Thursday, 28 April 2016

#StayingWellAfterPsychosis secure base, safe haven, roots, wings, striking a balance

Monday, 25 April 2016

Access to Politics Event & Hustings #SP16 Edinburgh 29 April @InclusionScot

"Disabled and interested in being fully included in politics?

Inclusion Scotland is teaming up with Disability History Scotland to run a joint event on the theme of Access to Politics for disabled people. The first part of the event will fill you in on our Access to Politics advice and support service for disabled politicial activists and those who wish to become more active - including the brand new Democratic Participation Fund which will soon be offering financial assistance to disabled candidates wishing to be elected as Local Authority councillors in 2017.

The second part of the event will be an election hustings, hosted by Disability History Scotland, featuring candidates from the five parties who were represented in the Scottish Parliament in the previous session. We will be asking questions generated and agreed by the participants during the event, as well as giving parties the opportunity to turn the tables and ask disabled people a question of their own.

The event is free to attend, travel expenses are available for participants, we have put in a booking request for BSL interpreters and electronic notetakers (but please do let us know if you will need these or any other form of adjustment ASAP) and the event has lift access and accessible toilets. Parking can be booked upon request (there are also spaces nearby that could be used for free with a Blue Badge), and the venue is a short taxi ride from Waverly train station.

We are planning on livestreaming the event and allowing people to participate remotely over the internet for those unable to attend in person - apply to be sent details.

Macdonald Holyrood Hotel - 81 Holyrood Road, Edinburgh, EH8 8AU - View Map

Friday, 22 April 2016

A Dose of Nature: Green Prescriptions @NERCscience research summary

'A Dose of Nature: Addressing chronic health conditions by using the environment, research summary': A summary of relevant research; NERC & University of Exeter

"When immersed in nature a common response is of a connected fascination; this has been demonstrated empirically to be an active element in generating positive psychological affect (Gonzalez et al 2010)" 4.8

page 1 of 5

from page 3

Wednesday, 20 April 2016

#StayingWellAfterPsychosis: it's all about the story

NICE v SIGN on psychosis & schizophrenia: Tim Kendall et al #BJPsych; response Drs Taylor & Perera

Tim Kendall, Craig J. Whittington, Elizabeth Kuipers, Sonia Johnson, Max J. Birchwood, Max Marshall, Anthony P. Morrison, on behalf of the NICE guideline development group for CG178

A recent editorial claimed that the 2014 National Institute for Health and Care Excellence (NICE) guideline on psychosis and schizophrenia, unlike its equivalent 2013 Scottish Intercollegiate Guidelines Network (SIGN) guideline, is biased towards psychosocial treatments and against drug treatments. In this paper we underline that the NICE and SIGN guidelines recommend similar interventions, but that the NICE guideline has more rigorous methodology. Our analysis suggests that the authors of the editorial appear to have succumbed to bias themselves."


Mark Taylor, Udayanga Perera


9 February 2016:
Dr Mark Taylor: "you are either abstinent or promiscuous when it comes to industry" @RCPsychScot 

20% drop in dementia risk in 20 years @pulsetoday; Dr Peter J Gordon response

'Major UK study finds 20% drop in dementia risk in 20 years' in Pulse Today, 19 April 2016:

"The incidence of dementia in UK over-65s has decreased over time, a major UK study has found.

Overall there was a 20% drop in the incidence of dementia in the population aged 65 or over, but people living in deprived areas remained at a higher risk than others.

The Medical Research Council Cognitive Function and Ageing Study (CFAS) saw researchers at the University of Cambridge, Newcastle University, Nottingham University and the University of East Anglia interviewing 7,500 people in three regions of the UK, and repeated interviews after two years to estimate incidence.

This was then repeated 20 years later in a new group of 7,500 people from the same localities aged 65 and over.

The scientists found that as the population of over-65s was growing, the increase in the number of dementia cases recorded per year was far smaller than expected - from 183,000 recorded in 1991 to 210,000 cases per year at the present time.

Of the almost 210,000 per year currently diagnosed, 74,000 are men and 35,000 women, the paper published in Nature Communications said.

But the study also concluded more could be done to prevent the disease, estimating some 30% of cases may have been avoidable through lifestyle changes.

The paper concluded that brain health is changing across generations but, with people in disadvantaged circumstances most at risk, positive change was most likely with major investment in population health measures.

The paper said: ‘Lack in progress in access to education, patterns of malnutrition in childhood and persistent in equalities within and across countries will play out. Policy makers and politicians will need to take into account the now compelling evidence that such changes in the onset and occurrence of dementia are possible.’

A study published in the Lancet last year also found that dementia rates are actually stabilising rather than increasing, calling for policy makes to put more emphasis on prevention."

Sunday, 17 April 2016

my CUSP Induction Day Talk to DClinPsy trainees @UofGlasgow on 1 October 2014

This morning I was tidying bookshelves (Spring cleaning) and came upon my CUSP (Carers and Users of Services in Psychology Training) Induction Day talk, Wednesday 1 October 2014, given to the DClinPsy trainees and staff in the Mental Health and Wellbeing Unit, Gartnavel Royal Hospital.  I'd been a member of the CUSP group for over 3 years at that point, although had first attended a meeting in the red brick building 2009. 

Here is the one page talk, a photo taken this morning, a copy of which I'd sent beforehand to the lecturers:

My aims then were to learn about the programme and to engage with the trainees/students.  Also to influence services so as to make talking therapies more available and an end to forced drug treatment.  These last two aims are still current.   

Thursday, 14 April 2016

Need for a Wider Review: Hunter Watson April 2016: Mental Health Act #SP16

Here is a new paper 'Need for a Wider Review' by Hunter Watson, human rights campaigner, received this morning:


28 December 2015: Electro-Convulsive Therapy: W Hunter Watson, December 2015

19 October 2015: Consent to Treatment: W Hunter Watson; 18Oct15

13 October 2015: Antipsychotic Guidelines for Dementia Patients (2): W Hunter Watson, July 2015

12 October 2015: 'Revised Code of Practice for the 2003 Act': W Hunter Watson; October 2015

20 June 2015: Hunter Watson Paper: Section 242 of Scottish Mental Health Act 2003: is it ECHR compatible?

12 October 2014: 'Stand up to Mental Health Act' Letter by Hunter Watson, Sunday Express

Press & Journal Apr15

Ask Once Get Help Fast: SAMH Manifesto #SP16: Crisis Care Agreement; ESTEEM; safe havens

Ask Once Get Help Fast: SAMH Manifesto Scottish Parliament Election 2016

[Storify of tweets on the night: #AskOnce Dundee Hustings 14Apr16 #SAMH #SP16: mothers united; safe havens; choices;]

"Scotland should rightly aspire to become a world leader in the field of mental health. That is the challenge we are laying down to all political parties ahead of the Scottish Parliament Election in 2016.

We know that each year one in four of us in Scotland will experience a mental health problem. For some of us this can have the most profound impact on our physical health, our work and relationships, often affecting our wellbeing and quality of life.  In this manifesto, SAMH calls for a 10-year strategy to start in 2016 which transforms the mental health of people living in Scotland. The 2012-2015 Mental Health Strategy set out 36 commitments and yet we have still to see a comprehensive report on its delivery during the lifetime of the strategy. Although there has been progress in some of the commitments there have also been shortcomings. The strategy was inadequately resourced.  Nor was it constructed in a way that allowed annual progress to be reported and monitored with plans put in place for remedial action on failing approaches. 

However, significant challenges remain – people often don’t get the help they need quickly enough and may be passed from pillar to post. Although mental illhealth hits all genders, ages and socioeconomic groups, statistics tell us it is three times greater in areas of socioeconomic deprivation. Our mental health system still focuses on the acute side of care, rather than early intervention or prevention. ..."

page 9

page 13

page 7

page 6



Tuesday, 12 April 2016

Manifesto for Unpaid Carers in Scotland

Manifesto for Unpaid Carers in Scotland link

"This manifesto was produced by
the national carer organisations.
The national carer organisations are brought together by a shared vision that all
Scotland’s unpaid carers will be valued, included and supported as equal partners
in the provision of care and will be able to enjoy a life outside of caring.
They are Carers Scotland, the Coalition of Carers in Scotland, Minority Ethnic Carers
of Older People Project (MECOPP), Carers Trust Scotland, the Scottish Young
Carers Services Alliance, Crossroads Caring Scotland and Shared Care Scotland."

Link to Manifesto

Monday, 11 April 2016

Concerns voiced over Scottish NHS ‘marking its own homework’ @TheScotsman 9Apr16

Concerns voiced over Scottish NHS ‘marking its own homework’ in The Scotsman, 9 April 2016:

"When her elderly father was admitted to hospital after becoming dehydrated and emaciated under the care of his GPs, Jaqui Rae did not know where to turn.

Scotland on Sunday 10Apr16
Retired bar steward William Rae had suffered a devastating stroke in May 2014 but hospital doctors in Edinburgh were confident he would make a recovery. Yet after two months of supposed recuperation in a step down unit, Rae had lost nearly a sixth of his body weight, dropping to under seven stone.

GPs at Oxgangs Path Surgery, in Edinburgh, did not refer him back to hospital until July, by which time he was doubly incontinent and malnourished, Scotland’s ombudsman found last year.

Although the surgery has since apologised and pledged to take the ombudsman’s recommendations into account, Rae, 56, said the incident had a devastating impact on her father and he never fully recovered before his death.

Now she is backing calls for an independent regulator to be established for the Scottish NHS with investigatory and disciplinary powers to hold health boards to account.

This week a whistleblowers’ organisation known as A Safe and Accountable People’s NHS (ASAP NHS) will write to the UK government demanding a public inquiry in the light of what they see as the Scottish Government’s failure to enforce existing health and safety legislation.

About five people die every day in Scotland from preventable causes such as hospital superbugs, dehydration and kidney failure, the group has estimated.

NHS Scotland is scrutinised by both Healthcare Improvement Scotland (HIS) and the Scottish Public Services Ombudsman but concerns have been raised that neither has the appropriate powers.

Critics also say HIS is not independent of NHS Scotland. A recent OECD (Organisation for Economic Co-operation and Development) report said Scotland’s current system risked the inspector “marking its own homework”.

Scotland is also the only part of the UK where the Health and Safety Executive cannot bring its own prosecution as it has to go through the Crown Office first.

Rae, of Mortonhall, Edinburgh, said: “I think it’s very important. While the ombudsman upheld my complaint, I always wanted to know what would be done to follow up to ensure things change.

“I think a lot more of these cases would not happen if there was more independent regulation. So many things are swept under the carpet. I had to fight for everything for my father and I didn’t have anyone to turn to.

“I don’t want anyone else to have to go through that kind of agony again.”

Tougher regulation could have prevented high-profile scandals such as the Clostridium difficile (C.diff) outbreak at Vale of Leven Hospital which resulted in 34 deaths, as well as soaring death rates at NHS Lanarkshire hospitals, said Roger Livermore, a former Crown Office prosecutor for the Health and Safety Executive.

Livermore said: “I worked on policy to regulate healthcare during the 1990s. When I moved back to Scotland five years ago I found that regulation had somehow vanished in Scotland.
“It just beggars belief that there is no independent regulator in a sector that is one of the most dangerous of all.”

He said the NHS had fallen behind much more typically dangerous sectors such as railways and the offshore oil and gas industry, as these have been made safe by strong regulation.
Livermore, who lives in West Lothian, said: “The Scottish Government will not recognise that there are avoidable deaths in the NHS, which is part of the problem. Of course there are within the health service. 

“We will never have effective healthcare without a regulator.”

Initial calls were made for a public inquiry last year, when the group wrote to the then Scottish Secretary Alistair Carmichael with their concerns.

They now plan to write to the UK government, the Attorney General and the Department for Health, among others, with their concerns.

The Scottish Government has pioneered a dedicated Patient Safety Programme, which focuses on improving safety in hospitals, maternity units, tackling mental health and primary care, and preventing the spread of hospital superbugs.

Ministers reported a 23 per cent fall in surgical mortality since 2012. However Livermore said: “The Scottish Patient Safety Programme is just a catalogue of all the things they should have been doing already. It’s nothing dramatic – it’s just playing at safety.”

ASAP NHS also wants adequate protection for whistleblowers to speak out over problems within the NHS.

Plans for an independent whistleblowing officer were put forward by Health Secretary Shona Robison last November but legal experts warned the new role must have the power to compel public bodies.

Rab Wilson, a former psychiatric nurse who exposed a catalogue of errors at NHS Ayrshire and Arran, said: “There is no accountability within health boards and no one to hold them to account.

“We need an inquiry into the lack of a regulator ethically, morally and within the law. The fact we have no independent regulator is unreal.

“It keeps being kicked into the long grass.

“It’s clear we need this but we are being stonewalled.”

Dr Jean Turner, patron of the Scotland Patient’s Association, backed calls for independent regulation but said inherent problems within the system were playing a role.

She said: “I really think that things would be improved if people would take complaints on board as they come in. 

“We want people to be accountable, whatever job they do. It is important that staff are allowed to come forward if there are problems and don’t feel afraid.

“There are problems with continuity of care and shortages of experienced staff which means people are so short of time.

“I don’t think the ombudsman has enough power. Everyone knows you can’t save everyone but as long as everything that could have been done is done then most people will be as satisfied as they can be with the outcome.

“I am supportive of the idea provided it is actually independent and there are experienced people carrying it out.

“We need to have a more rigorous approach to ensure the culture that has developed within the NHS over the last 40 years can change.”

Politicians backed calls for a regulator.

Neil Findlay, Labour candidate for Almond Valley, said: “Scottish Labour has for some time been calling for an independent healthcare regulator in Scotland.

“This especially comes into focus when staff members expose issues within the NHS that have a real and genuine impact on the wellbeing of patients.

“And what is more, these concerns are often ignored or swept under the carpet and the person raising them is victimised.

“This is why we need an independent regulator of the NHS in Scotland.”

Scottish Conservative health spokesman Jackson Carlaw said: “These are obviously very damning allegations. 

“Patients in Scotland deserve much better than this and public safety is paramount especially when it comes to our NHS.”

An SNP spokesperson said: “Patient safety is one of the primary concerns of everyone working in the NHS and we have a robust regulatory framework in place to ensure that all patients can have confidence in the health service.

“Our world-leading Scottish Patient Safety Programme has contributed to a 23.6 per cent reduction in surgical mortality since 2012 – saving lives through the consistent application of best practice.”


Scotland on Sunday 10 April 2016:

#StayingWellAfterPsychosis tweets 1st April: compassionate mind preference

Saturday, 9 April 2016

troublemaker? No. Hardworking, financially poor, campaigner, writer, activist, carer, survivor.

It still rankles that a Professor on a wage of around £90K/annum (compared to my basic State Pension) should accuse me of being a troublemaker.  When the job he does is part-funded by NHS Fife and based at Stratheden Hospital.  And has likely been influenced by the whistleblowing and campaigning work that I've been involved in.  Which has cost me, in terms of time and money.  Benefitting Fife health board to the tune of £4.4million, keeping other people in work. 

Some academics don't appear to have a clue as to how the other half lives.  Psychiatric survivors and mental health service users, and their carers, having to fire fight, pick up the pieces when nurses aren't doing their jobs properly.  Health boards aren't funding mental health treatment properly.  Under-resourced.  Over-stressed.  Blaming families for system failure. 

Mental health nursing programmes are not centres of excellence if they don't involve campaigners and people with lived experience who are questioning individuals with sometime critical voices.  Rather they prefer to insult the grassroots activists and change agents, keeping them on the sidelines.  With the result that nothing is likely to change, abusive cultures continuing.

I recommend that the Professor desists from this type of behaviour and looks to improving his attitude and the way that he engages with women and mothers who have been at the sharp edge and survived the experience.  

Dear @NicolaSturgeon: 9Apr16 tweets: MH Minister, peers, safe havens, de-medicalising misery

Thursday, 7 April 2016

The Glasgow ESTEEM early intervention service #Psychosis #Recovery

Operationalising psychological therapies in early intervention services for psychosis
Development of early intervention services for psychosis
University of Glasgow 

Summary of the impact

"Psychosis affects 3-4% of the UK population and is ranked as the third most disabling condition worldwide by the World Health Organisation. Research at the University of Glasgow has changed treatment and services for patients with psychosis by identifying therapies that improve emotional recovery and prevent psychosis relapse and by contributing to the development of early intervention services for individuals with a first episode of psychosis. This work has supported the inclusion of cognitive behaviour therapy (CBT) for psychosis in national clinical guidelines and the implementation of these guidelines via an expanded UK Department of Health programme. University of Glasgow research has also driven the development and expansion of local early intervention services for psychosis, the success of which has directly informed the current Scottish Government Mental Health Strategy.

Underpinning research

Psychosis is a mental health problem characterised by a loss of contact with reality, with symptoms that include hallucinations and delusions. It often first presents in 16-35 year olds. Within 5 years of a first episode of psychosis, 80% of patients will have experienced a relapse. Most of the lifetime disability arising from psychosis is caused by relapse, which leads to more persistent and distressing psychotic experiences. Research at the University of Glasgow led by Professor Gumley (2001 — present) developed and refined therapies to prevent psychosis relapse and promote emotional recovery, and supported the design of service models that are responsive to the needs of service users (people accessing mental healthcare) who are at risk of relapse and poor outcomes.

Psychological therapies research

In 2003, Gumley conducted the first randomised controlled trial of CBT for psychosis relapse. CBT is an evidence-based form of psychotherapy that aims to educate patients about their condition and to provide them with the skills to manage it. Gumley's research showed that CBT leads to a reduction in relapse and hospital admissions (15.3% in CBT compared to 26.4% in the treatment as usual group; n=72 participants in each group), and improvements in day to day functioning.1 Gumley also showed that each subsequent relapse leads to increased emotional distress, especially feelings of shame and stigma about psychosis. However, users who received CBT experienced improved emotional outcomes.2

These studies demonstrated that relapse emerges from how service users' cope with the early signs and symptoms of a forthcoming relapse. By improving service users' abilities to recognise, tolerate and cope with distressing experiences through CBT, service users can develop greater control and choice in their recovery.1,2 The connection between emotional recovery and relapse prevention first identified at the University of Glasgow has led to a fundamental adaptation of CBT for psychosis. This adaptation focuses on the development of skills to improve emotional regulation, and is published in a treatment manual released in 2006 in collaboration with Matthias Schwannauer (University of Edinburgh).3

Between 2006 and 2010, a large UK, multi-site, randomised controlled trial (EDIE-2), with a substantial Glasgow contribution led by Gumley, provided further evidence that CBT can help to prevent relapses of psychosis.4 The trial showed that CBT reduces the severity of psychotic-like experiences, which are recognised risk factors for developing psychosis, and this finding had important implications for the design and development of services for the early detection of psychosis.

Service design research

Gumley's research has been developed in close collaboration with an NHS early intervention service in Glasgow (ESTEEM). Between 2005 and 2008, Gumley evaluated the outcomes of ESTEEM's comprehensive and dedicated early intervention service, which serves 16-35 year olds. The study, funded by the Chief Scientist Office, compared ESTEEM with adult community mental health services based in Edinburgh. Throughout this study, the duration of untreated psychosis was reduced in Glasgow compared with Edinburgh (13 versus 23 weeks), as was the delay before help-seekers were aided by the services (1 versus 3 weeks). Furthermore, the number of days spent as inpatients in Glasgow was fewer than half that seen in Edinburgh (33 versus 72 days) in the 12 months following a first episode of psychosis. This study demonstrated the value of a dedicated early intervention service over a community-level service.8

The University of Glasgow research has also explored the importance of attachment (the emotional tie between individuals that endures over time) and its role in recovery with service users and staff of the ESTEEM service. In 2011, Gumley's team used the `gold standard' measurement of attachment, The Adult Attachment Interview, to assess and understand an individual's capacity to form useful and productive relationships and thus engage with the therapies and supports offered by mental health services.5 The team also demonstrated that avoidance of attachment relationships was associated with specific problems in service users' ability to regulate their emotions and that such avoidance is therefore a core predictor of relapse and poor outcome.5

Key researchers (Glasgow): Professor Andrew Gumley (Honorary Clinical staff, 1998-2001; Senior Lecturer, 2001-2008; Professor of Psychological Therapy, 2008-present).
External collaborators: Matthias Schwannauer (Professor of Clinical Psychology, University of Edinburgh), Tony Morrison (Professor of Clinical Psychology, University of Manchester),
Max Birchwood (Professor of Youth Mental Health, University of Birmingham) ..."

Read complete case study



Promoting recovery for people experiencing psychosis: University of Glasgow article, 18 March 2016

Staying Well After Psychosis blog page

Tuesday, 5 April 2016

‘I’d Rather Die Than Go Back to Hospital’: Why We Need a Non-medical Crisis House in Every Town @AnneCooke14

‘I’d Rather Die Than Go Back to Hospital’: Why We Need a Non-medical Crisis House in Every Town by Anne Cooke, Mad in America, 28 October 2015

"Drayton Park women’s crisis house in North London offers an alternative to hospital admission for women experiencing mental health crises. It was Shirley McNicholas’ vision that brought it into existence and she has been leading the service since it opened.  As it approaches its twentieth anniversary in December, she talks to Anne Cooke."

Drayton Park Women's Crisis House

 "It was exciting going back to my old stamping ground.  Years ago I’d worked in one of the local community mental health teams and had referred many women to the Drayton Park Crisis House.  Walking up the steps of the house to meet Shirley brought back memories of standing there with desperate and suicidal clients, some of whom had told me that they would rather die than go back into hospital.  As you can imagine, to say I had been glad that there was an alternative would have been an understatement.

The house is a large Victorian villa which looks much like its neighbours in a typical North London street.  Shirley showed me round.   The house was as I remembered it: furnished in a homely, ‘Ikea’ type style, with a lovely, airy living and dining space at the back overlooking the garden.  Each resident has her own en-suite room, with a key, and there are cosy rooms for individual conversations and even massage. Residents’ children are also welcome.  If I have a mental health crisis, take me there or somewhere like it.  

Unfortunately that’s unlikely to be possible – despite their overwhelming popularity there are still only a handful of crisis houses in the UK.  I was keen to find out from Shirley how and why Drayton Park happened, and what has sustained it for twenty years.  So on to my first question.

Anne: How and why did Drayton Park come into being?

Shirley: In 1994 I became co-ordinator of Camden and Islington NHS Trust’s project – instigated after extensive lobbying by local women – to create a crisis house as an alternative to hospital admission.   The steering group shared a basic philosophy:  a holistic, psychosocial approach to mental health, drawing on social constructionist and feminist ideas, on work highlighting the links between trauma and mental health, and on the service user/survivor movement.    I was also personally influenced by systemic theory, having studied it at the Tavistock Institute.   We wanted to create something new that would be robust enough to provide an alternative to hospital for women in acute crisis, but with a very different philosophy and therapeutic approach.  Women were telling us that such a service was desperately needed.  For my part, having trained as a psychiatric nurse and worked as a ward manager for many years, I was determined to create something very different to what I had experienced working in hospital.

Anne: Different in what way? 

Shirley: The illness model – the idea that psychological problems arise primarily from problems in the brain and so need medical treatment – still dominates most of our thinking within services and is enshrined in law in the shape of the Mental Health Act.   By contrast, social constructionists emphasise the power of ideas and language to shape our experience of the world (Gergen, 1985).  This is nowhere more relevant than in the field of mental health, where diagnoses powerfully determine how people are treated, both within services and also in the wider world.   It is not that diagnoses can’t be helpful, but they have immense power, leading us to view someone’s problems in a certain way and often to overlook other ways of understanding what might be going on.  For example, they can distract our attention from ways in which the person’s problems might be related to their prior experience of the world.  By contrast, a systemic way of thinking sees each person within the context not only of their family and their immediate social setting but also their social roles as, say, a woman or someone from a devalued group. It recognises that different people have different ‘stories’ about a particular situation or problem.  None of these have a unique claim to truth, including those advocated by the ‘experts,’ but all impact powerfully on decisions about what might help.

Anne: So what does that mean in practice for how you do things at Drayton Park? 

Shirley: One example might be the referral process.  Professionals can refer in the usual way, but women, their families and friends can also self-refer.  This obviously gives women more control, but it also makes an important statement about power and ownership.  Over the years we’ve often had to resist pressure to limit or stop self-referrals, and go back to the old system where clinicians decide. People worry that the service might be abused or overwhelmed, that women who are not in acute crisis might get in. I think it’s interesting those questions are not raised when it’s clinicians who refer.  We’ve fought hard to stick to the principle of ‘no decision about me, without me.’

Anne: What about mothers who are in crisis but have young children?

Shirley:   Drayton Park is relatively unique in that children can stay here with their mothers.  This can be a challenge, of course, but many mothers have the main or sole responsibility for their children,  and even when they really need help they will often wait until they are sectioned rather than leave their children.

Anne: You are a women-only team.  Tell me about that?

Shirley: Interestingly in 1994 this was not questioned and nor was the makeup of the team: the Trust and the local authority were open to trying a new way.   We created a team based not on professional qualifications but on skills, experience and attitude.  Compiling job descriptions was exciting: our ‘person specifications’ included an expectation that staff had an understanding of the relevant political debates, for example.  Within boundaries, women are expected to draw on their own life experiences in their work. Staff come from a wide range of backgrounds including the voluntary sector and social care settings as well as psychology graduates.

Anne: So you were quite different to most services.  How did people react?

Shirley:  Really well, mostly.  The service was hugely popular both with the women who used it and with local colleagues from all professions. We knew we were getting it right when audits showed that whilst the demographics and reasons for admission were similar to the inpatient wards, the feedback was much more positive.  Women who stay here are choosing to do so, so the basis of the relationship was often different.  Nevertheless, there is no doubt that the experience was very different too. Women told us that they appreciated the authenticity of the team, and that they particularly valued our willingness to hear and bear traumatic accounts, and to work jointly with women to contain suicidal feelings and self-harming behaviours.

Anne: You mention self-harm, which is often something services struggle to know how best to respond to.  What is Drayton Park’s policy?

Shirley: This was something we gave a lot of thought to.  We had learnt from specialist services, but we were also learning from each woman who came to stay. Women were often skilled in using alternatives to self-harming, and keen to participate groups and to try to understand why they harmed themselves.  We agreed a policy that included staff keeping clean blades that women could use when nothing else was working. Although this seems dramatic and risky, it had a paradoxical effect, as the women knew it would:  the knowledge that they could come for a blade meant that self-harming behaviour reduced. Women were also learning to trust others with their injuries.  Our non-judgmental approach enabled many women to show their scars and wounds to someone else for the first time.  We also had to work with women who harmed internally, inserting blades inside themselves. Again, although it felt counter-intuitive to those staff more used to working in settings which intervene by force if necessary to keep someone safe, we found a way of working that didn’t involve taking control away from the woman.  We worked with each woman to be as safe as she could be, trusting her judgement but also being aware of our limits and being honest about this. It has been a very rare occasion where working with someone in this way has not been possible.

Anne: Tell me more about your risk management policy?

Shirley: Our policy has to be consistent with the Trust-wide one, but the basis is collaboration and psychological ‘containment’. It was a woman staying who first used those words, and I immediately recognised that this was a very useful way of describing how risk is held within the service.  Rather than the ‘observations’ made in hospitals, we make contacts.  The team follow a structured 24-hour timetable: at particular intervals each worker finds and connects with each woman she is allocated.  We know that the woman is safe, and the woman knows that she is held in mind. The feedback about this has been very moving.  People really appreciate not being left alone for hours in a bedroom, and knowing someone will come and find them.  However withdrawn, irritable, or unwilling you are, your worker will come and find you. Each worker on every day shift offers a one-to-one session to each woman she is looking after, so everyone gets regular private time to talk.

Anne: What are the talking sessions used for? 

Shirley:  Often they are used to address practical issues or simply for support and reassurance.   However, sometimes we listen and bear witness as women describe past and present traumas that are that are overwhelming and painful. We know that the majority of the women who use our service – and indeed other acute mental health services – have experienced trauma. It still amazes me how little attention is paid to this. In the two to three weeks that women generally stay with us, we offer counselling, grounding techniques, mindfulness, and help people develop coping strategies. We are also supported by a massage therapist whose input is highly valued by the women.

Anne: Do you think the physical surroundings are important?

Shirley: They are hugely important.  We were fortunate enough to be offered a large Victorian house to house the service. This allows for a homely atmosphere with space for art and information.  We’ve tried to create a space that is comfortable for a diverse range of women, and people certainly tell us that they find it a comforting and soothing environment. Our policy, which is on the notice board in every bedroom, is that staff will knock three times before using a key. This small practice has huge ramifications. It symbolises respect and privacy but also communicates recognition of the trauma that so many women have experienced, often in bedrooms. The simple act of giving people time to open the door powerfully communicates symbolically that ‘you are in control here’.  The spirit of the Drayton Park model is reflected and perpetuated in the details.

Gergen, K. (1985) The Social Constructionist Movement in Modern Psychology. American Psychologist, 40, 3, pp 266 - 275


Drayton Park Women's Crisis House, Camden and Islington NHS Foundation Trust