CAMHS FACILITIES Lucy’s story
Lucy was a bright, intelligent, ‘A’ star student working towards her ‘A’ levels. She was also a popular teenager, very driven, with all the normal angst and interests. What we know now is that she was also high functioning, with acute anxiety, which developed into being diagnosed with an acute eating disorder (anorexia nervosa) in 2017, and eventually coming under a CAMHS outpatient referral. She was also my eldest daughter.
In truth, Lucy’s issues started way earlier, early in high school, with an almost obsessive focus on successfully completing her GCSEs, and setting herself huge targets to reach. Having received nine A* grades, she moved on to ‘A’ Levels, where the effects of her condition became more pronounced and obvious. Irrational behaviour, panic attacks, high fat burn exercise obsession, calorie counting, body dysmorphia, depression, weight loss, heart issues, and blackouts, all followed. Lucy was referred by our GP to attend CAMHS outpatients, and in time CBT (Cognitive Behavioural therapy). This involved weekly sessions, attended both as a family and individually, as the work began to rebuild Lucy’s mental wellbeing. It was also the start of my real education in CAMHS services.
Andrew Arnold, and together with his daughter, Lucy (inset).
Learning the triggers, rationale, and skewed logic
Through Lucy’s treatment and therapy, we/I learnt – first-hand – the triggers, rationale, and skewed logic, that underpinned her disorder. To this point we put her conditions down to teenage anxieties, exam stress, even social media. These were all real factors, but the deep- rooted underlying mental health drivers were harder to recognise and address. In truth, everything I thought I knew about Eating Disorders proved to be very limited. Fast forward to Christmas 2020, and despite the pressures of a COVID lockdown, Lucy is thriving again, enjoying life at university, and recalibrating her mental health by herself. The journey through CAMHS was at times difficult for both Lucy, and ourselves as parents, but ultimately it saved her life and repaired our family. The CAMHS team was amazing, and I have nothing but admiration for the work they do with such scarce resources. The irony of my personal and professional lives crossing over was not lost on me, and has had a profound effect – both in terms of appreciation of the issues, and in my work as a designer.
Appreciating the impact of the environment
Looking back, despite the years of designing mental health facilities, it was only when I was experiencing them as a father, and at my most vulnerable, that I really started to connect with the issues
THE NETWORK | JANUARY 2021
and appreciate the impact environment has on your mental health and anxiety. At the time, I was heavily involved in designing the new inpatient CAMHS units in Hull and Leeds (in the latter case at the city’s St Mary’s Hospital), and it is fair to say they were heavily informed by my experiences with Lucy. The CAMHS facility we visited with her was old, institutional, dark, and dingy. Family therapy rooms were long and thin, with staff positioned between you and the door. The entrance was overlooked by a busy bus stop/main road, with an ironically located KFC directly opposite. It was the place where the ‘crazy kids’ went. Families sat in silence in the waiting room, pretending they were not there. A cold, uninviting place that stigmatised the whole process. External space was a bare yard, and the car park was around the rear, and not the safest location. There were some inpatient bedrooms at the back of the unit, but thankfully Lucy never needed to spend a night there. Despite all these negatives, the CAMHS team was amazing, and really excelled in dealing with eating disorders, anxiety, and challenging behaviours, in a simple and human way.
The dangers of assumption An example of how my experiences changed/informed the design approach came home on our Leeds CAMHS project, which we were designing in the middle of Lucy’s treatment. My initial ideas for the new building included a central communal
café, functioning gym, and even a beauty salon. Following a very traumatic episode at a university open day with Lucy, at which she had a panic attack at the refectory, it dawned on me that I had committed a gross error as an architect – assumption. Suffice to say that our design radically changed after that incident, with a more pared back, measured approach that did not ‘build in’ areas of ED trigger or obsessive behaviour, but instead replaced these with more appropriate spaces to aid and support wellbeing.
The long-lasting effect of Lucy’s experience on her mental health and wellbeing will only become apparent through time. Addressing poor mental health is not about dealing with a short- term, quick fix, ‘take your medicine’ illness. It is a more far-reaching and elongated state, which ebbs and flows through the challenges of life. CAMHS services are a most vital cog in the mental health support machine, and the services’ importance and impact in supporting young people today, and tomorrow’s adults, is undoubted. Our/my experiences at first hand have only reinforced my passion to deliver quality spaces for such services, allowing them to flourish and achieve positive clinical outcomes. It is a shame, though, that it took a dark episode in our family life to teach such an important lesson, but I am thankful that I have an outlet in my job to strive for better environments, and hopefully help somebody else’s Lucy.
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