After 20 years as a forensic nurse, Kirsty Murray smiles when asked if she still thinks about any of her patients. There are too many to count. “It’s really fulfilling,” she says about working with offenders with mental health conditions. “When you see someone come in acutely unwell and they have a difficult journey that sometimes requires restraint, or medication to be given forcibly, the relationship can be quite tense at times. They can be quite angry at you.
“Then you work through that with somebody. You both start to think about how they can manage situations differently when they leave; how they might want to stop using illicit substances, get a bit more structure in their day, reconnect with their families,” she adds. “And then you see them being discharged, leaving the unit and saying goodbye. I think that’s a fulfilling feeling, supporting someone through their recovery journey.”
As head of nursing and quality for forensic, specialist and national services at South West London and St George’s Mental Health NHS Trust (SWLSTG), Murray oversees three medium-secure inpatient wards, a low-secure unit and a step-down facility that’ s just outside the hospital perimeter. There’s also a community outreach team, which includes a liaison and diversion service that works in the local courts and police stations, and a sexual behaviour service run by highly specialised psychologists and nurses. Forensics is just one of the specialist services SWLSTG provides – others include provision for eating disorders, obsessive compulsive disorder (OCD), national deaf services, and traumatic stress services. Forensic patients can be a complex and high-risk group to work with, says Murray, some of whom may return to prison to continue their sentence after treatment, move to lower levels of security, or start new lives in the community. But the service has very experienced multidisciplinary teams. “From a nursing perspective, it develops your nursing skills [and] it develops your therapeutic intervention skills, [by working] closely with psychiatrists, psychologists, occupational therapists, dance and music therapists, and social work colleagues,” she says.
SWLSTG is also part of the South London Mental Health and Community Partnership (SLP), an innovative collaboration with South London and Maudsley NHS Foundation Trust and Oxleas NHS Foundation Trust. It’s the first of its kind in London and aims to bring together the clinical expertise of thousands of specialist NHS staff to identify, promote and implement best practice, thereby improving patient care. “We recently had a quality summit where we all got together to celebrate and share what we’re doing well, what innovative practice our services have, what we’re struggling with, and how we can share learning across the three organisations to improve the service user experience,” says Murray. “It’s a brilliant opportunity for staff to celebrate what they are proud of and to share with others.”
Enhancing the triangulation of care – between patient, clinicians and carers – is something Daniel Ibukun, clinical pathway manager for adult specialist services – including the deaf, OCD/body dysmorphic disorder (BDD) and neuropsychiatry wards - says is an ongoing priority. The trust’s OCD and BDD service recently ran its first carer’s conference, which highlighted the support family members feel they need to help loved ones cope with the condition. It’s the UK’s only 24/7 OCD inpatient ward, with patients receiving treatment (typically comprised of cognitive behavioural therapy and medication) for four to six months for their condition, which has been ranked by the World Health Organization as one of the top 10 most disabling illnesses. “It’s about how we’re all able to work together,” Ibukun says, adding that the service has committed to running the conference again in the future. “It was a very productive and successful meeting. [It’s so important], especially for the OCD team. The patients are away for six months, and there can be anxiety now [they’re] coming home.”
Support in the community is also helping Jean Pierre Kune’s team on the National Deaf Adult Services ward minimise the need for admission before a patient reaches crisis point. The team covers the southern part of England – the other inpatient adult deaf services are in Manchester and Birmingham – and all staff (psychologists, speech language therapists, occupational therapists, and nursing associates) are trained in British Sign Language (BSL) up to level three or higher. “A lot of work has been done by the deaf adult community team to avoid unnecessary admission … advising local teams nationally where to get support and how best to communicate with that patient,” Kune says.
For those on the ward, the average length of stay can vary – particularly for complex cases such as those who are deaf and blind, or those with learning disabilities – but all will leave with a support package in place, devised by an occupational therapist and psychologist. “The journey doesn’t stop here obviously,” he adds. “It’s quite complex [but means] when they go into the community, they’re not alone.”
Working in such specialist teams may seem far removed for nurses and other staff in more traditional settings, but Murray says the most important qualities she looks for are a curiosity and passion for patient care. “[These services] offer staff the opportunity to work in bespoke, really specialist areas, and hone their skills in a way that you wouldn’t get the chance to do anywhere else,” she says. “[We’re] really receptive to that and will develop people. I think it’s a wonderful place to come and work.”
Find out more at swlstg.nhs.uk
