news focus: When former mental health service users helped to run acute services, their understanding of patients'needs saw conditions improve. Lynn Greenwood reports

Published: 30/05/2002, Volume II2, No. 5807 Page 16 17

Mother of four Sheila Cleugh 'went to pieces' at the age of 38, years after an abusive childhood which drove her to attempt suicide at the age of five.

Almost two years of therapy ended eight years ago.

Colin Edington spent ten weeks in an acute psychiatric ward with severe depression soon after his parents died within 27 hours of each other from unrelated conditions. Five years on, he was re-admitted for a further 13 weeks - also eight years ago.

Ms Cleugh and Mr Edington are now actively engaged in involving service users in the development of mental health services on Tyneside. Both were also members of the UK's first mental health collaborative, a 15-month project which was commissioned jointly by the Trent and Northern & Yorkshire regional offices and the Northern centre for mental health.

The aim of the project, which will celebrate its achievements at a major conference in Leeds on 13 June, was to improve service users' experiences of acute inpatient care, and to achieve better outcomes throughout the process of admission, stay and discharge.

Ms Cleugh and Mr Edington, who will feature in a video to be shown at the conference, are enthusiastic with results.

'I think the collaborative model is wonderful as it gets frontline staff and patients involved, ' says Ms Cleugh, appointed a service user development worker in north Tyneside seven years ago, after completing her degree in health studies.

'The atmosphere on the wards is less clinical, and staff and patients are working together for the good of the ward, to create a community spirit, ' says Mr Edington, who assists on acute inpatient wards at a Durham hospital, and is studying for a teacher training qualification to expand his work with student nurses and social workers.

More specifically, both can list several important improvements generated by the experience of service users themselves.

A 'welcome' nurse and an information pack are now key parts of a patient's reception. 'If you are a first-time patient, you do not realise you have to make your own bed and do your own laundry, ' says Ms Cleugh. 'So we reviewed the literature from other wards and went on to develop a pack with just enough information to be helpful but not to overwhelm someone who may be very ill.'

The 'welcome' or reception nurse now greets new patients and their carers, shows them around, introduces them to staff and patients, explains the routine over a cup of tea and stays with them until they feel comfortable.

For Mr Edington, the return of staff uniforms is important. 'I know what it is like entering a ward for the first time, and when nobody wears a uniform you do not know who are staff and who are patients. In fact, the only reason you know It is a hospital is because someone told you.'

Now staff where he is based wear a relaxed uniform of blue polo shirts and black trousers, making it easier for patients and their carers to identify them immediately.

These can seem to be small changes to outsiders but they make huge differences to the ward environment and patient experience, says Ms Cleugh.

One example was when no cold drinking water was available. 'Can you imagine taking tablets with warm water?' she asks. 'Hot meals were only provided at lunchtime until we discovered that if we changed to the children's menu, patients could have two hot meals - provided they do not mind having fish fingers in the shape of a fish!'

Not every suggested change has been 100 per cent successful: a 'comments, complaints and compliments' leaflet for patients to complete has not produced the expected response and attempts to encourage service users to set up community groups has foundered through lack of volunteers.

But the achievements and failures have both proved the value of collaborative working.

'The beauty of the collaborative approach is that if you make a change that works, fine; if it needs tweaking, you can do it, but if it doesn't work, scrap it, ' says Mr Edington. 'That way you do not waste time and resources trying to make it work.'

Between February 2001 and January 2002, 37 project teams generated 370 permanent changes.

They included an improved admission pathway for patients, an increase from 20 per cent to 70 per cent of patients receiving one-to-one time with their named nurse twice a week, and a personalised, laminated crisis card issued to all patients on discharge.

'But it definitely needs service users to be involved, and not just in a token way, 'Mr Edington says.

'There is a common saying that we get more information from patients than staff about what's going on, because they feel more relaxed telling someone who has been through the experience.'

Project co-ordinator Yvonne Stoddart says: 'The involvement of service users as core team members has been a big factor in the project's success, enabling everyone to see the service through their eyes.'

She adds: 'Teams have developed new ways of involving service users in planning, redesigning and monitoring the care they receive and now many of the changes made around patient information and therapies have been user-led. They have also helped to make aspects of the traditional ward round - in some cases now called patient reviews - more user-friendly.' l