care is integral to the nursing team's approach; 

"Death is a progression with an older adult service that must be addressed, and it opens up that complexity then of supporting  patients' futures; knowing that everyone has a future but that it might be a limited future and what preparations they might want to make for that. So we speak to people about what they want and and who they want within their lives and whether perhaps they would like to renew some relationships".

Supporting the patient - holistic care and expert interventions

Muthu Natarajan is Consultant Forensic Psychiatrist and Clinical Director for Neuropsychiatry services. In his video he discusses the considerations when supporting older adults and talks about our Lowther dementia hub, which he has been at the forefront of developing;

"The Lowther village was very much a critical part of our ability to deliver the best care for patients who are living with dementia...they are able to interlink with the community throughout their journey with dementia, and that's what we try to do, both in an inpatient setting, also patients who are on Mental Health Act sections and DoLS but also making sure that they have the least sort of possibility of feeling as though they are in an inpatient setting."

"When somebody comes to us, we carry out a comprehensive multidisciplinary assessment that is the basis of the care and treatment. An individual might require specific psychological therapies like reminiscence therapy, individual sessions to look at what the actual cognitive impairment is actually meaning for them on a day to day basis, we may look at life story work. We also look at what is the least restrictive approach to their management, so one of the key things we will look at is what activities and supports are going to help them through their journey, and that will include activities within the unit, but it also may include activities within our grounds and also further afield into the community.  The third thing is obviously in terms of our medical support, and we have a full complement of doctors, a responsible clinician, a geriatrician who works alongside us and also our specialty doctors and the medical team who look at the treatments we're offering and making sure that is the most holistic approach to that individual's care."

Promoting independence and preparing for discharge

Where appropriate, discharge planning is put in place when we admit someone into both our secure and non-secure older adult services. On our forensic wards, like Cranford and Moor Green where Matthew and Anna are based, planning to support step-down to an environment of least restriction is key to the team’s approach. This involves building people’s access to and engagement in the community and supporting their activities of daily living, as Anna explains;

“One way the team support our older adult patients is by trying to promote independence as much as possible. So it’s our job to support people to do the basic things like; their laundry, making a drink, the skills that they will need to live independently”

Find out more about Anna's role and her plans to become a Mental Health Nurse in her video.

As a Clinical Nurse Lead, Matthew works closely with Occupational Therapists and Technical Instructors to ensure that patients have access to a full programme of activities which allow the team “to minimize risk but take positive risks regarding leave off the ward and sections.”

Cranford is based within our secure service, Willian Wake House, where on-site facilities include gyms, a swimming pool and heavy and light industry workshops, the extensive grounds also “enable us to really develop people's skills outside of a ward setting.”

David, is 81 and has vascular dementia and in his video he shares his enjoyment of the activities that take place on the ward;

“I do a lot of writing for the magazine they’ve got here, that is one of my things. The stories I write are true (ish) because you know I add a bit of fun to the stories.  I like the music sessions where you can choose what music you like, and of course I’m the 50s era, rock ‘n roll.  I used to go to the gym and the exercise bike and everything, just keep myself busy. You know and going out shopping, I’ve got an electric scooter, which was left to the ward. That’s why Bekki here; the story I wrote was about Bekki, trying to teach me on a scooter, when I was already a biker, and the scooter looked like a small motorbike; so I had to get my own back! (laughs)”

Extract from ‘The Geriatric Biker Rides Again, Biker Vs OT’ by David

‘Our ward was given a mobility scooter…and up steps the OT. Look at it, it’s a small bike! She, my mentor, is aware that I have been riding bikes since the mid 50s; here lies the problem, she’s heard of my reputation with the lads and our passion for speed! Lesson two I had to ride between the tables in the dining area – no problem – thumbs up! There was one table slightly higher and longer, I knew if I got down low on the bike, I could make it – so head down and go. NO! out steps my mentor – good brakes on this!’

Individualised care and treatment

Individualised treatment programmes incorporate the principles of the RAID (Reinforce Appropriate and Implode Disruptive) model – positive, meaningful engagement and reinforcement.

We use specialist age-appropriate interventions and tools, which address psychiatric symptoms, risk and offending behaviour.

Our commitment to Dementia Care Mapping (DCM)

Structured professional judgement tools, such as HCR-20 and RSVP, are used to assess risk on a regular basis and we use Dementia Care Mapping as an observational means to improve the quality of life and wellbeing of our patients. With a team of mappers, including Advanced Mappers we are able to routinely map on a quarterly basis complementing a holistic approach across services for older adults in our care.

Importantly for our patients their DCM data is presented on the BI Patient Portal and comes up on individual patient's dashboard, and it is therefore able to be included in ward round discussions and CPA reports.

Our older age adult service was the first to be awarded the RAID Centre of Excellence, recognising our environment of positive engagement.

Partnership working in our Older Adult services in Birmingham

Our low secure Older Adult ward in Birmingham, Moor Green, is part of the West Midlands Reach Out partnership, prioritising care closer to home. Following admission we also work with Reach Out to define a patient's discharge plan and pathway.

As an older adult service some of our patients have palliative care needs and we work closely with the local hospice and Queen Elizabeth Hospital for any acute physical health needs, as Shazad Farooq, our Consultant Forensic Psychiatrist based in Birmingham explains:

"We have patients who have palliative care needs and it's about that joint care planning to make sure that patients are as comfortable as possible and that any needs are appropriately addressed."