Contents
HUG
and the reasons for this report
The closure of Craig Dunain
Should the new acute unit be sited in Raigmore?
Stigma
Where the new unit should be sited in the Highlands
How the new unit should be - in or out of town?
Access to local amenities
The appearance of the new unit
How to avoid people being frightened of the unit
The environment of the wards
Recommendations and key issues
Acknowledgments
HUG
and the reasons for this report
In
some ways Craig Dunain has been closing for the last 20 years - with
more than a thousand beds being lost and patients be located in the
community since the 1960's. However, now we seem to have reached a
point where the closure of Craig Dunain itself will happen soon.
For
some time users had been expressing concern and anxiety over the closure
of Craig Dunain and the siting of the acute unit.It
was decided that the first series of meeting of HUG would concentrate
on three topics: the closure of Craig Dunain as a principle, the location
of the new acute unit.
It
was decided that the first series of meetings of HUG would concentrate
on three topics: the closure of Craig Dunain as a principle, the location
of the new acute unit and what the new unit should be like.
Over
the month of August a series of 8 meetings took place to discuss these
issues. A total of about 70 people were involved in these meetings.
One of the meetings took place in Nairn, where no branch of HUG is
established and some users from Badenoch and Strathspey also contributed
their views - again a place where no branch is established.
The Closure of Craig Dunain
All
the groups concerned resisted the idea of closing Craig Dunain and
argued instead that it be modernised or alternatively a new unit be
built in the grounds of Craig Dunain.
There
were views that it felt secure and felt like home. There was, however,
an acknowledgment that modernising the hospital might not be financially
possible.
This
did not, however, mean that users were against the principles of community
care. Most users involved were considering the future of their service
when acutely ill which in the main is provided in the acute wards.
There were frequent calls that community services need to be increased
whilst retaining the provision of hospital services.
Should the new acute unit
be sited at Raigmore?
For
the majority of the discussions our information was that the plans
re to build an 84 bedded acute unit at Raigmore. The proposal was
discussed and strongly rejected. Of all the people involved only 2
people didn't mind going to Raigmore.
The
reasons for rejecting this proposal are as follows:
-
People
said that they would not feel safe in that environment with particular
reference to the high level of activity there and the major roads
surrounding it.
-
People
felt that there would possibly be less freedom in a unit built
in Raigmore and also envisaged becoming the brunt of more prejudice.
-
People
felt that there would be no peace, no quiet or privacy on the
site and regarded the whole environment as too clinical for a
psychiatric unit.
Stigma
In many circumstances users got into a discussion about stigma.
There
was a feeling that one of the reasons for moving a unit to a general
hospital was to reduce the stigma of mental health problems and to
incorporate psychiatry into mainstream medicine.
This
argument was soundly rejected. People thought that the siting of a
new unit in a major access point for the public only increased the
stigma and in fact left users very exposed to patronising and discrimination
attitudes which at the best of times are hard to cope with even more
so when in distress as an acute patient.
The
solution to stigma and prejudice was agreed to be a major mental health
education program and also a project to help users to come to terms
with the negative feeling that can accompany a diagnosis of a mental
health problem. It was also thought that users who were confident
and supported should be encouraged to present a positive image of
people with mental health problems. A last suggestion was that part
of the public education program should be education in schools about
mental health.
Where
the unit should be sited in the Highlands
Members
of HUG did not necessarily see the siting of the new unit in Inverness
desirable. There were arguments made that this unit should be split
up and the beds allocated to the various areas of the Highlands, thereby
bringing services closer to the local community and greatly reducing
the problems of admission from areas that are a long way from Inverness
- a fact that was cited by one group as greatly adding to the distress
and trauma of admission to a psychiatric hospital. Another reason
given was that visits from friends and relatives were hugely curtailed
by having the unit in Inverness.
HUG
ended up split on the with some branches in favour of a dispersal
of the unit to the localities and others against it and yet others
undecided.
The
main reason for keeping the unit in Inverness was given as: stigma
- going to Inverness people had complete anonymity and no-one needed
to know where they were going whilst having a small unit in or on
the edge of a small community would instantly identify people to their
community as having mental health problems.
Other
reasons given were that with longer stays the feeling of being removed
from everyday life could come as a great relief and that a lot could
be got out of meeting new people with similar experiences. A last
reason given was that in the more distressing phases of an illness,
many people did not like visits from friends and relatives and were
thankful that distance prevented them coming (the converse being true
in periods of rehabilitation and recovery).
However,
there was unanimous agreement that there should be emergency beds
or crisis beds provided in each of the areas of the Highlands accompanied
by psychiatric staff. Users in some of the more remote areas spoke
of having to wait up to four days to see a psychiatrist following
an emergency that clearly required admission to Craig Dunain felt
unacceptable.
Where the new unit should
be - in or out of town
The
majority of groups thought that the unit should be sited on the outskirts
of town in an environment similar to that of Craig Dunain. This environment
should provide peace, tranquillity and security. There would be less
noise and it would give the relief of being situated away from the
general public. However, it should not be too far outside town.
Two
groups, however, had the opinion that it should be sited in a good
setting in the community and developed in such a way that the whole
community felt secure, in order that users will feel no stigma to
go to it and that the local community will not feel threatened or
frightened by.
Access to local amenities
Whilst
not necessarily important in the more serious stages of an illness,
all the branches of HUG considered access by a good local bus route
to everyday amenities to be very important. It was considered less
important to have amenities sited close to the hospital.
The
physical environment around the hospital:
Almost all
users considered that the grounds within which the new hospital is
situated to be of great importance. They
wanted trees, grass, peace and quite. Room to walk or feed the ducks
all in an attractive, relatively private, environment. This
environment (as is presently found at Craig Dunain) was found to be
soothing and relaxing in the more distressing stages of an illness
and helpful as people recovered.
The
appearance of the unit
Whilst
the building should incorporate modern technology, efforts should
be made to prevent the building from looking like a hospital - instead
it should give a homely feel. It should give a feeling of providing
physical and emotional warmth and should make strenuous efforts to
avoid looking threatening.
How to avoid people being frightened
of the unit
As
stated before the main solution to this is public education, ideally
involving those users prepared to participate. However, members stated
that Craig Dunain has a mythology surrounding it of fear and as somewhere
people were sent to. This image still exists today.
Other
suggestions for changing this image were to change the name of the
unit and to have open days for the public to see it (although this
argument was resisted by many as taking away from the privacy they
need when they are ill).
Some
users felt that even with an education programme little could be done
to change the image of a psychiatric unit. It was also suggested that
doctors should explain what the unit was really like before people
were admitted.
The
environment of the wards
The
wards themselves should have nice décor and furniture and present
a homely feel. There should be room for privacy as well as space to
meet other people. There were mixed views on the size of the wards
- all agreed that each ward should cater for a small number of people
but some groups expressed the view that there should be lots of space,
whilst others expressed a contrary opinion.
Recommendations and key
issues
Single
rooms - Access to single rooms was considered important
but it was not felt desirable to have single rooms for everyone. The
element of choice being the key point. In some situations people need
the privacy of a single room but in other situations there is more
of a feeling of security in having people around you.
Sitting rooms/day rooms - These were
considered very important, one suggestion being that there should
be a small room and a larger room.
Public
telephones -
There should be easy access to public telephones on all wards. These
should be designed in such a way to allow for conversations to be
carried out in private.
Visitors
- there should be facilities provided to allow visitors and patients
to meet in private. Accommodation should be provided for relatives
who have to travel a long distance to visit.
There
should be unrestricted visiting hours.
However,
in keeping with users wishes for privacy and security, people should
all be aware of who visitors to the ward are - people should not be
allowed to visit without staff being aware of this.
Most
branches were of the opinion that crèche facilities should
be provided for people with children visiting patients.
Refreshments
- There should be access to tea and coffee making facilities. There
should be a shop and a café.
Smoking
- Many users
of mental health services smoke and feel a great need to smoke whilst
in hospital. There should be facilities designed for smokers and non-smokers,
all of which maintain an attractive décor.
Single
sex wards
- Many people, both men and women, stated that they would prefer to
be treated on a single sex ward and also have the choice of the sex
of the staff primarily responsible for their treatment. It was, however,
agreed that many people benefited from mixed wards. It was thought
that there should be the choice of treatment on single sex and mixed
wards.
Mother
and baby unit
- People should be able to be treated within the unit when they have
small children without being separated from them purely because of
the necessity of admission to hospital.
Young
people's unit -
Although not discussed at all branches, those that did found a young
peoples' unit based in the Highlands to be very important both to
reduce the trauma that can arise when being forced to mix with adults
in distress and also to reduce the trauma of being sent away for long
distances.
Intensive
psychiatric care unit -
It was felt important that this provision be retained in the Highlands.
Social
centre
- The
present social centre providing activities, sports, recreation, outings,
music and so on was considered very important for people in hospital
and should be retained in the new unit. There were also calls for
an additional social centre to be provided in the community.
Observation
levels -
It was agreed that the manner in which close observation is carried
out cam be very intrusive and intimidating. There was a call to make
the layout of the wards such as to make observation by staff and patients
less obvious. How this was done was unknown. There were suggestions
of the use of video cameras or two-way mirrors, but these ideas were
strongly rejected by other groups.
Activities - There should be lots
of things to do both on the off the ward, including having access
to people to talk to. There should be access to occupational therapy,
alternative and complementary therapies and art therapy.
Spiritual/religious
beliefs
- These
beliefs he should be respected. There should be access both to places
of worship and to people to talk about spiritual matters.
Admission
to hospital -
On admission to hospital there should be someone to meet the person
(this person could be a patient) and take them to the ward and explain
the hospital and ward layout and procedures. An information pack should
be provided with details of how to access advocacy services if required
included in it.
Assessment
and referral to hospital -
People should be able to be assessed for admission to hospital at
any time of the day and wherever they live. People should be able
to present themselves at the hospital for an assessment and there
should be access to people to talk about problems outside the hours
of nine to five.
Information
on the closure of the hospital - Many people are very worried
about the closure of the hospital and a few, despite media articles
on the contrary, believe that there will be no beds left for psychiatry.
Verbal and written information on the progress of closure should be
provided at frequent intervals to patients in and out of hospital
and to community facilities.
Disabled
access -
The
hospital should be full accessible to people with physical and sensory
disabilities.
Discharge
from hospital -
There
was considerable worry over the growing trend for discharge from hospital
in a relatively short time. It was felt that people with mental health
problems are more likely to cope in the community and less likely
to relapse if proper attention is given to recovery from the trauma
of illness and to rehabilitation (both in hospital and in the community).
Bed
numbers
- There
were queries over how the size of the new unit had been worked out
in terms of bed numbers and hopes that the Trust would not attempt
to provide the minimum number of beds that can lead to overcrowding,
especially if beds become blocked.
Community
services -
These were considered vital for people to be able to cope in the community.
Both hospital and community services must be adequately resourced.
Staff
numbers
- A vital part of treatment is having someone to talk to. There was
a call for staff numbers to be increased to enable this to happen.
Paying
for the new unit
- Users wondered where the financing for the new unit would be obtained
from.
Acknowledgment
Many
thanks to all the users of mental health services who participated
in this. For more information about HUG call Graham Morgan on 01463
718817.
