Summary of Policy and Implementation Process

The Refocusing the Care Programme Approach Policy ^refImplementation GuidanceMainstreaming Gender and Women’s Mental Health (DH, 03) pertaining to all service users further reinforced by Refocusing the Care Programme Approach Policy and Positive Practice Guidance, Section Four Assessment and Care Planning (DH, 08) states that mental health services should acknowledge and address the links between violence and abuse and mental health and, in particular:

• After staff training, all service users should be asked routinely at assessment whether they have experienced child and/or adult abuse
• After disclosures, victims/survivors of abuse should receive sensitive and appropriate care

The policy is clearly relevant to all secondary care services linking through to primary care.

It’s not regarded as an ‘add on’ but fundamental to the delivery of mental health services and underpins many current key drivers eg suicide prevention; equality agenda; service improvement; new ways of working; Health Care Commission review of inpatient services; safeguarding children and adults; linking through to primary care (and, of course, essential to reviewing the Care Programme Approach).

Other requisite building blocks of the policy include embedding in clinical audit/governance procedures; active service user involvement; ensuring sexual safety in inpatient units; providing effective staff support and supervision; enabling staff survivors to access confidential counselling; establishing opportunities for staff to develop their clinical practice; partnership working with Social Services, the Police and the Voluntary Sector.

Pilot implementation was an opportunity to ‘test out’ the process with a robust evaluation to ensure that the learning outcomes informed the national roll-out. The outcomes of both Wave One and Wave Two were extremely positive and bode well for the national process.

The primary focus - of the pilot process and subsequent national roll-out - is child sexual abuse although routine enquiry relates to all forms of child and adult abuse; staff convey most reluctance/anxiety to address this form of abuse, not least because many have not had the training to do so.

National replication of the pilot process has two key (long term) outcomes:

That violence and abuse becomes:

• 'core business' for every mental health provider trust;
• an essential element of the pre- and post-registration training curriculum for all mental health professionals