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Animal Magic – Options for patient contact with animals

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Resident ward pets

It’s worth saying again that different wards, and different current patients on a ward require different considerations. Cats and guinea pigs currently top the list of wards’ own pets, with fish (unsurprisingly) the most common pet for patients to have with them. Again unsurprisingly, the greater the commitment (eg having a ward pet), the greater the benefits and it can be best to start off with relatively low-effort animal contact (eg Pets as Therapy dog visiting).

 

The following are the sorts of things that are important to think about

Patient group issues

  • Age
  • Physical health
  • Relationship with animals (eg rural communities have more contact with animals, large and small.)
  • Religion

 

Patients’ individual issues

  • Importance of animals in the person’s life
  • Likely therapeutic benefits of contact with animals

 

Pet’s characteristics

  • Feeding & care needs
  • Health
  • Lifespan
  • Attention needed
  • Cost
  • Size (including ability to be carried & space needed)
  • Gentleness, tolerance
  • Responsivity to humans
  • Stroking – none, furry, feathery, scaly, soft, rough
  • Playfulness
  • Energy
  • Sensitivity
  • Indoor/outdoor
  • Risks eg:
    • Noisiness (barking, spinning round in wheel all night….)
    • Potential for injuring people
    • Allergies
    • Phobias
    • Cultural/religious considerations –

Some people avoid going into hospital because they have a pet to care for. They may even go missing to go home because they are concerned about their pets.

This excerpt from NHS Forth Valley is very helpful:

 

9.2     Selecting a Pet Animal

Choosing a residential pet animal involves long-term commitment to it.  It must also be remembered that not all people are pet animal lovers, and some people may have allergies to them so their wishes must also be taken into consideration.

Permission will not be given for exotic pet animals e.g. reptiles, snakes or fish that require specialist facilities and foods, which could introduce infections into NHS Forth Valley.

Some pet animals may be refused on grounds of type of behaviour, infection risk or amount of space needed for it to be treated well.

A pet animal that is clean and healthy, has all required immunisations, is temperamentally suitable and predictable (friendly, calm, under control) should be chosen.

Any pet animal selected should be registered with a recognised veterinarian

(preferably local) and ideally enrolled under an insurance policy scheme.

Ward examples

  • Fish in a sealed aquarium unit which staff will oversee.
  • Chickens are starting to be seen amidst the parsnips and petunias on hospital allotments.
  • The hospital’s Pets Corner has three guinea pigs.
  • We have chickens but no poultry policy as yet!
  • One hospital is blessed with beautiful, extensive, wrap-around grounds, including steep banks which are difficult to mow, so they’re considering getting sheep!
  • Garden designed to attract wild life – birds, bees, butterflies and the odd squirrel!
  • We’re a male Medium Secure Unit which has a huge enclosure for rescue chickens. The men identify with the chickens – both the freedom they have compared to how life used to be for them (giving the men hope for their eventual release) and that they are still not free to roam wherever they want. Above all, the chickens give the men a sense of purpose, satisfaction, responsibility and interest. The eggs are sold to pay for the cost of feeding and caring for the chickens, so management don’t complain about the costs!

The much-mentioned (because it’s so great!) State Hospital Scotland (a high secure unit) has a sparkling array of animals:

 

Currently we have:

3 outdoor rabbits             4 indoor rabbits

4 guinea pigs                     2 kune kune sows

2 pygmy goats                   A pair of geese and a gosling

15 ducks                             20 hens

10 cockatiels                      2 borrowed lambs

A (blind) cat                      A parrot

12 stocked fish tanks       Three indoor ponds with koi carp

2 terrapins                         1 chipmunk

3 visiting dogs

 

Where to get pets from?

They come from various sources: some are donated, some are purchased, some bred on the premises and others rescued. Initially we received several enquiries about taking  in animals  from the local veterinary practice. This was a very good way of obtaining animals  since their suitability as pets had already been assessed, and they were healthy.

While most experts in the field of Animal Assisted Therapy stress the importance of only taking in well-behaved animals, we have found that this is not necessarily true for our situation, with the exception of visiting animals such as dogs. There is a rationale behind this:

  • Firstly, an animal that has been abused and is aggressive can learn to trust.
  • The person that the animal learns to trust can gain a great deal of fulfilment and sense of self-worth from the effort required to change this situation.
  • Many of our patients have come along a parallel line with these animals: they have been abused, they have suffered and learned mistrust, they have been dealt with aggressively and have subsequently used aggression, and when they observe how an animal’s behaviour can be changed dramatically using positive reinforcement, they can relate this to how their own behaviour can change.

Animals in residence

At Sherwood House, they like to do things differently. “We thought about getting a budgie,’ said Ricky Holland, the hospital manager, “but one of our clients is interested in birds of prey so we ended up with a red-tailed buzzard instead!” She’s called Tilly. Looking after her has been a project for helping to construct an aviary, consulting the RSPB and receiving advice from a local bird expert. Tilly has given some of the clients a focus, a reason to leap out of bed in the mornings, and a topic of conversation.

Storthfield has gone for something a little easier to catch – Flash the red-footed tortoise! She is at her happiest wandering around the conservatory, occasionally handled by clients. A quiet reptile who is not demanding, all she requires is a daily feeding regime and a regular cleaning schedule which benefits her and provides responsibility for clients.

Peacocks and colleagues

photo-1454551434781-2e5c58959f85We have for the past few years now we’ve had rabbits, guinea pigs, finches, cockatiels and peacocks and we have currently 4 rabbits and 8 guinea pigs. Patients take turns to clean out and feed etc.. We did consider having sugar gliders.. but I had to say no to any animals being housed inside the building  due to concerns for allergy amongst the patient group, attracting mice etc if not cared for correctly. We did at one point have ferrets  but they were not so friendly.. so I would not recommend them unless they are used to be being handled. Rabbits have been taken to other wards for holds and fuss etc,  but again  some patients can be sensitive to the fur.. so any engagement with the animals or birds, follows risk assessment and physical screen by the ward doctor.

Branwen Ward – Ty Llywelyn, North Wales NHS Trust

From Star Wards’ newsletter #49.5

The day room was light and airy; the big sliding doors were opened onto the garden and an enormous lawned area. One of the patients appeared carrying two oversized babies’ bottles filled with warm milk. I was invited to follow round to the other part of the garden where the ward’s two lambs, Alice and Bruce, were about to be bottle fed. I didn’t need to be told what effect taking care of these animals was having; I could see for myself the care and affection being lavished on them by the patients. I was given the chance to bottle feed one of the lambs myself so was able to experience that indeed pets as therapy really works – it was a really fantastic experience, that had me smiling and laughing as the lamb tugged eagerly on the bottle, not stopping to draw breath until it was completely empty.

One patient in particular has benefited greatly from taking care of the lambs while others had made the ‘hutch’ (not sure what you call an impressive wooden, straw lined ‘house’) for the lambs to sleep in. This was made in the unit’s workshop where patients can get hands on experience with many wood work projects. For those of you worried about what usually happens to Welsh lamb and what effect this might have– no need to worry, Bethan lives on a farm and is taking the lambs to live with her when they mature to full grown and next year the ward will become foster parents to another pair of orphans to hand rear.

photo-1443806798002-651c462956ffIt’s fascinating that Switzerland has a hospital where each ward has a resident ‘therapeutic dog’. This was enthusiastically written up in The Schizophrenia Commission’s report (p23-4):

The Burgholzli Hospital in Zurich, where Bleuler coined the term schizophrenia, provides mentally ill people with facilities which give 24 each patient access to beautiful gardens, exercise facilities, and, in most cases, single rooms with showers. In addition each unit has a “therapeutic” dog relieving tension and bringing comfort to people. It is not unreasonable to expect that such examples of good care and treatment should be the norm for people who are acutely unwell with a serious psychotic condition such as schizophrenia.

Pets visiting the ward

 

The two most popular arrangements are staff bringing in their dogs for the day and linking up with the local Pets as Therapy group so that a volunteer and trained pet (usually a dog) visit regularly.  This video from CNWL describes the positive effects PAT dog visits have on patients. (Confusingly, this Buddy is not Star Wards’ Buddy, but also totally delightful.)

Some wards have imaginatively got round the problem experienced by most wards of being on a waiting list for a PAT visitor for months or longer, by staff registering their own dogs with Pets as Therapy and bringing them in on that basis. The American Psychiatric Association reports that Animal- Assisted Therapy was associated with reduced state anxiety levels for hospitalized patients with a variety of psychiatric diagnoses. There are a zillion (well, lots anyway) of research studies and books providing compelling evidence and moving examples of the disproportionate benefits that hospital patients experience from being with animals. A good summary of them can be found here.

The annual Bring Your Dog to Work Day is an ideal opportunity to have doggy visitors and happy patients and some hospitals have special Animal Days where creatures from local farms, or with specialised companies (such as Zoolab) visit. This is what happened at a mental health hospital where visiting animals included this outrageously beautiful (and of course tame!) snake. (We’re grateful to patients and staff for giving us permission to use this photo.)

A lower-key version of this is to ask local animal and wildlife experts and enthusiasts to come and talk with patients eg from:

  • Dogs Trust, Cats Protection, RSPCA, PDSA, RSPB and other animal charities
  • Your local Wildlife Trust
  • Animal rescue centres
  • Vets
  • Zoos, wildlife parks, aquariums, bird parks, farms, nature reserves, animal sanctuaries

To celebrate the opening of their new Therapeutic Community, Harrison House invited along… a pony! Here’s a photo of Marion enjoying the ride with two HH wonderstaff – Ellie Walsh and Suzanne Brown.

Patient experiences

  • A Labrador came to visit us quite often and we took it out for a walk. Pet therapy helps.
  • I cried when we had a talk from the Dog’s Trust lady. But it was a relief to cry about something from the ‘real world’.
  • We had a pets and animal day. I love watching animals and wondering if they ever question their own sanity or if they are even aware of it.

 

Ward examples

  • Many wards have Pets as Therapy dogs visiting (although many more linger on waiting lists).
  • We have a pets for patients visit on a regular basis (acute psych ward) there hasn’t been any particular problems…. patients just seem to see it as “a dog”!  The ward domestic appreciates it, as it hoovers-up during the visit.
  • Alex Ground Floor, South London and Maudsley, have a dog on the ward for two days per week all day. We formulated a risk assessment and discussed this with Health and Safety, Infection Control and our senior management before the go ahead.  There have been no problems at all having Max on the ward, in fact he has been a complete success with everyone.  He has motivated patients to exercise, he has also been a great source of conversation with patients and staff.  Feedback from patients and carers has been nothing but positive.  Patients have reported that their mood lifts when he is around and he also has a calming effect on the ward.  I cannot encourage people enough to do this as it has untold benefits for patients.
  • The Head of Therapies brings in her dog who the patients take for walks and practice training techniques.  There is a hamster which plays an important role in enabling patients to regain their equilibrium. The patients have also started having horse riding lessons which has been very popular and a great mood lifter.
  • A member of staff guide dog ‘’Tom’’ is a regular visitor to the ward.
  • There’s a kennel in the ward garden, with a plaque for George Junior above the door. The eponymous part-time resident is a whopping Great Dane, ‘Pets as Therapy’ registered dog. His human is an OT and George Junior enjoys taking patients for runs around the garden and nearby.
  • Have a physio Assistant who brings her dog into the unit one day a week (it even has its own I.D. name badge on its collar), and she runs a long-established ‘dog walking’ group.
  • “One of our porters brings her dogs to work. She leaves them in the car with the boot open and a safety mesh on and we get a group of patients and take the dogs for a walk around the grounds. It is good exercise for the patients and the dogs and it also helps bring the patients together. It’s also a good bonding session. It helps builds their confidence as we often notice that the quiet and slightly withdrawn patients will take charge of the dogs leads and this helps bring them out of themselves a bit. We also have a good chat and a laugh over who is going to be in charge of the poop scoop!”
  • A hugely popular animals’ day was held, with visitors ranging from reptiles to rodents. Patients bravely and enjoyably cuddled even the slithery snake.
  • We invited a falconer to the ward. He brought 5 birds with him. The patients were able to interact with the birds at close range, and were allowed to feed them and fly them from perches on their wrists. The photographs taken that day are prominently displayed on the ward. The patients were so delighted by this close encounter that the falconer has been invited to make a return visit in May.
  • Visiting birds of prey – very popular.
  • Falconry training takes place in grounds
  •  [Welcoming pets on wards is] not before time and would have a huge impact on our service users., we have our own, search/sniffer dog and she visits wards and service users when she’s not working also and has been used very successfully to help a gentleman who was extremely unwell mentally to go to the local hospital as he wouldn’t leave the PICU before and he travelled with the dog and she visited him in the general Hospital also!! We had tried everything to try and persuade him to go to hospital before that and she had the magic touch so to speak, I’m a huge fan of pets on wards.
  • Having a pre-training Guide Dog puppy.

photo-1449628275652-6a7d8df8951bOnce a month, the patients at St. Augustine’s have a chance to spend some time with Stella the labrador, from ‘Pets as Therapy,’ who is blessed with a wonderful calming disposition. Staff-nurse Alison made the arrangements. “It’s very soothing to spend time with a dog as placid as Stella and the reaction has been very positive. Patients who are very withdrawn seem to open up when she’s around.”

Visits from Stella allow the patients to build a trusting relationship with a creature who gives unconditional love and affection. Her presence improves interaction between patients too, giving them something in common to discuss.

At Storthfield, Katie, a sheltie who belongs to Monika Payne, Head of Nursing Care, visits the unit regularly to allow the patients to pet and walk her. She’s a gentle dog and wanders around the unit with a supervisor. The clients enjoy her company and spend time talking to her, grooming and feeding her.

Wildlife outdoors

 

Wildlife is the new mindfulness! It can be totally absorbing and satisfying to watch birds, bunnies, squirrels – even insects can be fascinating, with spiders’ webs a miracle of engineering, art, architecture as well as a super-effective hunting creation. Butterflies are a joy to watch and lots of plants can help attract them into the garden. Tiverton Hospital have embraced the health benefits of making a wildlife garden, and all wards can attract more wildlife visitors by doing easy things like having bird-feeders and nestboxes.

Many wards, especially those in rural locations, are blessed with a wondrous array of wildlife just outside, much of which can be enjoyed by gazing out of the windows. Horses, sheep, cows, rabbits… And a colourful, often choral range of enchanting birds. Even urban wards will have creatures that patients, staff and visitors can enjoy.

The simplest, low/no cost experiences with animals are through making the most of whatever wildlife is in the garden/car park/fields/sky/trees outside the hospital.

Visiting animals off-site

 

As you’ll see from the examples below, wards have found all sorts of ways to enable patients who have leave to go off-site to enjoy being with animals. And there are lots of local visiting opportunities, offering more exotic experiences than the abundant wildlife in local parks and gardens, including:

  • zoos
  • wildlife parks
  • aquariums
  • bird parks
  • farms
  • nature reserves
  • animal sanctuaries

 

And of course woods, fields and all the other outdoor places where it’s possible to see stunning wildlife. The Wildlife Trusts has an inspiring website feature about places to see wildlife and your local Wildlife Trust can tell you about fab places near the hospital. They might also be happy to come and give a talk to patients.

Ward examples

  • Patients access the local dogs home for volunteer work and also to pet the animals.
  • Patients visit the local city farm to help with animal care
  • Horse-riding. This happens quite often in private sector hospitals but it’s worth checking if you have a local Riding for the Disabled group which could provide rides or other contact for some patients. Equine Assisted Therapy for people with mental illness is becoming increasingly well-established: A relationship developed with a horse can offer challenges to help overcome fears, build up trust, respect, compassion, develop communication skills, problem solving & coping techniques, self confidence and self esteem. These skills are transferrable to many other areas of ordinary day to day life.
  • Patients have access to Local RSPCA dog-walking scheme.
  • Occasional visits from keepers of reptiles/unusual pets

Animals in the community

Dog walking is good for your health!

photo-1464964165638-96827ce7e617It raises the heartbeat from around 80 beats per minute to 140. A raised heartbeat means more blood and oxygen is being delivered to the heart muscle helping to maintain a healthy heart and lungs.

Patients from Aspen House and Lodge have just started horse riding at the Northern Racing College. There are both indoor and outdoor facilities, so whatever the weather, patients can enjoy the activity and exercise.

A group of about five patients go there on a regular basis. There have been significant benefits observed for two patients in particular, who usually find it difficult to participate in group activities.

Adele, who has never ridden before said, “It’s really nice to have the interaction with the horses, they are so gentle. It was my first time, but they didn’t push me, I’m trying trotting next week!”

Denise thinks “It’s a good scheme and good for motivation. The horses like me and I warm to them. I think the indoor facilities are great, I love grooming the horses.”

Dog-walking is an activity enjoyed by many Cambian clients. From Sherwood, a group go to the Jerry Green Dog Rescue Centre in the neighbouring village of Blidworth. Kelly Brandon, Therapy Co-Ordinator, tells us: “The patients have a dog each that they walk around the field. We have seen improvements in them since they have been interacting with the dogs. In some it has helped their interpersonal skills, morale and motivation. It’s also a little light exercise for some of our less active patients.

Some of the men take treats for the dogs and tins of food, as the kennels relies on donations. Some now have plans to adopt their own rescue dogs when they return to the community, when most would have opted for a new puppy. Some of the men also enjoyed a visit to Twycross Zoo.

We could all put our names to a statement from the Pet Health Council: “It will come as no surprise to animal lovers that research shows that pets are good for our health. Contact with animals can bring real physiological and psychological benefits.”

Horse riding has many therapeutic benefits:

  • photo-1463790323425-d6f5456869d7Reach therapeutic goals: improve muscle tone and posture, develop fine and gross motor movement
  • Combat social isolation: build relationships, enjoy events and competition, develop self-confidence
  • Develop life skills: improve communication, take responsibility, be a team player
  • Experience the outdoors: ride in the countryside, access rural Britain
  • Connect with animals: bringing positivity and optimism, adding a new element to life

Alternatives to resident pets

 

I am delighted to have contributed to the effort by introducing the patients to an elephant orphanage in Kenya. Dr John McGinley, Psychology Director, State Hospital Scotland

This elephant adoption is a particularly imaginative way of connecting patients with animals – although it must be said that the magnificent State Hospital also have an extensive animal therapy programme, much referred to on this website. For some wards, it isn’t possible at the moment for patients to have much contact with animals, even their own pets, and creative alternatives can be a help in bridging the gap.

Firstly there are animal-themed activities – arts and crafts, DVDs, Youtube, discussions about the role animals do or don’t play in people’s lives and the sorts of displays described in ward examples below. In particular, most days there are programmes about animals and wildlife on at least one channel and these are great opportunities to get conversations going.

Then there are animal substitutes – a rather questionable old piece of research suggested it was possible to identify patients with Borderline Personality Disorder by looking for those who have soft toys in hospital with them! (However dodgy this theory is, I do have BPD and do indeed bring a toy bunny or dog with my when I’m admitted!) For many patients, such a small thing as having a cuddly animal toy with us is disproportionately comforting and we explore some of the issues on Wardipedia in the ‘comfort objects’ feature.

And, inspired by the State Hospital’s adoption scheme, some wards or individual patients may want to fundraise for an animal charity.

Ward examples

  • A pets wall within the ward for staff or service users to put up pictures of their pets to create a discussion point and brighten up the ward!!
  • A ‘virtual pets corner ‘ i.e. developing a pet photo display of patients’ and staffs’ pets and wards sponsoring an animal e.g. a retired donkey or a guide dog
  • Occupational Therapy encourage the use of pet photographs, and encourage the sharing of pet stories and pictures within the recovery sessions.  Photographs can be enlarged and placed on display boards, or placed within an individual’s Wellness Recovery Action plan ‘Box of Delights’.
  • Within Occupational Therapy we promote the ‘celebration’ of pets, and have a pet wall, like a ‘Hall of Fame’ for photos of service users pets. We encourage people to put photos of their pets in their Wellness Recovery Action Plans, as well as pieces of writing about why their pet is so important to them.

Biscuit

image15Unfortunately there are loads of genuine, bureaucratic and plain stupid complications about getting pets onto wards. An astonishingly good substitute is the interactive toy dog from Furreal, Biscuit which Derbyshire are piloting on a ward for elderly patients.

I was astonished that stroking and cuddling Biscuit is such a similar experience to messing around with Buddy. He’s ridiculously lifelike, not just size-wise but by responding to voice commands, and spontaneously doing irresistible things like wagging his tail, putting his head to one side (more Princess Di than Buddy), whimpering (more Buddy than Di) and panting (we’ll leave it there.) Playing with Biscuit triggers ‘emotional memories’: warm feelings are evoked from our experiences and memories of being with other dogs. Become a Biscuit pioneer! Make your patients, visitors and colleagues very happy with a social and recreational purchase whose benefits are second only to the invaluable Wii. John Lewis are selling Biscuit for £75 which is a real bargain and something that League of Friends may be happy to pay for. (But! Biscuit takes 6 huge, D batteries, so rechargeable batteries and chargers are pretty essential.)

Our youtube channel has a video of my older foster son Eddie playing with Biscuit. http://bit.ly/wardskelly. Buddy also makes a guest star appearance.

Categories: Animal Magic
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