CMHTs and Mental Health Nursing Team

Mental Health Teams Manager

CMHTs and Mental Health Nursing Team in Primary Care- Julia Ferrari, Mental Health Teams Manager in FHSCP- Oct 2020

I am currently Integrated Mental Health Teams Manager in Falkirk. I am responsible for the integrated mental health community service for adult (18-65) and older adult (over 65). I also manage the Primary Care Mental Health Nurse Team (these are our mental health nurses that are based in GP practices across Forth Valley).

I feel incredibly privileged to have my job, I enjoy it immensely and have worked in mental health since the age of 18 so nearly 25 years.  Like most nurses I feel like I am best placed in a crisis and am comfortable when things are very challenging and difficult and require immediate decision making. The last 6 months has been some of the most challenging times we have all experienced. I feel slightly sheepish writing down my own story as I genuinely feel like ‘everyone’ has their own story and I don’t profess that mine is any more difficult but it has definitely been a personal journey which has made me think very differently about how we work as the NHS but also how I function as a leader, manger and nurse.

On March 17^th my husband Stuart tested positive for Coronavirus. When he got his results we think was the 13^th positive test in the Forth Valley area so it still felt quite new at that time. Whilst I was of course worrying about him and his health, (he had relatively mild symptoms at the time) in the back of my mind I was really concerned about not being at work due to myself and my young children having to isolate now that Stuart was positive and trying to get the systems up and running from home so that I could still run and support my services. 

After around 10 days I developed symptoms very similar to Stuart (dry throat, cough, high temp). I contacted Public Health and they advised that they would assume that I was positive and wouldn’t need a test. Mild symptoms meant I could still work at home throughout but the time at home was getting longer which was generating some anxiety that I couldn’t support my Team Leaders with so much change coming down from above.

Within this period of time I also received (and expected) letter from the Scottish Government to advise that I should shield from now on. I have Rheumatoid Arthritis and I am prescribed biological immunosuppressant medication so knew that I was likely to sit in the high risk category. I was actually devastated by this from a work perspective, mostly because I wanted to be there in the middle of the crisis, supporting the people we serve and my staff who I could see were struggling. I noticed very quickly that I felt overwhelmingly guilty about being at home – so much so that I found it really difficult to switch off from work and felt I had to do a little more than normal, so I was certainly doing more and more hours as the weeks went on.  So like many people I was trying to do my job which was feeling really challenging operationally, home school my kids and just try to keep well in the middle of it all. 

I feel as a leader my style would be transformational, I try very hard not to be transactional and very much work on the premise that we move forward quicker and stronger if we do it together.  There was a very directive command and control type way of working at this time across all organisations – which it had to be in order to keep our service users and staff safe, there was not time to sit down and debate how we might approach everything and to be too centred to particular services. It was tough but it was completely understandable and we all knew that this was the correct and in fact only way that this could be done quickly and safely. 

As I was at home many of these messages I was delivering via email or advising my Team Leaders to go and inform their teams, this was not natural for me, if I have news that’s not going to go down well I would always deliver that in person myself and I felt sad that I had to leave it to team leaders. An example of this is sending staff to be redeployed to inpatient areas in order to support the acute hospitals. Staff knew that they had to do it but it wasn’t easy and having to deliver that news from home rather to them as groups felt very foreign to me.  I also felt that my team leaders were working incredibly hard juggling demand from service users and carers, staff feeling uncertain and anxious and likely feeling their own well being suffering and again I wasn’t there to do what I would normally do to support them and walk along side them to execute whatever we need to ensure our jobs were done correctly.

I came out of shielding from the start of August 2020 and I was so please to get back to seeing some of my staff who have now mostly returned to their original roles, this is good news as the wave of mental health referrals seems to be increasing so I am glad we have all our staff back. I have listened to their reflections of the last 6 months and it’s been so interesting to hear them – those that have been redeployed have been pushed out of their comfort zone and in most cases they see that actually they have more skills than they thought, it’s made them think about other opportunities in our organisation. 

Crisis brings out the best and worst in us and I think we have all experienced every aspect of that. Mostly what I feel is proud though, proud to be a nurse and been part of this, immensely proud of my teams who have gone the extra mile to support those in need (even doing things like a collection to take to the local family centre for the staff to give to children and families that might make use of toys, clothes and non perishable food that our staff all donated). I have seen dedication, compassion between my staff to each other and to the patients and their families.  They have put up with me barking orders around the ever changing climate and me being (I think uncharacteristically) authoritative knowing that we have a job to do and we need to get on and do it so that we execute what’s expected of us safely.

 My manager Marlyn Gardner is incredibly supportive and demonstrated real and genuine care for me during this whole time, she constantly checked in and made sure I was continuing to manage to juggle everything – this made a huge difference especially as a felt a bit out of the loop at home.  As I manage services across a variety of sectors I have seen pressure points across the whole system. My primary care team have been under extreme pressure with the wave of social distress and anxiety that Covid has generated.  They  along with all the mental health services have done brilliantly well and being flexible, supportive and responding in  really person centred way to the needs of the population.

 I have to also say I am so proud of my kids Harris is 11 and Anna is 8, their resilience through this whilst I was locked in a room in front of a screen working hard to meet the need of my services – my son made me lunch nearly every day and they just stepped up knowing that I had to just get on and work. They also managed their school work really well.

Health wise things have continued to be challenging, I had what felt like a resurgence of Covid symptoms in late April, and this resulted in lung pain, shortness of breath. I have since had chest X ray, CT and ultrasound to rule out anything too concerning as it looked like there was a shadow on my lung, it seems to be improving now. My husband on the other hand 6ft 4”, very fit, healthy and active, exercises normally around 8-10 times per week has now 6 months later been hit with extreme fatigue and exhaustion. Having never had a medical certificate in his life he finally went to the GP and is trying to work through these symptoms of what look to be ‘long’ Covid. 

So this is a little but about my Covid journey as a nurse and a leader within the NHS/HSCPs, as a mum, wife and person who has shielded over this last 6 months.