Design in Mental Health 2016 Keynotes
encouraged the Trust to look more widely at the ‘green agenda’, and at incorporating sustainable design principles. Tom Cahill said of Kingfisher Court: “Our shaping of the building helped with natural light, we used a lot of colours on the windows to bring in colour, and harnessed cross- ventilation, solar shading, heat pumps, and low energy fittings – with a real focus on reducing energy consumption. Our aim was to build an economical-to-run and sustainable new inpatient unit, but equally one that our service- users could live in and enjoy.” He told delegates: “Imagine your son or daughter, aged 24-26, suffering first-time psychosis, feeling unwell, hearing voices, and feeling depressed. If they needed an inpatient stay you would want them in a safe environment that respects people, and within which they can thrive and recover. These were precisely our drivers here.”
IMPORTANCE OF TRAINING Tom Cahill explained that when the Trust was building Kingfisher Court, it was ‘all about hearts and minds, culture, and therapeutic environments’. He added: “We made sure we trained every staff member going into this new building on what modem mental healthcare is all about – recovery, and respecting and enhancing people’s lives.” The second part of his presentation focused a little on some of the Trust’s recent work for service-users with dementia. He said: “Some of our facilities were not dementia-friendly, so we undertook research, and considered expert thinking; this was primarily about modernising our existing buildings, and we are particularly proud of what we have achieved. For example we worked The King’s Fund, and studied the University of Stirling’s work, incorporating their suggestions, liaised with our servicers-users, and, probably most importantly, with carers, many of whose loves ones had passed away over the past few years while with us. The carers really helped us design new buildings in which there is a major dementia focus.” One of the key areas addressed was wayfinding. Tom Cahill explained: “We wanted to ensure that service-users could wander
associated IT costs. “Equally, at the time,” Tom Cahill said, “our staff told us they didn’t feel that the environments they were working in were fit for purpose.”
One of the courtyards at the Kingsley Green inpatient unit, where the overall healing environment was ‘shaped by a collaborative approach’.
around the building fairly freely and easily, without staff always having to locate them and guide them back when they felt ‘lost’. We allowed our service-users that freedom. We really looked at effective signage, whether it be for the lounge, bathroom, communal area, or bedrooms. We used things that are pretty simple, but that we hadn’t thought about – such as pictures of beds on doors, and colours; with different shades of carpets in the various rooms, and different-coloured toilet seats, as well as pictures that related to the people in the bedrooms. We did some really good work there, as well, for example, as looking at widened bedroom access to facilitate access for staff and equipment.”
GARDEN’S BENEFITS Tom Cahill showed slides illustrating some of the features that had been incorporated in new or refurbished dementia environments, with an emphasis on easily identifiable areas that created a homely environment, such as a fireplace. Showing a slide of the Lambourn Grove Continuing Healthcare Unit in St Albans, he said the Trust was particularly proud of the garden incorporated there. He said: “It allows service-users out, to be free. They don’t have to go out via a locked doorway. Those of you who have worked in mental healthcare settings where service-users are usually locked in know it can cause agitation, depression, and sometimes aggression. Features like this garden are thus key.” The third major area covered by Tom Cahill
One of the ward day spaces at Kingfisher Court. 12 THE NETWORK
was the Trust’s ‘community’. He said: “There was a stage when we operated about 120 sites Trust-wide – bearing in mind that we have about 37,000 service-users, most looked after in the community, and that most of our 2,000-3,000 staff work in community settings, a number of which were equally embarrassing, unproductive, and non-therapeutic. We thus began a journey of looking at our buildings.” The Trust could not afford to continue running 120 sites, especially against the current economic backdrop, particularly given the
OCTOBER 2016
CENTRALISING SERVICES The Trust thus embarked on centralising its facilities around the 10 key ‘conurbations’ in Hertfordshire, centred on retaining access, while ensuring that it provided facilities that staff would be proud to work in, and service-users proud to attend. “Our previous strategy was about having all access locally, which is right,” explained Tom Cahill. “However there is also the question of affordability and a pragmatic approach. We thus purpose-designed our new hubs and spokes – the spokes might be GP practices, and the hubs large buildings that most of our service-users and staff come into if they are not being visited at home.” For staff, the change in estates strategy led to a transition to ‘hot desking’, and open plan offices. While some of the buildings were ‘fabulous to look at’, Tom Cahill said many staff initially struggled with the concept of open plan, for example with noise and privacy. “This was, however, about a change of culture and hearts and minds,” he explained, “but we did see a dip in our staff survey over this particular change. We were moving people out of buildings that were not fit-for-purpose, and should have been closed years ago, into brand new buildings, and yet ratings in the survey went down.” Nevertheless, Tom Cahill felt, this transition and change of strategy was both ‘the right thing to do’ and would ‘work’. He said: “We are already seeing some evidence around a lowering of patient-to-patient violence, reduced use of restraint, and fewer assaults on staff. For us, however, it’s really about what our service-users are saying; they are constantly telling us how good these facilities are.”
OVERNIGHT STAY One night before the Trust opened Kingfisher Court, ‘20 or so’ staff , including the Trust’s Executive team, governors, and service-users, stayed in the facility for the night to experience what it was like there, which led to some changes being made. The facility’s subsequent shortlisting for awards gave all involved ‘a really positive feeling about what can be done’. Tom Cahill said: “We have really made the link between better environments and better outcomes. We must also ensure that our estate is flexible, and that we can use it to support many people in many ways, while the economic landscape means that giving existing buildings a makeover will increasingly be the way forward.” Kingfisher Court won the Project of the Year
2015 Award in the 2015 Design in Mental Health Awards, and the Building Better Healthcare
‘Those of you who have worked in mental healthcare settings where service-users are usually locked in know it can cause agitation, depression, and sometimes aggression’
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