|Royal Edinburgh Hospital
It’s a real privilege to finish the year with an account of a fantastic visit I had to the Royal Edinburgh Hospital. Susan Tennyson, the Commissioning Nurse, had invited me and has since become a greatly appreciated ambassador and in demand speaker about Star Wards. It was way back in August (so winter was well underway…) and the Edinburgh Festival was on, bringing to the city thousands of visitors and a challenging mix of nationalities and mental health problems. As Susan said, “It’s quite something to work with a manic French acrobat.” When needed, they bring in translators from Lothian Interpreting & Translation service. And they have a list of staff languages, eg Spanish-speaking domestics, Polish NAs, junior doctors from around the world. But it’s still very difficult to manage minority languages rapidly in an emergency. (Estuary English could be particularly challenging.)
There’s an interesting history of the hospital on their website, http://tinyurl.com/rehhistory. (The legacies, both positive and traumatic, of our asylums, tend to be ignored nowadays.)Thanks to the influence of the asylum’s first Physician Superintendent, Dr William McKinnon, who took up the post in 1839, patients were encouraged to be active, using any existing skills such as gardening, pig farming, carpentry or sewing, and to take part in sports, including curling. A printing press was installed, and a magazine, the Morningside Mirror, was produced.
The hospital has enthusiastically embraced Star Wards and Susan said that benefits have included a more therapeutic and nurturing environment, with the therapeutic relationship at the centre of care. They have regular meetings with their Star Wards champions, carried out an initial benchmarking exercise, and will do a re-audit in 6 months time. They found the process a valuable way of generating ideas and adaptations from the initial SW 75 ideas.
All wards have advocates, and this has become very systematic, proactively offered to patients. Advocates have drop-in clinics on wards. Therapets visit, and patients’ own pets are able to enjoy, and be enjoyed, in the lovely hospital grounds. Or patients can go home for the afternoon to see how their furry, finny or scaly friends are doing. All wards have a recreation nurse, which they find provides ‘”more definition” to this crucial area. There’s now a programme of daily activities and Protected Therapeutic Time and they’re developing a personal recovery file for patients, which the rehab wards are neatly calling My Plan. Since April all words have community meetings each weekday for housekeeping stuff and discussing planned and other potential activities. On Mondays they go through the suggestions box.
The hospital has a very interesting, unusual self-harm project run by a specialist nurse, including (brilliantly) a camouflage clinic for those who want this resource as well as support group, staff and training. The chaplain told me how at a community meeting, patients said they didn’t want to book into see or be referred to the chaplain but for her simply to ‘be around’. Formal referrals still have to take priority.
The corridor at the hospital’s entrance is greatly enhanced by fabulous, welcoming artwork. A local arts’ organisation Art Link manages the exhibitions in the main corridor, to which both patients and staff exhibit, which is a great idea. And there’s an annual open exhibition.
Ward 6 is a 25 bedded admission ward. I walked into the dining room which looked like the backroom of a florist’s, with cut flowers and whatever the green stuff is that gets put in vases. Fiona the charge nurse (aka ward manager south of the border) was running a flower-arranging session with several enthusiastically participating patients. I was impressed and touched that it turned out that the greenery all came from Fiona’s garden. The windows provide a stunning view of the incredibly huge and green site, complete with a faux-castle. (Was something psych-ish but is now part of the university.)
Activities provided, sometimes by outside groups, include aromatherapy, Tai chi, computer tutoring, basic body awareness, and they’ve run hip hop workshops with DJs and decks. They’ve taken patients to the Edinburgh Tattoo and resourcefully get cut-price tickets for local (including local and very international) events. The ward provides £50 socialisation money and £75 petty cash a week. Patients who can afford to are encouraged to contribute, which is an unusual and excellent idea.
The larger rooms were divided into smaller, more personal spaces. There are now lots of rooms including interview, family and quiet rooms. I couldn’t go into one room because… group therapy was taking place!! Joy!! I can’t remember having encountered group therapy during any previous hospital visit. They employed a group analyst 2 years ago and (rightly) see group therapy as an important element of patient treatment.
Fiona described how activity and therapeutic groups have created more relaxed relationships between staff and patients. An OT, pharmacist and social worker participate in the Monday review meeting. Although they have 2 wards for people with learning disabilities, these are often full so they do have LD patients on this ward, who can go to the LD day hospital.
A second ward I visited has an impressive patients’ gallery in the dining room, which is combined with the kitchen and very much the hub of ward. It was lovely to see flowers on the tables and beautiful plants – inspiredly, looking after the plants is one patient’s ward role. Patients can get £24 worth of lilies for £4 from Waitrose at the end of the day.
I was interested to hear that one of the benefits of the daily community meeting is that inappropriate behaviour can be dealt with by patients responding to each other. The value of peer pressure rather than staff leaping in. The ward manager is sanguine that “Not every community meeting is going to be an easy one” and told me that a student contributed the valuable idea of making sure meeting ends on a positive note. Because the ward is so appreciated by patients, they can find it difficult when they leave. Former patients keep in touch with each other and are very good at keeping on top of what’s really important to that individual, eg what motivates them.
The Friday football team consists of inpatients, outpatients and staff from across the wards. Brilliant! They feel there’s been a real improvement on the ward since Star Wards was introduced, with much more for patients to do eg games’ nights, karaoke, social outings, shopping trips. “It’s been different work, not more work.” This is now one of my favourite quotes about Star Wards.
The ITC has its own group programme run by OT- eg gym, art, computer, library (books, mags, short stories, poetry, light adventure yarns, foreign language books), women’s group, snack group, gardening group in courtyard working on sunken tubs while waiting for landscaping to happen. Great instant results! They also make full use of flowers, which are subsequently pressed into use (good gag!) in the creative group eg for pot pourri. The courtyard includes an area planted for their scents. OT also runs individual sessions eg relaxation and cooking with an emphasis on the practical.
I met with the Patients’ Council and was predictably delighted to hear one patient who had been here for 6 months say there’s been “a great difference since Star Wards was introduced”! They have ‘collective advocacy’ workers, a very helpful term I hadn’t come across before for this role. They run a collective advocacy drop-in at the MSU monthly. They’re doing a follow-up to their patients’ audit, on aggression and self-harm including looking at incident reporting.
Patients lobbied successfully for newspapers on wards and Internet access is going to be introduced. They’re negotiating for volunteering by patients (eg working in library) to be recognised as part of the supported employment Pathway.
The Hive is an amazing large hall, now operating as a social centre for patients. Incredibly, it was previously a ‘portable chapel’! (Collapsible, clapboard sides for bunging onto the roof of your Mini.) The Scottish Association for Mental Health run the Hive. My trip was timed to coincide with a Star Wards presentation in the Hive. The event was very well-attended by both staff and patients, including some from the MSU. When a patient asked “who arranged this meeting?” and was told “It’s for you”, he replied that this was “very moving, very touching. Who is giving us the gift of being so well cared for and loved?”
They’ve creatively and resourcefully produced their own version of a Star Wards logo, a pyramid of SW star shaped people, supporting someone juggling at the top.
A rehab ward manager showed a slide of ‘before Star Wards’, with people snoozing, looking bored etc accompanied by sound effects of snoring! There was mainly TV watching, whereas now there’s individualised time, activities, outings, which have the additional benefit of a blurring of staff/patient ‘fixed identities’. There’s much less boredom, replaced by motivation, a sense of responsibility and the recognising of skills.
Groups include lunch, cinema, walking, curry, board games, quiz, bingo, darts, model-making, relaxation, beauty therapy, theatre, retail therapy, council meetings….(I couldn’t type fast enough to get down more than this beginning of an extraordinary list!)
Outings are very important as some people haven’t left the ward for ages. The rehab ward Swanton has its own newsletter. There’s staff training on therapeutic skills including problem-solving therapy, groupwork, relaxation, working with women, safe conversations and, particularly impressively, a self-harm course.
I hope you feel as inspired by the work of Susan and her colleagues as I do. You can contact Susan at:
Wishing everyone in, north and south of Edinburgh a very enjoyable festive season and a happy and healthy 2009.
All the best