Inclusion Health: A Day in the Life of a Community Mental Health Nurse

Hello, I’m Gina and I’m a Specialist Clinical Practitioner for Homeless and Rough Sleeper Team in Torbay (mental health).

The “team” actually consists of Dr Tom Scott-Gatty ST5 Psychiatry on Thursdays and me full-time. So, we are a small team, but a team nevertheless with a huge number of rough sleepers in Torbay which has one of the highest levels of rough sleepers.

I’ve been working with Dr Tom for nearly 2 years and absolutely love it. We offer outreach, in-reach, assessment, signposting, prescribing and community treatment to prevent Hospital admission.

We work really closely with colleagues from the Council and are fortunate to have the support of the local Homeless and Vulnerability Forum which is held on a weekly basis.  This is a true multi-disciplinary team with a huge range of service providers, and we all come together each week to share concerns, manage risk and identify unmet needs and formulate a treatment and support plan.

Here’s what a typical working day looks like:

9:30am – Thursday starts at the hostel with a patient who has just recommenced his anti-depressant medication; I’ve known him for a long time and I’m pleased that he has re-entered JATIS (local addictions residential provision) and is focussing on his recovery.  We increased the dose and it was great to see him doing well.

10:00am – I met a new patient at Shrublands which is our local addictions service (just up the road from the Hostel).  He has been doing really well to address his addiction and offending behaviour and now is self-motivated to explore a range of psychosocial interventions to help him regulate his emotions and address his trauma history.  I’ll be supporting a referral into secondary mental health services for him and meet him again to review his medications in around a month’s time.

An IOM Police Officer colleague popped in to collect a prescription for a person she is supporting, who I met a couple of months ago, who is struggling to settle at an address meaning he is without access to his GP and his anti-depressants which he says he help.  I handed over another FP10 for a month to give him time to register with a GP in his new area.

12:00pm – I was on my way to meet another patient at Endeavour House, which is a local community hub run by our local charity Shekinah, it’s a safe space for women on Thursdays and is a friendly and welcoming venue. Unfortunately she wasn’t able to make it today so we re-arranged. Her Complex Lives Navigator (Torbay Council) worker and I have been working together to encourage and build engagement as she is a very vulnerable woman who is on the cusp of becoming a rough sleeper and who experiences symptoms of psychosis and has a difficult relationship to help. We are slowly and gently building trust and she has agreed to try some anti-psychotic medication with a view to helping to regulate her behaviour so she can apply for a place at the Hostel.

With that I received a call from Dr Scott-Gatty to say the interpreter booked for his appointment was running late; so could I join the NIHR Screening for Gambling research team meeting, as this is something we are involved with too.

1:00pm – I was back the Hostel for an MDT for a resident there who is presenting with increasingly aggressive and intoxicated behaviour; we are implementing a multi-agency support plan for him.  A quick “hello” to one of our patients in between who lives at the Hostel before an MDT at 2:30pm as another patient who is being treated with a depot, has just been released from custody and has arrived at the Hostel. We had a check in to ensure that we all are aware of the plan and actions needed to continue to meet her needs.

3:00pm – Dr Tom and I managed to grab a quick check-in as he is away for two weeks so we discussed a few patients we are supporting that he is mostly seeing – we do share our patients and most of them know us both, but sometimes work more exclusively with one of us than the other.  Dr Tom rushed off for another couple of appointments and I took the chance to check in with the Hostel team about anyone else they are concerned about, and also to share the plan agreed for the resident who is causing some concerns.

5:45pm – I managed to leave around 5:45pm and I just had to pop back for a quick visit to a patient who is now in temporary accommodation and someone we have been supporting for the past 18 months which represents the longest time in his adult life that he has remained in the community. His life story tells a painful and sadly familiar picture of someone who left the Care system at 15 to face the world alone. Life thereafter was a painful cycle of homelessness, addiction, offending, prison or mental health admission, then back to the streets. He was excluded from the whole of the town centre and was notorious, almost like he was “public enemy number 1” – I literally had no idea that such exclusion zones and community enforcement things existed prior to this job!  His last prison release we had the support of Torbay Council to try something different, and after months of us showing up, same time each week, this brave young man found the courage to build some trust, we eventually agreed upon some mutually agreeable treatment for Schizophrenia to support his OST. The Council funded a B&B for a prolonged period and as a team of staff, from different agencies (mental health, addictions, tenancy sustainment, ASB and Probation) persisted, same time, same place each week, without fail.  Now, his mental health is good, as is his recovery from addiction. “Public Enemy No 1” is actually a very sensitive, intelligent, warm and polite young man who turns 30 tomorrow and he will be spending it with his family with whom he has reconnected after a long time – so a birthday card and some confectionary was clearly in order.  Happiest of birthdays to him.

7:00pm – I got home at 7pm but a late finish was completely worth it.

Mental Health and Inclusion Health Nurses, Let’s Connect

Gina would like to connect with other nurses in similar roles and share best practice. Please contact gina.burrows@nhs.net if you would like to connect.