Young at heart the mental health & dementia facilities magazine JANUARY 2024 PROJECTS Better bed management; a new facility opens in Lincolnshire CRISIS CAFÉ How MIND’s Circle café is changing the support landscape LANDSCAPE GARDENS The importance of co-designing green spaces p5 p10 p15
mhdf magazine 3 Contents JANUARY 2024 Editor’s Note Design matters Hello and welcome to a new year. It is all change here at Stable as this marks the first MHDF with a new editor. I am a journalist with 15 years of experience across many industries and I am delighted to take the reigns in bringing you up-to-date and informative information on the sector. Designing for mental health is such a crucial industry for the well being of the country as a whole, and it is a privilege to take on the role. As knowledge of mental health and the care that is required to keep people safe continues to grow, the industry increases in stature and it is an exciting time to be part of it. There are several projects and initiatives underway in 2024 to develop the sector further and we will endevour to bring you the latest information as it comes. In this edition, we take an in-depth look at charity MIND’s excellent work in the development of its crisis support cafes in London. It is a particularly innovative way to provide care for a vulnerable group and something we hope to see more of in the future. Taking care of the next generation will be vital going forward and it is encouraging to see that support and care is improving so rapidly. Also inside, we bring you project updates, as well as an expert’s view on landscape gardens and their importance for service users. I’d like to wish you a very happy New Year from the team at Stable and I hope to engage with all of you further in 2024 as we kickstart a new era for the magazine. We value your feedback. Contact [email protected] Editor Dan Colombini Sales director Julian Walter Production Nicola Cann Design Mary McCarthy Managing Director Toby Filby Publishers Stable Publishing Limited, SBC House, Restmor Way, Wallington, Surrey SM6 7AH, England. t. 020 8288 1080 f. 020 8288 1099 e. [email protected] In this issue: 5 PROJECTS Hertfordshire Partnership University NHS Foundation Trust partners with The Access Group 8 CRISIS SUPPORT CAFE A look at the crisis support cafe, ‘Circle’, launched in Ealing 15 CO-DESIGNING GREEN SPACES The benefits of co-designing landscape gardens for mental health Crisis support cafe, ‘Circle’, launched in Ealing The publishers do not necessarily agree with views expressed by contributors and cannot accept responsibility for claims made by manufacturers and authors, nor do they accept any responsibility for any errors in the subject matter of this publication.
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mhdf magazine 5 Hertfordshire Trust partners with Access Group PROJECTS Clinicians will be able to access patient data and bed information at any time Hertfordshire Partnership University NHS Foundation Trust partners with The Access Group for better bed management Hertfordshire Partnership University NHS Foundation Trust (HPFT) has partnered with The Access Group to implement Access Patient Flow Manager (APFM); software that will help staff streamline bed provision across the region, meaning more people get the care they need quicker. HPFT, like many Trusts across England, is in the process of introducing new solutions and overhauling old ones to develop a digital ecosystem of care – as per NHS England’s long-term plan. APFM enables a live view of patients within a hospital or care setting, their condition, and resulting priority for care. This overview allows the trust to move patients accordingly; ensuring a high standard of care whilst also enabling the treatment and care of as many people as possible at any one time. The trust has approximately 400 beds for adults, frailty care, non-frail elderly care, and mental health – as well as a number of rehab units. Post-covid, HPFT is also utilising private beds to help with service backlog, which it is hoping APFM will help reduce. Without the visibility of health and care data to effectively manage beds, medical staff attend several meetings a day, carry out multiple phone calls, and send hundreds of emails to gather the required information – a task that is hugely time consuming on clinicians. The Access Group was the successful bidder in HPFT’s search for a patient management solution. Working together, the software will allow seamless integration with their existing electronic patient record (EPR) software to ensure the most up-to-date patient notes are available. The solution will provide a real-time view of bed occupancy and patient data through digital whiteboards and mobile devices. Clinicians will be able to access patient data and bed information at any time, meaning staff are better informed, allowing them to plan in advance. Enhanced data insights will also give greater visibility of partner organisations, highlighting barriers around hospital discharge to improve processes and support moving patients home quickly and safely. “Having a single version of the truth is very important for us; one reliable record that we can all see, and we can all work from. Access Patient Flow Manager helps us achieve that for our inpatient flows and will serve as an operations centre from which we can manage the great care and outcomes we deliver for all our service users, together,” said Hakan Akozek, director of innovation and Transformation at HPFT. Access Patient Flow Manager will provide HPFT with one single system which will support management by showing the levels of demand and capacity via an easy-to-read, colour coded display. This means information at a glance to save time and allowing for optimal bed usage. By utilising the trust’s beds, it will resolve the need for costly private beds; allowing this money to be reinvested elsewhere within the trust. Access will support HPFT with a phased rollout of the new software, train staff on how to use Access Patient Flow Manager and provide technical support throughout the partnership. Steve Wightman, healthcare director at Access HSC (Health Support and Care) said: “We are delighted to be working with Hertfordshire to roll out our Patient Flow Manager solution. The software will give better visibility of beds, minimise unnecessary long stays for patients and reduce the administration burden on hospital staff, allowing clinicians to focus on giving vital care to those who need it across Hertfordshire.” HPFT continues to strive to improve the quality of patient care. By using APFM, HPFT aims to improve communications, streamline data, and maximise bed usage, so they can continue to support the people of Hertfordshire for years to come. Original Image: Andy Holmes on UnSplash
mhdf magazine 7 PROJECTS WORKS BEGIN ON LINCOLNSHIRE MENTAL HEALTH UNIT Construction has begun to build a new state-of-the-art mental health inpatient unit in Boston, Lincolnshire. The new unit, which will be based at the Norton Lea site on London Road, is being built by Lincolnshire Partnership NHS Foundation Trust (LPFT) and will include a new 19-bed mixed-gender adult inpatient ward. The new ward will replace the outdated dormitory style accommodation on the existing Ward 12 at Pilgrim Hospital. Alan Pattison, LPFT’s Programme Lead, said: “Being part of breaking ground really brought home that construction of the new centre is commencing. This is a hugely exciting milestone for LPFT and a great opportunity to celebrate all the work it has taken to get to this point.” Breaking ground is an important construction milestone which publicly marks the start of building work on site. The build is part of a wider national programme to improve mental healthcare services, which also include the new £25m development in Lincoln where two new adult inpatient wards have been built. Kevin Lockyer, Trust Chair, added: “I would like to thank everyone who has worked so hard to get us to this stage. The creation of the new ward will improve privacy and dignity standards for people who use our services. “The building has been co-designed with our Experts by Experience, healthcare professionals and construction experts, so we are confident we will create a therapeutic space for those who receive care from us.” Feedback from patients, carers and staff has been used to help shape the plans for the site as part of LPFT’s ‘Building Together’ programme. Members of the project team, including Experts by Experience, and colleagues from Integrated Health Projects (IHP), who have been appointed by the Trust to undertake the building works, were in attendance. DEMENTIA SUITE OPENS IN BIRMINGHAM A new dedicated dementia-suite in Birmingham has now been opened. Austin Rose, a state-of-the-art care home situated on Alvechurch Road, West Heath, recently invited the Lord Mayor of Birmingham, Councillor Chaman Lal, to cut the ribbon on its new 29 bedroom Memory suite. Located on the first floor of the care home, the new community hub features a designated sports area, music area, garden area, and a quiet area with two lounge and dining suites to offer something for everyone. It also offers enhanced security measures to keep residents who choose to explore their community safe, with layouts and designs that promote familiarity. Residents will be offered a variety of activities and engaging programmes, whilst also benefiting from person-centred care that prioritises their individual needs. The decision to open the new Memory suite came after the home noticed a rising number of enquiries from individuals living with dementia, with there being a noticeable scarcity of dementia specific suites in the West Heath area. In an effort to support the community and raise awareness, Austin Rose has taken steps to address this gap. Additionally, the home is planning to host a dementia café to further contribute to community support.
....continued on pg 10 8 mhdf magazine MIND CRISIS CAFÉ A new year brings new challenges and young people in the UK are currently facing a crisis of identity as they navigate through life and try to establish their place in the world. The world has changed to such an extent over the past few decades that the challenges of many youngsters are lost on a generation of elders that simply did not face the same issues when growing up. Fortunately, support offered to those with mental health challenges is growing and there are increasing options for those that are struggling. Growing up in the UK at a time when we face a cost-of-living crisis, political turmoil and a host of other existential issues is certainly not easy. So, what help is out there? Mental health charity MIND is at the forefront of support in this area. Last year, the charity announced the launch of its new crisis support café, ‘Circle’ in Ealing, London, to help children and young people who are experiencing or nearing a mental health crisis. The service is being delivered in partnership with the Northwest London CAMHS Provider Collaborative led by West London NHS Trust, and is the first of its kind in the UK. It provides drop-in and appointment-based specialist mental health support 365 days a year, with the aim of relieving pressure on local A&E departments. After a successful first year in operation, MIND’s ‘Circle’ crisis support café in London is going from strength to strength. MIND’s Nana Owusu and Meg Wamithi speak to MHDF about their future plans and how new funding is vital to the café’s future. WHAT IS CIRCLE? Circle has its own dedicated space at 46 South Ealing Road, in Ealing, which has been specially designed to create a welcoming, calm, and safe space with café facilities for local children and young people. The service is staffed with both clinical and non-clinical highly specialised Crisis Support Navigators from HFEH Mind who have a background in CAMHS and crisis care. Young people can self-refer or be referred to Circle by school, social care, A&E, or CAMHS crisis services between 3pm-11pm on weekdays and 12-8pm on weekends. Nationally, the number of under-18s presenting to A&E with a recorded diagnosis of a psychiatric condition has significantly increased (more than tripling between 2010 and 2018-19). However, many of these do not require hospital care. In London in 2021, 50% of young people who attended A&E experiencing a mental health crisis were deemed not to require hospital treatment at that time and discharged home. The fact is that A&E departments are often the only place available to take children experiencing a mental health crisis. Many children do not require hospital care and cannot access the appropriate psychological help there anyway. Circle CARE IN THE COMMUNITY
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MIND CRISIS CAFÉ ....continued from pg8 10 mhdf magazine provides dynamic clinical assessments and more immediate practical help to de-escalate the presenting risk, as well as signpost to other local services. Nana, who is director of children & young people’s services, says, “A&E departments are already overstretched and often not the best place for a young person in crisis who’s already feeling distressed and overwhelmed. Circle provides a much-needed safe space and immediate support for young people who reach a crisis point with their mental health. STRETCHED NHS SYSTEM “We’ve seen a big increase in children and young people going to A&E with mental health problems in the last 10 years – but for many of them, A&E isn’t the right place. They don’t require hospital treatment; they need support from trained mental health practitioners to de-escalate in that moment of crisis or distress, and this is where Circle comes in.” With young people facing the very real prospect of falling through the gaps in the face of a stretched NHS system, Nana saw the opportunity to innovate. “We wanted to provide a service where young people were not overwhelmed by bright lights and felt comfortable to talk about their problems in safe a place,” she adds. “They can be retraumatised waiting long hours in A&E. A lot of young people that present there don’t actually need emergency support. There are other settings that would be better. But the hub has not just been set up as a café. The main goal is crisis prevention, providing a young person with a place to go in their community for help. Meg adds: “It is somewhere that is psychologically safe and where young people are comfortable.” Another exciting aspect in the design of the café was collaboration with young people themselves, providing them with a say in what the establishment would look like. “We worked with them directly,” says Meg. “We had a young people’s board from Hammersmith and Fulham MIND but we also worked really closely with Young Ealing Foundation, who collaborated with interior designer Heartwell Interiors. Following on from the success of the café, Meg and Nana are now setting their sights on expansion. However – as ever – funding remains an issue. Sustainability is more than just a buzzword and applies to the future of these kind of innovative approaches in the sector. Without support from the industry, it is an uphill battle for care of this nature to survive. “The Circle is only funded for 18 months,” says Meg. “There are amazing services out there, but funding is our biggest issue. “We need to get refunded so that all the people that access it can continue to grow and flourish. The funding officially ends in March 2024. “In terms of sustainability, at the moment the Circle primarily operates as a crisis prevention café but in the daytime, young people can access community programs centred around arts and sports, for example. “We are now hoping that the Circle expands into a one-stop shop where young people can go and access support from early intervention all the way to crisis prevention. The Circle is the first of its kind. But it needs to exist outside of Ealing.” A new café proposal is currently being built in the West End of London following the success of the Circle, which is an exciting prospect. But as yet, plans to ramp up the service into other areas of the country are slow to see action, with financing being a key issue. It is, of course, a huge learning curve for all involved but the intent is there to build on the work that has been achieved so far. Meg adds: “How can we take all these learnings that we have had and introduce these places around the country? That is the goal. We want it to be so a young person, no matter what their post code, can have somewhere to access free mental health support.” Nana has a background working within the NHS The team at the Circle have vast experience to provide the care that young people really need
mhdf magazine 11 MIND CRISIS CAFÉ It always feels like a Back-to-the-Future moment for me, every day I go into work as a lot of the young people that I see are essentially me. I was that 13-year-old who was presenting at A&E and had a very traumatic experience. Being a young kid and not knowing what is going on inside your head is frightening enough. But going to A&E and seeing all these bright, white lights just makes it worse. I was diagnosed with depression, anxiety and anorexia. I made my first suicide attempt at the age of 14 and my second when I was 16. I went through Child and Adolescent Mental Health Services and then into inpatient support to get my physical health back to where I needed to be, but mental health-wise I don’t think I really got the help I needed until I went into adult services. Fortunately, I had enough money to afford private support and that really helped, enabling me to flourish and be the person I am today. However, it wasn’t until my 20th birthday and my last suicide attempt where I was sectioned that the levels of communication between my GP and local support team enabled me to become home sectioned, which allowed for person-centred care, designed specifically for me. I had to be proactive, however. I was also eventually diagnosed with borderline personality disorder and social anxiety, so I know how tough it can be for these young people, who are extremely vulnerable. This is why I do what I do and my lived experience. My advice to the industry is that ‘you don’t know what you don’t know’. When you design buildings or spaces, speak to us as well. We are not architects for example, but we are programme designers. As a designer of these facilities, clearly you love the work you do. But it is easy to go on assumptions. An idea can be conceptually amazing, but you have to mindful that real people will have to use the space. It is really important to not just include them at the end when it has been built but actually collaborate and coproduce something from the on-set. For me, being able to flourish as I am now is because the mental health support I worked with saw me as a part of the process. I was consulted on what worked best for me and I think with this kind of collaboration, this kind of care can go so far. From my experience at the Circle, the faces of the young people as soon as they walk in is exactly what you want from someone that is in crisis. I know how tough it can be for these young people, who are extremely vulnerable Meg has used her lived experience to shape the progress of the cafe
PROJECTS IHP selected for Shrewsbury and Telford hospital plans Image: Mat Napo on UnSplash mhdf magazine 13 The Shrewsbury and Telford Hospital NHS Trust (SaTH) has appointed Integrated Health Projects (IHP) as its design and construction partner to progress the Hospitals Transformation Programme (HTP). Following the procurement process, the announcement of IHP – the Joint Venture between VINCI Building and Sir Robert McAlpine – as the Trust’s partner marks a significant milestone in the development of the HTP. IHP will support the trust as it prepares to take the HTP plans through the final stage of the national approval process and transform acute hospital services for its communities. Preparatory works are expected to start on the Royal Shrewsbury Hospital site from this month, with hoardings and site cabins being developed. The plans will mean the population of Shropshire, Telford & Wrekin and mid Wales will benefit from high quality, sustainable care and fewer delays for treatment for everyone, at two thriving hospital sites. The transformation plans have been developed by clinicians. The Telford site will specialise in planned care with the Shrewsbury site specialising in emergency care. THE BENEFITS FOR PATIENTS INCLUDE: • Planned care services in Telford that will be available throughout the year leading to fewer cancellations and delays for operations • Enhanced urgent care services which will be available 24/7 on both hospital sites • Improved emergency care services delivered from a new, purpose-built Emergency Department in Shrewsbury, meaning that patients will be seen more quickly, with shorter stays and faster ambulance handovers times. Dr Ed Rysdale, consultant in emergency medicine and clinical lead for the Hospitals Transformation Programme, said: “I’m excited that we are moving ever closer to delivering our vision of two thriving hospital sites. This is so much more than building works, this is about fundamentally improving care for all the communities we serve through better pathways and joined-up care between our services. “This is an important step forward for the programme and it is exciting to be able to welcome our contractors onsite as they prepare for the necessary enabling works.” Louise Barnett, chief executive of The Shrewsbury and Telford Hospital NHS Trust, said: “We are pleased to be working with IHP who bring a wealth of experience in large-scale construction, as well as offering genuine opportunities for local businesses. We will be continuing to keep local communities and clinicians involved at every stage of the works, to help design a positive experience for everyone.” John Roberts, managing director at VINCI Building, said: “We are delighted to be selected as the design and construction partner for the Hospitals Transformation Programme (HTP) and we are looking forward to working with the Trust to deliver this high-quality transformation programme for patients, which will provide significant improvements and benefits.”
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GREEN SPACES LET’S GO OUTSIDE Co-Designing for Dementia can ensure green spaces that empower people with dementia to lead active, healthy and joyful lives Angeli Gnoo-Fletcher, Director of Landscape Architecture at PRP Image: Aniston Grace on Unsplash The power of well-designed public realm should not be underestimated. It holds the ability to bring people together, mitigate the impacts of the climate crisis and enhance wellbeing. As the UK’s population ages, it’s time that landscape architects focus on leveraging public realm’s potential to combat the effects of cognitive and sensory decline by creating green spaces that empower people with dementia to lead active, healthy and joyful lives. The University of Stirling and the King’s Fund have undertaken significant research on how the built environment impacts people with dementia, including landscape design principles that we can draw from to make public realm easier to navigate, more engaging and feel safe. As visual and cognitive ability declines, some people with dementia increasingly function on a sensory level. The spaces that they thrive in are simple, clearly designed with vivid visual comfort and contrast. Best-selling author and dementia research champion Dr Wendy Mitchell shared that she “treats dementia as a game. It throws me a challenge and I solve it to try and keep one step ahead…that’s what dementia is about, a life of adapting.” Similarly, the places that we design as landscape architects should be adaptable and easy to navigate for people with dementia, whilst retaining the qualities that make green spaces joyful, engaging and mood-boosting. We can draw from a growing body of research on dementia-friendly design to achieve this. A safe, accessible and carefully planned external living environment can have significant therapeutic benefits. A well-planned garden can form part of a holistic treatment plan, providing scope for physical exercise to lessen tension and feelings of aggression, spaces for privacy and reflection, and ample exposure to Vitamin D, which is particularly important for the health of the elderly population. It should adapt to their changing needs by allowing for activities that are familiar and encourage participation – an important aspect of maintaining good physical and emotional wellbeing. mhdf magazine 15
GREEN SPACES CASE STUDY NHS GARDEN AT THE QUEEN ELIZABETH HOSPITAL, KING’S LYNN, NORFOLK 16 mhdf magazine PRP’s landscape team was recently commissioned by the NHS to create a serene garden space for patients, carers and staff of the West Dereham Ward at The Queen Elizabeth Hospital in King’s Lynn, Norfolk. The ward provides integrated care for older people and has recently undergone a comprehensive redesign to become the second dementia-friendly unit in the hospital. Designed to avoid a clinical atmosphere, the architecture and interiors incorporate a memory wall, photographs of the local area and staff and day rooms that open directly up into the garden. The Trust’s aspiration for the public realm was to create a secure, accessible garden that empowers patients with a sense of ownership and truly enrich their day-to-day lives; encouraging them to contribute to its upkeep, come together and interact with visiting family. To develop the brief, PRP held a series of co-production exercises with the Trust and local people impacted by dementia, such as members of Kings Lynn Dementia Café (which is run by the Trust’s charity partner West Norfolk Carers) and Carer’s Voice. This allowed us to ensure that the final outcome would truly reflect the needs of the people that will be using the space; a key element of PRP’s design ethos is to design with (not just ‘for’) communities. We then developed multiple concept sketches incorporating different ideas for the space’s layout and the activities it could host, whilst responding to and enhancing the garden’s existing features. The options were displayed in King’s Lynn Dementia Café, to ensure that staff, carers, patients and families all had a say in the design process, and subject to a vote. Members of the dementia café, Carers Voice, the Trust, Care of Elderly Doctors and West Dereham Ward staff all took part; this was a truly special activity that really enabled people living with dementia to contribute. A set of dementia-friendly design principles governed our developing landscape design, each of which addresses a unique difficulty experienced by someone living with dementia. PRINCIPLE 1: ACCESS, MOVEMENT AND ORIENTATION The garden will be accessible to all patients with level paths, clear signage and plenty of rest stops. A continuous walking route fringed by navigational trees will return patients to their starting point, so they can walk as far as they want without getting lost. With a terrace large enough for hospital beds and wheelchair-accessible tables and floors, everyone will be able to use the space. PRINCIPLE 2: MEMORY AND MENTAL MAPPING Our design allows year-round access to the outdoors with comfortable seating areas protected from the elements. Sensory features will stimulate memories and cognitive activity, and raised planting beds will encourage patients to garden and revive memories. PRINCIPLE 3: SENSORY STIMULATION The external space will provide seating for quiet contemplation, conversation and sensory stimulation. Colourful, textured plants such as sunflowers will provide visual interest for visually impaired people, whilst strongly scented plants such as lavender will act as markers and provide olfactory stimulation. Raised beds along PRP’s landscape team was recently commissioned by the NHS to create a serene garden space for patients, carers and staff of the ward The West Dereham Ward is at The Queen Elizabeth Hospital in King’s Lynn, Norfolk
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GREEN SPACES Image: Erda Estremera on Unsplash Image: Liza Zhukovska on Unsplash 18 mhdf magazine walking routes will make the plants more accessible for gardening whilst using a wheelchair. PRINCIPLE 4: SHELTER AND SHADE A large pergola will be the centrepiece of the garden design, providing a shaded outdoor space for relaxation and respite. Tree planting will further increase the amount of shade on sunny days, and awnings will provide sheltered areas with seating that can be adjusted depending on the weather conditions. By adhering to these core dementia-friendly design principles, the new garden will foster independence for those with dementia, motor difficulties, visual impairments and wayfinding issues alike. Encouraging movement, exercise, socialisation and quiet reflection builds a sense of normality and structure into a daily routine, which can significantly augment a holistic treatment plan delivered in conjunction with medical support. As we look ahead, well-designed landscaped gardens will play an increasingly important role in promoting health and wellbeing for all people, not just those with dementia. As landscape architects, it is our responsibility to put these considerations at the forefront of our designs and ensure that we are creating inclusive spaces for everyone to enjoy. As we look ahead, well-designed landscaped gardens will play an increasingly important role in promoting health and wellbeing for all people, not just those with dementia The final outcome intends to truly reflect the needs of the people that will be using the space
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