10. Shared decision-making activity

Psychiatrist:

so she's here under Section two for assessment how she been this week any management problems?

Ward Manager:

No no management problems and she's really fitting in well with the ward routine she's really settled and socially appropriate interactions.

Psychiatrist:

That's good.

Care Co-ordinator:

But Emma and I met before the ward round and she's described feeling overly sedated she has asked us to review her medication and this worked really well before when she was in the community not really think we ought to listen to to what she's got to say.

Psychiatrist:

She's been compliant and the nurses have reported a marked improvement in her mood and levels of agitation I am reluctant at this stage to review her medication, should we bring her in?

Ward Manager:

Yeah I'll go and get her. Do you want to take a seat here Emma?

Psychiatrist:

Hello Emma like to sit down, good. Now I understand you would like us to review your medication it's booked you want to sleep a lot you're feeling heavily sedated at this point in your admission we don't feel that that would be the best course of action in your previous impatient stay this medication worked very well for you and it does take a little while for it to take effect at this dose for you to feel the full therapeutic value and at that point there would be a reduction in the sedative effect.

Service User:

Right.Can we talk about this again?

Psychiatrist:

Yeah, should we talk about it again next week?

Psychiatrist:

Hi Emma, how have you been this week?

Ward Manager:

Emma would you mind if I shared our earlier conversation? Erm, so earlier I woke you up to take your morning medication and you told me that you hated being woken up for it and you just need you sleep at the minute.

Care Co-ordinator:

Yep Emma told me about taking medication made her feel really drugged up and sedated would you like to review that?

Service User:

I feel drugged up all the time I just want to sleep I really want to change my medication can we look at that please?

Psychiatrist:

We do see this sedation a lot with this type of medication and we know that it's worse than the first two weeks. I do know, I do understand that it's very difficult have you felt any benefits from taking the medication?

Service User:

Well I suppose my head isn't as noisy as it was when I first got in, do feel less worried

Psychiatrist:

that's good, that's good there are definitely pros and cons to this type of medication I am reluctant to change it this quickly and early on the admission but it might be that we can consider other medications around the side effects.

Ward Manager:

It could be the time of day that you taking the medication is there any way that we could look at changing the timing of the tablets maybe have a larger dose at nighttime and take away that 8AM tablet?

Service User:

Yeah I would like to feel a bit more awake during the day so when I go back to work I need to concentrate.

Care Co-ordinator:

You said works really important to you we discussed that when we were looking your recovery plan.

Service User:

Hmm.

Psychiatrist:

Okay great

Nurse:

Hi Emma, so what did you want to discuss in your ward review today?

Service User:

Now the main problem is the medication you won't give me leave because I'm not taking the tablets but that's because they make me sleepy all the time I just feel too drugged up.

Psychiatrist:

Okay that sounds really difficult these are common side effects of this type of medication. We do find it takes a couple of weeks for it to settle down. Have you felt any benefits to your mental health?

Service User:

My head's less noisy than it was and I do feel less weird.

Ward Manager:

So what would you like us to think about in relation to medication?

Service User:

Well I wrote an advanced directive about changing my medication to help me with my thoughts but so that I can take them when I want instead of all the time.

Psychiatrist:

Okay so the problem with those medications is they can be addictive.

Service User:

Well I know that but for me it's better than feeling half dead like I do now.

Care Co-ordinator:

The way we've managed to medication in the community, it might not be possible whilst you're here on the ward.

Psychiatrist:

Well that's true, and seeing as you're hear on section we will have to monitor that closely but if we can all agree how would you feel about trying an alternative medication?

Ward Manager:

I do have my reservations but providing that we're sharing the decision and that Emma you keep talking to us and letting us know what happens for you I'm okay with it.

Service User:

yeah I will say, I know I can manage better on them and if I am struggling I will talk to ya.

Ward Manager:

Thank you.

Service User:

Okay.