Policy: Staff should be aware of current good practice principles whilst providing care and support for people with anxiety disorder. Staff should be aware that a mental health diagnosis can be stigmatising, and that people may not want to admit to this. Staff should be able to identify other sources of support, including self-help groups, support groups and other local and national resources. Staff should be aware of the principles of the Mental Capacity Act 2005 (MCA). Staff should make reference to QCS policies on the MCA which provide further information when working with people who lack mental capacity to make decisions about their care. Staff should be aware that there are different types of anxiety, and recovery is possible
Procedure: Diagnosis of anxiety is undertaken by medical practitioners. It is regarded as a common health problem, in that the symptoms of anxiety disorders may be a common experience amongst the general population. Care and support staff may be working with someone who they feel has symptoms of an anxiety disorder in which case consideration should be given to referring that person to their General Practitioner. Signs and symptoms that care and support staff should be alert to include the following signs and symptoms: • Social symptoms. The person’s GP would advise on the prescription of these medications • Crisis intervention, where there is need for urgent intervention, particularly where someone is expressing suicidal intentions, may require the involvement of Crisis Resolution and Home Treatment (CRHT) teams and access to crisis intervention can be made through referral by the person’s GP All treatments and interventions should be offered as part of a Care Planning process based on an individual’s needs. The majority of people receiving treatment for anxiety will receive this from their General Practitioner. For those whose mental health needs are complex and severe, who receive care and treatment from mental health services, this should be delivered as part of the Care Programme Approach which is the care and treatment planning framework for delivering mental health care in England. The support and interventions by care staff should be included in the overall care and treatment plan, and these staff may be invited to contribute to Care Planning meetings. The person who is the subject of the Care Plan should have their own copy. Where care staff are aware that someone is in receipt of professional mental health services, they should be aware of how the Care Plan can be accessed, and who the person’s care co-ordinator is. If not, they should contact the appropriate mental health team. The contents of a care and treatment plan should include: • Details of who the care coordinator is (mental health professional) • Identify the interventions and anticipated outcomes • The date of the next planned review • Crisis and contingency arrangements • Arrangements for care and support • Arrangements for the management of risk to the Service User and others
Crisis and contingency planning would be conducted by the person’s care co-ordinator, but care staff should be aware of these plans. A crisis plan should identify responses to crisis situations that might arise for that person, such as a worsening of their anxiety disorder that cannot be managed with usual coping strategies. A contingency plan will outline a planned course of action that should follow some breakdown or failure in the person’s Care Plan. Contact names and numbers of key professionals should form part of these plans, but a list of names and numbers on their own would not be regarded as sufficient. For crisis and contingency plans to be effective and workable, the Service User should be involved in drawing up their own plan when they are experiencing a period of wellness.
If you believe someone you are working with is at risk of harm, you should share that information with others you work with, and where appropriate, the person’s GP. Assessment and management of people at risk is a specialist area of work that should be undertaken by health professionals, but care staff and the person themselves should be able to contribute to that. Risk management should not be seen as elimination of risk. There are risks for everyone in all walks of life, and to try and eliminate them would result in a loss of independence and choice. So risk management should be seen in the context of positive risk taking. Current policy thinking in relating to people with mental health problems can be found in the Department of Health’s Best Practice in Managing Risk (2007). The Best Practice document also describes the importance of a collaborative approach to managing risk, involving the person and the whole of the care team, so that trusting relationships are developed that aid communication. The framework for the compulsory care and treatment of people with mental disorder is governed by the Mental Health Act 1983 (which was amended in 2007). The Mental Health Act Code of Practice (p.26) gives guidance on the definition of mental disorder for the purposes of the Act. The Code includes the following as examples of conditions which could fall under the definition of a mental disorder: 'Neurotic, stress-related and somatoform disorders, such as anxiety, phobic disorders, obsessive compulsive disorders, post-traumatic stress disorder and hypochondriacal disorders'. Where a person lacks capacity as a result of an impairment of, or a disturbance in the functioning of, the mind or brain, to make decisions the principles involved in making decisions for someone in their best interests are governed by the Mental Capacity Act 2005. The Mental Capacity Act 2005 also includes provision for the appointment of lasting powers of attorney, regarding financial and welfare decisions if the person should lose the mental capacity to make these decisions.