Keeping forensic mental health services close to home: a lifetime’s work and leadership
Nurse consultant who transformed patient experience honoured with Special Recognition Award
- Noel McDonald’s years of persistence and leadership resulted in the transformation of forensic services in Northern Ireland
- Judges at the 2021 RCN Nursing Awards honoured his vision and commitment with a Special Recognition Award
- How he developed strategy, knowledge and training to improve services for patients and engage staff in the change
In the year 2000, Northern Ireland still had no dedicated inpatient forensic mental health service.
Instead, patients were sent to a high secure hospital in Scotland or other parts of the UK. Nurse consultant Noel McDonald witnessed the trauma caused to patients, family and staff as loved ones were transferred elsewhere.
Ensuring people could stay closer to home
‘I was the main transfer coordinator and it felt like we were exiling people,’ recalls Mr McDonald, who has just retired from Belfast Health and Social Care Trust.
‘Some did not need a high security service but could be cared for in a medium-risk setting closer to home, and this inspired me to do something about it’
Noel McDonald, winner of the Special Recognition Award at the 2021 RCN Nursing Awards
‘It was the hardest thing taking the patients over, and staff felt they had let them down. Some did not need a high security service but could be cared for in a medium-risk setting closer to home, and this inspired me to do something about it.’
Since this time Mr McDonald has overseen the transformation of forensic services in Northern Ireland, inspiring generations of staff and ensuring service users receive person-centred holistic care.
For his commitment and leadership he has been honoured with a Special Recognition Award by the judges in the 2021 RCN Nursing Awards.
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Inpatient forensic service: a model of care with user and carer involvement
This transformation was neither easy nor quick, explains Mr McDonald: ‘It was very hard to get people to take it on board, as the transfers did not come out of trust budgets. I took every opportunity to present and argue that we should not be sending people away. I started my master’s with a thesis on developing forensic services in Northern Ireland, not knowing I’d be that person to help drive it forward.’
Mr McDonald led the development of Belfast’s Shannon Clinic in 2005, an inpatient forensic service with a model of care based on user and carer involvement and a recovery focus, after working in a police station and the prison service.
This was the first such service for patients in Northern Ireland and meant they did not have to be sent to Scotland.
His ‘new-to-forensic’ programme to increase staff knowledge and understanding is his ‘pride and joy’.
‘It teaches people to look after people how they should be treated,’ he says. ‘If you educate your staff and educate your patients it’s a win-win. There are no seclusion rooms and the approach is based on least restrictive practice and a more dynamic way of working with patients.
‘This approach was challenged by staff but I reassured them that if they buy into it, the culture will change and a more positive outcome will be the result. Research results indicated a positive influence on care.’
Mr McDonald also initiated and developed the Forensic Managed Care Network, which makes recommendations to the Department of Health in Northern Ireland, and built strong links with services in the Republic of Ireland and other parts of the UK. It raises awareness of available services and promotes service development and strategic influence.
Turning this forensic services vision into reality
‘I had an inner self-belief that I knew what had to happen to get the forensic services we needed, and that gave others confidence,’ says Mr McDonald. ‘I knew what I was talking about and could articulate that vision. It’s about having a rapport and approach.
‘I was strategic and had to be knowledgeable. I travelled through the UK and to Australia to inform my vision, which gave me the confidence to share it with others. I didn’t always see good practice, but I found the best practice and brought it back.
‘I kept moving to get into positions of influence to drive it forward.
‘He has maintained a keen interest in developing the careers of nursing staff by example, giving hope and inspiration to other nurses to build on their skills and progress their own careers’
Orla Tierney, divisional mental health nurse who nominated Mr McDonald
‘If you set up a service you do not normally end up being the operational manager, because you annoy too many people along the way. I fell out with loads of people for the patients’ best interests and still managed to be the operational manager.
‘The true judge of services is the patients and how they experience them. It’s all about treating people the way you would like to be treated yourself.’
Strategy, integrity and transformational leadership
Chief nursing officer for Scotland Alex McMahon, who was on the judging panel, says: ‘We were so impressed by the transformational leadership shown by Noel, his strategic approach and ability to inspire others over many years, and the values that have driven him to achieve his goal to prevent people having to travel far from their families for forensic services.
‘His integrity shone through and the judges were unanimous in wanting to mark his lifetime’s work and the impact it has had on the people of Northern Ireland and those that nurse them.’
Belfast Health and Social Care Trust divisional mental health nurse Orla Tierney, who nominated Mr McDonald for an RCN Nursing Award, described him as a dedicated, transformational leader.
‘He has maintained a keen interest in developing the careers of nursing staff by example, giving hope and inspiration to other nurses to build on their skills and progress their own careers.’RCN Nursing Awards 2021: all the winners