‘It was a welcome chance to compare attitudes and examine each other’s role in delivering care’
We were recently offered the opportunity to present our work on simulation training for crisis mental health care at this year’s Crisis Care Concordat summit. Not only did this give us a chance to showcase the work we have been doing in North recently offered the opportunity to present our work on simulation training for crisis mental health care at this year’s Crisis Care Concordat London, but it also allowed us to hear from those engaged in similar work or interested in bringing simulation into their own setting, whether that be healthcare, police work or the third sector.
North East London Foundation Trust has been involved in creating simulations using actors to bring real-life scenarios to junior doctors for some years. The aim has always been to offer an often intimidating experience in a safe environment, to encourage compassionate and evidence-based practice. Our interest in simulation led to involvement with UCLPartners’ project ‘Breaking down the Barriers’, a key strand of which focuses on developing multi-professional, multi-disciplinary training sessions for frontline clinicians. To date, training has largely been unidisciplinary and delivered in an ad-hoc, lecture-based fashion. The idea was to develop a raft of materials that could be adapted locally to meet the needs of clinicians and match available resources.
Using our clinical experience working in A&E departments in London, we crafted a series of case-based discussions and role-play scenarios using actors. We wrote formal learning objectives for these, for the medical and nursing staff in both A&E and in Psychiatry. We then piloted across all four professional groups at two different sites, looking at the impact the sessions had on their confidence in helping people in mental health crisis.
Not only were we able to explain this process to Concordat participants, but to discuss the issues encountered. Foremost amongst these was the building of new relationships between lead mental health and A&E clinicians to allow pilots to happen. Balancing service provision with training to enhance quality and safety is not always an easy balance to strike, an issue that manifested in the cancellation of one session due to A&E staffing. However, the relationship building and problem-solving that happened amongst senior clinicians was a reflection of similar interactions during teaching sessions. A&E and mental health clinicians get no opportunity to interact with one another outside of the highly-pressured emergency situation. These sessions brought a welcome chance to discuss cases, compare attitudes and examine each other’s role in delivering care.
Presenting one of the case-based discussions which we had developed for use in the pilot training sessions demonstrated the level of complexity that clinicians face to the non-clinicians who were present. However, questions also revealed that the next challenge still looms large – how do we measure training effectiveness using patient safety and quality data? If the catalyst for us developing these resources is to improve the reportedly poor experience of those who present in mental health crisis, how will we know we are moving towards our goal? Furthermore, how can we embed this type of training into educational programmes for clinicians? Turnover of staff in these settings can be high so groups must meet frequently enough to keep frontline clinicians up-to-date and to allow relationships between disciplines and professionals to time to become established and useful. We hope to come back to the Concordat another year, a little closer to answering these vital questions.