Jack was a heavy cannabis and crack-cocaine user who had spent years in long-stay hospital wards. Once, while on drugs, 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 relapse prevention project in the London borough of Brent. 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 got accommodation. He’s now been living independently in the community for six years doing voluntary work.’
Using a relapse prevention technique pioneered in the substance-misuse field, Mr Jumnoodoo and his team began empowering people who had severe and enduring mental health problems to manage their own conditions. ‘We were frustrated by the plethora of interventions that were offered to service users and carers but which didn’t make sense to them,’ he says.
‘Relapse prevention is all about assuming that people can learn and modify their thinking, feeling and behaviour, and can sustain this to keep up a healthier lifestyle.’
The NT Awards judges said the work was backed by a wealth of research and gave evidence of good outcomes. Mr Jumnoodoo says most studies have shown the benefits of relapse prevention, and one by his team found clients’ motivation and feelings of control over their illnesses were enhanced.
Mr Jumnoodoo believes the project has had a positive impact on the lives of thousands. ‘I realised that the technique can be applied to a wide range of people – smokers, diabetics, people 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? ‘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. This 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 offer ways of managing stress. They begin to recognise their mood responses, understand their faulty thinking and see how they could change.’
Over a three-year period in Brent, 125 patients with complex needs have been discharged from residential services to independent accommodation. Six have relapsed and even they were hospitalised for only two weeks (in the past, these patients may have spent months in hospital).
What sets this project apart is that clients and their carers are in the driving seat. With support and training, clients are developing services that will enable them to manage their own conditions. Mr Jumnoodoo 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 find 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 participate.
Carers are also involved every step of the way. ‘Users and carers receive the same five-day training programmes we run for professionals,’ says Mr Jumnoodoo. ‘And they can follow this up with an 11-day accredited course.’
Clients and carers are on the steering group, they sit on interview panels in the trust and assist in advertising the project.
Since it began in 1999, it hasn’t all been plain sailing. Difficulties Mr Jumnoodoo faced included ‘getting agreement within the borough and trust, and finding colleagues to support and maintain the vision. We had to find funding for training packages and get them accredited, and integrate service users and carers into the programme, taking account of staff needs. It was also hard overcoming the idea that nurses, service users and carers aren’t leaders or substantial partners in audits and research projects’.
There were also challenges in developing teaching, creating expert practitioners and monitoring outcomes. But they built up the project year on year, embedding it into the community. They appointed an expert group, a clinical lead and management, and organised education and training, audit and research, reviews and workshops.
Mr Jumnoodoo has vast experience in the fields of psychiatry and psychology. He qualified both as an RGN and RMN, has a first-class degree in psychiatric nursing and a master’s in mental health interventions, and is now pursuing doctoral studies.
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,’ he says.
One of the award judges, Donna Eldridge, assistant director of nursing at Kent and Medway NHS and Social Care Partnership Trust, says much of Mr Jumnoodoo’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.’
Mr Jumnoodoo has ambitious plans. ‘We want relapse prevention to be at the centre of national policy, and to develop a service and carer-led institute to provide training and support. We want service users and carers to become accredited relapse prevention practitioners who will be educating, treating and supervising others.’
Mr Jumnoodoo has given his £1,000 prize money to staff in an acute setting within the service. ‘Winning this prestigious national award has inspired my whole team. All the service users and carers, and the health and social care staff, now have recognition for all their hard work. They never stop wanting to help others. This award belongs to them.’
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 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
Clients 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