DESIGN IN MENTAL HEALTH CONFERENCE 2019
Dr Hamid Alhaj, director of Research for NAPICU, is a consultant in Psychiatric Intensive Care on the Endcliffe Ward in Sheffield.
patients. Dr Alhaj added: “In terms of diagnosis, we tend in seclusion to see major psychiatric diagnoses such as schizophrenia, bipolar, and personality disorders, and organic and substance misuse-related disorders.” A 2007 Royal College of Psychiatrists survey, meanwhile, had indicated that forensic services were more likely than acute or rehabilitation services to use seclusion.
Here Dr Alhaj moved to discuss the current joint DiMHN/NAPICU ENDORSE study; its goal is to determine what the mental healthcare profession can do to reduce the use of seclusion and restrictive interventions generally, and how much of a positive impact an appropriate seclusion environment can have on de-escalation. He said: “Recent evidence suggests that the care environment plays a key part in how people feel. For example, we all know that access to windows and sunlight can help one’s general wellbeing – and this, of course, doesn’t only apply within psychiatry. There is the obvious element of access to sunlight; in a recent study on levels of vitamin D in patients within psychiatric settings, many had very low levels, and sunlight is in fact biologically, as well as psychologically and socially, important. There are also other aspects, such as sound, nature, and spatial layout, which we would immediately acknowledge are important, but around which there is less actual evidence.
No service-users the same “You can imagine the complexity with different service-users,” Dr Alhaj continued. “I have a patient, for instance, who is more subject to paranoid, persecutory beliefs if he listens to certain music, and the individual is very clear on this. I have also had service-users damage every single television in the unit because they were so concerned about what was on, and how particular content was ‘referring’ to them. There really isn’t a ‘one-size-fits-all’ situation.”
Looking at the Care Quality Commission’s expectations in terms of ‘suitable’ seclusion rooms, the NAPICU speaker said the emphasis was on elements including ‘privacy and dignity’, physical comfort, access to food and drink, and
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Paula Reavey, Professor of Psychology & Mental Health at London South Bank University, and DiMHN Research and Education Workstream lead.
communication with staff. If, in the CQC’s view, a mental healthcare provider deemed seclusion necessary, the room allocated needed to be specifically designed for it. “There are some set criteria for such rooms, for example in terms of communication with staff, furniture items, safety, window and door robustness, and lighting,” Dr Alhaj explained.
He next showed a number of images taken at the Endcliffe Ward where he works in Sheffield, but, he emphasised, these were not of seclusion facilities. He said: “The idea here is to address areas we feel might reduce the need for seclusion – for instance on the right here we have the Cardio Wall, an activity feature that patients enjoy.” Another slide showed a courtyard garden affording patients access to the outdoors, fresh air, and sunlight – as the speaker put it, ‘a Mediterranean-style area where service-users can relax without needing to be secluded or restrained’. Good practice was, Dr Alhaj believed, about ‘being creative in your design’. He said: “You will no doubt have seen other imaginative features and technologies designed for seclusion settings, such as the ‘media walls’ developed by Dutch company, Recornect, and I will now show you a video of this particular system – a wall that a service- user can, for instance, use as an iPad, to draw images on, show photos on, or play music via, while they are in seclusion.”
DiMHN and NAPICU partnership Here, the speaker switched focus to the fruitful ongoing partnership between NAPICU – of which he is an Executive
Member – and the Design in Mental Health Network. “He said: “We have worked together for a number of years to produce design guidance for psychiatric intensive care units. The latest, ENDORSE study is part of our partnership to produce a further evidence-based approach to the use of seclusion.” Here, Dr Alhaj invited Professor Paula Reavey to talk about the study. She began: “I am going to complete this joint presentation by describing the agenda for this research project. Sometimes when we discuss study ‘evidence’ we mean standardised evidence, but here we are designing a study that really seeks to capture the lived experiences of people in distress living in mental healthcare units, either for short or longer periods, but also to think about the staff there to care for them. This is all about thinking about lived experiences as relational activities; relationships between people, and how they provoke or encourage certain experiences.”
Data from psychiatric wards The Professor explained that in the ENDORSE study, DiMHN and NAPICU would be looking to collect data from psychiatric wards, and analysing it to identify how ‘escalations’, and the consequent use of restrictive interventions, commonly arise. Professor Reavey noted here that some mental healthcare professionals have called for a stronger wording for ‘restrictive intervention’, dubbing it ‘physical violence’. She said: “We are going to be putting together a study looking at a whole host of different data, including patient case records, and the environment on the ward at the time – the sounds, the smells, and the levels of staff stress and so on, and thus creating a comprehensive picture.”
An attractive external space at the award- winning Endcliffe Ward in Sheffield that affords service-users access to the outdoors.
Part of the research would involve considering how the design of the environment – both in wards and seclusion spaces in mental healthcare facilities – can encourage particular behaviour and experiences. She elaborated: “We are going to be looking at physical environmental factors, because as a psychologist I think we sometimes ignore these – and they are important. We will thus be looking at elements such as privacy, daylight, the
JULY 2019 | THE NETWORK
©Dr Hamid Alhaj
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