1. .Safeguarding Adults update Protecting adults from abuse and neglect.

2. Margaret Panting (1923 to 2001) 78yrs Steven Hoskin (1967- 2007) 40 years
Steven (st austell)murdered by three people who befriended him – 27 attendances to hospital, GP’s, and minor injuries units. Failure to identify vulnerability, share information and assess decision making process. Suffered hours of abuse. Swallow lethal dose of paracetomol, was walk around on dogs lead, burnt with cigs. Police, health, housing, ASC all missed signs to help. 40 missed opportunities.
Margaret Panting (Sheffield) – lived with daughter, son-iurdered. n-law, grandsons. 49 injuries on her body; Razor blade cuts to stomach and chest, fags burns, coroner unable to count the number of bruises on her body during autopsy. Cannot find photo of margaret.
Adults need protecting from abuse and neglect.

3. Care Act 2014 From April 1st 2015. Protecting Adults will be Law.
Section 14 of the Act
No longer “vulnerable” adults definition.
New trust safeguarding adults policy to guide you through the safeguarding part of the act

4. The safeguarding duties; apply to an adult who: has needs for care and support (whether or not the local authority is meeting any of those needs) and; is experiencing, or at risk of, abuse or neglect; and as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.
Why is the word RISK significant?
Answer; could be potentially lots of people (huge numbers requiring the safeguarding duty).

5. Safeguarding (2005) - umbrella term; Empowerment - Presumption of person led decisions and informed consent. Protection - Support and representation for those in greatest need. Prevention - It is better to take action before harm occurs. Proportionality – Proportionate and least intrusive response appropriate to the risk presented. Partnership - Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. Accountability - Accountability and transparency in delivering safeguarding.
Term safeguarding has been around since The DOH of health gave a definition for safeguarding in 2011; to include six principles.
Empowerment - = these are adults we need to support them when they feel are vulnerable (in hospital). Empower them. If they have any disability making reasonable adjustments to empower them. To help maximise decision making etc.
Protection from abuse – discuss further in next slides.
Prevention – (everyday work in hospital) safe discharges, increases in packages of care, CARE – adhering to Trust values.
Proportionality- ensuring the adult is at the centre of the admission/discharge. When potentials risks are identified we support the patient with the least intrusive option. Asking them what they want/ how can we reduce the risk together – please remember they are adults.
Partnership – this is working with our multi-agency partners like the Council, health partners, housing, advocates.
Accountability – to the patient, to out Trust and to the community.

6. 10 Categories of Abuse Physical Abuse Neglect Discrimination Sexual abuse Financial abuse Psychological abuse Organisational abuse *Domestic Abuse *Modern Slavery *Self Neglect
When we think about protection; we think about protecting the patient from the above areas.
The star categories are new in the Care act.

7. Self- Neglect
Definition:
Self-neglect – this covers a wide range of behaviour; neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding that causes a risk of harm.
Cases of severe self-neglect require management of the balance between protecting the adult from self-neglect against their right to self-determination is a serious challenge. It is not unusual for people to refuse a particular form of care due to lack of insight into the need for intervention.
Examples may be:
A person sends away a home care worker who is tasked to do cleaning or prepare a meal.
A person is incontinent but is reluctant to wear pads.
A person with diabetes refuses their insulin injection.
All cases of self-neglect recognised in the acute hospital must be referred to Safeguarding Adults Team.
If you identify anyone with signs of self-neglect please alert safeguarding adults team. These can be long and complex cases and need specialist input and referrals for a multi-agency approach.

8. Responding to a Disclosure;
Ask the Adult what they want to happen?
Follow the Trust’s safeguarding flowchart.
Outcomes could be;
Ring Police.
Adult protection referral.
Increase in Package of care
Referral to Domestic violence advocate
Referral for GP or Community matron to follow up
Referral to Adult social care for social worker for assessment.
Patients can feel safe in hospital and WILL often disclose abuse and neglect.
Ask the adult what they want (when possible); I have often seen cases where abuse has been suspected and reported to Council, but no-one has spoken to the adult; the principles are different to Child protection when the patient has capacity, they must be consulted on any referral about adult protection. When the patient doesn’t want a referral and you feel they are at risk please contact the safeguarding team for advice; out of hours contact the site cos. You can also ring social worker out of hours.
The Trust flowchart will guide you decide what actions to take. 8 8 8

9. Level Level Level Level Saf Level Level Level 1 – universal services Level 2 – Case management, complaints, discharge planning. Level 3 – risk assessment, risk management, complex discharges. Level 4 – Adult Protection (referral to the Council) Level 5 – Safeguarding Adults Review (when adults die).

10. Level 4 – Adult Protection (abuse and neglect) The Role of the Alerter/Referrer.
RECOGNISE /RESPOND/REPORT
If necessary call the police (abuse and neglect is a criminal offence).
Ensure immediate safety of patient.
Preserve forensic evidence
Speak with your line manager – inform the patient – contact Trust’s safeguarding adults team.
Hand write a report
Sometimes difficult to recognise abuse; please listen to your instincts if something doesn’t feel right; contact the safeguarding adults team to discuss if at weekend your line manager or site co’s.
It is important to discuss your concerns with the adult. If the adult has capacity to understand the concerns you must speak to them.
Adult Protection must involve the adult and they must be at the centre of any referral to the Council to investigate Adult Protection.
If the patient lacks capacity (and you are unable to seek permission for a referral) when possible please speak with family (but be cautious if they are the alleged perpetrator). 10 10

11. This leads into the mulit agency alert procedure located at Adult Care and Support. 11 11

12. Adult Protection referrals against the Trust
Adult Protection referrals against the Trust. * Poor discharges, no discharge information, no communication with those looking after the patient post discharge, and they are unable to communicate for themselves. * Not giving prescribed medication while an inpatient – patient here for 20 hours. *Patient sent home without recommencing Package of Care Protection from abuse and neglect
Patients came to harm.

13. Organisational Abuse
Mid Staffordshire hospital – public enquiry into the abuse at an acute general hospital.
There was a failure;
Focus on quality
Failure to listen to patients
Failure of the role of the regulator.
In our safeguarding role we have 2 responsibilities. 1. Support the person if we there is abuse and neglect and 2. preventing harm to the patient from our own organisation.
Robert Francis lead public enquiry into the abuse of patient at the acute hospital in mid staffs.
Patient’s were drinking water from flowers vases. 13 13 13

14. Organisational Abuse continued
Mid Staffordshire hospital – public enquiry of the abuse in the acute general hospital.
Although, no specific reference to safeguarding; safeguards have been instigated to prevent another mid staffs.
Francis emphasises the importance of Candour, Openness and Transparency for hospitals.
Focus on listening to patients.
CQC have improved their inspections, so there is focus on Quality.
Raising Awareness in the Public Interest policy.
Raising awareness in the public interest; if the inspections and candour are not working consider the raising awareness in public interest policy (on the document library. 14 14 14

15. Safeguarding Adults Named Nurse
Zoe Cooper – Bleep 3048
Monday to Friday. Site coordinators offer out of office advice, along with your line managers.

16. Email. Learning.disabilities@cornwall.nhs.uk
Learning Disabilities and Autism
Acute Liaison Nurses for Learning Disabilities and / or Autism.
Daniella Rubio-Mayer
Bleep 3054
Tristan Coombe
Bleep 3095
Jane Rees
Bleep 3053
All patients with a Learning Disability or Autism must be referred to the Team.
They safeguard patients in hospital – thinking about the definition of safeguarding, the empower the patient by making reasonable adjustments to care. Appointments, easy read information, enhancing communication. .
For Out of hours leave referrals on answer phone the clinical site co-ordinators.

17. Mental Health and Mental Capacity
For support, advice and information with regards to patients with a diagnosed or suspected mental illness or concerns with regard to a patients mental capacity contact:
Lerryn Hogg - Specialist Nurse for Mental Health and Wellbeing and Mental Capacity Via: Ext 2446 or Mobile
Lerryn Hogg, specialist nurse for mental health and wellbeing – also trust lead for Mental Capacity. Based in the Safeguarding adults team and available 8 – 4, 4 days per week (not available on Wednesdays). When Lerryn is unavailable contact Zoe McLean, psychiatric liaison (for mental health concerns only) or the clinical site-coordinators.
For deliberate self harm, mental health assessments or urgent mental health concerns contact the Psychiatric Liaison Team via: Bodmin Hospital Switchboard Ext For out of hours support contact the Clinical Site Co-ordinators via Switchboard.

18. Independent Domestic Violence Advocate (IDVA)
The IDVA is based at RCHT
in the safeguarding adults team
Anna Onslow
Out of Hours leave a message or contact
REACH on:
IDVAs-Independent Domestic Violence Advocates- based on the Treliske Site working primarily in the Emergency Department and Maternity Services but happy to take referrals for patients and any staff member who may be subjected to Domestic Abuse
There names are:
Anna Onslow
They are available and on-site 9am-5pm Monday to Friday & are contactable via their mobiles through RCHT Switchboard
Out of hours messages can be left for either of their mobiles via switchboard and they will respond ASAP

19. Confidentiality
Be sensitive to the views and experiences of others – Challenge the opinion not the person
Any personal issues around this subject please contact us after the session – or use following contact number/links;
REACH Project –
Ground Rules
**HEALTH WARNING – SOME CASES/ISSUES DISCUSSED MAY CAUSE OR TRIGGER DISTRESS – PLEASE FEEL FREE TO LEAVE THE ROOM AND TAKE A BREATHER IF NEEDED, OR CONTACT THE SERVICE IN CONFIDENCE FOLLOWING THE SESSION**

20. Definition of Domestic Abuse
“Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass, but is not limited to, the following types of abuse:
psychological
physical
sexual
financial
Emotional
New Government Definition 2013
**AGE IN DEFINITION USED TO BE 18 OR OVER – NOW 16 – SO TO ADDRESS NEEDS OF ABUSED YOUNG PEOPLE. IDVA SERVICE HAS RECENTLY APPOINTED A SPECIALLY TRAINED YOUNG PERSONS IDVA TO WORK WITH THOSE BETWEEN THE AGES OF – NORMAL PROCEDURES FOR CHILD SAFEGUARDING ISSUES WOULD STILL BE FOLLOWED.**
**DEFINITION NOW RECOGNISES COOERCIVE CONTROL – A term developed to help us understand DA as more than just physical - It is a pattern of behaviour which seeks to take away the victim's liberty or freedom, to strip away their sense of self. i.e – Isolation, intimidation, threats etc. **
**THE VAST MAJORITY OF DOMESTIC ABUSE IS COMMITTED AGAINST WOMEN BY MEN, BUT MEN DO SUFFER ASWELL AND OUR SERVICE RECOGNISES THAT, AND IS OPEN TO TAKING REFERRALS FOR MEN AS WELL AS WOMEN**

21. “Central to the capability required of all NHS staff is the ability to understand the risk factors for, and recognise the signs of, violence and abuse – not all of which are obvious. Clinicians should be more open to the possibility that violence or abuse is an underlying cause of the problems of the patient in front of them.”
[Role of NHS Taskforce Report]

22. Some Stats/facts
We know that there are 7,000 plus Domestic Violence incidents reported to the police in Cornwall each year.
We know that over 50% of Domestic Violence victims don’t report to the police.
HENCE THE NEED FOR DOMESTIC ABUSE PROFESSIONALS IN HEALTH BASED SETTINGS

23. 1 in 4 women and 1 in 6 men will experience DA in their lifetime
2 women each week are killed as a result of DV
35 – the number of times on average that a woman is assaulted before she will report to the police
A victim will present in E.D approx 30 times before they are killed
3 women a week kill themselves as a result of DA, a further 30 try to.
90% of children are in the same or next room when DA takes place.
**STATS ARE FROM WOMENS AID**
If domestic abuse is suspected then the professional has a responsibility to make a child protection referral.

24. Scenario Girl meet boyfriend at 15 years old.
She was now 18 years. IDVA met her in ED (Risk assessment).
Partner very controlling, take her to work, tell her what clothes to wear, monitor phone calls (high risk factors).
IDVA assessed young girl as high risk - She was at risk of significant harm or death.
She referred her to MARAC meeting. MARAC plan; alert on address, and IDVA remained in telephone conversation with victim at work, giving support and advice.
IDVA finally help her leave safely.

25. MARAC Multi-Agency Risk Assessment Conference
Victims referred to a MARAC are of the highest risk with the potential to sustain imminent and serious injury, or to be killed.
Monthly meetings which take place in each local area.
Currently chaired by the police.
Statutory and Voluntary agencies work together to discuss reducing risk and increasing safety for victims of DA.
The MARAC considers the HIGHEST risk cases in order to develop a coordinated safety plan.
This plan may include protection/help for any children or adults (including the perpetrator) at risk.
MARAC ALERT SYSTEM IN HOSPITAL
MARAC ALERT – ANYONE WHO HAS BEEN ON A MARAC IN THE PAST 12 MONTHS WILL SHOW UP ON HOSPITAL SYSTEM AS ‘DA MARAC ALERT’ OR ‘CALL IDVA’ – SAFEGUARDING TEAM WILL RECEIVE THIS ALERT AUTOMATICALLY WHICH WILL ALLOW IDVA TO ACT. THIS ACTION MAY CONSIST OF ADVISING STAFF ON HOW TO ASK QUESTION (SAFELY) OR SEEING THE PATIENT TO OFFER FURTHER SAFETY ADVICE/SUPPORT.

26. Thinking he/she will change Fear – afraid of repercussions/Threats
Why Don’t they leave?
Thinking he/she will change
Fear – afraid of repercussions/Threats
Don’t want to leave the family home/area/work
Don’t want to disrupt the children
Nowhere to go/Finances
Love & Attachment (Stockholm & trauma bonding)
Family/religious pressure not to leave/Shame
Believing the violence has been a ‘one off’
Previous experience of reporting/seeking help – police/social care involvement
**Case example – young woman referred to service via Emergency Dpt, presented with injuries in form of bruising to face, neck and wrists– disclosed assault by current partner – did not want to report to police for fear of repercussions from partner and stated she wanted to remain in relationship as she loved him, had been with him for many years and they had two children together. Whilst recognising risk this woman was not ready to contemplate leaving relationship – some of this was due to her own weighing up of risk – as she saw potentially more dangerous to leave, even if this meant Child protection proceedings. Patient was made aware of appropriate referrals to be made (MARU & MARAC but not adult safeguarding as this may raise risk) and agreed to work with IDVA service in safe way. LOVE, ATTACHMENT and FEAR were the biggest factors in this case. **Contemplating leaving an abusive relationship is the first step in the process and this can be a long process – sometimes over years, particularly where there has been high level control.

27. To Work effectively with victims of Domestic Abuse,
we MUST have an understanding of
why people remain in abusive
relationships or don’t seek help.
You tube link; Leslie Morgan Steiner; Why DV victims don’t leave.
Leslie is an American author who talks publicly about her experience as a domestic abuse victim/survivor – Talks about the Cycle of Abuse starting with process of grooming through love, seduction and charm – isolation, threat of violence, violence and abuse. A very good example of the psychological ‘trap’ in which victims find themselves, and how hard it is to leave an abusive relationship.

28. Safety
Never ask about domestic violence when anybody else is present – this includes partners, older children and other members of the family.
You should try and find a way of seeing the patient alone even if they insist on someone else staying with them.
Ensure privacy – make sure that you cannot be overheard.
Never advise a person to leave their partner; victims are at high risk of injury or murder when they leave a violent partner.

29. Some Possible Indicators of Domestic Abuse
Late booking/non-attendance at clinic appointments
Repeated attendances
Non-compliance with treatment regimes/early or self discharge
Minimisation of signs of violence on the body
Repeat presentation with depression, anxiety, self harm, psychosomatic symptoms
Constant presence of partner at examinations who may answer for the patient and be unwilling to leave the room
Patient is evasive or reluctant to speak in front of or disagree with her/his partner
LIST IS NOT EXHAUSTIVE

30. What risk factors can you identify?
What would you do?
What risk factors can you identify?
Health Based Scenario

31. Case Study - ‘Mary’
74 year old woman admitted to RCHT June 2013 following assault by husband - disclosed to health staff. Engaged with IDVA; Risk assessment, Safety Plan, MARAC and Adult safeguarding discussed (not ready to leave relationship). No report to police as fearful of being judged for alcohol use. On discharge from RCHT, referral into MARAC and Safeguarding Alert made – processes used to safeguard without raising risk– agreed Social worker would not alert abuser to DA disclosures but use health issues as reason for intervention with whole family. Mary re-admitted to RCHT again Mar 2014 – further disclosures of DA, fear levels increased, IDVA liaised with Social worker to ascertain patterns of continued controlling behaviour. With Marys consent IDVA, social care and partner agencies worked together to increase Mary’s confidence and find her alternative, safe, supported housing. Fear levels have decreased, minimal SAFE contact has been maintained with her family.

32. Further Training
If in your role you are required to have Child Protection level 3;
You must have Domestic Abuse, Stalking and Harassment and Honour Based Violence (DASH) awareness training - 1 day training. Please contact

33. Mental Health Awareness

34. Definition of Mental Health
“Mental health is a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.“ 2014

35. True or False?
1 in 10 adults will experience a mental health problem in any given year
1 in 10 young people will experience a mental health problem in any given year
People with mental health illnesses are usually violent and unpredictable
Discrimination against people with mental health problems has reduced significantly in recent years
FALSE:
1 in 4 people will experience a mental health problem in any given year. To put that into context the average Facebook user has 130 friends. That could be 32 people you know that might need your support right now.
The overall number of people with mental health problems has not changed significantly in recent years, but worries about things like money, jobs and benefits can make it harder for people to cope. 
Different types of mental health problem
Every seven years a survey is done in England to measure the number of people who have different types of mental health problem each year. It was last published in 2009.
TRUE:
Estimates vary, but research suggests that 20% of children have a mental health problem in any given year, and about 10% at any one time.  (Lifetime Impacts: Childhood and Adolescent Mental Health, Understanding The Lifetime Impacts, Mental Health Foundation, 2005) Rates of mental health problems among children increase as they reach adolescence. Disorders affect 10.4% of boys aged 5-10, rising to 12.8% of boys aged 11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls aged (Mental Disorder More Common In Boys, National Statistics Online, 2004)
The vast majority of people with mental illness are not violent.
People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime (Appleby, et al., 2001)
People with severe mental illnesses, schizophrenia, bipolar disorder or psychosis, are 2 ½ times more likely to be attacked, raped or mugged than the general population (Hiday, et al.,1999)
FALSE: 
9 out of 10 people with mental health problems experience stigma and discrimination
Despite attitudes about sexuality, ethnicity and other similar issues improving discrimination against people with mental health problems is still widespread. A survey carried out by Time to Change showed that almost nine out of ten people with mental health problems (87%) reported the negative impact of stigma and discrimination on their lives. 

36. Mental Health in RCHT
¼ of acute inpatients have mental health problems
Patients with a physical illness are up to 4 times more likely to develop a mental illness
Patients admitted to a acute setting have a 28% chance of also having a diagnosable psychiatric disorder
(NHS Confederation 2009)

37. Mental Health in RCHT
41% of patients admitted to a acute setting have symptoms of anxiety or depression
Treating the mental health needs of acute inpatients has a direct impact on the recovery of their physical health
Most patients who frequently re-attend the Emergency Department do so because of an untreated mental health problem
(NHS Confederation 2009)

39. What should you do? Assess for risk of suicide or harm
Listen nonjudgmentally
Give reassurance and information
Encourage appropriate professional help
Encourage self-help and other support strategies
Assess for Risk of Suicide or Harm:
When helping a person going through a mental health crisis, it is important look for signs of suicidal thoughts and behaviours and/or non-suicidal self-injury.
Some Warning Signs of Suicide Include:
Threatening to hurt or kill oneself
Seeking access to means to hurt or kill oneself
Talking or writing about death, dying or suicide
Feeling Hopeless
Acting Recklessly or engaging in risky activities
Increased use of alcohol or drugs
Withdrawing from family, friends, or society
Appearing agitated or angry
Having a dramatic change in mood
Listening Nonjudgmentally
It may seem simple, but the ability to listen and have a meaningful conversation with an individual requires skill and patience.  It is important to make an individual feel respected, accepted, and understood. Use verbal and nonverbal skills to engage in appropriate conversation – such as open body posture, comfortable eye contact and other listening strategies.
Give Reassurance and Information
It is important for individuals to recognise that mental illnesses are real, treatable illnesses from which people can and do recover.  When having a conversation with someone whom you believe may be experiencing symptoms of a mental illness, it is important to approach the conversation with respect and dignity for that individual and to not blame the individual for his or her symptoms.
Encourage Appropriate Professional Help
There are a variety of mental health and substance use professionals who can offer help when someone is in crisis or may be experiencing the signs of symptoms of a mental illness.
Types of Professionals
Doctors (primary care physicians or psychiatrists)
Social workers, counsellors, and other mental health professionals
Encourage Self-Help and Other Support Strategies
There are many ways individuals who may be experiencing symptoms of a mental illness can contribute to their own recovery and wellness.
These strategies may include:
Exercise
Relaxation and Meditation
Participating in peer support groups
Self-help books based on Cognitive Behavioural Therapy (CBT)
Engaging with family, friends, faith, and other social networks

40. Mental Health Act 1983
The Mental Health Act 1983 provides a legal framework for the detention of people who are deemed to be suffering from mental disorders.
‘Mental disorder’ means any disorder or disability of the mind
The powers within the Act are mainly used to assess and treat these disorders.
Only a small proportion of people with mental health issues will ever be detained under the Act

41. Sections of the MHA The most commonly Used sections of the MHA are:
Section 5(2): Doctors Holding Power – 72 hours
Section 136 and Section 135: Police power – 72 hours
Section 2: Admission for assessment – 28 days
Section 3: Admission for treatment – 6 months
Section 17: Leave of absence – as prescribed
Section 5(2)
Section 5(2) authorises the detention of a patient (previously informal) for a maximum of 72 hours to allow time for an application for admission under Section 2 or 3 to be made.
The power can only be used on inpatients, therefore cannot be used in outpatients or the Emergency Department
Sections 135 & 136
Section 135 allows for a police officer to use powers of entry when it is necessary to gain access to premises to remove a person who is believed to have a mental disorder and is not receiving proper care.
Section 136 allows for the removal to a place of safety of any person found in a public place who appears to a police officer to be suffering from mental disorder and to be in immediate need of care or control.
The person is deemed to be ‘arrested’ for the purposes of the Police and Criminal Evidence Act They can be detained for a maximum of 72 hours during which a prompt Mental Health Act Assessment should be arranged.
Section 2
A person can be detained for assessment under section 2 only if both the following criteria apply:
The person is suffering from a mental disorder of a nature or degree which warrants their detention in hospital for assessment (or for assessment followed by treatment) for at least a limited period; and
The person ought to be so detained in the interests of their own health or safety or with a view to the protection of others.
Section 3
A person can be detained for treatment under section 3 only if all the following criteria apply:
The person is suffering from a mental disorder of a nature or degree which makes it appropriate for them to receive medical treatment in hospital;
It is necessary for the health or safety of the person or for the protection of other persons that they should receive such treatment and it cannot be provided unless the patient is detained under this section; and
Appropriate medical treatment is available.
Section 17
Section 17 leave is prescribed by the patient’s Responsible Clinician (RC). The RC canbe prescriptive about the location, duration and conditions of the leave.
If a sectioned patient is admitted to your ward from a psychiatric ward ensure you have a ‘Leave of absence from hospital (Section 17)’ form and where possible a photocopy of the section papers. Inform the site co-ordinators, psychiatric liaison and the Mental Health and wellbeing nurse that you have a sectioned patient on your ward.

42. If you would like more support, information or bespoke training with regards to any aspect of mental health contact: Lerryn Hogg Specialist Nurse Mental Health and Wellbeing Contact: ext 2638 or Psychiatric Liaison Team Contact: ext 1300, Bodmin Hospital Switchboard Out of hours: Clinical Site Co-ordinators Contact: via Switchboard.
Lerryn Hogg, specialist nurse for mental health and wellbeing – also trust lead for Mental Capacity. Based in the Safeguarding adults team and available 8 – 4, 4 days per week (not available on Wednesdays). When Lerryn is unavailable contact Zoe Cooper, psychiatric liaison (for mental health concerns only) or the clinical site-coordinators.