Star Wards Jan/Feb Newsletter

8/3/2019 Star Wards Jan/Feb Newsletter

1/22

Welcome!

Happy new(ish) year! It probably feels like a loooong time since the Christmas break, and indeed I hope that

you did manage to get at least some relaxing, recharging time off during the holidays. I was in Israel with my

ex-Ausie Israeli relatives and the highlight was swimming (ethically no touching!) with dolphins. Magical.

In 2012 were going to be producing a few major new resources, beginning with Imagine that: 77 More Ideas.

Our first 75 Ideasremain the backbone to most member wards involvement with Star Wards, and this fresh

batch both for anyone whod like some new inspiration and for those wards which have all relevant 75 ideas inplace (Full Monty winners). Imagine Thatis very influenced by an extraordinary, wonderful book I read:IfD isney RanYour Hospitalby Fred Lee. The author has been a senior manager at both Disney and a hospital anddescribes in practical detail how to provide fabulous care for both customers and staff. Its all about trusting

and empowering staff and using our imagination to really see things from someone elses perspective,

especially that of the customer/patient. Imagine Thatis inspired by and full of examples of ward staff creatively

and compassionately putting themselves into the shoes of patients, visitors and colleagues.

Imagining what might be going on in someone elses mind is one half ofmentalising the other part being an

awareness of our own thoughts and feelings. This therapy-themed edition includes an article by one of the co-

creators of Mentalisation Based Treatment, Anthony Bateman about the value of effective mentalising for

ward staff. He presents us with the concept ofmentalising wards. One of the more bewildering and most

regrettable developments of the last few decades has been the decrease in group therapy for inpatients and

the still very patchy availability of individual therapy. Were very grateful to also have contributions from

Patrick Doyle, John Hanna, Jeremy Holmes, and the IAPT team, reinforcing the vital need for psychotherapy

for inpatients, placing it into the current context and providing practical ideas for achieving this.

Were also delighted to have several powerful contributions from members, about visits all the way from

London to Ethiopia(!) and the welcome news that Sheffields fantastic Recovery Jewellery can now be bought

online. And a big thanks to Clare and Annette White for putting together the newsletter and Nic Higham for

designing it. We hope you enjoy the newsletter and look forward to hearing your examples of therapy and

other patient experiences.

Love and


2/22

Lets talkThis edition of the newsletter focuses on the importance of talking therapies on inpatient wards. The

issue can be unhelpfully conflated into being about therapy for acute patients. But of course this is only

one group of hospital users, and just as there is huge variety in peoples illnesses, chronicity and life

situations, so a variety of therapeutic techniques are used on (and particularly off) wards. In my

experience as an inpatient, there are few people on acute admission wards who wouldnt benefit from

(nor be willing to attend) therapy, and particularly as the time to return home gets closer. The vital factor

is that the therapy is suitably low-key and the therapist warm, personable, sensitive and very flexible.

From the fantastic TV series about a psychotherapist and his patients,In Treatment

Contents

News from around the Star Wards community Lets Talk, a speedy introduction to Talking Therapies by the Star Wards team and special contributors

TalkWell travels to Ethiopia

Community Visits, by Kevin O Hanlon of the Jim Birley Unit in Camberwell

Get involved! Contributing to the Star Wards newsletter

Plus: look out for Cheap as Chips Tips and Starred links

2
http://www.hbo.com/in-treatment/index.htmlhttp://www.hbo.com/in-treatment/index.htmlhttp://www.hbo.com/in-treatment/index.htmlhttp://www.hbo.com/in-treatment/index.html


3/22

Professor Jeremy Holmes describes the use of talking therapies on inpatient units

A crucial ingredient in mental health is the capacity for self-reflection, or mentalising as it is now called -

which I define as the ability to see oneself from the outside and others from the inside. 'Talking therapies'

have an essential place in fostering mentalising and are needed in the in-patient unit at three levels.

First, the stresses and challenges of working on in-patient wards means that staff members need a safe

space where they can reflect on their own feelings and actions, and come to understand them both in

terms of their own lives, and those of their clients. A weekly or better still daily staff group, facilitated by

a skilled group therapist, where hierarchies can be levelled and the team reflect on itself, is in my view an

essential element in any well-functioning in-patient psychiatric ward team. The leadership and

endorsement of this must come from the top. Resistance must be seen as a normal and expectable

response, carried perhaps by some recalcitrant members who are acting out the difficulty of facing one'sfeelings for the whole group.

Building on that, daily or twice weekly community meetings where the whole unit - patients and staff

alike - come together to discuss the practical and emotional aspects of living together is also highly

desirable. Such large groups can be stressful and at times disrupted, but have a vital holding function that

helps create cohesion and compassion within the unit, and is a place where the inevitable tensions of

group living can be explored.

Thirdly, many individual patients need regular, preferably daily, one-to-one sessions with staff members,

who themselves have access to a supervision session where their interactions with the patient can be

discussed in an open and non-judgmental way. These sessions will vary is style and content. Many will

provide an opportunity for the patient to review their li fe-history and the part played in it by their illness.

Support and validation are essential. Some may benefit from Cognitive Behavioural (CBT) approaches,

e.g. in dealing with psychotic phenomena. Others may want to look in depth at the ways in which factors

in their life of which they are unaware may have played a part in their breakdown. Thus training in

Rogerian Counselling, CBT, and psychodynamic thinking will all be important in the skill-mix of a fit-for-

purpose in-patient psychiatric unit.

Prof Jeremy Holmes MD FRCPsych

Consultant Psychiatrist (retired), Devon partnership Trust

Visiting Professor Psychological Therapies, University of Exeter

3


4/22

Mentalizing and Mental Health Wards

The OEDquoted G. Stanley Hall, a founder of American psychology, as having written in 1885, The

only thing that can ever undermine our school system in popular support is a suspicion that it does

not moralize as well as mentalize children. This is the first recorded professional use of the word

mentalize. It is difficult not to wonder now, over a century later, if the thing that might undermine

our mental health system in popular support is a suspicion that it moralises whilst not giving a

mental quality to patients and/or fails to develop or cultivate a mentally sensitive system in our

mental health wards.

Currently, the OED gives two senses for mentalize: first, to construct or picture in the mind, to

imagine, or to give a mental quality to; second, to develop or cultivate mentally or to stimulate the

mind of. Devoid of these senses a service can only become a mechanism of behavioural control and

there can be few places in the mental health system more vulnerable to this danger than the in-

patient ward. Mental health wards need to be mentalizing wards.

Mentalizing as it is currently used lies at the very core of our humanity it refers to our ability to

attend to mental states in ourselves and in others as a way of understanding our own actions and

those of others. Without mentalizing there can be no robust sense of self. We cannot know who we

are or why we do things if we do not understand what is happening inside our mind; equally there

can be no constructive social interaction if we cannot understand what l ies behind someone elses

actions; there can be no mutuality in relationships if we cannot understand someone and they

cannot understand us; there can be no sense of personal security if we lose our mind or lose sight

of the other persons. So, maintaining mentalizing is vital for mental health, social function, and

intimate relationships and yet is so easily lost under stress and in circumstances when action and

inaction are apparently incomprehensible.

Disordered mental processes affect the capacity to think and to represent states of mind in

ourselves and others; conversely losing our ability to represent states of mind will disorder our

mental processes. Crucially, loss of mentalizing in one person tends to stimulate non-mentalizing in

another if someone makes no attempt to understand things from your perspective you are

unlikely to easily try to understand things from their perspective. So disordered mental processes in

mental health patients will stimulate non-mentalizing in staff. In the hurly burly of in-patient wards

the staff need a star to steer themselves

4


5/22

and this star can be mentalizing for just as non-mentalizing begets non-mentalizing so mentalizing

begets mentalizing. So a primary task of staff on mental health wards is to develop and maintain a

mentalizing milieu, to make things mental. Only then can they help a person with a disordered

mind gain some order and coherence. There are a number of ways that this can be done.

First staff on mental health wards have to maintain mentalizing in themselves and each other.

Patients will have little chance to regenerate their own mentalizing to help them order their mental

processes if the staff act and react in non-mentalizing ways. Second, staff need to organise around

a shared understanding of psychological processes. Mentalizing is important as a unifying mental

process because it interfaces with a wide range of psychological functions - cognition, affect, non-

conscious process, subjective and interpersonal experience and so on. This suggests that whether

or not a formal mentalizing approach is adopted in treatment, there is a need for any clinician to

5


6/22

see the world from the patients perspective, and that whenever that focus on the patients

internal mental process is dominant there is intrinsic value because of the powerful commitment to

the patients subjectivity. It is this consistent focus on the subjective reality of the patient that is a

hallmark of the mentalizing process and is something that all mental health professionals can sign

up to. Third, clinicians need the skills to adopt a mentalizing dialogue between each other and

between themselves and their patients. Their training and organisational structures need to

support this.

Finally the whole purpose of the mentalizing milieu and interaction with staff is to develop

attachment processes between staff and patients that effectively facilitate more robust mental

states. We need others to find ourselves and the prototype for this is the attachment relationship.

It is in the attachment relationship that mentalizing first develops and may flourish. But we also

know that disorganised attachment can undermine mental development and even make people

more disordered. This is particularly so when the attachment system is over-stimulated which leads

to mental collapse due to a vulnerable mind being swamped. Excitement and pleasure, for

example, become over-excitement and terror; uncertainty about feeling can become panic about

survival. A mentalizing ward respects the balance between too much stimulation through intrusion

and too little through neglect. A mentalizing member of ward staff appreciates that many patients

have complicated feelings of loss when they leave hospital, such is the strength of attachment

when a therapeutic alliance has been effective. Recognising these attachment processes informs

the interactions between patients and staff and makes the ward a safer place for all.

Prof Anthony Bateman, MA FRCPsych

Consultant Psychiatrist and Psychotherapist and Honorary Senior Lecturer at University College and

Royal Free Medical Schools, Barnet, Enfield, and Haringey Mental Health NHS Trust

Visiting Professor in the Psychoanalysis Unit at University College London

6


7/22

Tea and Therapy: A Dialogue with Karen

The patient so compellingly described in Patrick's piece has given her agreement for this to be sharedand identifying details have been changed

The first time I met Karen, she asked me if I wanted a cup of tea a nurse told me later it was the

first time she had spoken in eighteen months. I was new to the ward and I felt a little ill at ease with

her silence initially, but she reassured me:

Its okay, you dont have to say anything yknow.

I knitted my eyebrows in confusion.

Lets just sit here for a while; I think I could deal with that.

Of course.She nodded and returned to staring out of the window and sipping her tea.

It was during Karens first session that I really began to understand what it was merely to listen and

observe and sit with someone. The ward was quite chaotic and I could hear snippets of

conversation in the day-room; chairs scraping on the floor; the ward clerk walking past in her high

heels. At the end of the session Karen walked towards the door, paused and asked without turning

around, Could we talk about the voices next week?

We can talk about anything.

The week after, Karen slowly began to talk more and more. She didnt talk about the voices to

start with; there was an unspoken agreement that we would get to the voices. Instead we talked about:

the weather; the news; how she liked the view of the cherry blossoms from her bedroom window at

home; her favourite pet cat Ozymandius Ozzy for short; how she trained as a teacher before she got ill;

my garish ties - anything and everything.

7


8/22

Karen liked to make top 10 lists: top 10 favourite sweets from the Eighties, top 10 favourite singles; top

10 favourite films of all time. Here there was common ground and a shared experience through dialogue

and reflection and it was fun.

One day about three months later, Karen finally felt comfortable enough to tell me about the voices and

the reason she was unable to speak for so long. She explained that she had so many voices that she

couldnt hear herself think or speak and that it had been easier to stay silent. Sitting with someone -

someone simply being with her had allowed her to find her voice again.

Over the following weeks we started talking to the voices: asking them why they bothered Karen. One by

one they agreed not to give her such a hard time, or to leave her alone completely. Outside the sessions

she began chatting with the nurses and attending OT. Sometimes Karen asked if the nurses could sit-in

on the sessions so that they could learn to help with the voices.

Karen was eventually discharged from hospital and went back to teaching. She is now a successful

Lecturer and motivational speaker and uses her inpatient experience to help staff and patients. Karens

story is not unique though. In a sense its everyones story: we all need to be understood. Engaging in

dialogue is often borne out of a shared silence. Sharing an experience with someone, even if it is silence,

creates the opportunity for dialogue, and dialogue can often lead to understanding. In the words of the

Swiss physician Paul Tournier:

No one can develop freely in this world and find a full life without

feeling understood by at least one person.

Patrick Doyle is a Clinical Nurse Specialist and Psychotherapist working within a medium secure

hospital. He is the founder of Person First Solutions, who provide mental health training, consultancy

and clinical services for the NHS, private and voluntary sectors.

http://personfirstsolutions.synthasite.com/

www.twitter.com/PBTDoyle

8
http://personfirstsolutions.synthasite.com/http://www.twitter.com/PBTDoylehttp://www.twitter.com/PBTDoylehttp://personfirstsolutions.synthasite.com/


9/22

What is the Improving Access to Psychological Therapies (IAPT) Programme doing

for People with Serious Mental Illness?

The Improving Access to Psychological Therapies (IAPT) Programme aims to improve public access to a

range of NICEapproved and evidence based psychological therapies for depression and anxiety

disorders. Since the programme began 4 years ago, large numbers of people have been referred/self-

referred to IAPT services and have benefitted from psychological therapies.

The publication of the mental health strategy - No health without mental health: A cross-Government

mental health outcomes strategy for people of all ages in February 2011 signalled the Governments

commitment to invest around 400 million over four years in the expansion of talking therapy services.

The strategy was accompanied by Talking Therapies: A Four-Year Plan of Action, which sets out the policy

priorities indicating how the additional investment in psychological therapies will be used in the four

years from April 2011.

A key policy priority for the next four years is the expansion of the IAPT programme to include increasing

access to psychological therapies to people with severe mental illness (SMI) such as Psychosis, Bipolar

Disorder and Personality Disorder.

As part of the launch of this expanded scope, a Stakeholder Engagement Event was held on 23 November2011 which gathered views from about 120 people from mental health services, universities and third

sector organisations. It was a very successful event and the outputs from this are helping to inform

further development of the project. The views of service users and carers were sought through third

sector organisations who will be working alongside the IAPT SMI project as it develops. The project will

adopt a phased approach with an initial developmental phase.

9


10/22

NICE guidance gives a good indication of what works for people with SMI, for example Cognitive

Behavioural Therapy and Family Work for people with Psychosis and Bi-Polar Disorder. For people with

Personality Disorder the evidence is less clear although some psychological therapies are recommended

such as Mentalization and Dialectical Behaviour Therapy. However, the project recognises the need to begrowing further evidence of what works to include other therapeutic interventions which may be less

intense i.e. behavioural activation.

We have set-up an Expert Advisory Group which will provide expert advice as the project develops, and a

number of focused task and finish groups. All of these groups include service users from key third sector

organisations for Psychosis, Bipolar Disorder and Personality Disorder.

Some staff in mental health services and beyond already possess considerable levels of psychological

knowledge. It is the intention of the project to work with staff to expand their knowledge and skills to

increase their competencies to deliver effective psychological therapies to a consistent quality. We know

that some services are already developing a workforce that is psychologically informed who deliver very

robust and good quality psychological interventions. We need to learn from what works and what does

not to make sure that any developments continue to make a difference. All staff whether they are

working in community services or inpatient services will be encouraged to take part in this development.

Training initiatives will be developed to equip staff to work psychologically with people with SMI.

We are keen that inpatient staff use their knowledge back on the wards to work psychologically with

patients. The details of training is still at the early stages of development but we will continue to be

mindful of the needs of inpatient staff and would be keen to include them. All of this features in our

discussion so please keep an eye on theIAPT websiteas we plan to keep people informed via this

medium.

Measuring the outcomes from these psychological interventions is key. Firstly, to ensure that people

with SMI are being effectively treated but also to demonstrate the impact of the project on peoples lives

and the services they receive. Data will be collected throughout the life of the project to help us

understand what makes a difference to people with SMI to increase their quality of life.

Thus, it is early days in the life of the project and we are keen to learn any lessons from service users,

carers and workers about what works. We can be contacted via the IAPT websitewww.iapt.nhs.ukto

give us your thoughts or ask any questions.

Alison Brabban IAPT National Advisor, SMI

Alex Stirzaker IAPT National Advisor, SMI

Linda Charles-Ozuzu New Projects Development Lead, IAPT

10
http://www.iapt.nhs.uk/http://www.iapt.nhs.uk/http://www.iapt.nhs.uk/http://www.iapt.nhs.uk/http://www.iapt.nhs.uk/http://www.iapt.nhs.uk/http://www.iapt.nhs.uk/http://www.iapt.nhs.uk/


11/22

Current developments in inpatient psychological therapy

Access for inpatients featured strongly in the We Need to Talk campaign, resonant of NICE guidance

updates for schizophrenia and depression which call for the commencement of evidence-based therapies

during acute episodes. The NHS Constitution goes further, ensuring that service users are granted rights

of access to a range of evidence-based interventions, both medicines and therapies. Payment by results is

set to ensure that commissioners develop resource and capacity within services sufficient to ensure these

rightful treatments are offered, to inpatients and outpatients alike. Wards signing up to the Accreditation

of Acute Inpatient Mental Health Services (AIMS) are now mandated to provide a minimal psychological

practitioner resource alongside training for staff to enhance delivery of evidence-based psychological

therapies.

Now we welcome the Improving Access to Psychological Therapies for Severe Mental Illness programme,

in development across professional bodies and service user and carer representative organisation within

the Department of Healthbut we must ensure that access in this programme relates to inpatients as

well as users of community services. Access to evidence-based interventions, those demonstrated to be

clinically and cost-effective, is the primary objectivebut room, and investment, must be spared for

innovative new and as-yet-evidenced existing practice to be systematically reviewed and researched, to

eventually widen choice. Strong leadership is required to develop capacity and skill required to deliver

stepped psychological care with most or all staff delivering basic/low intensity interventions and

sufficient specialist staff to undertake more complex/risky clinical work.

Psychological therapies and interventions must be delivered in the context of priorities for, and at the

same pace of, the acute/crisis service. Interventions should contribute directly to resolving crisis, de-

escalating acute distress, avoiding hospital admissions, reducing the length of stay, moving patients

forward to less restrictive environments. Interventions should also contribute to community re-

integration and relapse prevention, reducing the likelihood of re-admission or re-presentation in crisis.

Equal access to underserved people, for example from BME groups, must be assured.

Dr. John Hanna

Director, Policy Unit, Division of Clinical Psychology, British Psychological Society

Consultant Clinical Psychologist, Acute Inpatient Clinical Psychology Service, Highgate Mental Health Centre

11


12/22

What are the most suitable therapies for inpatients?

Psychosocial interventions (PSI), uses cognitive behaviour therapy techniques among others, as well as

medication. Episodes of mental illness tend to be triggered through a combination of biological,

environmental and sociological factors, by some life events or by stress. PSI addresses the patient's illness

in an engagement and outcome-orientated assessment, takes into consideration the views of the family,

and helps with psychological as well as medication management through cognitive behaviour therapy,

coping strategies, training in problem-solving, etc. PSI is one of the most common forms of therapeutic

intervention on wards, with an increasing number of healthcare assistants as well as registered nursestrained in and confidently applying its techniques.

Cognitive behaviour therapy(CBT) is based on changing the patient's negative thought and behaviour

patterns. NICE recommends CBT for those diagnosed with schizophrenia, bipolar disorder, depression,

eating disorder, post-traumatic stress disorder and self-harm. It is also recommended for those with

personality disorder by the National Institute for Mental Health, England, although research suggests that

CBT (along with other cognitively based and dynamically orientated therapies) can be counter-

productive for people with Borderline Personality Disorder.

What CBT and similar therapies do is to teach new behaviours, first in the context of the ward and later in

the client's normal life outside hospital. In hospital the priority is to help patients to make sense of theirsituation. Patients will probably be confused and fearful, but they need to understand how they arrived

at their predicament and what they might be able to do about it. For example, one skill is to let negative

thoughts and memories go on an imaginary conveyor belt and watch them being carried off. Thus the

12
http://bjp.rcpsych.org/content/188/1/1.fullhttp://bjp.rcpsych.org/content/188/1/1.full


13/22

patients are encouraged to work actively towards getting well. Skilful practitioners help prevent patients

feeling somehow criticized by CBT formulations, thinking they have made themselves ill through wrong

thoughts.

Dialectical behaviour therapy(DBT)is a special variation of CBT, developed to treat borderline

personality disorder, working directly with problematic thoughts and feelings and developing skills to

deal with these, both individually and in groups. It differs from CBT in looking not just at behaviours but

also at their causes and consequences, and in emphasising validation, dialectics and the therapeutic

relationship. DBT views borderline personality disorder as resulting from skills deficits, especially an

inability to regulate emotions. It suggests that as children, people with BPD failed to learn emotional

management skills because their carers produced an 'invalidating' environment. Skills deficits can also

exist in interpersonal relationships, behavioural patterns such as self-harm, and cognitive processing such

as problem-solving under emotional stress. Dialectics in this therapy means a holistic approach, managing

tensions in the patients outlook, and adaptability to treatment goals as they evolve. DBT also employs

mindfulness, based on Zen Buddhism; validation which treats the patient's responses empathically;

dialecticalstrategies and other techniques. Consistent and progressive treatment is achieved by involving

other professionals as well as friends and family.

Mentalisation based therapy (MBT)is a type of treatment mainly for people with borderline personality

disorder (BPD). Mentalisation is about understanding ones own and other people's thoughts and

feelings, something which can be difficult for people with BPD. (See the article in this edition by Anthony

Bateman and also www.mentalising.com.) Research suggests that BPD is caused by early childhood

attachment issues, abuse or neglect, leading to patterns of feeling overwhelmed by intensely painful

feelings which make individuals automatically shut off their thought processes about themselves and

others. People with BPD are thought to have hyperactive attachment systems as a result of their historyand/or biological make-up, which in turn leads to a reduced capacity to mentalise. MBT teaches patients

in a safe and non-judgemental way to function in interpersonal relationships and to cope with extreme

internal pain without externalising it through self-harm or obliterate it through drink or drugs.

At times of stress people with BPD may turn to self-harm and other powerful but obviously problematic

coping mechanisms, which both divert from and prevent considering their own and others thought

processes. MBT can help them to sharpen up their ability to mentalise and be willing to use it. For

example, if a person with BPD is feeling particularly suicidal, being able to mentalise means they have to

properly reflect on their thoughts and feelings, and crucially, on how their death would impact on others.

Solution-focused brief therapy (SFBT) is based on social constructionist philosophy and focuses upon

what patients wish to gain from therapy instead of the problems that led them to seek help. This therapy

focuses on the present and future rather than the past. The client is invited to envision what they would

like their future to be, and then therapist and client together start to work towards these goals (the

13
http://www.mentalising.com/http://www.mentalising.com/


14/22

preferred future) in small steps. This is based on the idea that change is constant; the therapist helps the

client to identify first, what they want to change and second, what they want to continue to have happen

in their lives. This theory is based on the finding that the clearer clients were about what they wanted to

achieve, the more likely they were to achieve it. The therapy is very positive, using flowcharts and end-of-session compliments on what has already been achieved.

Individual and Group Therapy

Most forms of psychotherapy benefit from a one-to-one relationship between therapist and client, but

group therapy also has distinct benefits and lends itself well to the community nature of a ward setting.

In group therapy, groups find solutions together, guided by a facilitator. In a group setting, members can

learn about their assets/deficits through interaction with their peers and staff; they can also experiment

with newly learned behaviours in the protected environment of the group before taking them out into

the world.

Historically, at the turn of the 20th Century, a Boston physician first held group sessions to educate poor

tuberculosis patients for whom a sanatorium was not an option on how to fight the disease through strict

hygiene regimens at home. Freud later recognized the dynamics of group relationships and the role of

the charismatic leader. Psychoanalytic and interpersonal theory was integrated in group therapy

concepts. In the 1960s sensitivity training (T groups) and personal growth groups began, followed by

transactional analysis, gestalt theory, and many other variations. Important innovations were group

approaches in the workplace, the study of group morale, and management of large groups through the

role of the command psychiatrist. Types of therapeutic groups are self-help, medication, encounter,

interpersonal therapy, and psychodrama.

14


15/22

Various models of inpatient group psychotherapy share several features, especially establishing specific

goals according to the particular needs of the patients.

Skills development models include: -

The educative model: patients discuss the problems which led directly to their hospitalization andfind ways of coping.

The problem solving modelhelps patients to acquire interpersonal problem solving skills. The steps

are clarifying the problem, generating and evaluating alternatives, role-playing and reporting back to

the group.

The social skillsmodelis behaviourally oriented and fosters the acquisition of various interpersonalskills by dividing each skill into several behavioural components.

The interpersonal modelemphasizes the social isolation of inpatients and their difficulties in

interacting with others, focusing on current problems. In each session, members consider one

interpersonal problem that can be addressed within one session.

Practicalities

According to The Centre for Mental Health, in a hospital situation the full-time clinical psychologist to

inpatient ratio should be 1:20. Other advisors would add a full-time assistant psychologist to this in the

ratio 1:40. Star Wards believe that psychological therapy should be available to every patient who wants

it and that a clinical psychologist or similar specialist should also provide staff training, support and

supervision.

Definitions: other types of talking therapies in brief

Therapeutic goals needto be attainable..

15


16/22

Psychodynamic therapies

Exploring with a therapist how personality and early life experiences influence current thoughts and

behaviour. Helpful for depression, anxiety, post-traumatic stress, addiction etc and also for coping with

long-term physical health problems. Usually take several months to several years.

Humanistic therapies

Whole-person approach to problems, helping the client to grow and realise their potential. Helpful for

depression (including in children), schizophrenia, anxiety, addiction etc.

Couples, relationship or families therapies

Couples or families work with a therapist to sort our relationship problems where there are difficulties

with eating, depression or severe mental illness.

Interpersonal therapy

Links mood with interpersonal relationships. Used with people with eating disorders and various forms of

depression, etc.

Mindfulness-based therapies

Combines talking therapies with meditation, helping people to switch off from difficult thoughts and

feelings and make changes. For stress reduction, emotional regulation and depression.

Motivational counselling

Focuses on hopes, ambitions and problems that stop people reaching their goals. Most commonly used

with people with a dual diagnosis.

Eye movement desensitisation and reprocessing (EMDR)

Stimulating the brain through eye movements, to make distressing memories feel less intense.

Used in particular for people who have experienced abuse or other trauma.

16


17/22

Lets Laugh! Humour in Talking Therapies

Humour is good for the body as well as the soul, having beneficial effects on the cardiovascular and

immune systems and levels of stress hormones. If we can laugh at ourselves, it puts our problems in

perspective. The use of humour in therapy has several benefits. It creates a more relaxed and egalitarianrelationship between therapist and client; it can reach important emotions which the client may be

shielding from therapeutic intervention; and it can be a non-threatening technique for diluting the pain

of some issues.

Rational-Emotive Therapyreflects clients exaggerated perceptions of the seriousness of some issues by

using humorous counter-exaggerations.

Provocative Therapyuses a benevolently humorous approach to challenge what the therapist regards as

a clients distorted or dysfunctional beliefs, using reverse psychology.

The Humour Group, a popular and effective but short-lived project, used fun activities such as games,

songs, dance and skits in tightly structured sessions with many positive effects such as improved

communication and social skills, enjoyment of therapy, reduced stress etc.

Laughter Groups, which originated in India but have now reached the rest of the world, work on the

basis that simulated laughter together with breathing techniques and vocalisation produce genuine

feelings of well-being. Information onthe websitegives plenty of information about how elementsof Laughter Yoga could be introduced.

Youtube video:see Laughter Yoga in action with John Cleese.

17
http://www.laughteryoga.org/http://www.laughteryoga.org/http://www.laughteryoga.org/http://www.youtube.com/watch?v=yXEfjVnYkqMhttp://www.youtube.com/watch?v=yXEfjVnYkqMhttp://www.youtube.com/watch?v=yXEfjVnYkqMhttp://www.youtube.com/watch?v=yXEfjVnYkqMhttp://www.laughteryoga.org/


18/22

Therapy resources

Info for staff

Theres loads ofreliable information about different types of therapies from all the usual suspects Royal College of Psychiatrists, Rethink, Mental Health Foundation etc. Here are links to twolower-profile therapies, DBT and MBThttp://behavioraltech.org/resources/whatisdbt.cfm www.mentalising.comMentalization-Based Treatment for Borderline Personality Disorder Bateman and Fonagy

Info about and self-help resources for patients

CBT info and excellent downloadable worksheetshttp://www.mentalhealth.org.uk/help-information/podcasts/http://www.bemindfulonline.com/http://www.mentalhealth.org.uk/help-information/podcasts/http://www.dbtselfhelp.com/index.html

Stuff from Star Wards

TheStar Wards youtube channelhas a therapy playlist which includes remarkable, historicvideos of some of psychotherapys gurus engaged in therapy, including the gloriously humane

Carl Rogers, founder of person-centred therapy. The genius comedian Bob Newhart does asuperb parody of a terrible therapist:http://www.youtube.com/watch?v=Ow0lr63y4Mw

And of course theresTalkWell, a conversation training resource which is big on the wholepsychologicaly-minded staff team thing.

18
http://behavioraltech.org/resources/whatisdbt.cfmhttp://behavioraltech.org/resources/whatisdbt.cfmhttp://www.mentalising.com/http://www.mentalising.com/http://www.amazon.co.uk/Mentalization-based-Treatment-Borderline-Personality-Disorder/dp/0198570902/ref=sr_1_3?s=books&ie=UTF8&qid=1327490747&sr=1-3http://www.amazon.co.uk/Mentalization-based-Treatment-Borderline-Personality-Disorder/dp/0198570902/ref=sr_1_3?s=books&ie=UTF8&qid=1327490747&sr=1-3http://www.mentalhealth.org.uk/help-information/podcasts/http://www.mentalhealth.org.uk/help-information/podcasts/http://www.bemindfulonline.com/http://www.bemindfulonline.com/http://www.mentalhealth.org.uk/help-information/podcasts/http://www.mentalhealth.org.uk/help-information/podcasts/http://www.dbtselfhelp.com/index.htmlhttp://www.dbtselfhelp.com/index.htmlhttp://www.youtube.com/starwardschannelhttp://www.youtube.com/starwardschannelhttp://www.youtube.com/starwardschannelhttp://www.youtube.com/starwardschannelhttp://en.wikipedia.org/wiki/Carl_Rogershttp://www.youtube.com/watch?v=Ow0lr63y4Mwhttp://www.youtube.com/watch?v=Ow0lr63y4Mwhttp://www.youtube.com/watch?v=Ow0lr63y4Mwhttp://starwards.org.uk/images/stories/user_files/marion/TalkWell_2nd_Edition/TalkWell_2nd_Edition_4.1mb.pdfhttp://starwards.org.uk/images/stories/user_files/marion/TalkWell_2nd_Edition/TalkWell_2nd_Edition_4.1mb.pdfhttp://starwards.org.uk/images/stories/user_files/marion/TalkWell_2nd_Edition/TalkWell_2nd_Edition_4.1mb.pdfhttp://starwards.org.uk/images/stories/user_files/marion/TalkWell_2nd_Edition/TalkWell_2nd_Edition_4.1mb.pdfhttp://www.youtube.com/watch?v=Ow0lr63y4Mwhttp://en.wikipedia.org/wiki/Carl_Rogershttp://www.youtube.com/starwardschannelhttp://www.dbtselfhelp.com/index.htmlhttp://www.mentalhealth.org.uk/help-information/podcasts/http://www.bemindfulonline.com/http://www.mentalhealth.org.uk/help-information/podcasts/http://www.amazon.co.uk/Mentalization-based-Treatment-Borderline-Personality-Disorder/dp/0198570902/ref=sr_1_3?s=books&ie=UTF8&qid=1327490747&sr=1-3http://www.mentalising.com/http://behavioraltech.org/resources/whatisdbt.cfm


19/22

Out and about community trips

I started working on acute wards back in 1998 and noticed that a lot of violence on

the wards was due to boredom. Two years later I organised short trips to museums

in London for patients which they found very interesting.

Nine years on I started to organise weekly trips further afield to Herne Bay, Hastings

Folkestone, Brighton, Whitstable and Leeds Castle with the backing of the old wardmanager Karren Dixon and the new ward manager Andrew Blockley.

I have noticed a big difference in how patients are when they are visiting these

places as they find the environment very peaceful just sitting by the sea or walking

around lovely castle grounds to compare with sitting on a very noisy ward. It really

helps them with getting back out into the community and the so called real world. In

the past I have heard quite a few patients saying that the NHS dont care about what

happens to them. Which I dont believe is true. I get a lot of satisfaction out of seeing

how people are so much happier and different when away from the ward

environment because its gives them back their self confidence, self respect and self

esteem.

Over the last couple of months we have now also started swimming groups every

Wednesday and cycling groups every Friday. I started the swimming group mainly for

people that find it very hard walking. As one patient mentioned I have not been

swimming now for around 30 years and this has encouraged me to start going

swimming with my son and grand daughter every Friday which I really enjoy. I have

also found that my fitness as improved as well when walking.

Over the last 4 months I have also managed to get another ward involved with us to

do these activities as well with the help from Ruskin Units Activities Co-ordinator

Yildiz Kirney.

Benefits:

1) Tackling loneliness and isolation is one of the ways you can help maintain good

mental health. Encouraging patients to join community visits will mean they will

spend less time on the ward, isolating themselves in their room and actively

participate in activities which they have a choice in and enjoy. This will reinforce a

positive outlook on life and help patients to re-build self-esteem and confidence in

order to tackle isolation.

2) People with mental health issues are amongst the socially excluded. Patients

who attend community visits will be encouraged to try and communicate

effectively and appropriately with members of the community in order to tackle

the issues around social exclusion.3) Community visits aim to encourage patients to spend less time on the ward as a

patient and reduce or eliminate reinforcement of dependency, learned

helplessness or maladaptive behaviours. When patients are outside in the

community, they will be observed or assisted by staff member if necessary but will

be encouraged to be independent in order to prepare them for life after discharge.

4) To give people with mental heath issues something to look forward to each

week while on the ward and hopefully help towards a speedy recovery which will

help them get back out in the community.

Kevin O Hanlon HCA

Jim Birley Unit

South London and Maudsley NHS Foundation Trust


20/22

Were using Google Docs to create this newsletter. Google offer a wide range of freetools that between them can save a fortune on software investments. There are also

mobile versions of most of the tools which makes them easy to access from

smartphones. For all content and ideas that you want to share, these tools are

multi-lingual and will get you away from those awkward incompatible document moments.Explore more

here.

Whats new

Recovery Jewellery

What if people with Down Syndrome ruled the world? An affectionately written piece by

Dennis McGuire from the Adult Down Syndrome Center of Lutheran General Hospital, Illinois,

USA.Click here to read it.

Recovery Jewellery, featured in an earlier

newsletter, is now for sale on the web, through a

partnership with the National Paranoia Network.

Recovery Bracelets were developed by service

users and staff on Sheffields acute mental health

wards, and are made with skill and pride by

inpatients. They symbolise the hope and optimism

of the Recovery philosophy and the colours of the

beads in the design spell out the word Recovery.

When the bracelets were launched in Sheffield,

the response was phenomenal. Service users,

relatives and staff reported numerous benefits

from wearing them.

You can buy the inspiring bracelets fromhere.

20
http://www.google.co.uk/intl/en/options/http://www.google.co.uk/intl/en/options/http://www.google.co.uk/intl/en/options/http://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.nationalparanoianetwork.org/shop#ecwid:category=1683140&mode=category&offset=0&sort=addedTimeDeschttp://www.nationalparanoianetwork.org/shop#ecwid:category=1683140&mode=category&offset=0&sort=addedTimeDeschttp://www.nationalparanoianetwork.org/shop#ecwid:category=1683140&mode=category&offset=0&sort=addedTimeDeschttp://www.nationalparanoianetwork.org/shop#ecwid:category=1683140&mode=category&offset=0&sort=addedTimeDeschttp://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.nads.org/pages_new/news/ruletheworld.htmlhttp://www.google.co.uk/intl/en/options/http://www.google.co.uk/intl/en/options/http://www.google.co.uk/intl/en/options/http://www.google.co.uk/intl/en/options/http://www.google.co.uk/intl/en/options/


21/22

Student mental health nurses TalkWell in Ethiopia

NHS International Links is a scheme that supports exchanges of knowledge and skills between UK

based health organisations and their counterparts in developing countries. Leicestershire

Partnership NHS Trust joined the scheme in 2004, and since this time strong links have been formed

with mental health and learning disability projects in Nigeria, India and Ethiopia.

The mental health link with Gondar, a city in the north of Ethiopia, has been supported by the Trust

since 2008 and has enabled a wide range of staff to get involved in the training of medical and

nursing colleagues. The capacity to deliver mental health services in Gondar is limited two mental

health nurses provide an outpatient clinic service at Gondar Hospital, which serves a city population

of around 350,000 as well as the surrounding rural areas. There is no psychiatrist working in the

region, and the nearest specialist mental health facility is located around 300 miles away in Addis

Ababa.

The Gondar link is an active group that coordinates several trips over to the city each year, and this

enables us to have a high profile with medical and nursing students and also to undertake work to

support the development of mental health services - including the citys first mental health inpatient

unit, which is now at a well-developed stage of planning.

Our trip in October 2011 involved an extensive programme of work which included teaching the

psychopathology module to the group in their 2nd

year of the BSc in mental health nursing. We

started off the module with a full day based on TalkWell - the conversation training resource for

mental health staff produced as part of Star Wards. We used a TalkWell training package produced

by a Therapeutic Development Worker within Leicestershire Partnership NHS Trust that had been

successfully tested out with staff on several of our own wards. Due to the structure of nurse training

in Ethiopia and the lack of local specialist mental health services, the students had not had the

opportunity to undertake clinical placements or talk to patients, so they found this experiential and

practical approach to conversational skills very useful.

In the afternoon, the students put on their uniforms for the first time and it was arranged for each of

them to visit one of the wards at Gondar University Hospital. This gave them an opportunity to

develop some practical experience of engaging with patients and starting, structuring and finishing a

therapeutic interaction. Although the student nurses met patients with physical conditions on

general wards, unsurprisingly they were able to identify and explore mental health and related

issues (such as anxiety, low mood, trauma and stigma, for example) for all of them.

Three TalkWell books had kindly been donated by registered charity Bright, and these were given to

the university library for students to access.

Claire Armitage

Gondar Link Group

21


22/22

Star Wards Jan/Feb Newsletter

Documents