Published: 07/02/2002, Volume II2, No 5791. Page 16
Ask someone to describe a typical acute psychiatric unit and they will conjure up images of deeply disturbed people wrapped in a fog of boredom, cigarette smoke and powerful neuroleptic drugs.
But that cliché is a million miles away from the reality of the Lambeth early-onset unit in south London, which is a cross between a motorway motel and a neat and tidy student hall of residence.
The unit, which is part of South London and Maudsley trust, provides a safe supportive environment for 18 young men and women aged 18-40 undergoing the trauma of their first or second episode of psychotic illness.
It is model described in the NHS plan as the way forward for acute care. At the moment, the Lambeth unit is the only one of what are hoped will be 50 similar early-onset community mental health teams created across England and Wales.
Many of its patients, who come from one of the poorest areas in the UK, suffer paranoid delusions and auditory or visual hallucinations. Three-quarters of them have a history of violence and drug abuse.
Yet in the nine months of its existence, the unit has managed to achieve 'negligible' re-admission rates, used significantly fewer neuroleptic drugs than other acute units and 'minimal' use of restraint techniques.
Staff modestly point out that they do not have a magic touch and say many units could be achieving these results with their levels of staffing, quality of environment and community and trust support.
Team leader Carolyn Green says:
'You give someone who is disturbed and traumatised respect and a nice place to be and you actually try to listen to them, do not restrain them - there is nothing done here that can't be done elsewhere. If you have got a fully committed, motivated and enthusiastic team, you can do anything.'
And from the early indicators, providing a comfortable environment where patients and their families feel involved in all aspects of care and treatment could provide a better model for acute care which is often seen as frightening and alienating.
Conventional acute wards are seen as places where high levels of medication and restraint, and high staff turnover and low therapeutic input, contribute to the inevitable cycle of admission, release and readmission.
But the Lambeth unIt is drug spend is around a third lower than some local acute units.
Consultant psychiatrist Dr Paddy Power says: 'Even when we use neuroleptic medication, it costs less because we use lower doses and there are less side-effects.'
Patients exhibiting early signs of an impending crisis are referred to the Lambeth unit from accident and emergency departments, GPs, community mental health teams or other services, either as informal patients agreeing to admission or under section.
An average stay is 26 days, which is 'significantly less' than in other acute units. But the staff approach, which emphasises that the patient is still independent and engaged, could be a factor in readmission rates after three months, which according to Dr Power, are running at a 'negligible' 1-2 per cent.
The Lambeth unIt is emphasis is on making the hospital stay a 'lowtrauma' experience by helping the patients understand why they are there and what part the hospital plays in treatment and care.
Dr Power says: 'The whole atmosphere and philosophy is to make the stay much more of a partnership. When someone comes in, we do not immediately launch into medication. It is more engaging. We talk through treatment options, including options of care and medication and its side-effects.'
The unit is divided into 10 male and eight female rooms on separate corridors.
Each room has a bathroom and toilet and a socket for a television set. There is a portable payphone on both male and female corridors, which can be used in the bedrooms for privacy.
The low-trauma approach means spending a lot of time with patients. Patients are 'zoned' - given a colour coding which relates to the levels of risk, need and degree of illness.
Healthcare assistants, psychologists, social workers, occupational therapists, volunteers and carers also work on the unit.
A sister community team assesses patient needs and will work with patients and their families and the professions in devising a care plan and trying to ensure all their needs are met.
In the advocacy room, there is a computer with e-mail and internet access so patients can communicate with friends but also work with their primary nurse on developing CVs or job or college applications.
Nurses say it is important to help patients help themselves so they can carry out new jobs or learn new skills.
There is also a 'chill-out' room, which provides a safe and private refuge when a patient feels angry or upset, and helps minimise disruption and disturbance to others.
To combat the poison of boredom, there is a room with table tennis, snooker and exercise bike and a small smoking area, television, video, art materials - and even a graffiti wall.
A key factor in making people feel they have control over their environment is having 24-hour access to cooking facilities and, more importantly, open access to boiling water, which is denied in many acute hospitals.
Clinical nurse specialist Mark Hipkiss says: 'Food and water are basic human rights.
We also eat with patients - It is a way of checking if people are eating. It is also part of the concept of low trauma - it helps build trust with people.' l
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