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Mental health benefits of relapse prevention model

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Thousands of people have benefited from Rami Jumnoodoo’s award-winning relapse prevention project, as Alison Whyte finds out

Jack was a heavy cannabis, cocaine and crack user who had spent years in long-stay hospital wards. Once when he was high he attacked his father with a cricket bat and as a result was admitted to a secure ward. Jack’s life was spiralling downwards when he began working with the Brent Relapse Prevention Project.

Rami Jumnoodoo, the nurse who initiated and leads the project explains: ‘Jack was in a vicious circle – while he was on drugs, he had no money for food and couldn’t get accommodation. Homeless and hungry, he was more likely to take drugs. We had to break that cycle. We started with crack cocaine.

‘Through role-play we taught him how to say no to the dealers. When he resisted, he had money to buy food. Eventually he became drug-free, and was able to get accommodation. He’s now been living independently in the community for six years doing voluntary work. He’s even given up smoking’.

Using a relapse prevention technique pioneered in the substance misuse field, Rami and his team began empowering people with severe and enduring mental health problems to manage their own conditions.

He explains: ‘We were highly frustrated by the plethora of interventions which were offered to service users and carers, but which didn’t make sense to them. Relapse prevention is all about assuming people can learn and modify their thinking, feeling and behaviour, and sustain this to keep up a healthier lifestyle.’

The judges said the work this team were doing was backed by a wealth of research and provided evidence of good outcomes.

According to Rami, most studies have shown an advantage for people who receive relapse prevention.

One study carried out by the team found that clients’ motivation, insight, assertiveness and feeling of control over their illness were all enhanced.

Rami Jumnoodoo reckons the project has had a positive impact on the lives of thousands of people. ‘I realised that the technique can be applied to a wide range of people – smokers, diabetics, people who are dependent on drugs or alcohol, so why not people with mental health problems?

‘Basically there’s a cognitive discrepancy in all self-harming activities that can be tackled,’ he says.

So how exactly is this achieved? Rami explains:

• We motivate clients to find a pathway to a more balanced lifestyle

• We help them formulate a plan to prevent relapse, evaluate their progress and maintain a supportive network - which helps them avoid alcohol, drugs or a conflict situation that might lead them to give up and end up back in hospital or prison.

• We teach them to recognise warning signals of high-risk situations and we offer ways of managing stress

• Clients begin to recognise their mood responses, understand their faulty thinking and they see how they could change.

Over a three-year period in Brent, 125 patients with complex needs have now been discharged from residential services to independent accommodation. Six people have relapsed and even they were hospitalised for only two weeks (in the past, it was not unusual for these patients to spend months in hospital).

‘Carers are involved every step of the way’

What sets this project apart is the fact that clients and their carers are in the driving seat. With support and training from the Brent Project, clients are developing the kind of services that will enable them to manage their own condition.

Rami says users achieve recovery themselves, with the help of their carers and the health and social work professionals allocated to them. Clients learn skills that will improve their health and reduce their hospital stays.

Some move into supported or independent accommodation or even get a job. They teach health and social care professionals on formal courses and make conference presentations. They help keep databases, take part in reviews, come up with ideas, write funding applications and encourage others to get involved. Carers are also invovled every step of the way.

Rami explains: ‘Users and carers receive the same five-day training programmes we run for professionals, and they do as well if not better. And they can follow this up with an 11-day accredited course’.

Patients and carers are on the steering group, developing and managing the project. They are on interview panels within the trust, they use any language skills to help others and they help to advertise the project.

Challenges and achievements

Since the project began in 1999 it hasn’t all been plain sailing. Many of the difficulties Rami encountered were around leadership and management - ‘Getting agreement within the borough and trust, finding colleagues to support and maintain the vision and the operation during highly turbulent times.

‘We had to find funding for training packages and get them accredited, integrate service users and carers into the programme, taking account of the needs of staff. It was also hard overcoming the traditional idea that nurses, service users and carers aren’t leaders or substantial partners in audits and research projects.’

There were also challenges in clinical practice and supervision – developing teaching, creating a set of expert practitioners and monitoring outcomes.

But they built up the project year on year, embedding it in the community. They appointed an expert group, a clinical lead and management, and organised education and training, audit and research, reviews and workshops.

‘It’s essential to see barriers as opportunities’

Rami has vast experience in many fields of psychiatry and psychology. He qualified both as an RGN and RMN. He has a first class degree in psychiatric nursing and a master’s in mental health interventions and is currently pursuing doctoral studies in leadership in changing service delivery in mental health services.

He believes in taking risks. ‘It’s essential to see barriers as opportunities, to take a risk by involving service users and carers on an equal footing. If you want to succeed you can’t get distracted by failures. You need to keep on learning’.

One of the judges, Donna Eldridge, assistant director of nursing at Kent and Medway NHS and Social Care Partnership Trust, says a large part of Rami’s success centred on ‘his ability to sit a service user next to a consultant doctor’.

She adds: ‘He absolutely believed in the project he was creating and achieved it by skilfully taking all health professionals along with him. His enthusiasm was truly inspiring.’

Rami Jumnoodoo has ambitious plans for the project, both nationally and internationally. ‘I want the Relapse Prevention approach to be at the centre of national policy.

‘We want to develop a service and carer-led institute that will provide training and specialist support. We want service users and carers to become accredited Relapse Prevention Practitioners, educating, treating and supervising others’.

He hopes that in the future all boroughs in the UK will have an accredited branch of the ‘RPUK Institute’ producing RP champions and expert patients.

Rami has donated his £1,000 NT Award prize money to staff working in an acute setting within the service.

He says ‘Winning this prestigious national award has inspired my whole team. All the service users and carers, the health and social care staff now have recognition for all the hard work they have done. They never stop wanting to help others in the community. The award belongs to the.’

If you have any questions about the project, email: rami.jumnoodoo@nhs.net

THE VITAL ROLE OF CLIENTS AND CARERS IN RELAPSE PREVENTION

• They are trained alongside professionals and treated as equals who can negotiate their own care

• They help to develop the services they need and play a full role in development, leadership and management

• They learn to recognise and manage high-risk situations, and say no to drugs and alcohol

• They learn to correct ‘faulty thinking’, use problem-solving skills and evaluate progress towards a healthier lifestyle

• They spend less time in hospital wards and move from residential to other services

• They build self-confidence through public speaking, presentations and taking part in interview panels.

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