Castle Lodge, Telford

Welcome to the Star Wards’ newsletter and a warm welcome to the new members of the Star Wards’ community. This fortnight’s edition features an exceptional unit, possibly unique in the UK – Castle Lodge which provides a fantastic, local, responsive service which is sort of mid-way between current crisis services and the full-on inpatient experience. Many thanks to Ann-Marie Stokes and colleagues for patiently and enthusiastically showing and explaining the unit to me.

Service users have wanted a Telford unit for years, to prevent having to go all the way to Shrewsbury. It extends local support options eg GP, nurse, crisis team and local voluntary organisations. Central role of service users in planning and provision was very apparent, and has included:

• Consultation and focus groups with service users on everything from meals, facilities, visiting arrangements to choice of furniture (went shopping), colour schemes.
• 3 service users on team
• a service user has set up and runs a clients’ support group – called Mind over Matter.
• Suggestion box, satisfaction surveys.
• Wednesday – the service user consultant chairs daily meeting.
• Recruitment done with service users.
• Annual Reports – last one compiled by service users.

12 beds – lovely and compact. Nurse-led. Nurses agree admissions and discharges, in consultation with client, carer and care co-ordinator if there is one. Staff sometimes attend potential admission visits with crisis teams. Produce care plan before admission, weekly reviews and then plan before discharge, although discharge thought about from start of admission. CL also liaise with Shelton Hospital about patients who can return to Telford. Conversely, some patients feel insecure about not having a doctor treating them and if they feel insufficiently contained/controlled they sometimes ask to go to Shelton.

Unit only has the medication that patients bring with them. Assess with patient if they feel OK about having the key to their medication cupboard. Reviewed daily. Unit doesn’t provide any medication – eg if patient wants paracetamol, they go to the local shop. If someone becomes violent, the staff call the police, as they would in a home. If a patient overdoses, staff take them to A&E.

Try to keep one bed available for crisis admission each night. And try to plan admissions at least a few days in advance. Don’t need RMO permission for patient who wants planned respite days. On basis that if there aren’t beds because of crisis admissions, they’ll be offered alternative as near to time as possible. Pro-actively offer help, eg invitation to stay over Xmas. Alert for signs of relapse and able to engage people earlier, so that stay can be shorter. Previously, people would avoid going into hospital because didn’t want to abandon kids, pets etc. Got so ill they had to be sectioned. At Castle Lodge, can go home daily to feed pets, or pick up kids. (Or vice versa.) Can also continue with regular activities, eg attending Mind centre.

Wide range of activity options including

• Coping skills, cooking group for coffee afternoon, cook meal once a week.
• Tai chi fortnightly, about to start
• Relaxation – learning techniques in afternoon then have relaxation session half hour before bed.
• Very inclusive coffee drop-in
• Men’s healthy living group weekly – open to any CMHT.
• Men’s group – begins in unit but then move to bowling alley etc.
• Taster sessions then info about how to access these in community.
• Head massage. Could be trained support workers as well as qualified staff.
• Monthly carers’ group in evening.
• WRAP + relapse prevention planning.

Very domestic dining room, with lots of choices for each meal. Staff eat with clients

– not just in same room at same time, but sharing tables. Small enough for cook to ask each person what they’d like. Won gold award for providing healthy eating. Relatives of some Asian patients bring in meals, although cook will also prepare different meals.

Great or what?? Perhaps in 5 – 10 years the model will be the norm rather than the exception. In the meantime, you can contact Ann-Marie for further information:

[email protected]

All the best

Marion

[email protected]