Queen’s Nurse Kelvin founded region’s mental health crisis team
A community nurse from the region has hailed the nine-month process which led to him being named a Queen’s Nurse, describing ‘intense, fantastic, life-changing stuff’.
Kelvin Frew, 57, from NHS Dumfries & Galloway was one of just 20 nurses in Scotland awarded that title for the first time in almost 50 years at a ceremony in Edinburgh on Friday (Dec 1).
However, Kelvin was the only member of the Scotland-wide group working in mental health nursing.
Kelvin started training as a mental health nurse in 1985, but the nomination reflects his work particularly over the past 14 years building and leading a crisis team which has helped transform approaches to mental health care in the region, reduced the number of hospital admissions, and which was named Team of the Year at the NHS Dumfries and Galloway Celebrating Excellence Awards in 2013.
Proud of what the Crisis Assessment and Treatment Service (CATS) is achieving in Dumfries and Galloway, the one-time coal miner talks about how a job advert changed his life, how his daughter followed in his footsteps and now works as a Community Mental Health Nurse and is based in the same Crichton Hall building, and about the transformative impact the Queen’s Nurse honour has had on his life.
KELVIN ON BECOMING A QUEEN’S NURSE:
“The title was last given in 1969 in Scotland and then it fell away.
“It’s now been brought back by the Queen’s Nursing Institute Scotland, and among the group were a midwife, community cardiac nurses, renal nurses, district nurses, school nurses and people from BUPA and a parish nurse, a custody nurse to mention but a few..
“They were very keen to include in that a mental health nurse, and a call was put out asking health boards and others to nominate people who they felt fitted the Excellence Profile produced by the Queen’s Nursing Institute of Scotland.
“So, locally, line managers decided that I was one of the people who might perhaps fit that criteria. A number of people locally were nominated, and that went in front of a local panel and a decision was made to put myself and Hazel forward to the selection process.
“We were both delighted to then successfully navigate our way through the selection process and were accepted on the programme.”
KELVIN ON THE FIVE-DAY RESIDENTIAL COURSE A HELD IN FIFE:
“A major part of the programme was to commit to a 5 day residential programme in Balbirnie House in Markinch.
“We were pretty much locked away there for five days, with fellow Queen’s Nursing candidates and trainers. Exceptional people came in to lead master classes and we were offered inspirational talks from people in business health and politics.. It was almost like a retreat. It was looking at yourself and your values and the things that you hold dear – holding them up to scrutiny and examining them and trying to tease out what’s good about your practise, what’s good about nursing, and how can you use that to influence other people and to make a difference to the communities of Scotland
“The whole ethos of Queen’s Nursing is about being able to contribute to a thriving Scotland, so targeting communities – it’s very much about communities. In particular those parts of communities that are perhaps more difficult to reach.
“So we have got to demonstrate that we’ve got a commitment to the communities of Scotland, and to the welfare and wellbeing of the people living in those communities.
“It was intense but fantastic. Life-changing stuff. Really powerful stuff.”
KELVIN ON THE CHALLENGING APPROACH OF THE FIVE DAY COURSE:
“A lot of it was about having the courage of your convictions and being able to stand up for what you know is right, even if there is someone saying, ‘No, we’ve got our doubts’.
“It’s still about having the courage of being able to say, ‘I think we need to be looking at this’, and ‘I think we need to be doing it that way’.
“It’s very compassion focused, which is stuff that really floats my boat and something that I think is missing some of the time in nursing. It’s speaking out, rather than just going with the flow. It’s accepting that sometimes you have to toe the party line and go with what’s been said, but that shouldn’t stop you from saying what you believe and what you think is right.”
KELVIN ON HOW THE CATS TEAM CAME ABOUT 14 YEARS AGO:
“Before I came into this I was a community mental health nurse working in Upper Nithsdale, and I remember as a community nurse the limitations of that job and the frustrations that I had.
“This was particularly when I reached the weekend, where I was going off duty, and I had people I was worried about and anxious about. I would sometimes admit them to hospital because I had nothing else to offer and it was too risky to leave them at home.
“The manager at the time said there was a bit of a crisis in the admission wards at that time, and we needed to get some people move out of hospital quite quickly.
“So literally on a Thursday or Friday afternoon I was asked to put together a service for that weekend, to try and help support people at home rather than in the hospital.
“So myself and two other CPNs who volunteered to jump on board decided to run this thing over the weekend and see how it went.
“It was pretty much doing the same thing as the community nurse, going out and seeing people in their own homes but just doing it at odd times, out of hours and more intensively.
“But it was quite a restricted service, and I think at that time it was till 9 pm on a Friday and then from 11 am to 6 pm on the Saturday and Sunday. And it was Dumfries town only, so we didn’t go anywhere else.
“That was relatively successful, and we were able to support people at home that otherwise would have come into hospital. The client group and their relatives quite liked that idea, and that notion.
“The Government was pushing crisis services, so I was asked then to put together a template. What would a crisis team look like? But I had no experience working within a crisis team. This was totally new territory.
“So I put together a template with help from some others, and did a bit of touring round about other parts of the UK, looking at what other folk were doing and then putting together this thing which was rejected, because it was too expensive.
“So they then went for an incremental model – starting it off small and then building it over the years.
“And so 14 years later we’re at the stage that I originally proposed. It’s now a 24-hour, seven day a week service for pretty much the whole of Dumfries and Galloway.
“And a lot of the work done with the crisis team reduced admissions to the acute wards in the old Crichton Hospital. We were able to reduce the number of beds that were available, and potentially out of that, but not just because of that, they were able to put in a bid for Midpark Hospital to be built on a much more reduced bed model.
“That’s what the team’s all about. It’s offering alternatives to hospital admission where it’s assessed as being safe to do so.”
KELVIN ON THE APPROACH OF THE CATS TEAM:
“Our ethos is very much about people taking responsibility for their own lives and us trying to help them, because ultimately that’s what life should be about. It’s about being able to make your own decisions about things and have responsibility for the decisions you make. Our job is to try and support people, even when they’re quite ill, to regain some of that responsibility and autonomy.
“Some people don’t necessarily like having to take that level of responsibility, but it’s not that they can’t and it’s good for them if they do.
“I’ve got a good bunch of folk, and a lot of experienced nurses. It’s a good team.”
KELVIN ON HOW HE FIRST BECAME A MENTAL HEALTH NURSE:
“I was born outside Falkirk and I moved down just outside Ayrshire when I was very young when my parents moved for work, so I was brought up in Auchinleck and Cumnock – mining villages.
“I left school, didn’t want to go to university, probably wasn’t capable of going to university at that time, and went down the coal mines. I was a miner, or a mining engineer, for about seven or eight years.
“I had a road to Damascus moment where I decided I needed to go and do something different, and this was it.
“I was at a bit of a low ebb, and I was standing outside a job centre in Cumnock and I saw this notice on the window saying, ‘Mental health nursing students wanted in Dumfries and Galloway,’ and I thought, ‘The very thing’.
“I had no idea what it was, but I went home to my wife and said, ‘I think I’d like to become a mental health nurse’. She’s a general nurse, and she had a full-time job at that time living in Ayrshire.
“So she took half an hour and said, ‘Okay’, and gave her up a job and she and my daughter came down, I started my training at the Crichton in 1985 and I’ve been here ever since.
“Now that daughter who was only about a year old then is now a mental health nurse, and my wife’s a nurse over at the Alexandra Unit. My daughter is a Community Mental Health Nurse in a community mental health team. She’s a fantastic nurse. She’s way better than her old man – way better.
KELVIN ON WHAT MAKES A GOOD MENTAL HEALTH NURSE:
“It’s compassion, and an understanding that sometimes people end up in a place that’s not of their choosing. Circumstances have often led them to be there, and you meet people who can behave in a really destructive, sometimes aggressive fashion – usually aggression towards themselves.
“And it’s very easy as a mental health nurse to judge people because of their behaviours and the choices they’ve made, and it’s something about walking in their shoes and understanding how did that person get to that situation in their life, because it’s not what they would have chosen?
“It’s that compassion for your fellow man, attention to detail, diligence, stamina, a sense of humour, and an understanding about people and that people don’t always choose where they end up.
“So it’s not necessarily condoning some of the things that happen, but accepting that this has an influence on people and trying to see beyond what you’re seeing in front of you and trying to get to the reasons why that person’s behaved in a certain way.
“It’s a bit like police work – like detective work. You have a set of evidence in front of you, and you try and piece that evidence together and make a formulation.
“‘What do we think is going on here?’
“What can we do to improve things, even slightly?”
KELVIN ON WORKING AS PART OF THE CRISIS, ASSESSMENT AND TREATMENT SERVICES (CATS) TEAM:
“You don’t always see people when they’re at their best. Some nurses can’t work in a crisis team. They’re excellent nurses, but it’s not for them.
“Our job is very much about taking folk who are in a lot of distress, suicidal perhaps, and helping them move from that high distress, suicidal-type of place to less distressed and not suicidal.
“They still may have problems that require further input, but that doesn’t come from us – that comes from another part of the service.
“So my guys in the team don’t always see people once they’re completely well, so that can be frustrating. They’re not seeing the outcome of the work that people are putting in, but what they’re doing is very important
“The maximum length of time we would have anybody on our books is six weeks, and usually much less than that. But during that time it can be quite intensive work.
“Without being cold and distant, it’s being able to have the professional ability to not get too emotionally caught up, because as soon as you lose that objectivity you’re not helping the patient. As soon as you can’t say to them, ‘I think you’re making a really bad decision here, let’s think this through’, then you start to collude with the bad decisions because you’ve lost the objectivity. You’re not doing your job.”
KELVIN ON HIS CURRENT WORK:
“I’ve been given the challenge of designing our new Risk Assessment Forms and doing the training for the whole organisation with other colleagues involved in that, because risk assessment’s very much what we’re all about.
“This is for staff going out assessing people. Everybody should have a risk assessment done if they’ve being assessed by anybody in Mental Health Services.
“We’ve completely redesigned the process, and I’ve been asked to take a bit of a lead in rolling that out now and continuing the training.
“Risk management is very much what the team is all about.
“I’m also very interested in the impact that the job has on nurses, and I notice that there is a high level of people struggling with burnout in psychiatric nursing, and we definitely have difficulty in terms of the demands of the job and the pressures of the job on people.
“So I’m involved in that now, through my Queen’s Nursing links, in terms of how we can address that as an organisation. How can we support our staff teams better than we’re currently doing?
“It’s at the early stages of that, and hopefully something good will come from it in terms of having a sustainable workforce.”
KELVIN ON CURRENT CHALLENGES WITHIN THE JOB:
“It’s a more difficult job for community psychiatric nurses now than when I started as a community psychiatric nurse – there’s no doubt about that.
“Situations are more complex than they were. We are now right in the middle of those survivors of childhood abuse who are now adults, and the consequences of those childhood experiences are now coming to the fore, so we have a lot of people who are in those kinds of situations, struggling to cope, so that’s very complicated.
“The substance misuse issues have become more complicated than they ever were, so you’re not just looking at someone with a mental health problem – you’re looking at someone with a mental health problem who’s tried to deal with it by using other substances, and that’s become a problem, trying to work out which is which.
“The other thing is public demand and expectations. We seem to be in a society now where everybody has to be responsible for everybody else. So if someone goes out on a Saturday night, gets drunk, and then behaves in a less than sensible fashion, that seems to come under the heading of mental health now rather than, ‘Maybe you shouldn’t have got drunk’. There tends to be an attitude that ‘someone has to take responsibility for me now’.
“So the demands of the public are enormous.”