Autumn 2011

Issue #57

Welcome to our Autumn newsletter. I hope you had a delightful summer and are easing yourself into milder (but less rainy!) days. The last few months have seen particularly intemperate (did you see what I did there?), unhelpful, distorted media coverage of inpatient care. The most infuriating comes from representatives of mental health organisations who have little excuse for such ostentatious, inaccurate scaremongering. It wouldnt matter if it were only inaccurate/distorted and offensive. What I find so unacceptable is that the impact extends to demoralising and de-energising staff and to terrifying people anticipating a possible inpatient stay. My summer was rounded off with five days back in my local hospital, St Anns, Tottenham. (Im trying to suppress an affectionate strapline for St Anns: Theres More to Tottenham Than The Riots.) Im a tiny but deeply annoying patient (BPD package with self-harming and suicidal components) and the staff were almost all really wonderful. I describe aspects of my stay in a videoblog on youtube:

http://bit.ly/stannsvideoblog
There were so many things that made my stay so therapeutic and yet which had no financial cost, mostly thanks to others consideration, generosity and good humour. It is so true that (some of) the best things in life are free, and most of the rest are in the local 99p store. This newsletter is all about low-cost and no-cost ideas. Small changes, big impact. And some with huge impact.

Weve included five impact areas, but of course there are loads of others and wed LOVE to have your examples and ideas. Meanwhile, weve got: 1. Arts 2. Autonomy 3. Emotional connection 4. Social, emotional, spiritual 5. High Impact Each section starts with a mindmap overview, and then one or two of the ideas are illustrated. Please think of it as not so much a newsletter but more of a sort of scrapbook . Youll spot that animals feature repeatedly. Its not (only) because Im a dozy old animal-lover, or as Martin Clunes put it: My life is better because I share it with all these personalities. I am an unashamed bunny-hugger. But the evidence is overwhelming in its compellingness and the heart-warming effect that animals can have on people even in the most acute emotional pain. My favourites are faking smiles (just for a second or 2!). You cannot be both angry and smiling at the same time. And pictorial menus. (While in hospital Id have settled for a menu displayed low enough for me to be able to see it without the aid of either my glasses or a little step-ladder.) Choosing food can be an overwhelming emotional experience for many patients as well as cognitively inaccessible for many others.

Please do let us have your examples and ideas!

Love

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1. Arts

Toastal art
Love it or hate it, Marmite led the way in turning toast into art, self-expression and a more interesting snack. Grab a squeezy tub of Marmite, honey, ice-cream sauce, and get doodling!

Scrapstores
From: www.scrapstoresuk.org/
Scrapstores are a fantastic resource for community groups who are in need of high quality art and craft materials for their members. The range of materials in your scrapstore changes from day to day and could include card, paper, textiles, paint, corks, wool, cardboard tubes, netting, gauze and a thousand other things! All scrapstores have different means of accessing their scrap materials. In some you need to pay an individual membership fee, at others you simply pay for the scrap you take on the day. Many scrapstores also have shops open to the public selling high quality art and craft materials from glue to paintbrushes to complement the scrap.

So scrapstores are veritable Aladdins Caves of affordable creative resources. Theres a surprisngly inspiring and creative video about scrapstores. 6 minutes, and you can fastforward! http://youtu.be/EvtY0Q9wiwo

2. Autonomy and community

Shopping
Patients on wards on general hospital sites may have (escorted) access to shops for toiletries, mags, snacks etc. But its much harder for most mental health inpatients to be able to buy things we need. Varying degrees of ingenuity and flexibility can be needed to make this possible. Here are some examples.

1. Staffing and ownership

Options include: service users eg from local Mind or other MH or user group or through patients council, PALS etc volunteers eg through WRVS, hospital League of Friends, other local vol org part of staffing of hospital outsourcing youve got Star Wards, now how about Starbucks??

2. Virtual
Now that lots of wards have Internet access, theyre actively both enabling (and limiting) online shopping by patients. In addition to the perennially popular Indian takeaway.

3. Improvising
If youre really stuck for space/personpower/time/everything, you could try: Vending machines Staff doing shop runs Patients doing shop runs for other patients Trolley preferably a funky one rather than a gloomily clinical one Trestle table sales in corridor/wards

4. Cash
Is there anything that can be done to help patients who dont have enough cash with them: Enable them to go home or to their bank if theyve got money there that they could use Encourage them to ask friends or family to lend or give them some money, if that wont be problematic for their relationships Ward/hospital/Friends group welfare fund Petty cash

Making mealtimes special

Research into protected mealtimes shows that it does improve patients experience of hospital meals. And the investment is well worth it, in nutritional, social and emotional benefits and can result in substantial reductions in food wastage http://bit.ly/protectedmealtimes

New hospital crockery improves meal times for dementia patients

From: http://bit.ly/hospitalcrockery Mealtimes for patients with dementia are being improved at hospitals across County Durham and Darlington thanks to the introduction of new specialist crockery. People suffering from dementia often experience visual problems including not being able to distinguish between different colours. Studies have found that this can compound

difficulties at mealtimes. If the crockery is a similar colour to the food being served then a person with dementia may not be able to see the contrast and recognise the food that is there to be eaten. As part of its 'dignity in care' campaign, County Durham and Darlington NHS Foundation Trust has recently introduced new crockery for four elderly care wards across its hospitals to help improve mealtimes for those patients suffering from dementia. Thanks to funding from each of the hospital 'Friends' organisations, Darlington Memorial Hospital, University Hospital of North Durham and Bishop Auckland Hospital are now all serving meals on new yellow melamine crockery.

3. Emotional connection

Its tough but worth it staff making emotional connections with patients

Ward staff and patients spend a lot of time together. Ive been to summer camp, Skyros (hippyish retreat sort of), St Anns, family holidays I really know about spending a lot of time with others! But what is particularly striking about the relationship between ward staff and patients, is that staff are required to make continuous emotional connections with patients. It feels like a lot to ask of ward staff, as of others in caring professions. In addition to all their professional expertise and cognitive skills, patients need staff to engage with us on an emotional level. To be moved by our situation, stories and struggles. Or to get a bit therapyish about it all, were asking staff to not only hear and understand what were going through, but to also feel it to some extent. Literally sharing our pain. Thats a huge ask! I find it much easier to get my head round there being no controversy about staff experiencing warm, positive feelings and states i.e. feeling happy, optimistic, energised, motivated etc. To experience positive emotion, you need to be emotionally switched on which inevitably results in being in touch with painful feelings. Another way Ive tried looking at this is that all jobs requiring work with other humans (whether colleagues, clients, suppliers etc), requires the exercise of emotions (and mentalising.). But few have a similar level of intensity and frequency to that used by ward staff. From shift start to finish, ward staff are, ideally, in touch with and managing (or regulating) their own very personal emotions like compassion, or anger. A big ask.

Conversely, of course, being able to harness your emotions and skillfully involve them in your work, is one of the strong attractions of working with mentally ill people. At its best, caring work is deeply emotionally satisfying and uplifting provided enough support is given to enable staff to cope with this almost invisible but highly demanding element of their work. As the mindmap attempts to illustrate, its only through staff being willing to emotionally share the experience with patients that patients can truly feel safe enough to express what theyre going through. Wed love to hear your thoughts on the personal costs and gains from working in an emotionally connected way with patients.

4. Spiritual, emotional

Gardening and ecotherapy

An OT favourite, indoor and outdoor gardening offers an almost perfect variety of enjoyable tasks and potential appeal across all ages, health states etc. Gardening can be a group or individual activity, is a rich source of interest and conversation (including when plants are going wonky) and can very pleasurably involve relatives and volunteers, including ex-patients. A growing (in both senses) number of wards are setting up allotments, with all the multiple benefits of being literally in touch with nature, exercise, companionability, nurturing, problem-solving.. But even growing a few lettuces on a windowsill can be surprisingly popular.

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[Mind] looked at the role the environment plays on the effectiveness of green exercise for mental wellbeing. Using 20 people in two contrasting walks, one inside and the other outdoors in a natural setting, we found: 90% of people reported an increase in self-esteem after an outdoor walk verses 17% indoors. 71% of people experienced a decrease in the levels of depression after an outdoor walk verses 45% indoors. 71% people stated they felt less tense after an outdoor walk verses 28% indoors. http://www.mind.org.uk/campaigns_and_issues/report_and_resources/835_ecotherapy or http://bit.ly/ecotherapy

From: Landscape design: Patient-specific Healing Gardens http://www.worldhealthdesign.com/Patient-specific-Healing-Gardens.aspx or http://bit.ly/healinggardens

Therapeutic spaces
For people with mental or psychological, rather than physical, problems, a series of remarkable therapeutic outdoor spaces are beginning to appear. Unique in this category are two gardens in Sweden for those suffering from depression or what is termed in that country as burn-out syndrome. The Alnarp Rehabilitation Garden encompasses a twohectare site on the campus of the Swedish University of Agricultural Sciences at Alnarp in southwest Sweden. Staff in the department of landscape architecture namely, Patrik Grahn and Ulrika Stigsdotter along with a horticultural therapist, physiotherapist, occupational and psychotherapists have developed a therapeutic landscape divided into a number of garden rooms. Participants (they are not referred to as patients) who can no longer work because of depression or burn-out are recommended to the garden programme by their doctors, insurance companies or employers. They start by coming to the garden one morning a week, increasing to four mornings over a three-month period. While at the facility, patients can if they wish do nothing but relax in the quiet, hedge-enclosed Welcoming Garden; or they can do light gardening tasks in the greenhouse, vegetable garden or orchard; take a walk along a forest path; or relax in a large meadow. Art 11

therapy, relaxation exercises, snacks, etc are available in a traditional house within the garden; weekly psychotherapy sessions take place in a geodesic greenhouse. A research project is under way, comparing patient outcomes at the Alnarp garden with a control group of comparable patients who are receiving the normal treatment resting at home, using an antidepressant such as Prozac, and having a few psychotherapy sessions. Preliminary results indicate very positive results from the non-drug, garden treatment approach. A similar approach is being applied at Haga Halsotradgard (Haga Health Garden) where a green therapeutic environment has been created inside a large commercial greenhouse in a Stockholm park. The greenhouse has been skillfully redesigned by Ulf Nordfjell and Yvonne Westerberg into five rooms so that a patient can choose to lie in a hammock among olive trees, relax on a chaise-longue under a palm tree, join a group for coffee and conversation at a candle-lit table, engage in gardening tasks, or create art pieces using plant materials. A recent study at another Alzheimers facility with a garden revealed that those who spent as little as five to ten minutes of unprogrammed activity in the garden each day in the summer months showed significant improvements on a number of parameters, including aggressive behaviour, physician-ordered medication, pulse rate, blood pressure and weight gain.

Smiling
Smiling evokes physical as well as emotional memories. Its a gift that costs nothing, is priceless to receive and comes completely calorie-free! You cannot be both angry and smiling at the same time. 1. Smiling Makes Us Attractive We feel and appear approachable and welcoming, helping others feel more at ease. And smiling makes other people feel noticed and perhaps liked or valued.

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2. Smiling Changes Our Mood Smiling is an expression of and even a trigger for an increased sense of happiness, which can stimulate greater optimism, which could spark a little surge of energy, activity, achievement, happiness. All from flicking up the corners of our mouths! Even faking a smile for a couple of seconds can quickly result in a genuinely felt grin, and feeling at least a bit better about ourselves, others and the world. Research (including by me a few minutes ago) proves that smiling can trick the body into helping change our mood. Simply using the same muscles as smiling will put you in a happier mood. Thats because use of those muscles is part of how the brain evaluates mood. according to Dr Michael Lewis, psychologist at Cardiff University. Charles Darwin noticed that our expressions may actually intensify our feelings: the feedback loop theory or facial feedback hypothesis.

3. Smiling Is Contagious And having someone smile back at us neatly reinforces a sense of feeling good.

4. Smiling is healthy Apparently it has even more health benefits than an hour a day work-out at the gym. (OK. Not really. But its less sweaty.) Smile and you boost your immune system, lower your blood pressure and even set off a flush of endorphins, (natures painkillers) and Serotonin (natures contentment drug.)

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A few smiley ideas!

Practice smiling fully, consciously, joyously. When alone is good, but youll probably get an enthusiastic if surprised response if you fling on and luxuriate in a deep smile when in company. Practice smiling ridiculously (now that should certainly bring back some childhood memories) Happy memories of special occasions, favourite music, closest friends. Thinking of people whove been kind, generous, gentle, robust with us Young kids and/or animals being funny and/or cute Comedy TV & radio progs, films, newspaper articles, lines in books, jokes (joke books are a terrific ward resource)

Practical ideas for making mental health wards funnier

Wards are already organising lots of different activities which are humour spreading eg: funny board and other games eg Pictionary, Twister books joke books, humorous books, comics, novels, daily joke or cartoon or humorous quote on a noticeboard comedy films, TV and radio programmes, poetry, music, drama. themed days whether Abba or Halloween religious festivals tend to be rather serious, if not gloomy, but there are some which are particularly good fun, such as the Jewish festival of Purim comedy outings eg films, plays and of course comedy clubs pets. Dogs in particular can be very funny, as can meerkats and aye-ayes but these are even less likely to slip under Infection Controls penetrating radar starting ward meetings, staff meetings, handovers etc. with a joke and ensuring theres some humour in training, conferences and other events. All these can of course be adapted for use with patients.

Oxleas House in south Londons Queen Elizabeths Hospital has a comedy room! Complete with CDs, tapes and videos of great comic performances as well as humorous magazines. Ward manager John Kelly was quoted as saying: "Research has shown that humour and laughter are beneficial to health, including mental well-being. There is no reason why patients should not benefit from something which is so easy to set up."

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Skype.
The best thing since sliced Spam became unpopular. Skype is an extraordinary, too good to be true (but it is true!) Internet service. Its basically a videophone conversation, via computer, and being able to see the person youre speaking to can be a powerful way for patients to keep in touch with friends and family. Skype has been introduced around the world to a number of hospital wards including maternity, isolation, dementia care and kids. And its free!! www.skype.com

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Animals
You may have spotted that animals feature in most of these impact sections and it was only through extreme exercise of self-control that they havent appeared in all of them. Wards can significantly help patients by recognising the importance of pets in their lives, and wherever possible enabling contact whether on or off the ward.

Excerpts from the transcript of Radio 4s A Point of View: Behaving like animals http://bbc.in/pcZrHY Written by the philosopher John Gray.

But the idea that animals are inferior versions of humans is fundamentally misguided. And it's the fact that they are so different from humans that makes contact with them so valuable to us. Whatever you feel about cats and dogs, it seems clear that the human animal needs contact with something other than itself. For religious people this need may be satisfied by God, even if the God with whom they commune seems too often all-too-human. For many landscape gives a sense of release from the human world, even if the land has been groomed and combed by humans for generations, as it has in England.

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a temporary exit from the introspective human world. What birds and animals offer us is not confirmation of our sense of having an exalted place in some sort of cosmic hierarchy, it's admission into a larger scheme of things, where our minds are no longer turned in on themselves. Unless it has contact with something other than itself, the human animal soon becomes stale and mad. By giving us the freedom to see the world afresh, birds and animals renew our humanity.

Let pets visit hospital patients, NHS told

http://bit.ly/petsinhospital Daily mail online 11th May 2004

Pet power: Research has shown animals can aid recovery

Hospital patients should be given "pets on prescription" to speed their recovery, a leading psychologist has claimed. Dr June McNicholas said that more hospitals and care homes should give visiting rights to animals when their owners were ill. She said that in most cases patients were more likely to catch something from their human visitors than they were from their pets. More hospitals should acknowledge the importance of animals in people's lives and provide visiting rooms for those patients desperate to see their pets, Dr McNicholas told nurses in Harrogate. She said if possible pets should have as much contact with their owners as possible without turning hospitals into a menagerie. This could also be achieved by letting patients see their pets through a window in a garden area outside the ward. "Pet visiting rooms should be acceptable in hospitals wherever they can be fitted in, and where possible pets should be allowed on to the bed. I know this is going to raise huge cries of the risks but to be perfectly honest people are more likely to catch infections from their human visitors. It's not like we put every person through a sheep dip when they come into hospitals," Dr McNicholas said.

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5. High Impact

Single consultants
The benefits of each ward having one consultant, rather than up to 6, are staggering. The consultant gets to see patients outside the unreal, stress-fuelled setting of ward rounds/reviews, providing a much fuller, more holistic understanding of patients health, needs, strengths, aspirations. They also establish much more productive and mutually respectful relationships with ward staff and relatives. Whats not to like?

Ward rounds
The excerpt below is a piece written by Ian Trodden, now of Penninecare, when at Sandwell Park Hospital which was one of the pioneers of replacing the multiply awful ward round with individual appointments with their consultant. The full article is at: The full paper is available from: http://bit.ly/wardround

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User/carer feedback informed us that they found the ward rounds as intimidating, threatening and traumatic. They reported on how the whole ward round made them feel powerless and in many instances they felt they were passive recipients of decisions made about their care. In particular they found the huge numbers of people attending the meetings and hear about their difficulties, some of which they felt ashamed off, as humiliating. Thus the ward round instead of being a healthy experience for many of the users/carers impacted negatively on their wellbeing. We deliberately changed the label (ward round) in conjunction with the user/cares to consultant appointments. An integral standard to consultant clinics is that appointments are made at least three days in advance of the clinic day. This enables families to have time to make arrangements, if appropriate, to attend. It also supports time for comprehensive reports from both the ward and community teams to be ready and available for these appointments. Furthermore and importantly it enables the users and those they identify to formulate discussion points so they feel they are in control to have their views listened to.

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