1. Fiona Couper and Debbie Spain Department of Mental Health
Florence Nightingale School of Nursing & Midwifery
Partnership Working
Fiona Couper and Debbie Spain
Department of Mental Health

2. Learning Outcomes By the end of this session, you will be able to
Discuss the meaning of ‘partnership working’ in mental health services
Critically examine factors that may prevent and promote partnership working
Identify implications for clinical practice
Have opportunities for reflection

3. Background
Individuals in contact with mental health services typically benefit from involvement with more than one health professional and more than one agency
Partnership working: “any situation in which people are working across organisational boundaries towards some positive end’ (Huxham and Vangen, 2005, p.4 in Tait and Shah, 2007)

4. Shared Knowledge, Skills and Values
Pulling Together (SCMH, 1997) promoted collaborative teamwork while retaining separate professions
Ten Essential Shared Capabilities (DH, 2004): broad domains of competency for all workers
Clinicians may not have full awareness of other disciplines in terms of scope of practice, values, codes of conduct and organisation

5. Group work In small groups identify the :- Benefits of team working
2. Barriers to team working

6. Ten Essential Shared Capabilities (DH, 2004)
Working in partnership
Respecting diversity
Practising ethically
Challenging inequality
Promoting recovery
Identifying people’s needs and strengths
Providing service-user centred care
Making a difference
Promoting safety and positive risk taking
Personal development and learning

7. Shared Knowledge, Skills and Values
How do members of
your team conceptualise
presenting difficulties ?
Do all professionals
share ideas about the
treatment plan ? 7

8. Some benefits of team working
holistic approach to care and support
reflects the need to offer Recovery-focused interventions
increases efficiency, reduces duplication
shared knowledge and expertise
better use of resources, value for money
improved communication and engagement
stimulates creativity
combined influence
distinct conceptualisations of symptoms / treatment
anything else ?
(e.g. DH, 2006; SCMH, 2000; Tait and Shah, 2007)

9. Factors affecting partnership working with service-users
attitudes / perceptions
nature / severity of mental health symptoms
MHA status
withholding information
relationship dynamic
unclear expectations
inconsistency
resistance
staffing levels / retention
resource constraints
(e.g. McCloughen et al, 2011; Simpson and Brennan, 2009)

10. Barriers to working with professionals
perceptions and attitudes
no common shared language
inequalities in relationship
accountability and responsibility not clear
conflict of interests / agenda
power struggles
resistance
‘a blame culture’
end points / outcomes not clearly identified
different organisational policies, priorities, IT structures
disagreements re cost
bureaucracy
reluctance to share
team dynamics
poor support mechanisms

11. Triangle of care
Service User
Professional
Carer

12. The Triangle of Care. National Mental Health Unit(2010)
This document provides a guide to the views of users, cares and professionals about best practice. Their view about what constitutes a mental health crisis can differ. Consider some one you have cared for recently and note how:-
The user described the crisis
The carer described the crisis
The Professional described the crisis

13. Barriers to inter-agency working
Five significant obstacles to inter-agency working between health and social services:
Structural
Procedural
Financial
Professional
Status and legitimacy
(Wistow and Hardy, 1991 in Holton, 2001, p.431)

14. Group work
Consider one of the five Barriers and find examples in practice.

15. Improving partnership working with service-users and their families
recognising need
being prepared to work together
listening
acknowledging service-user expertise
adopting a collaborative, goal-orientated approach
promoting open and reciprocal conversation
developing a shared understanding
facilitating self-management skills and self-efficacy
providing information in accessible formats

16. Improving partnership working with service-users and families contd.
encouraging service-user feedback
named / designated nurse / team
providing choice
evidence-based decision making
signposting to PALS and advocacy service as needed
emphasising relapse prevention techniques
using advance directives / crisis planning when appropriate

17. Working in partnership in day-to-day clinical practice
Strategies include:
clear communication: a shared language
effective leadership
making time
meetings ! (need to specify when, where, how often)
inter-agency training

18. Working in partnership in day-to-day clinical practice contd.
Strategies also include:
identification of individual strengths and resources
joint assessments
sharing of information / ideas / experience
mechanisms for providing feedback
willingness to manage change

19. Enhancing partnership working
leadership skills
negotiation skills
assertiveness
flexibility / creativity
feedback
responsiveness
trust
motivation
skills-based intervention
familiarity with policies
shared resources
clarity in aims
clinical supervision

20. Is there one thing that you could change in yourself to encourage more cohesive partnership working with others ?

21. Summary and some considerations
A need to consider a whole-systems approach to care
Service-user involvement in design, delivery and evaluation of services
Increasing emphasis on evidence-based practice – we need to develop broad systems for evaluating inter-agency interventions

22. References
Audit Commission (1998). A Fruitful Partnership: Effective Partnership Working. Audit Commission. Department of Health: NHS Modernisation Agency, NATPACT. Working separately together: A guidebook for successful partnering between organisations within the NHS. Leeds: HM Government. Department of Health (2006). From Values to Action: The Chief Nursing Officer’s Review of Mental Health Nursing. London: HM Government. Department of Health (2009). Putting People First. Working together with user-led organisations. London: HM Government. Department of Health (2011). No Health Without Mental Health. London: HM Government. National Mental Health Unit(NMHDU)(2010) The Triangle of Care. London. NMHDU Holton, M. (2001). The partnership imperative. Joint working between social services and health. Journal of Management in Medicine, 15(6), pp Involve:

23. References
McCloughen, A., Gillies, D. and O’Brien, L. (2011). Collaboration between mental consumers and nurses: Shared understandings, dissimilar experiences. International Journal of Mental Health Nursing, 20, pp Rethink. Sainsbury Centre for Mental Health (2000). Using opportunities for inter-agency partnership in Mental Health. Taking Your Partners. London: SCMH. Sainsbury Centre for Mental Health. (2004). The Ten Essential Shared Capabilities. London: Sainsbury Centre for Mental Health. Simpson, A. and Brennan, G. (2009). Working in partnership. In P Callaghan, J Playle and L Cooper (eds). Mental Health Nursing Skills. Oxford : Oxford University Press. Tait, L. and Lester, H. (2005). Encouraging user involvement in mental health services. Advances in Psychiatric Treatment, 11, pp Tait, L. and Shah, S. (2007). Partnership working: a policy with promise for mental healthcare. Advances in Psychiatric Treatment, 13, pp