Contents
HUG and the reasons for this report
The closure of Craig Dunain
Should the new acute unit be sited in Raigmore?
Stigma
Where the new unit should be sited in the Highlands
How the new unit should be - in or out of town?
Access to local amenities
The appearance of the new unit
How to avoid people being frightened of the unit
The environment of the wards
Recommendations and key issues
Acknowledgments
HUG and the reasons for this report
In some ways Craig Dunain has been closing for the last 20 years - with more than a thousand beds being lost and patients be located in the community since the 1960's. However, now we seem to have reached a point where the closure of Craig Dunain itself will happen soon.
For some time users had been expressing concern and anxiety over the closure of Craig Dunain and the siting of the acute unit.It was decided that the first series of meeting of HUG would concentrate on three topics: the closure of Craig Dunain as a principle, the location of the new acute unit.
It was decided that the first series of meetings of HUG would concentrate on three topics: the closure of Craig Dunain as a principle, the location of the new acute unit and what the new unit should be like.
Over the month of August a series of 8 meetings took place to discuss these issues. A total of about 70 people were involved in these meetings. One of the meetings took place in Nairn, where no branch of HUG is established and some users from Badenoch and Strathspey also contributed their views - again a place where no branch is established.
The Closure of Craig Dunain
All the groups concerned resisted the idea of closing Craig Dunain and argued instead that it be modernised or alternatively a new unit be built in the grounds of Craig Dunain.
There were views that it felt secure and felt like home. There was, however, an acknowledgment that modernising the hospital might not be financially possible.
This did not, however, mean that users were against the principles of community care. Most users involved were considering the future of their service when acutely ill which in the main is provided in the acute wards. There were frequent calls that community services need to be increased whilst retaining the provision of hospital services.
Should the new acute unit be sited at Raigmore?
For the majority of the discussions our information was that the plans re to build an 84 bedded acute unit at Raigmore. The proposal was discussed and strongly rejected. Of all the people involved only 2 people didn't mind going to Raigmore.
The reasons for rejecting this proposal are as follows:
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People said that they would not feel safe in that environment with particular reference to the high level of activity there and the major roads surrounding it.
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People felt that there would possibly be less freedom in a unit built in Raigmore and also envisaged becoming the brunt of more prejudice.
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People felt that there would be no peace, no quiet or privacy on the site and regarded the whole environment as too clinical for a psychiatric unit.
Stigma
In many circumstances users got into a discussion about stigma.
There was a feeling that one of the reasons for moving a unit to a general hospital was to reduce the stigma of mental health problems and to incorporate psychiatry into mainstream medicine.
This argument was soundly rejected. People thought that the siting of a new unit in a major access point for the public only increased the stigma and in fact left users very exposed to patronising and discrimination attitudes which at the best of times are hard to cope with even more so when in distress as an acute patient.
The solution to stigma and prejudice was agreed to be a major mental health education program and also a project to help users to come to terms with the negative feeling that can accompany a diagnosis of a mental health problem. It was also thought that users who were confident and supported should be encouraged to present a positive image of people with mental health problems. A last suggestion was that part of the public education program should be education in schools about mental health.
Where the unit should be sited in the Highlands
Members of HUG did not necessarily see the siting of the new unit in Inverness desirable. There were arguments made that this unit should be split up and the beds allocated to the various areas of the Highlands, thereby bringing services closer to the local community and greatly reducing the problems of admission from areas that are a long way from Inverness - a fact that was cited by one group as greatly adding to the distress and trauma of admission to a psychiatric hospital. Another reason given was that visits from friends and relatives were hugely curtailed by having the unit in Inverness.
HUG ended up split on the with some branches in favour of a dispersal of the unit to the localities and others against it and yet others undecided.
The main reason for keeping the unit in Inverness was given as: stigma - going to Inverness people had complete anonymity and no-one needed to know where they were going whilst having a small unit in or on the edge of a small community would instantly identify people to their community as having mental health problems.
Other reasons given were that with longer stays the feeling of being removed from everyday life could come as a great relief and that a lot could be got out of meeting new people with similar experiences. A last reason given was that in the more distressing phases of an illness, many people did not like visits from friends and relatives and were thankful that distance prevented them coming (the converse being true in periods of rehabilitation and recovery).
However, there was unanimous agreement that there should be emergency beds or crisis beds provided in each of the areas of the Highlands accompanied by psychiatric staff. Users in some of the more remote areas spoke of having to wait up to four days to see a psychiatrist following an emergency that clearly required admission to Craig Dunain felt unacceptable.
Where the new unit should be - in or out of town
The majority of groups thought that the unit should be sited on the outskirts of town in an environment similar to that of Craig Dunain. This environment should provide peace, tranquillity and security. There would be less noise and it would give the relief of being situated away from the general public. However, it should not be too far outside town.
Two groups, however, had the opinion that it should be sited in a good setting in the community and developed in such a way that the whole community felt secure, in order that users will feel no stigma to go to it and that the local community will not feel threatened or frightened by.
Access to local amenities
Whilst not necessarily important in the more serious stages of an illness, all the branches of HUG considered access by a good local bus route to everyday amenities to be very important. It was considered less important to have amenities sited close to the hospital.
The physical environment around the hospital:
Almost all users considered that the grounds within which the new hospital is situated to be of great importance. They wanted trees, grass, peace and quite. Room to walk or feed the ducks all in an attractive, relatively private, environment. This environment (as is presently found at Craig Dunain) was found to be soothing and relaxing in the more distressing stages of an illness and helpful as people recovered.
The appearance of the unit
Whilst the building should incorporate modern technology, efforts should be made to prevent the building from looking like a hospital - instead it should give a homely feel. It should give a feeling of providing physical and emotional warmth and should make strenuous efforts to avoid looking threatening.
How to avoid people being frightened of the unit
As stated before the main solution to this is public education, ideally involving those users prepared to participate. However, members stated that Craig Dunain has a mythology surrounding it of fear and as somewhere people were sent to. This image still exists today.
Other suggestions for changing this image were to change the name of the unit and to have open days for the public to see it (although this argument was resisted by many as taking away from the privacy they need when they are ill).
Some users felt that even with an education programme little could be done to change the image of a psychiatric unit. It was also suggested that doctors should explain what the unit was really like before people were admitted.
The environment of the wards
The wards themselves should have nice décor and furniture and present a homely feel. There should be room for privacy as well as space to meet other people. There were mixed views on the size of the wards - all agreed that each ward should cater for a small number of people but some groups expressed the view that there should be lots of space, whilst others expressed a contrary opinion.
Recommendations and key issues
Single rooms - Access to single rooms was considered important but it was not felt desirable to have single rooms for everyone. The element of choice being the key point. In some situations people need the privacy of a single room but in other situations there is more of a feeling of security in having people around you.
Sitting rooms/day rooms - These were considered very important, one suggestion being that there should be a small room and a larger room.
Public telephones - There should be easy access to public telephones on all wards. These should be designed in such a way to allow for conversations to be carried out in private.
Visitors - there should be facilities provided to allow visitors and patients to meet in private. Accommodation should be provided for relatives who have to travel a long distance to visit.
There should be unrestricted visiting hours.
However, in keeping with users wishes for privacy and security, people should all be aware of who visitors to the ward are - people should not be allowed to visit without staff being aware of this.
Most branches were of the opinion that crèche facilities should be provided for people with children visiting patients.
Refreshments - There should be access to tea and coffee making facilities. There should be a shop and a café.
Smoking - Many users of mental health services smoke and feel a great need to smoke whilst in hospital. There should be facilities designed for smokers and non-smokers, all of which maintain an attractive décor.
Single sex wards - Many people, both men and women, stated that they would prefer to be treated on a single sex ward and also have the choice of the sex of the staff primarily responsible for their treatment. It was, however, agreed that many people benefited from mixed wards. It was thought that there should be the choice of treatment on single sex and mixed wards.
Mother and baby unit - People should be able to be treated within the unit when they have small children without being separated from them purely because of the necessity of admission to hospital.
Young people's unit - Although not discussed at all branches, those that did found a young peoples' unit based in the Highlands to be very important both to reduce the trauma that can arise when being forced to mix with adults in distress and also to reduce the trauma of being sent away for long distances.
Intensive psychiatric care unit - It was felt important that this provision be retained in the Highlands.
Social centre - The present social centre providing activities, sports, recreation, outings, music and so on was considered very important for people in hospital and should be retained in the new unit. There were also calls for an additional social centre to be provided in the community.
Observation levels - It was agreed that the manner in which close observation is carried out cam be very intrusive and intimidating. There was a call to make the layout of the wards such as to make observation by staff and patients less obvious. How this was done was unknown. There were suggestions of the use of video cameras or two-way mirrors, but these ideas were strongly rejected by other groups.
Activities - There should be lots of things to do both on the off the ward, including having access to people to talk to. There should be access to occupational therapy, alternative and complementary therapies and art therapy.
Spiritual/religious beliefs - These beliefs he should be respected. There should be access both to places of worship and to people to talk about spiritual matters.
Admission to hospital - On admission to hospital there should be someone to meet the person (this person could be a patient) and take them to the ward and explain the hospital and ward layout and procedures. An information pack should be provided with details of how to access advocacy services if required included in it.
Assessment and referral to hospital - People should be able to be assessed for admission to hospital at any time of the day and wherever they live. People should be able to present themselves at the hospital for an assessment and there should be access to people to talk about problems outside the hours of nine to five.
Information on the closure of the hospital - Many people are very worried about the closure of the hospital and a few, despite media articles on the contrary, believe that there will be no beds left for psychiatry. Verbal and written information on the progress of closure should be provided at frequent intervals to patients in and out of hospital and to community facilities.
Disabled access - The hospital should be full accessible to people with physical and sensory disabilities.
Discharge from hospital - There was considerable worry over the growing trend for discharge from hospital in a relatively short time. It was felt that people with mental health problems are more likely to cope in the community and less likely to relapse if proper attention is given to recovery from the trauma of illness and to rehabilitation (both in hospital and in the community).
Bed numbers - There were queries over how the size of the new unit had been worked out in terms of bed numbers and hopes that the Trust would not attempt to provide the minimum number of beds that can lead to overcrowding, especially if beds become blocked.
Community services - These were considered vital for people to be able to cope in the community. Both hospital and community services must be adequately resourced.
Staff numbers - A vital part of treatment is having someone to talk to. There was a call for staff numbers to be increased to enable this to happen.
Paying for the new unit - Users wondered where the financing for the new unit would be obtained from.
Acknowledgment
Many thanks to all the users of mental health services who participated in this. For more information about HUG call Graham Morgan on 01463 718817.
