DESIGN IN MENTAL HEALTH 2023
perspective. Building and design have been of great relevance in my farming career. The comparisons made while in my psychotic states live on. At home, I’ve been better able to empathise with the animals in our care. We’ve altered housing, handling, airflow, stocking rates, feeding, and medication and its administration. We’ve rounded the sharp corners, improved and installed effective lighting, restricted vision where it causes disturbance, and opened up the environment where it helps.” He continued: “Biosecurity is also
a constant challenge; there may well be parallels with infection control in healthcare settings. There is benefit in a change of perspective; any fresh environment will stimulate comparison. You may have heard of Temple Grandin – a woman with autism whose innovations revolutionised practices in the humane handling of livestock on cattle ranches and slaughterhouses in America. Most interestingly, for me, the habit – when stressfully overwhelmed – of restraining herself in a ‘squeezebox’ – not dissimilar to how we safely handle cattle – is of great interest. When I was talking to Stephen last night,” Bernard Fox continued, “he suggested to me that in some instances, in our services, we use heavy blankets to create a similar effect. I think there should be more research into that concept. In fact, I believe research shows that applying firm, gentle deep touch pressure can stimulate the parasympathetic nervous system, effectively putting your body into rest mode. The result is a feeling of calm and contentment that makes it easier to cope with anxiety.”
Lowering heart rate Bernard Fox said he had explained to Stephen Dye that this had certainly been his experience when he had caught a fledgling bird banging its head on opposite windows in his kitchen at home. He said: “When I catch it, the bird’s heart is going 10 to a dozen, but very soon, when restrained, you can physically feel it calming and its heart rate slowing, so I think it’s an area certainly worth looking into.” He acknowledged, however, that ‘none of this fresh learning is of any use until we make into practice’, adding: “I’m not suggesting you go psychotic and get committed!” Dr Dye said here that what his former
patient had just said highlighted ‘some of the challenges we face day-to-day with disturbed individuals’. He said: “Bernard has personal experience of being secluded, and of being rapidly tranquilised and restrained, including in a straightjacket, and I think the environment in which that happened was not the best possible, and the staff perhaps were not adequately communicating with him.” Bernard Fox took over: “Clearly,
when you’re in that state, it’s difficult to communicate, and again – the simpler things and the prevailing environment are,
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Bernard Fox said: “When I catch it, the bird’s heart is going 10 to a dozen, but very soon, when restrained, you can physically feel it calming and its heart rate slowing…”
the less people you’re faced with, and the less choice you’re presented with – the easier it is to cut through the confusion and get the message across. I think we lose sight of that.” He added: “Political correctness has gone mad in many situations, and I would argue, for example, that a sensory room for an inpatient in the early stages of admission would probably be totally inappropriate, and rushing things a little.” Stephen Dye said he and Bernard
Fox had been talking earlier about when somebody is in a really psychotic state. He said: “The definition of delusion is ‘a fixed false belief that is unamenable to reason’ – and when somebody is in that state, things need to be simple, and kept simple. When somebody is then gradually recovering from that state, they realise there are perhaps other choices, and this can then sometimes overwhelm people – for example the opportunity to go into a sensory room.” Bernard Fox said the pair had been talking about ‘the enormous responsibility that goes with that recovery’. He said: “In fact careful titration of reality is so vital that if you rush it, you should simply expect to see the patient back around again. It’s not rocket science.” Stephen Dye stressed that in his
view, while many of the more effective improvements in mental health settings are
made to the care environment itself, the empathy of staff is equally key to recovery. Bernard Fox said he would suggest that when harnessing the experience of patients and carers to improve mental healthcare environments, their ‘relevance’ would be further enhanced by a ‘switching of perspectives’ from staff. He told delegates: “The more specialist we become, the more intransigent we are, so get out and see and sense different perspectives, and then return and positively resolve your specialism. These conferences seek to stimulate that evolution.”
Observations ‘while in a psychotic state’ Returning to his own experiences, he said: “When broken, in a psychotic state, and committed within a system I had no knowledge of, I naturally sought to make sense of my new environment, I found I could estimate roughly the vast resources that had been employed seemingly for very few patients – a bit like our state- of-the-art dairy unit on my farm, which is capable of milking 500 cows in a couple of hours. If all that infrastructure, labour, and machinery, is employed to tend to just 12 inpatients, you’ll understand my struggle to sense how I deserve such input.” He continued: “My ‘unworthiness’ was quickly
Carefully, plan, inform, and titrate, all transfers and transitions; control food and hydration to maximise good general health; encourage appropriate rest and recreation; stimulate self-worth with occupation, and encourage positive, rewarding relationships, while fostering good society
Bernard Fox AUGUST 2023 | THE NETWORK
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