12th November 2018
Alison Eley is the Named Nurse for Safeguarding Children, Domestic Abuse and Marac lead for South London and Maudsley NHS Foundation Trust. Alison has previously worked as a mental health nurse in a number of services in East London and has represented mental health services at various London Maracs for the past 11 years. She has also lectured in domestic abuse at City University of London.
Being asked to represent your mental health trust at a Marac meeting could make you feel a number of things. You might see it as a great learning opportunity. Alternatively, it may appear to be just another meeting in your diary. It might even seem daunting if you’ve never attended one and don’t understand the process or your role in it. There could be the assumption that your attendance is enough in itself to demonstrate agency sign-up and involvement.
I can recall having both of the latter responses when I first attended a Marac meeting many years back. Over time, however, I have come to appreciate and advocate the importance of Marac representation and processes being embedded across all mental health services. Mental health staff shouldn’t feel intimidated or doubt their role, as they can have so much to contribute to the action planning. And most importantly, they can help ensure victims/survivors access services they may desperately need.
If you’ve been asked to be a representative, a good start would be to ask to shadow any current representative from your trust, to get an idea of what the role involves. It can be a shock to take up the role only to discover the amount of preparation and follow-up work required. Find out if your local authority has any Marac training that you can access. SafeLives also offer free e-learning packages via the SafeLives Community.
Make friends with your Marac co-ordinator; they are invaluable in tracking actions and providing information. Contact your trust DVA lead to see if there has been any guidance produced in-house, or any meetings that take place to help navigate the process.
It is important to familiarise yourself with your organisation’s information sharing and record keeping protocols, to ensure you are following your internal policy correctly. You will need to undertake careful research prior to the meeting, and attend prepared to share information, participate in proactive discussion and to assist in action planning, where appropriate. It is not enough to merely attend on a passive basis. The success of Marac depends on the involvement of all the agencies attending.
Ensure you have booked enough time in your schedule to undertake accurate prior research and subsequent actions. This can take a lot of time, depending on the number of cases being discussed. Even if there are few cases known to mental health services, the cases may be so complex that it can take hours to extract the required details and action outcomes. In extracting information to be shared, remember that this needs to be relevant, focused and proportionate to the case being discussed. Individual discussions in the meeting are time limited, so providing huge tracts of past history over many years, irrelevant facts or any personal beliefs held is neither helpful nor needed. Nor will it sit comfortably with information sharing agreements.
Ensure that cases are flagged on your electronic system, as a third party entry. This may be via an alert, or ‘red triangle’. It is crucial to flag cases up as having come to the attention of Marac. Victims and perpetrators of domestic abuse may present to different services within an organisation, and it is important that whoever picks up the case is aware of potential risks involved. It also helps workers to monitor ‘repeat’ cases. If undertaking a check on addresses, be aware of any other vulnerable people in the household who may not be included on the research list. This information can make a substantial difference within a case. We must consider the effects of domestic abuse on children and young people within a family or situation. I have come across a number of cases where CAMHS and/or perinatal staff have been involved, and have not previously been aware of domestic abuse within a family. It’s a crucial part of your role as Marac representative to reach out to and engage a range of clinicians within the trust.
If any person known to your trust is being care co-ordinated within mental health services, ask their care co-ordinator to liaise closely with you or if appropriate, attend the meeting for that one case. It’s important that you spend some time explaining to them the Marac process and their role within the meeting. Always ensure that you seek approval from the Marac Chair and Co-ordinator if you are inviting a member of staff to attend.
There are a number of actions you could offer at Marac. As one example, if you have reason to believe that the service user is needing urgent support, you might suggest to the Marac that you ask the care co-ordinator to issue an appointment earlier than planned. Other Marac representatives may have limited knowledge as to specific mental health diagnoses and the risk implications of them. Here the mental health representative can share their knowledge, enhance understanding and reduce stigma.
This might also lead to joint working outside of the Marac process: I have seen excellent joint training being provided in one mental health trust, in partnership between personality disorder services and DVA teams. There is real potential to develop shared learning opportunities, and to promote local service knowledge at a time where the health landscape can frequently shift.
Some cases on the Marac agenda may state that the people involved have mental health problems, but they are not known to secondary services. The role of the Marac rep here would be to help the meeting consider whether they are receiving support within primary care, what the thresholds are for higher tier services and/or whether they need help with accessing services. External agencies may not be aware of referral processes, how to access mental health services locally and the nature of these services. The Marac representative can provide an educative role, providing this information.
Another benefit of attending Marac is being in a position to potentially identify areas of your service where there are gaps in Marac referrals or indeed where there are high instances of clinicians working with victims and perpetrators. In one borough, it became noticeable that a high number of perpetrators were known to a therapeutic community team. This provided an opportunity to offer the team more focused support around working with perpetrators, in order for them to be better able to identify risk indicators attached, and to promote links with external agencies that could assist.
Finally, if there are a number of Marac representatives from your service, ensure you are meeting on a regular basis to discuss and log activity, monitor hotspots, consider how to embed Marac knowledge in directorates and services and to share information. Consistency of approach by Marac representatives in a borough – and indeed the organisation – means that all Marac meetings and cases discussed receive the same high quality input. Regular meetings can help you to support each other; knowing that there are people in-house who understand the work involved and possible challenges helps. Working together and promoting Marac brings so many benefits to the both the organisation and to victim/survivors and this cannot be underestimated.
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