Design in Mental Health 2015 Keynotes
30 seconds’ of walking onto an unfamiliar unit, he could usually form a view of whether it was providing good care.
KEY CONSTITUENTS OF A ‘SAFE’ FACILITY He told delegates: “When looking to identify what makes a good healthcare facility, Lord Darzi a few years ago defined the key constituents as a combination of safety, clinical effectiveness, and patient experience.” Looking first at safety, John Short said the design of mental healthcare units had ‘a huge impact’ on providing safe care. He said: “Let us not forget that, although we have made huge strides in advancing safety, between 50 and 70 people in England and Wales will kill themselves in our inpatient units each year.” Indeed, reported the National Confidential
Inquiry into Suicide and Homicide by People with Mental Illness 2014 Annual Report for England, Northern Ireland, Scotland, and Wales, between 2002 and 2012 some 1,360 people killed themselves in inpatient units across all four countries. John Short said: “When designing new inpatient units, we all have a major responsibility and role in helping our nursing and clinical staff keep mentally unwell people safe. Although inpatient suicide numbers are falling, the fact that there were well over 1,000 such deaths over a 10-year period suggests we need to be doing better.” He added: “There is still a major issue in relation to inpatient suicide by hanging, and how we deal with that. We have improved the design of many inpatient units, but I believe we can do a lot more to reduce the number of people taking their own lives.”
A PARTICULAR CHALLENGE One area John Short wanted to set the audience a challenge on – and indeed he had done so within his own Trust – was to raise the quality of interview and therapeutic areas. He said: “I don’t think I‘ve seen an inpatient unit yet that incorporates really fantastic clinical spaces, where, for example, psychologists and
John Short, chief executive of the Birmingham and Solihull Mental Health NHS Foundation Trust.
A number of service-users’ first contact with mental health services may be the inside of a police cell.
‘I don’t think I‘ve seen an inpatient unit yet that incorporates really fantastic clinical spaces, where, for example, psychologists and other professionals can undertake talking therapies’
other professionals can undertake talking therapies. Most inpatient units end up with a nice occupational, nursing, and communal areas, but don’t have really well-designed areas where service-users can feel safe and have therapy in a quiet, comfortable setting. I think that is a gap we need to address.” Remaining on the patient experience theme, albeit more broadly, John Short said providing a design where people felt comfortable was ‘extremely important’. He said: “One or two of the consultants at my Trust feel I spend too much time talking about the environment and
design, and not enough about staff quality. However, I believe they are wrong. The compassion, diligence, and commitment of staff are all key, but as a service-user you may spend anything from 72 hours to years in an inpatient unit – much more time than most consultants. Staff change and move about, but the building tends to stay the same. This has a huge impact on patient experience.”
HOW DO SERVICE-USERS EXPERIENCE THE WORLD? He continued: “The thing I want you to really think about is: ‘How do we experience the world, and how do our service-users and staff experience the wards and inpatient environments? Think about this in terms of the five senses.” Looking at these briefly in turn, John Short began with ‘taste’. He said: “It is very difficult to taste an inpatient unit, but, anecdotally, I can remember arriving at one asylum in 2000, to be told: ‘You mustn’t drink the water, because it’s not safe’. I took that advice until the second day, when I visited my first ward, to find that although the staff had been told not to drink the water, we were happily allowing servicer-users to do so. Taste may sometimes thus be a pretty important issue. “The other thing to mention on taste is that for many years we had a fascination with building standalone, small inpatient units in the community, but none with their own kitchens. One of the major areas for questions in the inpatient sessions I attend is the quality of food served. If you are concerned about the issue, my advice would be to go and eat a meal with service-users, or drink the water they drink.”
MOVING AWAY FROM BRICK INTERIORS Looking at touch, which he argued was ‘perhaps harder to deal with’, John Short advocated a move away from ‘rough internal surfaces’ and brick interiors within buildings. He said: “Most of our service-users don’t like them; you don’t tend to encounter them in houses, and if you bash against them you can end up badly bruised.”
The third of the senses was smell. “When I 14
‘Places of safety’ of varying comfort and quality. J u l y 2 0 1 5
THE NETWORK
go into an older people’s inpatient ward,” he explained, “I immediately stop and try to gauge the smell. I remember being shocked, about
Photos courtesy of Birmingham and Solihull Mental Health NHS Foundation Trust.
Photos courtesy of Birmingham and Solihull Mental Health NHS Foundation Trust.
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