Mental Health: Within Reach
Treating people with acute psychiatric problems can mean sparse, unappealing wards – but what if stimulation is the key?
The second thing that strikes you is the televisions. They are not suspended from the ceiling, or encased in protective cages, but placed at eye level – as they would be in your own home – and could easily be smashed in, should anyone feel that way inclined.
In the three years that the Tarn has been open, two TVs have been broken. That’s not bad going for a psychiatric intensive care unit (Picu) catering for men with episodes of severe mental disorder, more often than not exacerbated by drink or drug misuse. Visitors from similar units find it hard to believe.
But maybe there is a connection with the first thing that catches the eye when you enter the Tarn, which is run by Oxleas NHS foundation trust at the Queen Elizabeth hospital in Woolwich, south London. You cannot help but notice what is displayed on the walls: football shirts, donated by many of the country’s top clubs and signed by their players, and a cornucopia of other sporting memorabilia from the worlds of cricket, boxing, basketball and beyond. As you pass through the ward door, you see a display sent by the squad at Liverpool FC with the message: “To the lads at the Tarn – you’ll never walk alone.”
This is evidently no run-of-the-mill mental health facility. It is, in fact, “Picu of the year” – an honour bestowed by the National Association of Picus – and has been acclaimed by the Star Wards campaign for improvement in the too-often drab environment and too-often dull routine of psychiatric inpatient units.
It helps, no doubt, that the Tarn is in a relatively new building and was purpose built. For one thing, the location of the staffing station at the centre of the ward, commanding uninterrupted views of all areas, is certainly likely to have reduced the number of incidents. But Francis Adzinku, the trust’s acute and crisis services manager, insists that he and his colleagues developed their distinctive approach in former, very rundown wards, and that it is much more about attitudes and principles.
“If you prepare an environment where you think people are going to throw things around, then they come prepared to do that,” Adzinku says. “But if you put people in an environment where they feel comfortable, where it is clean and where there are nice things to look at, the effect can be wonderful. The philosophy is to have, as much as possible, an ideal environment, and we have a very good multi-disciplinary team who have a clear idea of the philosophy they are working with.”
The Tarn serves the three London boroughs of Greenwich, Bromley and Bexley and has capacity for 13 men whose conditions and behaviour have proved difficult to manage on acute psychiatric wards or in prison. The typical patients are in their 20s or 30s and will stay for an average 32 days until stabilised – a markedly longer spell than in other Picus, where the emphasis is on short-term crisis management. It is not a low-cost option, staffing input being relatively high, but it delivers results in terms of low readmission rates, positive staff satisfaction and retention figures, and minimal recourse to restraint of patients.
“Every time you restrain a patient, you fail,” says Chris Naiken, ward manager. There used to be a seclusion room, but it was never used and it has now been done away with in changes that have created three new places for women patients in a self-contained section.
Activities are key to the Tarn’s approach. Two activity coordinators work the day shift, though this does not excuse the nursing staff from involvement too, and each patient has an activity plan. Although the patients are detained, regular attendance at the daily community meeting can earn them the right to go out on escorted shopping trips and, on Friday afternoons, to play five-a-side football at a nearby sports facility. No one has absconded.
Football is a common interest for most of the men, and it was this realisation that prompted the memorabilia initiative, led by staff nurse Owen Luck, who qualified only two years ago. A loyal Charlton Athletic fan, Luck has had to swallow hard when writing off to other clubs requesting signed shirts and photos for display. With one or two notable exceptions, the response has been gratifying.
For 42-year-old Neil (not his real name), a patient at the Tarn, the experience has been a pleasant surprise. “I have been in a medium-secure unit before and I was expecting to see some terrible things,” he says. “But in six weeks I have seen only a couple of incidents, and they were not violent.”
And the shirts? “Absolutely fantastic.”