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Star Wards Sep 2011 Newsletter

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    Autumn 2011 Issue #57

    Welcome to our Autumn newsletter. I hope you had a delightful summer and are easingyourself into milder (but less rainy!) days. The last few months have seen particularlyintemperate (did you see what I did there?), unhelpful, distorted media coverage of

    inpatient care. The most infuriating comes from representatives of mental healthorganisations who have little excuse for such ostentatious, inaccurate scaremongering.It wouldnt matter if it were only inaccurate/distorted and offensive. What I find so

    unacceptable is that the impact extends to demoralising and de-energising staff andto terrifying people anticipating a possible inpatient stay.

    My summer was rounded off with five days back in my local hospital, St Anns,

    Tottenham. (Im trying to suppress an affectionate strapline for St Anns: Theres

    More to Tottenham Than The Riots.) Im a tiny but deeply annoying patient (BPDpackage with self-harming and suicidal components) and the staff were almost allreally wonderful. I describe aspects of my stay in a videoblog on youtube:

    http://bit.ly/stannsvideoblog

    There were so many things that made my stay so therapeutic and yet which had nofinancial cost, mostly thanks to others consideration, generosity and good humour. Itis so true that (some of) the best things in life are free, and most of the rest are in

    the local 99p store. This newsletter is all about low-cost and no-cost ideas. Smallchanges, big impact. And some with huge impact.

    http://bit.ly/stannsvideobloghttp://bit.ly/stannsvideobloghttp://bit.ly/stannsvideoblog
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    Weve included five impact areas, but of course there are loads of others and wed

    LOVE to have your examples and ideas. Meanwhile, weve got:1. Arts2. Autonomy3. Emotional connection4. Social, emotional, spiritual5. High ImpactEach section starts with a mindmap overview, and then one or two of the ideas are

    illustrated. Please think of it as not so much a newsletter but more of a sort ofscrapbook . Youll spot that animals feature repeatedly. Its not (only) because Im a

    dozy old animal-lover, or as Martin Clunes put it: My life is better because I share itwith all these personalities. I am an unashamed bunny-hugger. But the evidence is

    overwhelming in its compellingness and the heart-warming effect that animals canhave on people even in the most acute emotional pain.

    My favourites are faking smiles (just for a second or 2!). You cannot be both angry and

    smiling at the same time. And pictorial menus. (While in hospital Id have settled for amenu displayed low enough for me to be able to see it without the aid of either myglasses or a little step-ladder.) Choosing food can be an overwhelming emotionalexperience for many patients as well as cognitively inaccessible for many others.

    Please do let us have your examples and ideas!

    Loveand

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    1.Arts

    Toastal artLove it or hate it, Marmite led the way in turning toast into art, self-expression and amore interesting snack. Grab a squeezy tub of Marmite, honey, ice-cream sauce, andget doodling!

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    Scrapstores

    From: www.scrapstoresuk.org/

    Scrapstores are a fantastic resource for community groups who are in need of highquality art and craft materials for their members. The range of materials in yourscrapstore changes from day to day and could include card, paper, textiles, paint,corks, wool, cardboard tubes, netting, gauze and a thousand other things! Allscrapstores have different means of accessing their scrap materials. In some you needto pay an individual membership fee, at others you simply pay for the scrap you take onthe day. Many scrapstores also have shops open to the public selling high quality artand craft materials from glue to paintbrushes to complement the scrap.

    So scrapstores are veritable Aladdins Caves of affordable creative resources. Theresa surprisngly inspiring and creative video about scrapstores. 6 minutes, and you canfastforward!http://youtu.be/EvtY0Q9wiwo

    http://www.scrapstoresuk.org/http://youtu.be/EvtY0Q9wiwohttp://youtu.be/EvtY0Q9wiwohttp://www.scrapstoresuk.org/
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    2.Autonomy and community

    ShoppingPatients on wards on general hospital sites may have (escorted) access to shops fortoiletries, mags, snacks etc. But its much harder for most mental health inpatients to

    be able to buy things we need. Varying degrees of ingenuity and flexibility can beneeded to make this possible. Here are some examples.

    1.Staffing and ownershipOptions include:

    service users eg from local Mind or other MH or user group or through patientscouncil, PALS etc

    volunteers eg through WRVS, hospital League of Friends, other local vol org part of staffing of hospital outsourcing youve got Star Wards, now how about Starbucks??

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    2.VirtualNow that lots of wards have Internet access, theyre actively both enabling (and

    limiting) online shopping by patients. In addition to the perennially popular Indian take-

    away.

    3.ImprovisingIf youre really stuck for space/personpower/time/everything, you could try: Vending machines Staff doing shop runs Patients doing shop runs for other patients Trolley preferably a funky one rather than a gloomily clinical one Trestle table sales in corridor/wards4.CashIs there anything that can be done to help patients who dont have enough cash with

    them:

    Enable them to go home or to their bank if theyve got money there that they coulduse

    Encourage them to ask friends or family to lend or give them some money, if thatwont be problematic for their relationships

    Ward/hospital/Friends group welfare fund Petty cash

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    Making mealtimes special

    Research into protected mealtimes shows that it does improve patients experience ofhospital meals. And the investment is well worth it, in nutritional, social and emotional benefitsand can result in substantial reductions in food wastagehttp://bit.ly/protectedmealtimes

    New hospital crockery improves meal times for dementia patients

    From:http://bit.ly/hospitalcrockery

    Mealtimes for patients with dementia are being improved at hospitals across CountyDurham and Darlington thanks to the introduction of new specialist crockery. Peoplesuffering from dementia often experience visual problems including not being able todistinguish between different colours. Studies have found that this can compound

    http://bit.ly/protectedmealtimeshttp://bit.ly/hospitalcrockeryhttp://bit.ly/hospitalcrockeryhttp://bit.ly/hospitalcrockeryhttp://bit.ly/hospitalcrockeryhttp://bit.ly/protectedmealtimes
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    difficulties at mealtimes. If the crockery is a similar colour to the food being servedthen a person with dementia may not be able to see the contrast and recognise thefood that is there to be eaten. As part of its 'dignity in care' campaign, CountyDurham and Darlington NHS Foundation Trust has recently introduced new crockery

    for four elderly care wards across its hospitals to help improve mealtimes for those

    patients suffering from dementia.

    Thanks to funding from each of the hospital 'Friends' organisations, DarlingtonMemorial Hospital, University Hospital of North Durham and Bishop Auckland Hospitalare now all serving meals on new yellow melamine crockery.

    3.Emotional connection

    Its tough but worth it staff making emotional connections withpatients

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    Ward staff and patients spend a lot of time together. Ive been to summer camp,

    Skyros (hippyish retreat sort of), St Anns, family holidays I really know aboutspending a lot of time with others! But what is particularly striking about therelationship between ward staff and patients, is that staff are required to make

    continuous emotional connections with patients. It feels like a lot to ask of ward staff,

    as of others in caring professions. In addition to all their professional expertise andcognitive skills, patients need staff to engage with us on an emotional level. To be

    moved by our situation, stories and struggles. Or to get a bit therapyish about it all,were asking staff to not only hear and understand what were going through, but to

    also feel it to some extent. Literally sharing our pain. Thats a huge ask!

    I find it much easier to get my head round there being no controversy about staffexperiencing warm, positive feelings and states i.e. feeling happy, optimistic,energised, motivated etc. To experience positive emotion, you need to be emotionally

    switched on which inevitably results in being in touch with painful feelings.

    Another way Ive tried looking at this is that all jobs requiring work with other humans(whether colleagues, clients, suppliers etc), requires the exercise of emotions (andmentalising.). But few have a similar level of intensity and frequency to that used byward staff. From shift start to finish, ward staff are, ideally, in touch with andmanaging (or regulating) their own very personal emotions like compassion, or anger.

    A big ask.

    Conversely, of course, being able to harness your emotionsand skillfully involve them in your work, is one of the strongattractions of working with mentally ill people. At its best,

    caring work is deeply emotionally satisfying and uplifting provided enough support is given to enable staff to cope withthis almost invisible but highly demanding element of theirwork.

    As the mindmap attempts to illustrate, its only through

    staff being willing to emotionally share the experience with patients that patients cantruly feel safe enough to express what theyre going through.

    Wed love to hear your thoughts on the personal costs and gains from working in an

    emotionally connected way with patients.

    http://www.mentalising.com/http://www.mentalising.com/
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    4.Spiritual, emotional

    Gardening and ecotherapyAn OT favourite, indoor and outdoor gardening offers an almost perfect variety ofenjoyable tasks and potential appeal across all ages, health states etc. Gardening canbe a group or individual activity, is a rich source of interest and conversation (includingwhen plants are going wonky) and can very pleasurably involve relatives and volunteers,including ex-patients.

    A growing (in both senses) number of wards are setting up allotments, with all themultiple benefits of being literally in touch with nature, exercise, companionability,nurturing, problem-solving.. But even growing a few lettuces on a windowsill can be

    surprisingly popular.

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    [Mind] looked at the role the environment plays on the effectiveness of greenexercise for mental wellbeing. Using 20 people in two contrasting walks, one inside andthe other outdoors in a natural setting, we found:

    90% of people reported an increase in self-esteem after an outdoor walk verses17% indoors.

    71% of people experienced a decrease in the levels of depression after an outdoorwalk verses 45% indoors.

    71% people stated they felt less tense after an outdoor walk verses 28% indoors.http://www.mind.org.uk/campaigns_and_issues/report_and_resources/835_ecotherapyorhttp://bit.ly/ecotherapy

    From: Landscape design: Patient-specific Healing Gardens

    http://www.worldhealthdesign.com/Patient-specific-Healing-Gardens.aspxor http://bit.ly/healinggardens

    Therapeutic spacesFor people with mental or psychological, rather thanphysical, problems, a series of remarkabletherapeutic outdoor spaces are beginning to appear. Unique in this category are twogardens in Sweden for those suffering from depression or what is termed in thatcountry as burn-out syndrome. The Alnarp Rehabilitation Garden encompasses a two-hectare site on the campus of the Swedish University of Agricultural Sciences atAlnarp in southwest Sweden. Staff in the department of landscape architecture namely, Patrik Grahn and Ulrika Stigsdotter along with a horticultural therapist,

    physiotherapist, occupational and psychotherapists have developed a therapeuticlandscape divided into a number of garden rooms.

    Participants (they are not referred to as patients) who can no longer work because ofdepression or burn-out are recommended to the garden programme by their doctors,insurance companies or employers. They start by coming to the garden one morning aweek, increasing to four mornings over a three-month period. While at the facility,patients can if they wish do nothing but relax in the quiet, hedge-enclosedWelcoming Garden; or they can do light gardening tasks in the greenhouse, vegetablegarden or orchard; take a walk along a forest path; or relax in a large meadow. Art

    http://www.mind.org.uk/campaigns_and_issues/report_and_resources/835_ecotherapyhttp://www.mind.org.uk/campaigns_and_issues/report_and_resources/835_ecotherapyhttp://bit.ly/ecotherapyhttp://bit.ly/ecotherapyhttp://bit.ly/ecotherapyhttp://www.worldhealthdesign.com/Patient-specific-Healing-Gardens.aspxhttp://www.worldhealthdesign.com/Patient-specific-Healing-Gardens.aspxhttp://bit.ly/ecotherapyhttp://www.mind.org.uk/campaigns_and_issues/report_and_resources/835_ecotherapy
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    therapy, relaxation exercises, snacks, etc are available in a traditional house withinthe garden; weekly psychotherapy sessions take place in a geodesic greenhouse.

    A research project is under way, comparing patient outcomes at the Alnarp gardenwith a control group of comparable patients who are receiving the normal treatment

    resting at home, using an antidepressant such as Prozac, and having a few

    psychotherapy sessions. Preliminary results indicate very positive results from thenon-drug, garden treatment approach.

    A similar approach is being applied at Haga Halsotradgard (Haga Health Garden)where a green therapeutic environment has been created inside a large commercial

    greenhouse in a Stockholm park. The greenhouse has been skillfully redesigned by UlfNordfjell and Yvonne Westerberg into five rooms so that a patient can choose to lie ina hammock among olive trees, relax on a chaise-longue under a palm tree, join a groupfor coffee and conversation at a candle-lit table, engage in gardening tasks, or create

    art pieces using plant materials.

    A recent study at another Alzheimers facility with a garden revealed that those whospent as little as five to ten minutes of unprogrammed activity in the garden each dayin the summer months showed significant improvements on a number of parameters,including aggressive behaviour, physician-ordered medication, pulse rate, bloodpressure and weight gain.

    Smiling

    Smiling evokes physical as well as emotional memories. Its a gift that costs nothing, ispriceless to receive and comes completely calorie-free! You cannot be both angry and

    smiling at the same time.

    1. Smiling Makes Us Attractive

    We feel and appear approachable and welcoming, helping others feel more at ease. Andsmiling makes other people feel noticed and perhaps liked or valued.

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    2. Smiling Changes Our Mood

    Smiling is an expression of and even a trigger for an increased sense of happiness,

    which can stimulate greater optimism, which could spark a little surge of energy,

    activity, achievement, happiness. All from flicking up the corners of our mouths!

    Even faking a smile for a couple of seconds can quickly result in a genuinely felt grin,and feeling at least a bit better about ourselves, others and the world. Research(including by me a few minutes ago) proves that smiling can trick the body into helping

    change our mood. Simply using the same muscles as smiling will put you in a happiermood. Thats because use of those muscles is part of how the brain evaluates mood.according to Dr Michael Lewis, psychologist at Cardiff University. Charles Darwinnoticed that our expressions may actually intensify our feelings: the feedback loop

    theory or facial feedback hypothesis.

    3. Smiling Is Contagious

    And having someone smile back at us neatly reinforces a sense of feeling good.

    4. Smiling is healthy

    Apparently it has even more health benefits than an hour a day work-out at the gym.(OK. Not really. But its less sweaty.) Smile and you boost your immune system, loweryour blood pressure and even set off a flush of endorphins, (natures painkillers) and

    Serotonin (natures contentment drug.)

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    A few smiley ideas!

    Practice smiling fully, consciously, joyously. When alone is good, but youll probablyget an enthusiastic if surprised response if you fling on and luxuriate in a deep

    smile when in company. Practice smiling ridiculously (now that should certainly bring back some childhood

    memories) Happy memories of special occasions, favourite music, closest friends. Thinking of people whove been kind, generous, gentle, robust with us Young kids and/or animals being funny and/or cute Comedy TV & radio progs, films, newspaper articles, lines in books, jokes (joke

    books are a terrific ward resource)

    Practical ideas for making mental health wards funnier

    Wards are already organising lots of different activities which are humour spreadingeg:

    funny board and other games eg Pictionary, Twister books joke books, humorous books, comics, novels, daily joke or cartoon or humorous quote on a noticeboard comedy films, TV and radio programmes, poetry, music, drama. themed days whether Abba or Halloween religious festivals tend to be rather serious, if not gloomy, but there are some

    which are particularly good fun, such as the Jewish festival of Purim comedy outings eg films, plays and of course comedy clubs pets. Dogs in particular can be very funny, as can meerkats and aye-ayes but these

    are even less likely to slip under Infection Controls penetrating radar starting ward meetings, staff meetings, handovers etc. with a joke and ensuring

    theres some humour in training, conferences and other events. All these can of

    course be adapted for use with patients.

    Oxleas House in south Londons Queen Elizabeths Hospital has a comedy room!Complete with CDs, tapes and videos of great comic performances as well as humorousmagazines. Ward manager John Kelly was quoted as saying: "Research has shown thathumour and laughter are beneficial to health, including mental well-being. There is no

    reason why patients should not benefit from something which is so easy to set up."

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    Skype.The best thing since sliced Spam became unpopular.

    Skype is an extraordinary, too good to be true (but it is true!) Internet service. Its

    basically a videophone conversation, via computer, and being able to see the personyoure speaking to can be a powerful way for patients to keep in touch with friends andfamily. Skype has been introduced around the world to a number of hospital wardsincluding maternity, isolation, dementia care and kids. And its free!! www.skype.com

    http://www.skype.com/http://www.skype.com/
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    Animals

    You may have spotted that animals feature in most of these impact sections and it wasonly through extreme exercise of self-control that they havent appeared in all of

    them. Wards can significantly help patients by recognising the importance of pets intheir lives, and wherever possible enabling contact whether on or off the ward.

    Excerpts from the transcript of Radio 4s A Point of View: Behaving like animals

    http://bbc.in/pcZrHY

    Written by the philosopher John Gray.

    But the idea that animals are inferior versions of humans is fundamentally misguided.

    And it's the fact that they are so different from humans that makes contact with them sovaluable to us.

    Whatever you feel about cats and dogs, it seems clear that the human animal needs contactwith something other than itself. For religious people this need may be satisfied by God, evenif the God with whom they commune seems too often all-too-human. For many landscape givesa sense of release from the human world, even if the land has been groomed and combed by

    humans for generations, as it has in England.

    http://bbc.in/pcZrHYhttp://bbc.in/pcZrHY
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    a temporary exit from the introspective human world.

    What birds and animals offer us is not confirmation of our sense of having an exalted place insome sort of cosmic hierarchy, it's admission into a larger scheme of things, where our mindsare no longer turned in on themselves. Unless it has contact with something other than itself,the human animal soon becomes stale and mad. By giving us the freedom to see the worldafresh, birds and animals renew our humanity.

    Let pets visit hospital patients, NHS told

    http://bit.ly/petsinhospitalDaily mail online 11th May 2004

    Pet power: Research has shown animals can aid recovery

    Hospital patients should be given "pets on prescription" to speed their recovery, a leadingpsychologist has claimed. Dr June McNicholas said that more hospitals and care homes shouldgive visiting rights to animals when their owners were ill.She said that in most cases patients were more likely to catch something from their humanvisitors than they were from their pets.

    More hospitals should acknowledge the importance of animals in people's lives and providevisiting rooms for those patients desperate to see their pets, Dr McNicholas told nurses inHarrogate. She said if possible pets should have as much contact with their owners as possiblewithout turning hospitals into a menagerie.

    This could also be achieved by letting patients see their pets through a window in a gardenarea outside the ward. "Pet visiting rooms should be acceptable in hospitals wherever they canbe fitted in, and where possible pets should be allowed on to the bed. I know this is going toraise huge cries of the risks but to be perfectly honest people are more likely to catch

    infections from their human visitors. It's not like we put every person through a sheep dipwhen they come into hospitals," Dr McNicholas said.

    http://bit.ly/petsinhospitalhttp://bit.ly/petsinhospitalhttp://bit.ly/petsinhospital
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    5.High Impact

    Single consultantsThe benefits of each ward having one consultant, rather than up to 6, are staggering. Theconsultant gets to see patients outside the unreal, stress-fuelled setting of wardrounds/reviews, providing a much fuller, more holistic understanding of patients health, needs,strengths, aspirations. They also establish much more productive and mutually respectfulrelationships with ward staff and relatives. Whats not to like?

    Ward roundsThe excerpt below is a piece written by Ian Trodden, now of Penninecare, when at SandwellPark Hospital which was one of the pioneers of replacing the multiply awful ward round withindividual appointments with their consultant. The full article is at: The full paper is availablefrom:

    http://bit.ly/wardround

    http://bit.ly/wardroundhttp://bit.ly/wardround
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    User/carer feedback informed us that they found the ward rounds as intimidating,threatening and traumatic. They reported on how the whole ward round made them feelpowerless and in many instances they felt they were passive recipients of decisions madeabout their care. In particular they found the huge numbers of people attending themeetings and hear about their difficulties, some of which they felt ashamed off, ashumiliating. Thus the ward round instead of being a healthy experience for many of theusers/carers impacted negatively on their wellbeing.

    We deliberately changed the label (ward round) in conjunction with the user/cares toconsultant appointments.An integral standard to consultant clinics is that appointments are made at least three days inadvance of the clinic day. This enables families to have time to make arrangements, ifappropriate, to attend. It also supports time for comprehensive reports from both the ward

    and community teams to be ready and available for these appointments. Furthermore andimportantly it enables the users and those they identify to formulate discussion points so theyfeel they are in control to have their views listened to.


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