Saturday, 20 December 2014

my experiences of OT in Stratheden, Fife, compared to Carseview, Dundee, and in the communities

"STRICTLY STAFF ONLY PLEASE" toilet Ceres Centre, Stratheden Hospital (taken Dec12)

I remember meeting with the head of OT for mental health (AHP Clinical Services Manager) in Stratheden Hospital, Ceres Centre (patients' cafe here), where she was based, late 2010 think it was.  I was unhappy about the lack of OT group activities in Lomond Ward when my son was a patient that summer.  I'd also asked for a meeting with the head of psychology (Head of Service, Clinical Psychology), for the same reason.  

I had witnessed there being no therapeutic activities in the wards for patients who were detained or restricted and thought this was detrimental to recovery and to the wellbeing of patients.  I'd noticed patients pacing in the wards, up and down, and going round in circles even.  Nothing to do.  Aimless and restless due to the medication/drugs. 

As a community education worker group work was central to what we did to empower and encourage learning in communities, of children, young people and adults.  From 1980 I'd been involved in grassroots initiatives, being part of groups, helping set them up and also leading from the front.  In 1998 I gained a postgraduate qualification to back up my work experience.

Therefore when I met with the OT head it was from a knowledge that groupwork was of real benefit.  However during the meeting of 2 hours and more I met with resistance from the offset.  There was no shifting her stance.  My words fell on deaf ears.  

In February 2012 my son became an inpatient of the Stratheden IPCU where the ward situation was dire.  An activity room locked for long periods, only getting pens to write with if two nurses were available to oversee.  Where were the OTs?  I saw one of them at the clinical meeting on occasion but never saw any working with patients. 

Then in late December 2012 another son of mine became an inpatient of the Carseview IPCU, then the open ward and eventually into the community, using day services.  I witnessed OT groupwork in a variety of situations, in the wards and in the community.  This is what I'd been looking for in Stratheden but didn't find.

In the Carseview IPCU there was an art group held regularly by an OT and I noticed this happening on one occasion when visiting, my son being part of the activity.  I saw the conversations and sharing of information, relationships formed and the art work was a bonus.  

There was a greenhouse out in the Carseview IPCU patio where a volunteer, a retired gentleman, planted out seedlings and patients occasionally helped while others smoked and observed from a distance.  Once a patient was allowed out of the ward they could join a horticultural group in the building, and my son did this although not a gardener in "real" life.  The main benefit to him and others, so I heard, was the human interaction.

The OTs were involved in helping patients to budget, to plan meals, to prepare for discharge, and sometimes went on buses down town with them so as to help build confidence and/or to find out information.  The engagement with patients and planning of activities was done in the ward.  

Unlike in Stratheden where appointments were made in the ward, to go to the Ceres Centre, and often the patients didn't turn up on the day because they didn't feel like it or weren't well enough.  I witnessed this happening and thought it wasn't a good use of time.  On occasion I tried to contact OTs at Stratheden but when I phoned the OT office was told that there was no diary for OTs so no-one appeared to know where any of them were.  Nice job if you can get it was my thought.  A service run for the staff.

My son has been using the Dundonald Centre services in Dundee since discharge from Carseview where there are a range of activities going on, by OTs and nurses who work together therapeutically with the people who use services.  Again there are volunteers involved in leading eg a weekly art group in the Centre.  The programme is flexible and adaptable.  Service users are able to join groups, to play pool, to get themselves a tea or coffee.  I've visited on occasion and the atmosphere is non-clinical even although nurse managed.

It hasn't been like this in Stratheden or in Weston Day Hospital, the latter of which lost the OT input a number of years back.  Not sure why.  It seemed that the OT strategy in NE Fife was to withdraw from involvement in clinical settings and to concentrate more on one-to-one work with patients, occasional groups in the community and management tasks.  This has been detrimental to patients and service users.

However it's been my experience that in Fife psychiatric services any negative or critical feedback from carers, patients or service users is met with defensive attacks and a refusal to engage further.  They do not listen to the voices of experience and have been allowed to do what they like in and with their service, and not be accountable.  Great job if you can get it.

This is what was going on in the Stratheden IPCU in February 2012, I contend.  They had been getting away with it for years.  Using a locked seclusion room with no toilet or drinking water.  Leaving patients locked in for hours at a time, unobserved.  Locking other rooms in the ward, not allowing patients in to their bedrooms through the day so they had to lie down wherever they could find a space eg the corridor in my son's case.

I believe that the OTs were taken out of the Stratheden wards because of the dire state of affairs going on there.  Abandon ship.  Rather than stay onboard and try to sort out the problem, repair the holes, get everything shipshape.  Leaving the patients to suffer for it.  And the carers.  Well it's just not good enough, in my opinion. 

The failures in the wards at Stratheden Hospital are the responsibility of all the staff working there.  It's a corporate affair and you can't just turn a blind eye to human rights abuses, saying it's nothing to do with me.  Yes it is if you're on the payroll.  If patients are not being allowed pens to write with in the Stratheden IPCU, no freedom of expression, then the OTs and others who attend clinical meetings in the IPCU are witnesses and involved.

I will be sending this blog post, as usual, to the senior mental health managers employed by NHS Fife and based at Stratheden Hospital and to the heads of OT and clinical psychology, for their information.  If I receive any responses I will publish them.  So far I have had no response.  I would prefer a dialogue or a debate but I have no power to make this happen.

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