Over three quarters of the staff in Forensics who participated in a survey on experiences of sexual violence said that they had experienced this : True or False The answer to the first question is true. As a service we were shocked and not surprised by this that it galvanised us to design a simple, effective support system for staff who have experienced sexual violence at work. . In order to provide consistent support to staff we asked for and got 26 volunteer Buddies who are trained to offer very specific emotional support and practical guidance once an incident of sexual violence has occurred.
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
Over three quarters of the staff in Forensics who participated in a survey on experiences of sexual violence said that they had experienced this : True or False The answer to the first question is true. As a service we were shocked and not surprised by this that it galvanised us to design a simple, effective support system for staff who have experienced sexual violence at work. In order to tackle such a difficult, complex and widespread issue as sexual violence we needed to take a long hard look at ourselves and the culture within Forensics. Frankly, it’s not pretty, we don’t like what we’re uncovering but the lid is off this particular can of worms and it’s not going back on any time soon. It’s not easy talking about Sexual Violence in any context and for some reason it’s even harder to do so in Forensics. The prehistoric, all-pervasive culture of ‘suck it up…….get on with it because it’s part of the job’ is in its’ death throes and is slowly being replaced with an honest, open, caring and supportive structure that wants to retain, support and invest in its staff. This has been a long time in coming. We’re determined to tackle sexual violence and the impact it has on our staff in our service, and have skull dragged this really complex, difficult, embarrassing, seldom talked about issue to the forefront of our collective work consciousness. In order to provide consistent support to staff we asked for and got 26 volunteer Buddies who are trained to offer very specific emotional support and practical guidance once an incident of sexual violence has occurred.
We have devised two support packs: one for the victim that contains an over view about the support they’ll receive, guidance and signposting information; the other pack is for the Buddy which contains very specific, detailed information relating to the support and care needs of the victim juxtaposed with the procedural needs of the service, post incident. We have an Independent Sexual Violence Advisor (ISVA) currently based within Forensics who provides support and guidance to the Buddies to ensure they can carry out this really important victim support work. What we’re doing in Forensics is ground breaking, scarily good and very exciting. We have a brilliant group of Buddies who care, are compassionate, will listen, never judge and most importantly give the victim time, options and choice. Here are some thoughts from our newly trained Buddies: ‘I think this role is really needed and will make a big difference’; ‘Absolutely fantastic – I’m so excited this is finally being addressed’; ‘This is a good service’. In future we are planning to roll this across to service users as a way of supporting service users and really change the culture!
What makes your service stand out from others? Please provide an example of this.
A lot of staff struggle with sexual violence because of where we work and the nature of the patients we work with. There may also be a perception amongst staff that the service users are rightly placed and nothing can be done to support them but also to bring out a questioning culture for sexual violence. Some of the quotes from staff and service users at the beginning of the project suggested ‘is in the right place (John Howard Centre) so they (service, police and public” wont take this seriously’ – this is not the case. Over the past 18 months or so we have been having open and honest conversations with each other and our patients about sex, sexual needs and sexual identity slowly reducing the stigma around it in our setting. We have opened up a dialogue regardless of how uncomfortable this made people feel because, ultimately, we are all human and most of us have sexual needs. It does make some people feel very uncomfortable and has sparked conversations across the service which have further developed our strategy to work with sexual needs/violence. We feel this is necessary in order to develop healthier and positive ways of managing a difficult subject. We have engendered a more open and accepting culture within our environment which is often viewed as oppressive, restrictive and an extremely tough place for staff to work and patients to live in. Our Mantra has been “if sexual violence occurs in the community would you really let it go and wouldn’t your initial reaction be to call the Police? You’re at work and doing your job, you didn’t invite or encourage this interaction, didn’t give your consent so you don’t need to put up with it. Below is an extract from our developed staff support pack which encourages victims to seek help.
You know when you’ve reached the point where you’ve had enough. It can be down to one incident or lots of small incidents comprising of comments, looks, innuendo that happen day in day out. However you got there, we can support you now. All you need to do is speak up, shout, cry, vocalise it in some way and we can give you a Buddy who will stay with you and support for as long as you need it. The support they will give you is twofold, practical and emotional. Most importantly, they will listen to you, give you time, space and not judge you. All of the Forensic Buddies have volunteered to do this role and received specific training to support staff who have experienced sexually inappropriate behaviour in our work place. We have as stepped guidance for dealing with sexual violence and we are starting to look at support for service users impacted by sexual violence. We have brought sexual violence to the consciousness of the service. We are guiding and supporting other organisations in putting systems in place for supporting patients and staff impacted by sexual violence. We have instituted MDT away mornings for the service which run monthly and are MDT which comprise of case discussions, reflective practice spaces and training on specific ward issues. We have recently as part of commissioning of the SAV project run some awareness sessions across all 17 wards within the service bringing awareness of the culture of sexual violence supporting staff to develop skills to work with victims. 26 staff have so far been trained to support others when impacted by sexual violence in the service.
How do you ensure an effective, safe, compassionate and sustainable workforce?
The SAV Group communicates a lot and meet regularly because we feel it’s very important to keep the momentum going with this as often, victims of SAV often feel isolated and alone so we work hard to stop this happening. Senior Managers at the John Howard Centre feel very passionate about this workstream and offers total support, guidance and somehow manages to simplify and get to the nub of the issues we face, thus enabling us to think and develop clear, simplified solutions. This project would not have started or gained the momentum it has and continues to do so without his vast experience, knowledge, calm judgement, risk taking, charisma, humour and compassion. We talk very openly and reflect about the many challenges we face, what’s working, what we need to develop more and have less of. We encourage victims, if they want to, and especially the Buddies to take part, add value and to feel that they are a vital component of this important work moving forward.
There is a support system comprising of regular clinical supervision, group and individual, dependant on the level of support the Buddies require, as well as signposting to community support organisations if additional support is required. Regular reflective practise sessions are also held once a month and training is ongoing to ensure that Buddies have a strong foundation on which to build and adapt the support they give to victims. As a group we are noticing a shift in our perceptions of what isn’t acceptable in terms of sexualised behaviour at work. Previously we adhered to the ‘suck it up, it’s expected in forensics and therefore part of the job’ way of working but not anymore. We have empowered staff to have the confidence to report sexually aggressive and violent behaviour, whether it’s happened to them or their colleagues and to ensure they receive, empathetic, practical, tailored support. Conversely, this is improving our care and practice for our patients in that we need to listen more, emphathise and cater to our patients’ sexual needs in a supportive, boundaried, safe way that doesn’t entail rigid, formal care planning within a clinical structure
Who is in your team?
Emma Furlong – Design lead Band 4, Claire Bingham – Lead Psychologist , Dadai Dandato – Matron , Jodie Pritchard- Matron , Luke Quane- Band 4. This is the core team and they are 26 other staff trained.
How do you work with the wider system?
In the past year we have run this project as part of the North London Forensic Consortium Learning system. We have been invited to share our learning with other organisations struggling with these issues – (oxford Health). The trust has recognised this as an important project and we have been working across the organisation raising awareness of sexual violence outside of the forensic services. We have developed a training package and have seconded a member of staff within the service in recognition of this important issue to ensure it is give enough attention. We are planning to now have a dedicated quality improvement project to ensure all the learning is captured and can be published of staff and patients experience of sexual violence.
Do you use co-production approaches?
Co-production with victims of SAV whether its staff or patients is a key factor and vital as we develop this work stream. The development of the staff support pack was a result of a survey and steering group experiences of what good support would look like. we have continued to review in practice some of the useful interventions (support) following incidents and this is in cooperated and discussed in our monthly reflective practice.
Do you share your work with others? If so, please tell us how.
We share our work through the SAV steering group for the service each month, through the lead nurses group and reducing restrictive practices (time to think strategy for the trust. We also share with the forensic quality network group through peer reviews. Over the last year we have been sharing our work to other secure services through the North London Forensic consortium. We are starting a quality Improvement project and we will be sharing our work through publication in the next year or so. We share work with the police Liaison team for the service.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
There are two ways in which we do this: each ward has a Safety Cross in addition to violence and aggression, incidents of SAV are also recorded with purple dots; and there is Datix incident recording where there is a sub section for sexually aggression + violence. Purple dot recording started in January 2018 and evidence indicates that recording of SAV incidents is now fully embedded across wards due to the increase in awareness following or campaign over the past year . We’re currently developing other methods of collecting this data which is very sensitive in nature, juxtaposed to ensuring that staff feel safe and confident to record incidents of SAV. We will be completing another survey in the service and trust to review our position and also tell stories of success and areas we need to focus on going forward.
Has your service been evaluated (by peer or academic review)?
CQC reviewed our service and recommended the work as positive work on reducing sexual violence and the open nature of our conversation to this.
How will you ensure that your service continues to deliver good mental health care?
We are in the process of sourcing funding to employ a member of staff to hold the work for the directorate and organisation. We have trained staff across the service and this is not held by management but we are ensuring they are champions on each ward,. This year we will also be sending another member of staff for the specialist sexual violence training in order to improve and sustain the gains. Added to that we have a timeline of eighteen months to complete a focused quality improvement projects with change Ideas we will implement into the system for longevity.
What aspects of your service would you share with people who want to learn from you?
The challenges of sexual violence and victim support have been widely documented recently to include “me too” movement. This includes victims having a voice, trauma and the inherent nature of mental health services shying away from discussing the issues of sex and sexual violence. The difficulties of getting the balance right when you consider the diverse nature of our service users and staff in articulating and opening up conversations around sex/sexual violence.
Additional Questions
The following questions are an opportunity for you to provide further details on how you implement positive practice in your service delivery and how you ensure your service is advancing access and equalities. Answers to these questions will not influence how your PPiMH awards application is assessed, however any responses received may contribute to the potential inclusion of your service/team as a positive practice example within published guidance developed by NCCMH and NHS England.
How many people do you see?
all staff in the service and across the trust.
How do people access the service?
Process developed for staff in service
How long do people wait to start receiving care?
n/a
How do you ensure you provide timely access?
we have trained 26 staff in the service and we will be increasing this in the next few months.
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England):
NHS England
Provided by (e.g. name of NHS trust) or your organisation: East London Foundation Trust
Population details
Brief description of population (e.g. urban, age, socioeconomic status):
Forensic services comprise of the John Howard Centre, a medium secure, inpatient, mental health hospital comprising of eleven (11) wards. Ten (10) wards are for adult males, one (1) ward is for adult females. Wolfson House is the low secure inpatient mental health hospital which comprises of 5 wards for adult males. Both units take referrals from East London boroughs: Tower Hamlets, Newham, Barking, Havering + Redbridge and Waltham Forest. The patient population comprises of multi ethnicities, varying degrees of socioeconomic status and ages range, the minimum age for admission to the Forensic service is 18 years old.
Size of population and localities covered:
Forensic services comprise of the John Howard Centre, a medium secure, inpatient, mental health hospital comprising of eleven (11) wards. Ten (10) wards are for adult males, one (1) ward is for adult females. Wolfson House is the low secure inpatient mental health hospital which comprises of 5 wards for adult males. Both units take referrals from East London boroughs: Tower Hamlets, Newham, Barking, Havering + Redbridge and Waltham Forest. The patient population comprises of multi ethnicities, varying degrees of socioeconomic status and ages range, the minimum age for admission to the Forensic service is 18 years old.
