FORENSIC MENTAL HEALTH
specialist knowledge; they had been involved with secure hospitals before – in the UK, in the Netherlands, Australia, and various other places. That meant that when my colleagues and I – and particularly the Director of nursing, said to health service managers and civil servants: ‘We really do want a five-metre fence’ and they reacted as if we were ‘bad people’, Chris Shaw, particularly, as a distinguished international expert, would say: ‘Absolutely you do’, and that backing was worth its weight in gold. “In fact,” he continued, “when we
started writing our Model of Care, that was mainly prompted by Chris saying: ‘I need a design brief.’ When we responded, asking for a few headings, he asked us to show him our Model of Care, knowing full well that he had gone to lots of teams like us at this design stage, and expecting us to tell him we hadn’t actually got a written one, though we did have a highly developed needs assessment and options appraisals. That was the point when he started asking really sensible, practical questions, such as: ‘How many admissions do you expect to have in a week or a month?’ And therefore is it better to have one admission ward or two?’
“In fact, parts of the DUNDRUM Toolkit,
written in 2009, and the chapter on pathways and processes in the Model of Care, arose out of those conversations.” I wondered whether the Professor and his team had had much feedback on the new hospital in Portrane yet. He said: “The buildings were almost finished in 2020, just as COVID hit; the snagging, however, took over two years to complete, and patients were finally moved in last November. “Feedback-wise, it’s still early days. I
think it’ll be at least a year before we know that everyone has adapted to the new place.”
Biggest achievements I wondered what he felt had been the biggest achievements in getting the new hospital built. He replied: “The answer won’t, I think, be known for about 10 years. With an established hospital you hope you start in a steady state, where you are having, let’s say, 50 admissions and 50 discharges every year. You don’t, however, know you’re in a steady state in the new hospital for 5-10 years, and one of the things I’m most pleased with is that Ireland’s HSE has agreed to evaluate the move to see if we can measure the patient benefits – a review that will continue for
Coloured glazed entrances to the ward buildings at the new Portrane inpatient facility appear as beacons in the woodland when illuminated at night.
five years post-move. All of us involved with this hope the new hospital will make things better.”
Relative importance of the building and the care provided I asked the Professor how important he feels the built environment of mental healthcare facilities is compared with the care provided? He replied: “I’ve spent most of my career in Ireland arguing that environment is third out of those three, but that’s probably because I’ve mainly been working in buildings condemned as unfit for purpose two years before I returned to work in them. So, we are left with the other two – relational security, which I truly believe is the most therapeutic, ethical, and effective part, and the procedural things you do to make it safe and effective and therapeutic too. “However,” he added, “I have spent an
entire career in really dark, depressing buildings where no matter how often you cleaned, it looked dirty – even through it was meeting the minimum standards. If you brought visitors from abroad, or the latest Minister, to walk around, you could see them saying; ‘Oh, Professor Kennedy; I’m delighted to meet you’, but once they entered, you could see their faces fall and them thinking: ‘These people are horrible; they must be; they’re in a horrible place,
Lots of people I know either do or do not ‘get’ the uplifting elements of good architecture. In my holidays, I quite often walk around a cathedral somewhere. I often find myself telling managers – and particularly those from consultancy firms, that a clinic is not a shop; it’s something different, and a hospital is not a factory
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and what they are doing must be horrible.’ It’s paradoxical. Now, you walk around the new hospital, and people light up and say: ‘Isn’t this inspiring, and gorgeous?’ Frankly, though, they have no idea whether we’re doing good or bad stuff clinically.”
International expertise I put it to the Professor that he must have some interesting international expertise. He said: “I do. For instance in Denmark, the model of care and resourcing are very different. Equally, in the Netherlands, they do this sort of hospital building and services to a very high standard. Italy is really interesting; they have been the most radical of all in how they’ve suddenly changed everything. “I’ve also always also had strong links
with colleagues in Toronto and Montreal, and Nova Scotia too. In Canada it’s really inspiring how closely all their psychiatric services are linked to medical schools and universities. It’s very different here; a great pity. The constant struggle is that you’re working with a non-clinical management, who don’t understand the idea that scientific progress, and getting better real outcomes for patients, is what the clinicians want to do. These days they often have business degrees, where they are primarily interested in customer satisfaction and value for money. Even the best, most enlightened, and most sympathetic, who’ve worked with us for long periods, still often don’t get what we are trying to do.” The Professor added that when he told non-clinical people that individuals with schizophrenia have their life expectancy reduced by 16 years, i.e. worse than breast or bowel cancer, and that he wants to make progress in addressing this, they say: ‘You must be wrong.’ He said: “They simply don’t believe it.”
n NOVEMBER 2023 | THE NETWORK
Paul Tierney
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