QA(MH)

#1
Evening,

Was flicking through The medic magazine the other day at the TAC, where it listed the current operational deployments and it seemed to be RGN, CMT and MSO dominated for all Ops

Is there currently anything deployment wise for RMNs/RN(MH) currently or are we defunct “operationally” since the draw down of Herrick into Toral? Is our(ie regular counterparts) work all DCMH based for the foreseeable?
 
#2
Actually, RN(MH) PIDs now exist in Med Regts. The problem is that generally, with the exception of 16 Med Regt, units don't know what to do with their new MH assets.

There is also the problem of what CA(Psych) Army calls 'the Firm Base Dilemma'. Unfortunately, such is the stovepiped focus of SG/DMS/DPHC on clinical care delivery that there is little-to-no opportunity for Army RN(MH) to actually get out of their DCMHs and do any actual soldiering. I don't think it's even appreciated (or cared about) at higher formation that there is no provision for us to complete our MATTs. Generally, uniformed PHC staff belong to whichever Army unit their med centre supports (they are effectively that unit's RAP) and so they do their MATTs with their parent unit and also go on exercise with that unit. DCMHs have no such arrangement. I can arrange to do MATTs for my troops with mainstream Army units through my contacts, but as DPHC has no interest in our operational readiness, no-one is pushing us to complete them - the firm base dilemma. DPHC want our bums on seats seeing patients at all times, not scurrying off to 'play soldiers' when we have waiting lists of patients to be seen.

I don't know what the take-up will be of the RN(MH) PIDs in the Med Regts. Neither do I know how the 'guinea pigs' who fill them for the first time will get on. My gut feeling is that it will not be a good experience for them, because Med Regts have precious little understanding of, or empathy for, mental health. I spent a little while with a TA Med Sqn before I was able to 'escape' onto an FTRS contract and they had no idea whatsoever what to do with me. Fortunately, being a major, I could decline their invitation to sit in the back of a class on combat tourniquets or whatever and I spent my time trying to decipher the draft pre-hosp care CONUSE to work out exactly what they wanted a Force MH Team to do and how. Of course, as a cadre we've never had the chance to go out on exercise and try it out for real, thanks to both the firm base dilemma and the lack of support or interest from the Fd AMS.
 
#3
“My gut feeling is that it will not be a good experience for them”, let me confirm for you that it’s utter dogsh*t and that indeed they don’t know what to do with us. The regiment(V) is going to Nijmegen next year to
support the marches, I’ve already said I’m not going as it’s pointless as an RMN, I was invited to come and “drive a landy”.
I brought this up to the 2Med Corps RSM, this year, reference your entire response, which went no where. So I suggested that we as reserves go to specialist 19 day a year units “to be opened in a time of war” and that was disregarded as well.

My gut feeling is that we should have been left at R3 where we at least filled PIDs as a stores Sgt or front of house, etc. This current arrangement suits no none.
 
#4
Fortunately for me, I'm dual-qualified, so if I were still a Reservist I could go to an R3 unit in the strength of my RGN qual, but that doesn't help you guys.

All I can say is that I've been in the Forces now for thirty years (I say 'Forces' because I did eight years in the RAF...hence the username) and I know a lot of relatively senior folk who are concerned about these issues and would like to find some resolution. However, as we all know to our cost, the Green Machine moves with geological slowness in these matters and despite all the high-level focus on MH, at the coal-face there is rather less enthusiasm and more scepticism and cynicism. Myself and like minded colleagues will keep plugging away at the hierarchy so please don't think you're forgotten. Sadly, what we need is another bloody good war...so the Army can be reminded of why it needs operationally deployable MH assets.
 
#5
Well, firstly the thing that needs examined is the PIE model, the current epidemic of suicides exposes a fact that the current model from 1914/1939 whereby a service man spent on average 40days in combat over 3yrs vs the era from Vietnam onwards where they’re in combat nearly everyday is testament to this.

Secondly, the Reseve Forces much like the police, tend to recruit older entrants with a wealth of experience, knowledge and qualifications, which their rank betrays. This also needs acknowledgement, as opposed the the current “s/he’s just a lance jack what do they know” that permeates.
 
#6
Shock! Horror! You're challenging the Holy Writ of PIE!!!???

Good for you. I think it's bollocks, too, but we're somewhat hamstrung by 'evidence-based practice'... or rather the lack of an evidence base. We need some fresh doctrinal thinking. I'm shortly to complete a PhD and I have a long list of aspirations for my post-doctoral research, but mil MH doctrine is at the top.

As for the Reserves, my own experience (going back to 92-96) is that there was something quite reassuring about the 'melting pot' of TA units. I remember once going out on exercise as a lieutenant and I was in a landy being driven by a LCpl and with a full screw rad op in the back. Out in civvy street, my driver was a solicitor and my rad op was a chartered accountant, whereas I was a humble D grade staff nurse, but on exercise the socio-occupational hierarchy was reversed. At the same time, we shared our RHQ with the RMP and the captain that ran the det was a PC, whereas his SSgt was an inspector. Back in my own unit, I was OIC Clin Trg and my 2ic was a lance jack, who was an H grade clinical nurse specialist in her day job.

However unfortunately, as you rightly observe, 'big' Army doesn't appreciate any of that and defaults to (an often erroneous) assumption that rank equates to experience and capability. It's even more challenging in the multinational environment, where most NATO partners commission all their nurses and so can't understand how a UK cpl or sgt can be as qualified and competent as one of their captains or majors.
 
#8
Why are the DCMHs struggling so much? Are they being overwhelmed by referral numbers, or is it an organisational problem?
 
#9
20% increase in referrals over the last five years. Reductions to establishment, poor recruiting, no attempt at retention, emasculated CoC and subordination to primary health care.
 
#11
That's cos they're all bloody dodgy matelots, mate - can't hack it!! [/joking]

The additional feature of recent times has been the 'New Working Model', introduced by the incumbent DCA(Psych). Long story short, it's basically an attempt to turn us into a pale imitation of an NHS IAPT service. THere is no provision within it to cater for the fact that we're supposed to be operationally deployable med (MH) assets, not just khaki IAPT psychotherapists.
 
#12
I think the DCMH model of service provision is totally outdated and that this explains a lot of the problems we currently have. While they want us to be an IAPT service, we remain a Community Mental Health Team by another name, as well as a specialist Occupational Health advice/management provider. Then you can throw in bits of a Crisis Team and MH Liaison Service too. That's before you remember that any attempt at providing a separate substance misuse service went out the window years ago. You can debate the merits of separating MH and SM until the cows come home, but having one team responsible for both is virtually unique in the UK outside of a few rare and highly specialist dual-diagnosis agencies. It's also hard to ignore the fact that we are also a generic counselling and baby sitting service for the chronically acopic amongst the service population.

A DCMH needs to be all things to all men in terms of the service it offers. A passing familiarity with NHS practice will tell you that structures and delivery in MH have changed dramatically. OK, not all of it is necessarily evidence based, but quite a bit is. We are still operating a model that would have been familiar to our NHS colleagues 25 years ago. Whilst I would hesitate to recommend following the NHS wholesale, there would be benefits in looking at splitting up areas of provision e.g. here's a crazy idea, if we want an IAPT service, let's set one up. A minimum division of labour between the CMHT and IAPT functions in terms of staffing would help stop individual clinicians from being pulled in several directions at once.

I know the bottom line is probably cash, but it's got to be worth thinking about. Certainly better than the periodic adjustments to peoples' job plans that seem to be happening with greater and greater frequency and certainly don't benefit the lucky recipients...
 
#13
I think the DCMH model of service provision is totally outdated and that this explains a lot of the problems we currently have. While they want us to be an IAPT service, we remain a Community Mental Health Team by another name, as well as a specialist Occupational Health advice/management provider. Then you can throw in bits of a Crisis Team and MH Liaison Service too. That's before you remember that any attempt at providing a separate substance misuse service went out the window years ago. You can debate the merits of separating MH and SM until the cows come home, but having one team responsible for both is virtually unique in the UK outside of a few rare and highly specialist dual-diagnosis agencies. It's also hard to ignore the fact that we are also a generic counselling and baby sitting service for the chronically acopic amongst the service population.

A DCMH needs to be all things to all men in terms of the service it offers. A passing familiarity with NHS practice will tell you that structures and delivery in MH have changed dramatically. OK, not all of it is necessarily evidence based, but quite a bit is. We are still operating a model that would have been familiar to our NHS colleagues 25 years ago. Whilst I would hesitate to recommend following the NHS wholesale, there would be benefits in looking at splitting up areas of provision e.g. here's a crazy idea, if we want an IAPT service, let's set one up. A minimum division of labour between the CMHT and IAPT functions in terms of staffing would help stop individual clinicians from being pulled in several directions at once.

I know the bottom line is probably cash, but it's got to be worth thinking about. Certainly better than the periodic adjustments to peoples' job plans that seem to be happening with greater and greater frequency and certainly don't benefit the lucky recipients...
Speaking of IAPT type services, is the only uniformed clinical psychologist still in?
 
#14
I think the DCMH model of service provision is totally outdated and that this explains a lot of the problems we currently have. While they want us to be an IAPT service, we remain a Community Mental Health Team by another name, as well as a specialist Occupational Health advice/management provider. Then you can throw in bits of a Crisis Team and MH Liaison Service too. That's before you remember that any attempt at providing a separate substance misuse service went out the window years ago. You can debate the merits of separating MH and SM until the cows come home, but having one team responsible for both is virtually unique in the UK outside of a few rare and highly specialist dual-diagnosis agencies. It's also hard to ignore the fact that we are also a generic counselling and baby sitting service for the chronically acopic amongst the service population.

A DCMH needs to be all things to all men in terms of the service it offers. A passing familiarity with NHS practice will tell you that structures and delivery in MH have changed dramatically. OK, not all of it is necessarily evidence based, but quite a bit is. We are still operating a model that would have been familiar to our NHS colleagues 25 years ago. Whilst I would hesitate to recommend following the NHS wholesale, there would be benefits in looking at splitting up areas of provision e.g. here's a crazy idea, if we want an IAPT service, let's set one up. A minimum division of labour between the CMHT and IAPT functions in terms of staffing would help stop individual clinicians from being pulled in several directions at once.

I know the bottom line is probably cash, but it's got to be worth thinking about. Certainly better than the periodic adjustments to peoples' job plans that seem to be happening with greater and greater frequency and certainly don't benefit the lucky recipients...
How do our US counterparts work?
(Bar the obvious fact they are RNs that then sub specialise)

Call Me old fashioned, but I genuinely can’t see the NHS releasing me to go and work in the DCMH for 3-6mths. Which comes back to the issue at hand for R.M.N(R), what do they want us for.......
 
#16
How do our US counterparts work?
(Bar the obvious fact they are RNs that then sub specialise)

Call Me old fashioned, but I genuinely can’t see the NHS releasing me to go and work in the DCMH for 3-6mths. Which comes back to the issue at hand for R.M.N(R), what do they want us for.......
My contact with the US, and most other NATO countries armed forces, suggests that they don't use MH nurses in the same roles as the UK has traditionally. Most of them seem to go with Psychologists, Psychiatrists and (US anyway) internally trained "technicians" (not sure that's the right term though). Most US military MH nurses I've encountered have been in inpatient and firm base outpatient settings.

As to what the role and utility of reservist MH nurses is in the current day and age, it's an excellent question, well stated and deserves an answer...

Kept in reserve maybe?

BTW, does anyone know if any of the reservist Medical Units have available PIDs for RN(MH)'s?
 
#17
My contact with the US, and most other NATO countries armed forces, suggests that they don't use MH nurses in the same roles as the UK has traditionally. Most of them seem to go with Psychologists, Psychiatrists and (US anyway) internally trained "technicians" (not sure that's the right term though). Most US military MH nurses I've encountered have been in inpatient and firm base outpatient settings.

As to what the role and utility of reservist MH nurses is in the current day and age, it's an excellent question, well stated and deserves an answer...

Kept in reserve maybe?

BTW, does anyone know if any of the reservist Medical Units have available PIDs for RN(MH)'s?
Yes, some of the Med regt squadrons do. I was in Germany recently with a regular US field hospital co-located with our reserve one. They brought a CASC with them, which is basically a 45 strong self contained group of psych nurses, OT, social workers and others, inc counsellors and psychiatrists plus 2 chaplains and can deploy anywhere independently of their field hospital, which also has some psych people too, though their very much focussed on stress prevention activity.
 
#18
Yes, some of the Med regt squadrons do. I was in Germany recently with a regular US field hospital co-located with our reserve one. They brought a CASC with them, which is basically a 45 strong self contained group of psych nurses, OT, social workers and others, inc counsellors and psychiatrists plus 2 chaplains and can deploy anywhere independently of their field hospital, which also has some psych people too, though their very much focussed on stress prevention activity.
Yep, they're virtually a Field Mental Heath Hospital by another name. Given the US propensity to deploy personnel on bucketfuls of psychotropic medication, I'm not surprised they need that capability. Their FMHT equivalents generally seem to consist of a Doctor, Psychologist and a few Techs. Although to be fair, my main recent contact has been with the US Marines and their naval medical support. No idea if they have a Joint doctrine.

I'm specifically looking for a unit with an presently unfilled PID, if anyone knows of one. Any tips offs gratefully accepted.
 
#19
Yep, they're virtually a Field Mental Heath Hospital by another name. Given the US propensity to deploy personnel on bucketfuls of psychotropic medication, I'm not surprised they need that capability. Their FMHT equivalents generally seem to consist of a Doctor, Psychologist and a few Techs. Although to be fair, my main recent contact has been with the US Marines and their naval medical support. No idea if they have a Joint doctrine.

I'm specifically looking for a unit with an presently unfilled PID, if anyone knows of one. Any tips offs gratefully accepted.
Does it matter geographically?
 

Top