Published: 13/10/2005 Volume 115 No. 5976 Page 39
Lynne Greenwood reports on an initiative that has turned round a badly neglected home for mental health service users
Most of the 34 residents of Forest Close, a complex of five bungalows set around attractive gardens, will spend the rest of their lives in the Sheffield home. The men and women living there, whose ages span six decades, have severe and enduring mental illness, most with schizophrenia.
The patients moved in following the closure of the nearby Middlewood Hospital in Sheffield. But consultant psychiatrist Dr Katy Kendall admits: 'This place - the patients, the staff - was forgotten. It was seen as a place where people went forever, and therefore a low priority when it came to resources.' Clinical nurse manager Julie Simmons adds: 'In 1995 the physical nursing environment was poor and this affected staff and client morale. The clients had complex and challenging needs, yet staff had the least access to training. Their development and support needs were not prioritised, and at this stage clinical supervision structures were absent. Now investment in rehabilitation and continuing care is seen as essential.' Today, around 10 of those patients now have paid work experience in the sweet shop at the city's Northern General Hospital, each accompanied by a support worker for their usual one-day-a-week shifts. 'People told us 'you can't have crazy people working in the shop', ' says Katy. 'But we did it anyway.' At the end of each day, the patients write down what they have done. Dr Angela Carradice, who manages the shop, says: 'One man wrote that being part of the shop had really increased his selfesteem and confidence. Work is so important for mental health.' In her view, it is all about improving people's quality of life to help the patients' mental health. 'Patients have a say in what we do here, and some of the decisions about the service.' Some go to college, the gym, walking, or do pottery. Others enjoy aromatherapy treatments. When potential new staff members are interviewed, patients are involved in the panel and encouraged to ask questions. One asked: 'Are you a worker or a shirker?' and another: 'What would you do if I didn't want the injection you were giving me and I pulled it out?' 'You could say it focuses their minds, rather more than asking how good they are at team working, ' says Katy.
And against all expectations, patients have occasionally been discharged into residential care or independent living.
Angela says: 'It is not perfect now, but it is so much better.' Julie goes further: 'The ambience here is beautiful. And now, because the senior team works so well together, staff are encouraged to discuss their grievances and we work with them to overcome the difficulties, ' she says.
The catalyst for change was the appointment by Sheffield Care trust of Consultancy Works to conduct an in-depth review of the service (see box).
Although the senior staff were passionate about providing a better service, it took an outside review to show them how it could be achieved.
'If this had been an internal review - one set of health managers telling another set how to do it - it would not have had the same results, ' says Dr Kendall. 'The external review was important because it demonstrated a financial commitment on the part of the trust to explore problems.' The review provided the impetus for changes, which have since been sustained and developed. Some of these are now enabling clients to enjoy responsibilities many had never experienced.
Tackling isolation: 'uncared-for and abandoned'
When Consultancy Works partner Jane Linklater first arrived at Forest Close she found 'uncared-for and abandoned' staff. 'There was no real team working, no cohesive leadership.' She did a three-month review, followed by 15 months of development work carried out by the Consultancy Works team.
After initial interviews Jane identified the main issues as:
isolation of the service from its parent organisation following the hospital closure;
isolation of staff groups from each other;
poor staff relationships resulting in low morale;
lack of clear strategy for the service.
After the review the consulting team also worked with four middle manager nurses as a group, conducted focus groups with staff and organised 'away-days' for each bungalow.
Looking back, Jane highlights the following important factors:
establishing the senior team;
providing opportunities for developing the service vision and strategy;
creating an atmosphere where all staff work together;
helping staff feel valued at work.
Clinical nurse manager Julie Simmons says Jane's work 'was like teaching us to drive a car; after we passed the test, it was up to us'.
'It is important to recognise that the successful changes were achieved by combining external consultation work with ongoing effective leadership and provision of training, ' she adds.
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