Peer Support in the Emergency Department – Barnet, Enfield and Haringey Mental Health Trust

In April 2018 Barnet, Enfield and Haringey Mental Health Trust employed seven Peer Support Workers to work a shift system alongside the medical staff in their Mental Health Liaison Service.  Here, one of the peer support workers and one of the psychiatrists reflect on the impact they have had.

Responding to suicidal thoughts in the Emergency Department

A peer support worker’s perspective

Mr Sharif Mussa: As a Peer Worker with lived experience of having suicidal thoughts I can’t help but empathise with patients who present with suicidal ideation. From personal experience I believe that stigma plays a big role in how and when we present. Sometimes it’s the last option. I know I always presented once everything else had failed. All we need at that moment in time is to talk to someone who isn’t going to judge but listen and try to understand. Too often I have seen patients presenting with suicidal thoughts waiting for hours to be seen by a clinician. They’ve had to wait because the team is busy. Too often during this time some patients may abscond and may go unnoticed by the system.

A young woman presented in ED in the morning agitated, confrontational, teary, with very angry facial expressions and was refusing to talk to any of the clinicians. She was brought in by Ambulance with a suspected overdose and there were some concerns about her from everyone in the department. She was discussed in afternoon handover and I was assigned to go in and make first contact. When I met her, initially she didn’t want to talk to me and said she was fine, and just wanted to be alone. I introduced myself as a Peer Worker with lived experience of mental health working in the Mental Health Liaison Team and she immediately asked me if she was going to get sectioned. I told her I play no part in those types of decision, but I was there to make sure that she is heard, and the right type of help can be prescribed. I asked if it was okay to disclose about my history with mental health to see if that would help her trust, to which I could see her body language relax more and become more comfortable with our conversation. She disclosed how difficult it had been for her to get to this point in ED especially after her experience with mental health liaison services in the past. See the patient had presented in the past with the same presentation and ended up on a section order against her will, so her relationship with mental health services had become tarnished.

I went on to explain to her how things worked in our team and how the process should be to protect her and not harm her. I shared with her my negative experiences within the system and how I learnt from them. At this point she said she had something in her bag that she was afraid to share in case she ended up on a section again. I told her she shouldn’t feel bad about thinking that way as it showed that she wasn’t unaware of what’s going on and ideally wanted help just not the wrong kind of help. I advised her of the benefits of opening up against those of closing up and allowing the system to choose what’s best for her, at that point she hugged me and said that she would like for me to support her through the process of seeing the clinician. She decided to share with the clinician a suicide letter that made his decision making clearer and more informed. In light of her opening up, which was a challenge as she openly said to the nurse that she wouldn’t have opened up had she not seen me first, the nurse decided to discharge patient home with Crisis Resolution & Home Treatment Team and further psychological therapy.

During our interaction I also told her about the Wellbeing plan, a wellness tool that I had as a tool to help me cope. She expressed an interest in doing it so we did it together and at the end she said she felt a lot better and was grateful that I had taken time out to do it with her.

Through mutual respect and sharing lived experience I was able to allow someone else to feel like they were being listened to and that they are human, which as a result allowed them to trust and open up about why they were behaving the way they were. I fell in love with my job that day. Not only did it help me do my job but sharing my experience with mental health and my role as a Peer Worker with lived experience of mental health actually made it a better experience for the patient. By sharing and allowing myself to be vulnerable I allowed the patient to trust, feel listened to and understood.

It’s not always easy for clinicians to have that much time to spend with complex patients in a busy ED but my role as a Peer Worker allows me to.

A psychiatrist’s perspective

Dr Susie Lingwood: I work as a Psychiatrist in the Mental Health Liaison Team at the North Middlesex University Hospital. I have worked in this team for 5 years and in mental health services for 16 years. Over time my approach to talking to people presenting in mental health crisis has changed a lot. Several things have influenced my practice over the years, but the past 6 months have been hugely useful in terms of growth. I have been able to access training which has really made me think about the power of truly connecting with people, and I have worked with Peer Support Workers who have helped me do this. The barriers that exist between patients and clinicians can exist for many reasons, but one of these is fear. Fear drives us to become distant; to defend ourselves from the reality that suicidal thoughts could affect us too given the wrong circumstances; and to focus on categorising risk or referrals to other mental health services rather than engaging with hopelessness, staying with difficulties and supporting approaches like Safety Planning. I feel inspired every day I work with Peer Support Workers who share their lived experience and overcome fear to help others. I know that our services for people who self-harm or experience suicidal thoughts are better as a result of the reminder that embracing our own vulnerability helps us to do better work.

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