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"GMMH Trust employs over 6,500 staff. For patient wellbeing, it was crucial that each and every member of staff had to complete either Basic Life Support (BLS) or Immediate Life Support (ILS) training. However, ensuring consistency of training across such high numbers presented a significant challenge."
Above: Toni Murch, Senior Resuscitation Officer at Greater Manchester Mental Health Trust.
Content Warning: This article discusses self-harm, suicide, and severe mental illness. For support on these topics, please visit the NHS website.
In the UK, people living with severe mental illness (SMI) have a life expectancy that is 15-20 years shorter than the general population. The causative factors of this disparity are numerous and varied, but according to Professor Stephen Powis, the heightened increased risk of cardiovascular disease is a common thread running through the wellbeing of those living with SMI. Alongside this, instances of self-harm and negative lifestyle habits can lead to physical health problems being more commonplace among people living with SMI.
High-quality CPR forms a crucial step in strengthening the chain of survival for patients with SMI. To better understand this, we spoke with Toni Murch, Professional Lead for Resuscitation at Greater Manchester Mental Health (GMMH) Trust.
Toni comes from a varied background having spent 34 years in pre-hospital care within the military and later a civilian paramedic. He’s also been a clinical educator and has worked in the commercial sector, delivering CPR training to major organisations and businesses.
Following the COVID-19 Pandemic, Toni moved to the GMMH Trust to oversee their resuscitation training and implementation.
What is Greater Manchester Mental Health Trust?
GMMH Trust covers the whole of Greater Manchester, including ten major units, 16 prisons, and numerous smaller facilities. The Trust supports all manner of mental health requirements ranging from forensic units to psychiatric intensive care, later life units, and a substantial child and adolescent mental health sector.
It also provides one of only three units in the country that specifically accommodates patients with deafness who live with mental illness.
Many long-term patients have been supported by the Trust for more than two years, with some having been involved for over 20 years.
“Mental and physical health go hand-in-hand.”
Patients with poor mental health tend to live in less affluent areas,” Toni told us. “They may eat a less nutritious diet and are more likely to smoke and drink excessively.” To mitigate this, GMMH Trust has smoke-free campaigns and works with dieticians to promote a healthy relationship with food, but CPR still plays a crucial role.
Above: A graph displaying the prevalence of physical health conditions for patients with SMI. Source: The Health Improvement Network
This lifestyle can lead to weight gain, as can the psychoactive medication that is often used to treat mental illnesses. Excess weight, as well as smoking and excessive alcohol consumption, are well-documented contributors to cardiovascular health concerns.
In acute general hospitals, a Crash Team delivers expert advanced life support instantly. Mental health units do not have these specialised teams, meaning they rely on 999 services, often with a variable response time in cardiac emergencies.
This means that patients depend on staff to deliver effective CPR and support until paramedics can arrive.
The presentation of cardiac emergencies differs depending on facilities, too.
Generally, within an acute general hospital, patients are monitored continuously. However, many mental health patients may refuse monitoring, which can make identifying risks more difficult.
Furthermore, in the mental health sector, patients can be in greater danger of rapid deterioration due to self-harm from choking, ligatures, overdoses, or other factors.
The heart-stopping in these situations differs from other cardiac emergencies:
If a person experiences a heart attack or cardiac arrest, their heart may be fibrillating. However, in the case of self-harm, the heart typically does not exhibit this behaviour, rendering defibrillation ineffective.
The importance of high-quality CPR is paramount in oxygenating the heart and allowing for effective defibrillation.
With these instances accounting for a significant number of cardiac emergencies at GMMH Trust, it’s clear that effective CPR training is an absolute priority for all staff.
Toni explained that while preventative measures are in place to reduce these instances, they are not a replacement for effective CPR training.
A Fresh Approach to CPR Training
To help mitigate these risks, it was clear that a new approach to CPR training was needed across GMMH Trust, with priorities around competency and engagement for staff of all levels.
“When I came to the Trust, I saw that CPR was being conducted with insufficient depth and speed and without the correct hand positioning,” Toni told us. “Due to the Pandemic, a lot of our staff were learning CPR online. This is a great tool for public awareness but wasn’t giving our people the skills they needed.”
GMMH Trust employs over 6,500 staff. For patient wellbeing, it was crucial that each and every member of staff had to complete either Basic Life Support (BLS) or Immediate Life Support (ILS) training. However, ensuring consistency of training across such high numbers presented a significant challenge.
Overcoming the Challenges with Self-Directed Learning (SDL)
SDL is at the centre of his strategy to improve CPR training outcomes across GMMH Trust, and Brayden systems were identified as a key tool in pushing this forward.
Now, GMMH Trust is into its second year of Brayden, with manikins in use at Prestwich, Bolton, Wigan, Moorside, and further across the Greater Manchester area.
Currently, GMMH Trust has 4385 users on the Brayden Online system, with 240 users per month undergoing self-directed learning. Of these, only around one user per month requires extra support from a resuscitation instructor. The SDL tool alone has had a profound impact on allowing people to self-assess and improve, with flexibility encouraging learners to take control of their schedule to plan their CPR training.
Once the training is completed, the results are inputted into the GMMH Learning Hub with minimal administrative strain, giving clear information on the competencies of learners across the Trust.
Public engagement also has a role to play.
“We had a CPR booth fitted into The Curve, our headquarters,” said Toni. “We’ve had it in place for about seven months. This isn’t linked to Brayden Online, but it’s a great way for members of the public just to get a feel for CPR training.”
By encouraging bystanders to engage in CPR training, outcomes from cardiac emergencies can increase dramatically.
Above: The CPR booth in The Curve, Greater Manchester Mental Health Trust headquarters.
Diversity is Crucial to Managing Mental Health
GMMH Trust encompasses people of all backgrounds, ages, and needs – something that Brayden manikins were able to accommodate.
Baby Manikins
GMMH Trust has a perinatal service with 250 members of staff that supports mothers who live with mental illness. As part of the staff’s training, the Brayden Baby was added to the Trust’s SDL system.
“The staff love it,” Toni told us, “and we’ve found that competency has improved. The staff can go in and practice CPR on the Baby manikin which allows people to train in their own schedule.”
Junior Manikins
Having previously bought the Brayden Pro, the Junior conversion kit was also incorporated after staff on a unit for 13 to 18-year-olds requested a Junior manikin. Once again, this was met with high satisfaction from the staff. The reduced time constraints from SDL have made CPR training “less of a chore” and more accessible to employees.
Above: Brayden Junior in use with Brayden Online.
OBI Manikin
Toni was proud to have utilised the Brayden OBI manikin, an anatomically correct CPR manikin based on a black adult male. He highlighted the importance of different face and body shapes that provide trainees with a more representative learning experience.
Bariatric Patients with SMI
Due to lifestyles associated with mental illness, as well as some of the psychoactive medications administered in mental health units, presentations of bariatric patients are quite high.
This can lead to challenges in delivering effective CPR, predominantly due to difficulty in hand positioning for wider patients, as well as issues around airway anatomy and movement due to excess weight.
Ensuring that CPR manikins continue to be as inclusive and diverse as possible is clearly an ongoing priority for providers around the world.
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