Our mental health services are always keen to work in partnership with our service users and carers.
We have found that working together is the best way to gain improvement and overall well-being.
This section provides information about your rights relating to mental health, the Patients Rights Act, Advocacy information and also the Mental Health Act in Scotland and how it relates to you and your care. The Mental Welfare Commission have information concerning your rights called Rights In Mind.
Your rights are always important within mental health treatment. However, there may be circumstances when your ability to make a decision about your care is impaired or you require treatment with which you do not necessarily agree. Further to the Patients Rights Act for all in Scotland treated by the NHS, The Mental Health Act (Scotland) has a number of principles for the care provided by Mental Health services as well as safeguards to protect patients’ wishes.
Important Concepts
These concepts are important because they are key to the decisions mental health services will make when deciding how best to respond to your needs.
Mental Capacity
In Scots law, adults are presumed to be capable of making decisions and manage their care. While having a mental disorder, an adult is still assumed to have capacity unless they are unable to meet one or more of the tests of the law. These being unable to: understand information regarding decisions; or retain information to make a decision; or weigh information to make a decision; or communicate decisions. Mental capacity can be important in the treatment of those with dementia or learning disability.*
With respect to the Mental Health Act, decision-making capacity regarding treatment can be impaired as a consequence of a mental disorder.
Further information about Mental Capacity is available
Management of Risk
At every consultation, there will be an assessment and consideration of risk and Mental Health services have a duty to ensure your safety, especially when there is an impairment of mental capacity. For most, risk can be managed in collaboration with Mental Health professionals, but significant risk is also one of the guiding criteria in the use of the Mental Health Act.
Those most at risk usually pose harm or vulnerability to themselves, but Mental Health professionals must also take into consideration risks to others.
Further information about Management of Risk is available
Supported Decision Making
This is when a person receives support to enable them to understand information and to express their will. In the context of mental health treatment, this support is often received when under the compulsory powers of the mental health act, e.g. advocacy support.
Substitute Decision Making
This is when an external person is appointed to act in the best interest of someone else. These are commonly Guardians or those with Power of Attorney.
*The test to be applied is different in Scots law S1(6) AWISA:
- “adult” means a person who has attained the age of 16 years;
- “incapable” means incapable of:
(a) acting; or
(b) making decisions; or
(c) communicating decisions; or
(d) understanding decisions; or
(e) retaining the memory of decisions, as mentioned in any provision of this Act, by reason of mental disorder or of inability to communicate because of physical disability; but a person shall not fall within this definition by reason only of a lack or deficiency in a faculty of communication if that lack or deficiency can be made good by human or mechanical aid (whether of an interpretative nature or otherwise); and - “incapacity” shall be construed accordingly.
We’re used to hearing about the importance of looking after our physical health – such as the advice to eat five portions of fresh fruit and vegetables per day – but we’re less used to talking about keeping mentally well. However, there are lots of things we can all do to look after our mental health – whether or not we’ve had any kind of long-term health condition.
We share here a number of practical ways that we can all promote our best possible mental health. And rather than thinking of good mental health as the lack of mental illness or the absence of worry and stress, it should really be seen as a set of coping resources that helps us deal with everyday life better.
Practical ways to look after your mental health
We provide below some practical suggestions of the kinds of steps you can take to keep well and look after your mental health.
There are five steps we can all take to improve our mental wellbeing. If you approach them with an open mind and try them out, you can judge the results yourself.
- Connect – connect with the people around you: your family, friends, colleagues, and neighbours. Spend time developing these relationships.
- Be active – you don’t have to go to the gym. Take a walk, go cycling or play a game of football. Find the activity that you enjoy and make it a part of your life.
- Keep learning – learning new skills can give you a sense of achievement and new confidence.
- Give to others – even the smallest act can count, whether it’s a smile, a thank you, or a kind word. Larger acts, such as volunteering at your local community centre, can improve your mental wellbeing and help you build new relationships.
- Be mindful – be more aware of the present moment, including your feelings and thoughts, your body, and the world around you. Some people call this awareness “mindfulness”, and it can positively change the way you feel about life and how you approach challenges.
You can get further ideas here, with tips from Mind’s Five Ways to Wellbeing resource:
Also, the Mental Health Foundation has produced a guide: “How to Look After Your Mental Health” which you can download for free. This contains 10 practical areas that you can take action on.
The above list is not exhaustive. In order to maintain and strengthen your mental and emotional health, it’s important to pay attention to your own needs and feelings. Check out the section below on Mind Waves as well, with some extra “keeping well” tips and ideas, created by local people.
More Information
Mind Waves
There are loads of great stories of how these five steps to wellbeing can be put into action.
You can find some of these stories on our Mind Waves website, the majority of which are created by our volunteer “Community Correspondents”. Use the Topics tab on the Mind Waves site to explore particular themes and issues and find other top tips:
Did you know you can share your own contributions about mental health and wellbeing via our Mind Waves Community Media Project? You can also connect on Twitter – @mindwaves1
Stressed? Get help and give help
We all have times when we have low mental wellbeing – when we feel sad or stressed, or find it difficult to cope. Sometimes, there is no clear reason why we experience a period of poor mental health but it is important to give yourself permission to feel your feelings; we all need to be better at acknowledging that there are times when “it is OK to not be OK”.
Whether you have a mental health problem or not, there may be times or situations in your life that are more difficult than others. For example, when we suffer some sort of loss; experience loneliness or relationship problems; or are worried about work or money.
It can be easy to turn towards negative things to cope when you are feeling down, for example: drinking too much alcohol. However, this type of behaviour will probably only make things worse in the long term and so it is important to look after yourself and actively engage in reaching, and maintaining, good mental health and wellbeing. There is a helpful guide from Mind that gives lots of practical pointers.
And how can you help someone else who may be struggling with stress? The award-winning Power of OK campaign from Scotland’s See Me programme gives some very practical advice (videos contains strong language)
What’s causing you stress? Get help
We know that there are lots of things that can cause us stress and impact on our mental health – we provide some information and resources below to help you with some of these issues too. There is also a stress section within Heads Up that has further information and advice.
One resource you may find helpful for coping with stress is the Steps for Stress resource – including a free guide to download, and relaxation videos. But there’s plenty of additional support available on a wide range of things that might be causing you stress. Try searching for specific resources on NHS Inform or via the ALISS info database or check out the resources below.
What’s worrying you? Get support on…
Social media, the internet, and mental wellbeing
Many people are finding that social media and the internet can be very beneficial in supporting mental health and wellbeing, but it’s important to find the most positive ways to use these technologies safely and avoid the pitfalls. Our colleagues at Outside the Box Development Services have been working with people who have experienced mental health problems to develop some guidance on getting the best out of the internet.
Here’s some background from Outside the Box:
“For many of us using the internet has become an essential part of everyday life. Sometimes it’s hard to remember how we did things without it. From finding recipes to booking holidays, the internet can make a lot of things simpler. Over time a range of internet services have been developed for people with mental health problems, including online community forums and places for advice and support.
“There are other ways we can use the internet to keep well, such as staying in touch with friends and family through social media. Sometimes we aren’t well enough to see people but we still want to chat to and feel connected to others. This can help us to feel better. However, people with poor mental health are less likely than the general population to use the internet and digital ways of communicating. They are less likely to have internet access at home.
“Outside the Box spoke to people with mental health problems to ask about the barriers that prevent them from getting online. We also heard about the benefits people get when they do have access to digital technology. We’ve used this information to put together some hints and tips about digital inclusion and mental health.
“Speaking with people also helped us to get an idea of some downsides to think about, so we’ve included a section about staying safe online. Digital inclusion is about ensuring that as many people as possible have access to and skills to use things like smart phones, tablets and computers, social media and the internet so they can participate and benefit in the new technology. We hope that many people find this resource useful.”
Mental health charity MIND has information on staying safe online and using the internet for positive mental health support.
If you are a carer, you may also find this Mind Waves piece from carers’ champion Tommy Whitelaw of interest: “When caring became too much, my blog became my pal”
Emergency
If you, or someone you know, need an immediate response call the emergency services on 999.
Confused or distressed
If you are experiencing confusing or distressing thoughts, or if people around you have expressed concern about your well being, arrange an appointment with your GP or call NHS 24 on 111.
If you, or someone you know, are currently being seen by someone from a community mental health team and require urgent attention, please contact the Out of Hours Team by the number you will have been provided with.
Support
If you just need to talk with someone, then the following organisations are here to help:
Please note: if you go to an Accident and Emergency Department (A&E) because of worries about how you are feeling or what you are experiencing, they will be able to assess your difficulties and arrange for you to see a specialist if needed. But A&E is a busy and stressful place, and you may have to wait a long time. It can be quicker to phone NHS 24 on 111, as they can arrange for you to get to the right help.
Heads Up is not continuously monitored and is not able to provide direct advice or support to those in mental health distress.
Heads Up provides advice, and information, on mental health conditions – about how you can support yourself or the people you care for, the services available for you and the range of interventions you may participate in.
Heads Up has mental health information described in British Sign Language (BSL)
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Future Care Planning Champions
A Future Care Planning Champion can be any professional who has an interest in helping us create a culture of open and honest conversations about future planning.
What is a Future Care Planning Champion responsible for?
The Future Care Planning Champion role is an opportunity to further develop your knowledge and skills. You will be able to work with the HomeFirst Programme to help create a person-centred culture. You can help us by:
- Helping colleagues understand the importance of Future Care Planning
- Signpost colleagues to useful resources
- Offer feedback to the HomeFirst Programme on behalf of your colleagues
- Collaborate with the HomeFirst Programme to produce resources
What is a Future Care Planning Champion not responsible for?
If you are a Future Care Planning Champion this does not mean that you are the only member of your team who should be completing Future Care Plans. Helping people make informed choices and feel in control of their health should be everyone’s business.
The Future Care Planning Champion is not a registered role and is not mandatory for staff.
Why become a Future Care Planning Champion?
By becoming a Future Care Planning champion you will be helping NHSGGC deliver excellent person-centred care, however it is also a great opportunity for your personal development.
Champions will be able to develop their knowledge and skills through:
- Access to Future Care Planning training and resources through the Future Care Planning Champion Hub
- Representing colleagues in feedback forums
- Helping shape training for colleagues across NHSGGC
- Opportunities to pursue quality improvement projects within teams regarding Future Care Plans
- Support from the HomeFirst Team
- Support from fellow Future Care Planning Champions
These development opportunities link to the following KSF categories:
C1 – Communication
C2 – Personal and People Development
C4 – Service Improvement
Q5 – Quality
If you would like to find out more you can download this Role Description
To become a Future Care Planning Champion please register.
Please note you will need to have permission from your Line Manager before becoming a Future Care Planning Champion.
Clinical Advisory Network
If you are a professional and have an interest in this area, you might be interested in joining our Clinical Advisory Network. This network offers comment and feedback to help us create the right resources for staff.
What tools can we use?
As health care professional we will find some planning tools more useful than other, however we should still encourage everyone to think about all the different tools.
These include:
- Future Care Plans
- Power of Attorney
- Emergency Care Plans
- Carer Support Plans
- Wills
We need to use these records as a foundation for all clinical decisions that we make. We should always try and involve the person and those that matter to them as much as possible when making treatment plans.
Future Care Planning (also known as ACP)
A Future Care Plan is one of the most important documents that we can help people with. It is a record of what matters to them and information that will be useful in making any decisions. If someone loses capacity, or we cannot discuss the situation with those that matter to them, we can use the record of discussion to help us make decisions.
Power of Attorney (POA)
If someone has a welfare Power of Attorney, and they have lost capacity, we must include the attorney in the discussions. Even if someone still has capacity it is a good idea to try and involve the attorney where possible.
Emergency Plans
If someone is admitted to hospital, or is likely to be admitted we should enquire about emergency care plans and where possible help to implement them. These emergency care plans will often identify things which people may be concerned or stressed about e.g. a family member or pet. By helping to quickly resolve issues we can make people feel less anxious.
What is a Future Care Plan?
Future Care Planning helps people to think ahead and understand their health. It helps people know how to use services better and it helps them make choices about their future care.
This is a process and should involve ongoing conversations between a person, the people that matter to them and the health care professionals involved in their care.
The decisions made during these conversations are recorded in a Future Care Plan.
The plan should include:
- a summary of discussions
- a record of the preferred actions, treatments and responses that care providers should make following a decline in health
Future Care Plans will often include information about care at the end of life. This includes where people would prefer to be cared for and their wishes about different treatments, including resuscitation. All these discussions should be had sensitively and with consideration.
How do I use a Future Care Plan to inform Care?
People’s wishes and the wishes of those that matter to them, must always be taken into account when deciding on treatment plans. By doing this you will make a plan specific to this individual and based on what is important for them.
A Future Care Plan can help us plan for where treatment should be delivered and this in turn may lead to discussions about the level of treatment which can be provided in these locations. It is important that we come to an understanding with people regarding their health goals so that we can make realistic plans.
What is the difference between a Treatment Escalation Plan (TEP) and an Future Care Plan (also known as an ACP)?
What is a TEP?
A Treatment Escalation Plan (TEP) is a document which is completed during a hospital stay (usually on admission or following a change in circumstance). This document records decisions related to escalation of treatment, and the investigations and interventions that are deemed appropriate in the event of deterioration. The aim of this process is to give clear instruction so as to avoid any unnecessary or non-beneficial interventions at the end of life.
A TEP is only valid until a the person is discharged or has died. Upon each new admission a new TEP must be completed.
What is a Future Care Plan?
A Future Care Plan (also known as an ACP) documents the goals and preferences of the person, which may include decisions about end of life care and treatment. This helps everyone make a unique treatment plan which reflects the person’s wishes and values. A Future Care Plan is a record of ongoing discussions which may evolve as circumstances change. A Future Care Plan may be used in acute or community settings. Anyone may have a Future Care Plan and the document is valid at all times.
A Future Care Plan may inform what information is recorded in a TEP (review the Portal Future Care Plan on admission). Similarly any new discussions or decisions that are made when making the TEP should be recorded on the Portal Future Care Plan so that colleagues out-with acute setting have all the relevant information they require.
More information on TEPs is available on the NHSGGC Right Decision’s webpages.
We need to record Future Care Planning discussions and the decisions made so that everyone has an understanding of what matters to each individual and how we can best support them and those that matter to them.
Recording Relevant Information
Most services will have their own paperwork which they use to document important conversations and decisions. For instance, social work might be aware of any home care services which are used; physiotherapy may have had a conversation about what is a realistic mobility goal; the district nurse may have spoken to the person about where they would prefer to receive end of life care. As health care professionals it is your responsibility to try and ensure your colleagues in other departments know this information.
Using the Future Care Plan Summary is a good way to share this information (also known as an ACP Summary).
You do not need to complete every part of the document. If we all take responsibility for inputting the information we have gathered in our own assessments, then this will help ensure the final Future Care Plan has all the information needed.
Which documents should I use?
Key information will be recorded in lots of different places. Your department might have their own records and documentation that they use.
The people you work with may also be using different documents to record their thoughts about Future Care Planning. They might have a “My Anticipatory Care Plan” or a ReSPECT form. There are other planning tools they might have used as well.
We can still use all these different documents. However the most important thing is key information from all of these places is recorded in the ACP summary which is available on Clinical Portal. It is your responsibility to help summarise this information and add it to the shared document.
This will ensure that your colleagues in different departments and services can access the information they need, and will also allow you to see information that other professionals have gathered.
The Future Care Plan Summary is held on Clinical Portal. For more information see “Sharing Future Care Planning Information”.
Sharing Future Care Planning Information
It is really important that this information is shared with all health and social care partners so that any treatment plans reflect people’s wishes. The easiest way to ensure that information can be accessed by everyone who needs it is through the Key Information Summary (KIS). This is an electronic record which NHS24, the Scottish Ambulance Service and hospitals can access.
To help transfer this information quickly and easily, all HSCPs in Greater Glasgow and Clyde use an Future Care Plan Summary to record Future Care Planning decisions. This mirrors the information on the KIS so GPs can, if they wish, quickly copy information to the KIS. It can be accessed either on Clinical Portal (it will sit under “Care Plans” in the Clinical Documents), or services can use an interactive PDF.
If you have access to Clinical Portal you can fill out the summary directly on there. Clinical Portal will automatically send the Future Care Plan to the GP and they can, if they wish, transfer the information to the KIS.
If you do not have access to Clinical Portal you can fill out this interactive PDF and email or post a copy to the GP.
Remember, if any changes are to the Future Care Plan this information needs to be sent to the GP so they can update the KIS.
Guide to updating Future Care Plans on Clinical Portal (PDF)
Guide to updating Future Care Plans on Clinical Portal (Video)
Guide for GPs Updating eKIS from Future Care Plan Summary (PDF)
We need to have good conversations where we can talk openly and honestly about people’s wishes and their health goals. We also need to make sure they have all the information they need to make informed choices and understand the benefits and limitations of different treatments.
Getting Started
Good communication is the key to success. Some people will not have considered these topics before. It is important that you give them time and space to reflect before having these conversations.
It may be useful to have an introductory conversation with people and those that matter to them, explaining that you would like to have further conversations soon. You can signpost them to the information in these pages.
Raising Important Topics
These discussions are really important; however we understand that some staff members might not always feel comfortable having them. Try not to overcomplicate the matter – we can often start conversations with a simple question like ‘what matters to you?’ or ‘how would you feel if you have to go to hospital?’ and we often find that people are keen to discuss this, as are those who matter to them.
What should we DISCUSS?
We have created some resources to help you think about the different topics you could talk about as part of an Future Care Planning Conversation. They use the “DISCUSS” framework.
You may also feel like you don’t know enough about some topics to give advice to others. For example you might not feel able to answer some questions about DNRCPR, or you might be unsure of the level of support home care can give. If someone asks a question that you don’t know the answer to, be honest about this. Tell them you aren’t sure right now but you will find the information and get back to them. Talk to your colleagues to try and find out the necessary information or you can email ggc.homefirst@ggc.scot.nhs.uk
Encourage Questions – It’s Okay To Ask Campaign/BRAN Questions
During these conversations, it is important that everyone is given a chance to express their views so that we can make shared decisions. It is also important for professionals to check in with people to make sure that they understand what is being discussed and are happy with the plan.
The BRAN Questions can be a useful way to check that everyone has the information they need to make an informed choice about different treatments or plans. These are four questions that ask about the benefits, risks and alternatives of treatment, as well as what would happen if we did nothing.
B – What are the Benefits of this test or procedure?
R – What are the Risks of this test or procedure?
A – Are there any Alternatives?
N – What if I do Nothing?
BRAN also applies to clinicians! We should also ask ourselves:
B – Will this patient really Benefit from this test / procedure / hospitalisation?
R – Am I exposing this patient to Risks?
A – What Alternative options have we discussed?
N – if I were this patient, would I consider doing Nothing at this stage?
Visit the NHS Inform: It’s Ok to Ask website for more information.
Training and Skills Practice
Communication is a skill which needs practice. There are lots of different courses and resources available to help you think about how to communicate with other. Here are some of our recommendations:
Face to Face Training Courses*
Sage & Thyme Communication Training
The MAP of Behaviour Change
*Please note that some of these course may not currently be running or may have moved to a virtual platform.
Online Modules
We have created our own online e-learning module which gives you a general overview of Future Care Planning.
There are 2 Learnpro Modules we would suggest. Please note you will need to have a Learnpro account to access these.
GGC 028: Anticipatory Care Planning
GGC 053: Palliative End of Life Care
The NHSGGC Primary Care Palliative Care Team run a variety of online and face to face training, including sessions on Future Care Planning, communication skills and DNACPR.
Please note you will need to make an account.
Suggested Courses:
Changing children’s attitudes to death
Working with children pre-bereavement
Coronavirus: Communication and Difficult Conversations
Palliative and End of Life Care including Bereavement
Personalised Care and Support – Building on the Recovery Package
Supporting Carers: A Professional’s Toolkit
Please note you may need to make a TURAS account to access these resources.
Suggested Courses:
Realistic Conversations – Shared Decision Making
Developing Practice Module 2
Building a Shared Understanding
Informed about palliative and end of life care
Other Resources
EC4H (Effective Communication For Healthcare)
Difficult Conversations – Talking About Death and Dying (Video)
SPICT Tools
Delivering Bad News Video – Irish Hospice Foundation
