The Personalities in Action group have flagged up the difficulties around care ending and the transition out of that supported space. It’s something the group has felt strongly about and have gotten really involved in the work around this. It’s still ongoing as it looks to be fully implemented, and below is a summary of the endings work so far.
You may recall that not long ago we shared the findings from a recent evaluation focused on service users and staff experiences of endings and discharge from the Leeds Personality Disorder Clinical Network. We wanted to summarise some of the key messages from this, along with the next steps. It was great to see how the evaluation gave rise to many important themes for service users and staff, which we hope will help shape our service for the better. We plan to share some of the main themes below.
Struggling with feelings around discharge was understandably an emotive theme. Service users clearly reported a range of feelings but anxiety and fear, around what next were central. “I was panicked, I was scared, and I had a lot of emotions.” They also commented on the challenges equally for staff and noticing how staff were also affected by discharge too. “I felt that staff cared very much but they couldn’t do anything about it.” The findings also show us that service users felt a lack of support when it came to discharge. “I think the follow up care is inadequate,” and, “You tend to find out about new groups and organisations through service users not staff.” Equally, setting up false expectation around step down services was another important issue. Service users reported understanding and accepting discharge would happen but that this could be dealt with differently. There were some really good suggestions around how to tackle this, including planning for discharge earlier and a post discharge resource pack. “That could be part of the discharge package that you could have a resource pack of support,” and, “A pack with lots of leaflets.”
Findings from staff highlighted a difficulty in building up a relationship and trust and then it ending after two years. Staff repeatedly felt a sense of responsibility for service users and this equally stirred up a range of feelings. “I guess it can feel like jilting somebody, jilting them repeatedly.” This extended further to staff perceiving that service users felt unwanted and abandoned. However, discharge was also considered as an intervention in itself enabling service users to practice endings of relationships in a supportive, safe and trusting relationship. “What we try and do is try to have a good enough ending that can mirror elsewhere in their lives.”
The report has clearly brought to our attention so many important experiences around what is and what will always be an emotive topic. As the report was commissioned in 2015, we are really pleased that a number of the recommendations have been implemented in the team. However, there is still more work to do and we need you help with this too!
Going forwards we really want to take forwards a discharge resource pack and leaflets that can help our service users and staff at an earlier stage in the planning of discharge. We want to let service users know what the staff and the wider team are doing in relation to endings. Sometimes our thinking isn’t always explicit and clear to service users and so we need to talk more about this with you.
Stepping down from services is not easy and developing better transitions between services is another area that we are taking forwards. The service has recently produced a guide of services in Leeds and perhaps a project going forwards would be to tailor this towards endings and transitioning from the network.
We really want to take this opportunity to say thank you to all the people who contributed to this evaluation and in helping us to develop the service. If you are keen to work with us on any future projects or you know of anyone who might be keen, please do not hesitate to contact us on the following email address LYPFT, Pdinvolvement firstname.lastname@example.org