Using a one-page profile for support with mental health

An example of how the process of producing a one-page profile can help a person to open up and talk about the things that are important to them that previously they may have kept hidden.  Duncan’s team are now much better equipped to support him since learning more about his personal ambitions, values and positive traits.

Duncan's one-page profile

Duncan’s one-page profile

Written by May Lee at Certitude.

Duncan is a 38 year old Jamaican man. He currently lives at Fanon House where he has been for almost a year and a half.  Fanon House is a hostel based in Brixton where we provide support to people with mental health support needs from African and Caribbean backgrounds.

Duncan’s interests include football and socialising. In addition to this he has a passion for music and especially reggae and rap, which he finds relaxing and motivating.   He is a practising Rastafarian and his faith is very important to him.

The purpose of Duncan’s one-page profile was to share information with people who may not work directly with Duncan such as other staff or bank workers so that they would be able to provide Duncan with the best possible support and understand his mental health needs.

In producing his profile, I met with Duncan in the early mornings just before he took his medication. This is when he is most alert and in a conversational mood. To get a good all-round perspective I also spoke to people who know Duncan well – people he lives with and other team members to get their views.

Duncan’s completed one-page profile was used on a daily basis straight away. It became particularly essential for bank staff who were directed to read it and gain a better understanding of who he was and how to approach and speak to him.

Through talking with Duncan about how his one-page profile has benefited him he appears to now have a clearer focus on what he wants to do and where he wants to get to. He would like to get to a stage where he can become fully independent and move on with his life beyond Fanon House. He understands that this will require working with his support team to achieve certain mile stones which he has identified, such as getting into employment. He now seems more prepared to do this. He has also expressed his need to see his daughter who he has not seen for a long-time. Until working on his one-page profile and Duncan opening up to us, we hadn’t known that his daughter existed.

Duncan’s one-page profile has helped us to gain a better understanding of the man that he is  and has enabled us to think more holistically about him than just his mental health support needs. It has helped the way we relate to Duncan, talking about a bigger range of things and in turn the way he sees staff.

An important part of the community

An example of how a one-page profile has helped one man’s team of support workers understand what is important to him and how best to support him in a social care setting.

Barry's one-page profile

Barry’s one-page profile

Written by Sam Potter

Barry came to live with us on 16 April 2012 from the St Helens Stewart assessment unit. He had been admitted to hospital under section two of the mental health act, from another nursing home after his behaviour became aggressive and they felt unable to support him. Barry had been known on a number of occasions to attack other people he was living with and this was an area of concern for the staff team there.  When first coming here, Barry was unsettled and would often have outburst. We knew that Barry had a history of hiding medication or refusing to take it, which led to a fluctuation is his mental state.

When Barry arrived at Woodlands, staff set about getting to know him, his likes, dislikes and his social history. We worked closely with his wife to do this. Staff worked towards building a detailed picture of how Barry communicates his likes and dislikes and his escalation signs so we were able to notice his mood changes early and help him stay calm.  All of this information was recorded on Barry’s one-page profile. When Barry appeared aggressive the team used soft de-escalation techniques and nursed him in quiet areas to help him feel safe.  We worked closely with Dr Koumuravelli (Psychiatric Consultant) and Janet Parry (Community Psychiatric Nurse) to get his medication balance correct.

Initially Barry continued to behave as he had done before, often refusing to engage with support staff. However as staff got to know Barry and how best to work with him to reduce his anxiety we have seen a marked improvement – this was continually recorded on his one-page profile. It was noted by nursing staff that when Barry seemed most unsettled it appeared to be linked in with a reoccurring urine infection so we began to regularly test for this.

Barry now engages with support staff and with the correct approach and prompt will shower, shave, meet his care needs and even take part in activities. The one-page profile means that all staff learn how best to support Barry quickly and importantly that they see him as an individual with his own qualities, likes and dislikes.

Barry’s overall happiness and general demeanour is greatly improved. Barry is an important part of the community here at woodlands and we continue to work with him and his family to try and improve his quality of life.

Can one-page profiles work in mental health?

Written by Sarah Carr, independent Mental Health and Social Care knowledge Consultant www.sarahcarrassocs.co.uk

Sarah carr

Sarah Carr

When I wrote my one-page profile I was thinking specifically about mental health and prevention. I reflected on what helps and hinders me and what makes me feel safe. I think my profile is a very effective tool for self-management – sometimes I lose sight of what can affect me! Because I had complete control over what is in the profile, I represented myself in a way that is true to me – I didn’t have to use a diagnosis, explain my history or fit into a category. I communicated who I am and what I need without having to label myself. In this way profiles can help with overcoming the stigma associated with psychiatric diagnosis and can challenge self-stigma. Like many people with mental health problems, I have a negative view of myself and fairly low self-worth. Here, I was especially challenged by the part where I had to think about what people appreciate and value in me, my gifts and my strengths. Although it was a hard exercise, for me it was a form of therapy. Finding good things about yourself and committing them to writing as part of a profile to be shared so you can be understood fully can be a powerful exercise for someone with low self-worth or internalised stigma. At the moment I’m using my profile to remain aware of what keeps me safe and well (and to remind me of what people value in me!) but if I should experience a crisis again I would use the profile to communicate with mental health practitioners and as a way to aid my recovery – that is recovering my life and self.

As an independent mental health and social care knowledge consultant, my lived experience of mental distress and service-use informs my work. I really wanted to join the conversation about one-page profiles on this blog site because I believe they have the potential to address many of the difficulties that people who experience mental distress or use mental health services often encounter.

One-page profiles in a mental health crisis

If someone is using mental health services a one-page profile can be a powerful way to communicate and maintain their personhood in what can often be a dehumanising, medicalised system. For someone who finds themselves in crisis and is admitted into hospital, a profile can be a very effective way of communicating who they are and what good support looks like at a time when they might not have the capacity or opportunity to do so in any other way. Many people who have been patients in psychiatric hospitals say that they felt reduced to their symptoms or diagnosis and weren’t understood as whole people with interests, strengths, talents and preferences. We now know how detrimental this can be and clinical guidelines are in place to emphasise the person-centred, human elements of mental health support such as empathy, optimism, dignity, respect, support for self-management, emotional support, being known and having appropriate activities. A one-page profile, written by the person when they feel well, with support if needed, can be an effective way to support continuity of understanding about an individual in changing circumstances and fluctuating mental health. They could be used alongside more formal Advance Directives, which are designed so the individual gets a say over treatment and other practical decisions should they become too unwell to make decisions themselves.

In the workplace

Many workers and workplaces struggle with understanding how to recognise and address the stress that can lead to new mental health problems or a relapse of existing ones. Employers may find workplace accessibility and reasonable adjustments difficult to understand for mental health. Stigma continues to be very a difficult issue for people with mental health problems who are job seeking or in employment. But as in mental health services, the solutions are often rooted in simple things like communication and being understood as an individual. Both these aspects are addressed in a one-page profile which could help facilitate a person with a mental health problem to self-manage at work and help their manager or colleagues to be supportive in practical ways. If an individual is having problems with workplace stress or is recovering from an episode of mental distress, the ‘how to support me’ part of the one-page profile can help with implementing reasonable adjustments and ensuring accessibility. Mental health stigma can be reduced and crisis prevention promoted in the workplace if every employee has a one-page profile, designed to communicate individual strengths, preferences and needs to line managers and HR personnel.

To summarise, I think that if used well, in mental health services profiles could significantly improve the experience of users and if applied in the workplace, this simple approach could make it a much safer and more accessible place. In both cases, it’s about being known as a person and being able to communicate what’s important to you, which can help with prevention and self-management as well as getting through a crisis period.

‘My story’ – Having control in life and in death

Michael created his one-page profile to help him move from an NHS mental health facility into supported living and to help the people around him understand him as a person and not just his schizoaffective disorder.  This story shows how Michael’s one-page profile transcended its first purpose and helped to support him at the end of his life, enabling him to leave behind ‘his story’ in the way that he wanted it to be told.

Written by Nicola Thompson’s (Michael’s nurse)

Michael's one-page profile

Michael’s one-page profile

Sixty-two year old Michael is described as a man’s man, with great strength of character, someone who has pushed through many difficulties in his life, an inspiration to others and someone who never gives up. Michael was a schoolteacher for many years but resigned due to problems with his mental health. Towards the end of his life he lived in a community mental health rehabilitation scheme in Manchester.

Michael had a diagnosis of schizoaffective disorder and his physical health had slowly deteriorated as he had stage three kidney failure and excessive oedema in both his legs. Sadly Michael died within months of producing his one-page profile which then supported him and his family in his passing.

Michael created his one-page profile with the help of his key nurse so that when he attended appointments where people didn’t know him they would have a better understanding of who he was as a person rather than as a patient.  Michael was also being supported to move into sheltered accommodation and it was felt that the profile could travel with him and that important information to him would not be lost within his move.

It took Michael approximately two months to create his profile because his condition meant that he had prolonged periods where he was either too unwell or unable to work on it.  Together with his key nurse, Michael worked through the person centred thinking tools including relationship map, good day/ bad day, important to/for, communication chart and his formal NHS assessments such as the MANCAS.  The sessions always took place at his home as this is where he felt most comfortable. He also produced a story to accompany his one-page profile and his wish was that he could leave a copy for his grandchildren after he passed away as they were both too young to understand his illness and subsequent death. It was important to him that they knew what he was really like as a person.

When Michael started his journey no one knew that his one-page profile would be used to support him at the end of his life and that it would help him to communicate about his physical health as well as his mental health. In the weeks before his death it meant that the people supporting him had a greater understanding of why Michael behaved in certain ways.  It helped reduced frustration for both Michael and his support team and meant everyone was more patient with each other. Michael and others were finally able to accept things the way they were, rather than questioning them. Importantly, it enabled Michael to have better control over his life without having to continually explain the reasoning behind some of his more unusual behavior.

Michael was able to take his story and profile to hospital when he became very unwell.  Again it helped the nursing staff see Michael as a person and not just a patient.  The team was able to use the profile to see what was important to Michael and what was important for him, allowing for better communication and understanding.

Michael was a proud father and grandfather. His wife had passed away ten years earlier and this was still the source of much upset for him. Being able to express himself to his family and to leave behind a story and one-page profile that would help others feel more connected to him would have made Michael very happy – as would knowing that his story lives on and that you are reading it now.

Carrying Sandra’s voice above the noise

A powerful example of how a person living with a mental health condition can be empowered by using a one-page profile to ensure her voice is heard.

Sandra's one-page profile

Sandra’s one-page profile

Written by: Marianne Selby-Boothroyd

Forty-seven year old Sandra likes going to church, listening to instrumental Jazz music, going to college, meeting new people and spending time with her cat, Molly. She doesn’t like it when she has flashbacks, feels paranoid or when the voices in her head take over and she can’t hear her own.

Born in Lancashire, Sandra moved with her mother, brothers and sister to the Caribbean when she was three. At 13 she returned to the UK and it was whilst living in London and attending secondary school that Sandra began to feel really isolated. As a child she was described as quiet, caring and overly sensitive. She was bullied at school where she felt she was not as clever as the other children. Leaving education at just 16 to escape the bullying, Sandra went to see her GP about her problems for the first time. But instead of getting the support and understanding that she craved, Sandra was prescribed sleeping tablets for anxiety and depression.

Sandra first tried to kill herself at just 20 years old by taking an overdose of sleeping tablets, thinking “If I just go to sleep and never wake, it will all be over”. This began a cycle which lasted throughout her twenties and thirties. Sandra’s life was mapped by frequent suicide attempts and admissions to hospital mainly under section. She experienced periods of mania followed by extreme lows and would also hear voices.

In recent years Sandra was introduced to person-centred thinking tools and was supported to produce a one-page profile. The aim was to regain control over her life, find new ways to manage her mental health (other than medication) and start looking to the future again. Sandra wants to get back into paid employment. She wants to travel. Move to a bigger house. Look into fostering. Spend more time doing the things she enjoys such as writing poetry. Much like anyone else, Sandra’s hopes for the future are all about leading a happy and fulfilled life – something that she now knows is possible by clearly communicating to people how best to support her in the here and now.

Of the profile Sandra said: “It has had a big impact on my life. It is so important to me to help others through my own experience but I find it really hard to speak in public or be in large groups. Doing my profile helped me understand the kind of support I need to prepare to be with others, being able to share this information with others has meant I have gone from strength to strength – last week I spoke at a conference full of medical professionals – I got a standing ovation!”

In 2000, there was a turning point in Sandra’s life. She was allocated a black social worker. For the first time she felt listened to – particularly in relation to her cultural needs. It was her social worker who found Fanon Resource Centre and who stuck with her for the eight months that it took Sandra to build up the courage to go there.

Sandra credits her social worker and Fanon Resource Centre for not judging her on her past, instead focusing on the present and the future. Through Fanon, Sandra started to get involved in groups and even completed college courses. For the last year she has acted as an Ambassador for Southside Partnership – which has involved speaking at public events and supporting others to identify the support they need in their recovery.

Struggling with a mental health condition is incredibly hard. The one-page profile has helped Sandra to communicate who she is, what she likes, what she doesn’t like, and how best to support her. She shares it with the important people in her life, her friends, family, doctors, mental health professionals and new people that need to understand her. With this support in place, Sandra has lots of good days and fewer bad days where she feels down and is hearing voices. She is doing a lot with her life including a three year college course learning British Sign Language with the plan of becoming an interpreter.

Sandra is now at a stage where she feels she is in recovery. She is moving ever closer to fulfilling her dreams. She still hears voices. But having her own voice carried through a one-page profile means that it can never be lost in the noise.