Judy Harrison works at the sharp end of general adult psychiatry. As a consultant psychiatrist and associate director of medical education at Greater Manchester Mental Health (GMMH) NHS Foundation Trust, she’s part of a crisis team helping people who are “acutely unwell or experiencing a mental health crisis”. Without input from the team, those patients would usually be admitted to hospital.
Referrals to the team, which covers a population of 180,000 in south Manchester, come from different sources: about a quarter come through A&E, while another quarter are referred by their GP. Some are referred by the community teams, while others come directly from inpatient wards, because they are well enough to be out of hospital, but still need some support. The problems patients have are wide-ranging – about a third, says Harrison, have severe depression or anxiety, while a quarter have illnesses such as schizophrenia or bipolar disorder. Problems resulting from substance abuse are also common.
The aim of the crisis teams is to keep patients out of hospital by providing intensive support. Each team is multidisciplinary, and includes nurses, social workers, support workers and psychologists as well as psychiatrists. Involvement with patients lasts about four to six weeks, until they are well enough to be referred back to their GP or community health team. During that time, the most unwell patients are seen twice a day, to make sure that they are taking their medication, and the care also involves helping with social problems such as accommodation. Often, says Harrison, their illness has been “made worse by the fact that they’ve got no money or food, or the housing is very precarious, or they’re very isolated”.
GMMH’s general adult psychiatry service covers a large geographical area that takes in Manchester, Bolton, Trafford and Salford. As well as the six crisis teams, it has five inpatient units, four community mental health teams and four early intervention teams, which work with people who have experienced a first episode of psychosis.
The trust has recently been developing a new care pathway for people in Manchester who use its community mental health and home-based treatment teams. This enhanced community model (ECM) will bring care closer to home and make mental and physical health more integrated and joined up, with the person’s needs at the centre. “There are major benefits in creating an ECM for the people who live in our community and work in our services,” says Harrison. “Service users now have faster access to services, more personalised care and home-based treatment that is available 24 hours a day, seven days a week. Staff now have access to an identified link worker in GP practices, which improves communication between health and care specialists and the ability to provide better continuity of care, leading to improved staff satisfaction,” she adds.
Harrison, who has been with the trust in its different incarnations for 23 years, has benefited from its generous approach to flexible working. “I’ve worked part-time, flexi-time, varied my days and hours to suit my family needs, and then, when I’ve wanted to take on extra roles in the past few years, I’ve been able to really put together a programme that suits me.” These days, she is also responsible for overseeing medical education. She typically has two medical students and three doctors in training, spending time with her for some of the week, seeing patients either with her or on her behalf. “You have this constant stream of bright young people wanting to find out about what you do, and I think that helps you remain enthusiastic.”
Consultant psychiatrist Swanand Patwardhan works on a 20-bed male inpatient ward, treating the most severely ill patients – often those having their first episode of mania or psychosis, or those experiencing a relapse. Patients can be there for up to two months. It’s not an easy job, as patients often lack insight into their own illness and resist treatment – but GMMH’s “recovery-focused approach” is a big support, he says. In other trusts he’s worked at, there can be an atmosphere where the managers and doctors work in silos, which can have an impact on patient care. “At GMMH, all the medical managers and clinical leads are very approachable and flexible.” The rewards come from seeing patients recover and return to their everyday lives, he says.
Patwardhan is relatively new to the role, but one of the reasons he chose to work at GMMH, having had placements there as a trainee, is the collegial atmosphere. “From colleagues at your own level to colleagues at a managerial level, everyone is really supportive,” he says. It’s a sentiment echoed by Harrison. “The staff are just incredibly committed. Unlike other office environments, there is very little bickering or ill feeling among staff. There’s good camaraderie in the team and some amazing people who just put their hearts and souls into the job.”
As a recent joiner, Patwardhan is already benefiting from the trust’s willingness to invest in its staff’s professional development. He has been assigned a mentor for the first two years, to help him with the challenges of working on the ward and advise him about his continued professional development. “I’m only two months into the role, but they’re already looking at training me to gain new skills and apply for new roles and responsibilities. I don’t think that you get that at other trusts.”
Having enjoyed a long career with GMMH so far, Harrison still enjoys the opportunities the trust provides for remaining informed about new research. “We’ve got a very big academic and research profile, so I’ve got consultant colleagues who are senior lecturers and professors who are researching all aspects of mental health, which means that you can stay in touch relatively easily with new developments.”
Manchester isn’t the city for those who like a quiet life. It is, says Harrison, “vibrant, diverse, very interesting, with never a dull moment”. The same, she adds, could be said about the trust: “It suits people who have quite a lot of energy and want to keep up to date and be involved in training.”
