Palliative Care Within Mental Health

Care and Practice

David Cooper, Jo Cooper

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781351348539
• Edition: 1
• Topic: Medizin
• Subtopic: Medizinische Theorie, Praxis & Referenz

This thought provoking and highly practical book is not just about caring for the dying within mental health, but also applying the quality care and practice of palliative care within mental health practice. Multidisciplinary in its approach, it focuses on intervention, treatment, care and practice, and the similarities in practice between palliative care and mental health. This common ground is an excellent foundation for integrating palliative care into mental health care, practice and service delivery, succinctly covering all aspects of psychological, physical, social, spiritual, sexual and emotional health. Featuring authoritative contributions from international experts, each chapter develops a theoretical framework before broadening its scope to include application in practice - addressing what, when, where and why with a definite focus on implementation in practice. Self-assessment exercises, advice for further reading, ideas for reflective practice and summaries of key points are also included, aiming above all else to improve the relationships, responses, care and practice necessary to be effective in interventions and treatment with those experiencing mental health concerns and dilemmas. Ideal for all health, social, psychological, legal and spiritual care students and professionals wanting sound theoretical and practical guidance, this book is highly recommended for General Practitioners and General Practice Registrars, healthcare assistants studying NVQ and health visitors. Educationalists, managers and service developers in health and social care will also appreciate its solution-focused, practical approach.

Chapter 1

Palliative care within mental health: the need

Jo Cooper and David B Cooper

Perhaps our human purpose is no more or less than that of providing warmth, companionship and acceptance of our fellow women and men, rather than trying to fix them.¹

Introduction

This book is about care, practice, intervention and palliative treatment within mental health services. This includes:

• ➤ person-centred practice
• ➤ relationship-based connectedness
• ➤ care and practice
• ➤ cultural dilemmas
• ➤ ethical dilemmas
• ➤ a belief in compassion, respect and dignity in care and practice
• ➤ respect for autonomy and choice
• ➤ quality of life issues
• ➤ the family as the unit of care
• ➤ the need for democratic and intra-/inter-disciplinary team work.

Palliative Care within Mental Health: care and practice offers an in-depth text to enhance the concepts offered in the first book Palliative Care within Mental Health: principles and philosophy. This edition is about the care and practice skills needed for us to be competent to address intervention and treatment in our work environment. Each chapter develops a theoretical and practical framework, and broadens to include application in care practice. Throughout, we adopt a person-centred approach. Both books anticipate that the reader will be able to follow the reasoning for palliative care, within her or his practice, from concept to application.

In this book we develop further the ‘What, When, Where and Why’. Overriding to the text is the ‘How’ in care and practice. Consequently, each chapter moves from informing to implementation - the ‘how to’. The aim is to improve, above all else, the relationships, responses, compassion, care and practice necessary to be an effective professional in offering interventions and treatment for those experiencing mental health problems. The emphasis throughout is on the individual and the family, compassion and the appreciation of the stigma such problems bring to the individual.

For the individual and family experiencing serious and enduring mental health, life presents many problems. The needs are complex and all-encompassing. For the professional, educator, researcher, manager and service providers/developers, this presents multifaceted challenges. To successfully, and innovatively, deliver interventions, treatment, care and practice responses and comprehensive services, professionals need to continually explore, and update knowledge and skills. Palliative Care within Mental Health: care and practice provides discussion and dissemination around the subject of palliative care within mental health. The book does not separate or address ‘mental health’ or ‘palliative care’ as individual subjects. Such concerns relate not only to the individual and family but also to the future direction of care, practice, interventions and treatment. Whilst presenting a balanced view of what is best practice today, we aim to challenge concepts and stimulate debate, exploring all aspects of the development of palliative care and practice within mental health and develop appropriate responses incorporating research-led best practice.

What is Palliative Care?

You matter because you are you. You matter to the last moment of your life, and we will do all we can to help you not only to die peacefully, but also to live until you die.²

Palliative care is widely accepted as best practice end-of-life care and is concerned with promoting and maintaining the best possible quality of life. Connecting with the person is the central focus in both palliative care and mental health disciplines. The World Health Organization defines palliative care as:

an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Affirms life and regards dying as a normal process that:

• provides relief from pain and other symptoms
• intends neither to hasten nor postpone death
• integrates psychological and spiritual aspects of care
• offers a support system to help patients to live as actively as possible until death
• offers a support system to help the family cope during the patient’ s [person’ s] illness and in their own bereavement
• uses a team approach to address the needs of patients and families, including bereavement counselling if indicated
• enhances the quality of life, and may also positively influence the course of illness
• is applicable early in the course of the illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiotherapy, and includes those investigations needed to better understand and manage distressing clinical complications.³

Every person has the right to receive high-quality palliative care whatever the ill-health problems, regardless of the course and nature of the ill-health. The principles and philosophy of palliative care can be applied to any condition, irrespective of the clinical setting (see Palliative Care within Mental health: principles and philosophy). The goal of palliative care is to meet individual need and to provide the best quality of life for the person and their family. This approach includes physical, psychological, emotional, social and spiritual health, extending into bereavement, grief and loss, which can occur before, during and after death.

The philosophy and knowledge within the mental health and palliative care disciplines can be integrated, thus providing the very highest standard of care and practice for individuals experiencing health problems.

As in mental health, palliative care relies considerably on intra-/inter-disciplinary teamwork, an integral part of the philosophy of both disciplines, providing a responsive and sustained approach to person-centred care and practice.

Respecting Life

The mandate for palliative care offers a respect for life, and accepts the inevitability of death. Therefore treatment is balanced against its inherent burdens. Supportive medical measures used in acute situations, such as the use of intravenous infusions, the taking of blood gases, recording of blood pressure, artificial feeding, etc. is responsible practice (see Chapters 3 and 13). However, when there is an acknowledgement that there is going to be no return to good health, and/or the person is diagnosed as dying, this becomes inappropriate practice, and all measures possible to ensure freedom from distressing symptoms, physical and psychological, are maintained.⁴

Good communication is a prime function and fundamental within mental health and palliative care. The essence of good communication is our ability to listen carefully to what we are being told if the person is to feel fully heard and understood (see Chapter 15). It is not only about our interpretation of the information in order to manage complex needs and symptoms. It is about ensuring that we convey, with empathy, the validity of the person and their story.

Communication is imperative with and between the families, so that they are in no doubt about what we are doing (see Chapter 6). If we are to give the person free choices, then they must be properly informed about what those choices are, and the consequences of the choices they make. The individual is facing strong feelings and emotions as a direct consequence of her or his ill-health, such as anger, sadness, fear and anxiety, and is facing existential concerns, which demand exploration and sensitive approaches in order to reduce and allay the many and varied emotions experienced. Improved awareness of palliative care is a first step toward reducing disparities in utilisation of important and useful services for persons experiencing life-changing, life-limiting ill-health. Lack of awareness may limit access to needed palliative care.⁵

Humanity in Caring

Humanity is the place where you will find someone who will enter into your suffering and never leave you there alone.⁶

The human condition encompasses the experiences of being human. Human nature refers to certain characteristics that humans have in common: as human beings, we have certain characteristics, such as empathy, compassion, aggression and fear.

Being human is about the acceptance of every human being for just being another human being, regardless of colour, religion, race or gender (see Chapter 4 and Palliative Care within Mental health: principles and philosophy Chapters 3 and 9). When caring for people who are ill, we are constantly challenged to provide support and care in a human and compassionate way. The person-centred philosophy of mental health and palliative care is based on humanness and compassion. The focus is not just on the ill-health or the complex symptoms it produces, but is actively involved in finding out the needs of the whole person. In order to carry out this level of person-centred care, we must attend to the three indivisible facets of the human condition - the mind, body and spirit of humankind.⁷

The Essence of Caring

Florence Nightingale⁸ firmly believed that the essence of nursing rested on the nurse’ s capacity to provide humane, sensitive care to the sick, which she believed would allow healing. The therapeutic relationship in mental health has its origins in the work of Peplau,⁹ who introduced her Theory of Interpersonal Relations, which focused on the human connection between the professional and individual. In today’ s healthcare environment, the human relationship is in danger of being overlooked in deference to computerised technology and financial restraints. We acknowledge the beneficial advantages of such technology - this registers the person’ s vital observations, but fails to provide information relevant to the person as a human being.¹⁰

When John was very ill, I would sit with him for hours on end. The nurses would come into the room, check the computers, which noted his pulse, breathing and blood pressure, check his drip, and take blood when needed. They were very efficient in this respect, but they never really talked to him, asked him ‘how’ he was feeling, or really talked to me. I was desperate for someone to tell me what was happening - I thought he was dying - but no one said anything only that ‘his obs [medical observations] are fine, he’ s just sleepy. They concentrated on the technology, not on John as a person with feelings; they did not see his suffering. (Anon.)

Warmth, Companionship and Acceptance

Caring for someone should be a human activity - performed as humanly as possible, one person to another, on an equal footing. We meet people at a time of emotional need. However, do we have the re...