Carrying out Social Assessments at an Acute Psychiatric Ward

A Practice ResearchCharlotta Hallén 5.8.2009

Education in Social Assessment

• Jorvi hospital psychiatric social workers

• Anna Metteri, Associate Professor in social work, Tampere University

• 2007-2008

• A tool tailored in collaboration for psychiatric social work with adult patients

Social Assessments 1.

• Gathering information about the patients´ life spam, living conditions, social network and family, education and work, income and social security benefits and matters that might be important around these themes.

• Based on information given by the patient and on documents.

Social Assessments 2.

• The social workers conclusion consists of:

• Assessing changes in the patients capacity to manage his social network, working, income, family ties and living, that are caused by the illness

• Possible alternatives and suggestions

• The patients motivation and own assessment on his situation

Social Assessments 3.

• Several meetings with the patient, 3-5• Time to gather and process the

information, and finally produce the report • The last meeting is personal feed back on

the report, which the patient can comment on or make changes or corrections

• The report and the information is used within the treatment, separately or as a part of a multiprofessional treatment plan

Why gather information?

• The sooner the patient gets a good and realistic plan, the better the outcome in recovery

• By gathering information of a patient you get a picture of what kind of rehabilitation a patient needs and what is possible for him to get.

Treatment at the Acute Psychiatric Ward

• Short term treatment, average duration 2008 was 18,5 days

• Aims at minimizing the patients symptoms• A team consisting of a psychiatrist, psychiatric

nurses, and if needed a social worker, a psychologist and an occupational therapist, is formed for every patient

• The social workers role is to keep in mind that the patient has a life outside the ward, and that he is returning there.

Symptoms and deficits

• Paranoia

• Lack of insight in illness

• Lack of reality insight

• Deficits such as distractibility, memory problems, lack of vigilance, attention deficits

• Limitations in decision making and planning

The theme for my research

• Difficult and challenging to carry out social assessments with patients in acute ward treatment

• To find out what makes it difficult and why???

• During 1 month I systematically evaluated every patient treated at the ward

Facts

• Totally 37 patients, 22 men and 15 women

• 11-19 patients treated at the ward per day

• The age range was 18-59, and one clearly elderly

• The treatment duration varied from 1 day to over 4 months

Three categories of patients

• Patients who have suffered from mental illness or are in treatment at a ward for the first time in their lives (10)

• Patients who have been in and out the ward several times, or have suffered of mental illness for a long time (18)

• Patients whose treatment clearly is supposed to be somewhere else (9)(severe abuse problems, elderly patient)

What I did

• Daily meetings where I evaluated every patient• The evaluation was based on information from

patient files given by a psychiatric nurse, and on my own perceptions from situations at the ward during the day or patientmeetings

• Claryfying questions when needed• The patients got a no, yes or maybe - in being

ready to engage in a social assessment

The results of the evaluation1. Reasons depending on the

patient• Too early: The patient has recently been admitted to acute

treatment/symptoms are that severe that any kind of action is impossible

• The patient is distracted, changes the subject all the time, interrupts others and talks at same time as others, gets stuck in subjects with no relevance/doesn´t talk/is manic/ is unobtrusive/is tense

• The patient already has program for the day, and two programs would be too much

• The patient doesn´t want to/ non-receptive to treatment/lacks insight in illness

• The patient doesn´t want/economically self-sufficient/no need

The results of the evaluation2. Reasons depending on the

wards practices• There is no time. The treatment is ending/others matters

at work take forehand• The patient is repeatedly at the ward/has ongoing

treatment elsewhere/the situation is known and under control

• The patient is not at the ward/is visiting home/is on some introductory visit/is attending a group

• The patient is temporarily at another ward(somatic)• The patients problems indicates that the treatment

should be somewhere else, and he will be transferred within a couple of days

Patients that were maybe ready

• Patients I thought would gain from a social assessment, both personally and as a part of the multiprofessional treatment

• Not yet ready

Patients that were ready

• Some patients I considered ready• Booked myself to the next meeting• In two cases I was told that the meaning of the

meeting is ending the treatment• In two cases I got this information at the meeting• In one case I considered a patient ready when

the treatment had lasted for 4 months, and this was 3 days before ending my research. There was no time.

Two social assessments made

• One consisted of one interview, the next day the treatment ended which I wasn´t aware of. The conclusion wasn´t based on very much and this I had to make on note on.

• The other lasted for over a month, with many meatings, constantly evaluating the patients condition to engage.

• We finished it, but the conclusion didn´t sound very accurate to me, with the patients symptoms going up and down.

Conclusions

• Is not something you do automatically with every patient at the ward

• Some patients are automatically out of reach of social assessment, because of the short visit to the ward, before being transferred to another treatment. They probably would gain though.

• Also those in the beginning of the treatment

Conclusions

• The patients who had suffered of mental illness for a long time, usually has a treatment plan done already. Some might gain of renewing the plan

• The patients that might gain the most are those who get mentally ill and those who gets admitted to a psychiatric ward for the first time

Some questions

• How does the fact that most patients at an acute psychiatric ward gets treated against their will affect the willingness and motivation?

• Can you think in motivational perspectives with these patients? Is motivation the base for success?

• Does diagnosis give a direction for when a patient is ready?

• Is being treated for a mental illness acutely in fact a crisis?

Some books on the theme

• Tossavainen, A. (1996) Johdatus kuntoutukseen ja kuntoutujan sosiaaliturvaan

• Farkas et al.(2000) Introduction to Rehabilitation readiness.

• Satka et. al. (2005) Käytäntötutkimus

• Vartiainen, H. (1999) Psykoottisuuden arviointi. Lääkärilehti 54(3) 189-193

• Thank You!