DESIGN IN MENTAL HEALTH 2023


tempered by the many inefficient and senseless comparisons I was making. Had I invested the vast amount of money, resource, and time the healthcare providers had to create a totally controlled environment, I would have rightly expected it all to work. When the system failed or fell short, those responsible for its creation would be charged with making it work. Further, they should appreciate fully the negative impression these oversights and failings present to the very minds we seek to treat. However,” he continued, “this sadly is not always how it works in our healthcare estates. There are often too many Chiefs, and not enough Indians, and regrettably, either too many, or not good enough, examples to follow. Sounds familiar? This exactly mirrored my own broken mind, so little wonder that I believed I was in an extremely cruel, ‘mickey-taking’, hole.


Need to demonstrate ‘failsafes’ “Thankfully,” Bernard Fox continued, “I’ve been blessed with a sense of humour. Dark as it became, I attribute being able to retain this to my aided ability to head towards recovery. I am now convinced that those creating new mental healthcare facilities should – at the point of initiation – be able to convincingly demonstrate their failsafes and back-ups during the particular unit’s expected lifespan. Additionally, they must detail and involve themselves in the eventual responsible decommissioning. When we find ourselves suddenly without a fully functional mind or bodily waste disposal system, it’s fair to say that we are – quite literally – properly ‘in it’. Please, all of you, fully understand the objective of your efforts. Plan and practice carefully to get us out and keep us out.” He added: ‘When confronted with procrastination from an overexcited manic depressive, pick and focus on the good bits, very sensitively explain how or why the gibbering is nonsense, and prepare for the most robust rebuttal, as it is in this very nonsense that we know you will find new sense.”


Drawing comparisons on care Drawing comparisons between good practice in handling livestock and animal husbandry with good practice when looking after the mentally unwell, Bernard Fox said: “Keep fresh meat from frozen and processed meat. Cook from raw, exercise great caution when mixing uninhibited livestock displaying signs of heat. 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. I felt unworthy to be receiving of your efforts, while hungry for good example. You all evolve the essential environments; please ensure that they are effectively controlled during their lifetime.”


THE NETWORK | AUGUST 2023


Consultant psychiatrist, Dr Stephen Dye, and farmer and former-service-user, Bernard Fox, gave an insightful presentation on some of the sometimes surprising things that can impact patients’ mental state while in a PICU setting.


Seeking to crystallise his co-speaker’s


message, Stephen Dye said: “We’ve spoken a lot about ambiguity, about everything having a place – but also about the need for staff to explaining what that place, ‘purpose’, and function is to service- users, and we’ve discussed the cleanliness and general upkeep of the environment. Also, if you look at Maslow’s Hierarchy of Needs – there is a physiological need to be hydrated, fed, and to be able to sleep, and of course a feeling of safety is important. While the latter can be difficult to achieve in a psychiatric intensive care unit – there needs to be an element of safety – both for staff and patient. You then come on to the need for belonging.”


First meeting encounter Here, Bernard Fox interjected, telling Dr Dye: “The first time I met you I had to take off my tie and belt; anything I could hang myself with was taken away. As ill as I was though, I could sort of understand what you were getting at, but on my next admission, in Oxford, I couldn’t tell patients from staff, because the latter weren’t wearing uniforms, and in fact some of the patients were wearing weighted necklaces There has to be consistency; and that completely fried my mind.” At this point, Dr Dye asked if there


were any questions from the audience. An audience member asked Bernard Fox when he first walked into a PICU, what was the first thing about the environment he had wanted to see changed? He replied: “Being able to identify who the characters are; absolutely foremost. Otherwise total confusion reigns – since you haven’t got a clue who people are and what they are doing there.” Dr Dye said he had seen Bernard Fox


in two different PICU settings, and asked him to comment on the differences from


his standpoint. The latter said: “As you know, I found the Amersham unit more formal, regimented, strict, and simple, and thus easier for me to get to grips with. Contrastingly, when I was literally transferred from my couch to the unit in Oxford by police van, it was a different set- up. I don’t know why, but I remember that every day they brought out a different- coloured ‘Henry’ vacuum cleaner, and I had no idea whether the person doing the ‘hoovering’ was a staff member or a patient. I had no idea of their identity, and why there were using a different-coloured hoover… stupid stuff like that.”


Impact of noise on mental health I asked Bernard Fox to what degree excessive noise had bothered him while he was in inpatient mental health units. He replied: “That’s a very interesting question. Thankfully – and I don’t know how or why – I never subscribed to the view that I might be hearing voices. Clearly, however, the worse the acoustics are in a mental health inpatient unit, the worse you feel. When you are in that highly aroused mental state, any – for example – bang of a door seems 100 times louder and ‘reverberating’ than it would normally. Present a number of such noises and it’s hell on earth for service-users. So, when Chris Dzikiti (from the CQC, who spoke immediately before Dr Dye and Bernard Fox on the conference’s opening morning) was giving his talk, extolling the virtues of all the space at Trinity House and Shaftesbury House at the Springfield University Hospital site in south London, I was thinking that the building’s designers, and the Trust, must have had to engineer something for the acoustics – because otherwise they would have created a new hell. That’s the sort of thing that concerns me greatly.”


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