The following is, sadly, a work of fiction. It’s based on the kind of excellent physical rehabilitation care I have seen elderly friends experience, where the focus is on as swift as possible a return to wellness. It also draws on care models such as midwife-led birthing centres, which again plan for a return to the community as quickly as possible after the acute event that is childbirth. It’s the model of care I need, now, and one that I doubt exists. Welcome to the Hope Centre.
I’m here because I don’t feel I can keep myself safe anymore. I’m here because I need a holiday from my life, a respite from being my own carer. I don’t want things to get to the level where something irrevocable happens. I need an intervention that’s going to get my life back on track before I get to the stage of coerced treatment, before I make an attempt on my life.
And so I’m referred to the Hope Centre. It’s smaller than the inpatient psychiatric unit and my consultant has explained that it’s focused on rehabilitation. A discharge target date is set for each person on admission and no one stays longer than a week. During their brief stay the residents (no, not patients, not service users) are offered the opportunity to be cared for in a supportive environment and to learn new coping skills. The staff group is consistent, their pictures and names shown on a notice board, so there is continuity of care. Nadia, the Centre manager, shows me round and helps me settle in.
We start with my room. It’s small, but that’s because a section has been used to make an en-suite bath and toilet so I’ll have privacy. Nadia shows me that there are extra pillows in the wardrobe in case I’m cold and shows me how to adjust the temperature on the radiator. “You can leave your things here if you like, and then I’ll give you the tour. Our unit is quite different from standard inpatient care so there’s quite a lot to show you. Our whole focus is on treating this mental crisis as a temporary event. We believe you can and will return to a good level of functioning and everything we do is geared to that end. We like to think we can do a lot for a person in a week.” Drawing back the curtain, she nods at the area my window overlooks. “Feel free to go out into the garden whenever you want. I don’t know if you’re interested in gardening at all, but we can always find something for you to do. The grass doesn’t need cutting much yet but it’s time to get some plants out there in the hanging baskets. Now, shall we take a look around?”
The first door we reach has a reversible sign turned to “vacant” but Nadia taps on the door anyway before opening it. She turns on the lights, which are on a dimmer switch, revealing a massage couch and a floor mat. “This is where we offer residents touch therapy. That can mean anything from full body massage for people who find that relaxing, to hand, foot or scalp massages for people less comfortable with a high level of touch. Our therapists are fully qualified and can use aromatherapy oils and hot stones if that’s something you’d like and you’re entitled to one treatment every other day. All touch therapy’s completely voluntary but we do encourage residents to at least learn some self-massage skills as a way of distracting and self-soothing once back at home.”
We move on to what looks like a mini gym. “Ah, let me introduce you to Amil. Amil, this is Charlotte.” Amil offers his hand. “Good to meet you, Charlotte. I’m a personal trainer. I used to work in a gym but now I’m here at Hope to help anyone who wants to find ways to help improve their mental health through fitness.”
I wrinkle my nose. “I’m not exactly a gym bunny. In fact getting out of bed’s been enough of a challenge lately.”
“That’s OK! Lots of residents feel the same way. I’m not here to make you do anything you’re not comfortable with. I’m a resource for you. If you’d like to try something out, just let me know. That could be anything from having a go on some of the gym equipment – lots of people find it’s not actually as intimidating as it looks! – to learning some basic yoga positions. I’m all about helping you learn a few skills that you can take home with you when you leave us. Have you met Zita yet? OK, well she and I work closely together and she runs regular classes – that’s yoga on Tuesdays and Thursdays and relaxation on Mondays, Wednesdays and Fridays. No need to book, just turn up. And no pressure! We’re here if you want us. Then there’s the quiet room. That’s great for relaxation too.”
“That would be next on my list,” smiles Nadia, “but I think it’s in use right now.” She turns back to me. “The quiet room’s for people feeling overwhelmed by their thoughts or experiences who need to reduce sensory input for a little while. We keep the lighting dim and the room is soundproofed so users don’t have to hear the rest of the unit going about its business, although we have relaxation music in there too if that’s helpful. Some people like to sit in the armchairs, others prefer to stretch out on beanbags or the floor. I’ll show you later.”
Nadia steers me on past the library area (“There are some novels in there but the focus is on self-help books for mental health”) and into a room marked Creative Therapies. “Hi, Tikva,” says Nadia quietly. “Hi, guys. Sorry to disturb you, but can I just show Charlotte what you get up to in here?” There are some smiles and nods, although not all the women are able to make eye contact. There are five of them at a table among an array of paints and coloured pencils. The work of previous residents is displayed on the walls. Some of it is beautiful. Some of it is painful to look at. The Creative Therapies room reminds me of nursery school, but in a good way. It’s a place where it’s OK to play and experiment, pa lace where it’s not necessary to have a goal beyond being and doing. “I love this room,” says one of the women. “It’s brilliant. I haven’t drawn anything since I was at primary school, but Tikva lets you do what you want and she doesn’t make you feel stupid, you know?”
“I believe that every single person has something valuable to say through art. We run art sessions most days,” explains Tikva, “although we’re starting to experiment with writing workshops too. We find it can be really helpful for people to share the narratives of their lives, really help them pinpoint what it is that’s brought them to the Hope Centre. Do let me know if that would be something you’d be interested in.”
“OK,” says Nadia, “now everything we’ve seen so far is voluntary. We’re not going to force you to get a massage or paint a picture. That would be silly. But of course we strongly encourage you to make the most of what’s on offer. You won’t be with us very long and when you have to go back to your real life we’d rather see you leave with as many new skills in your toolbox as possible. We do however expect that you’ll engage with taking therapies. The whole point of the Hope Centre is to get you back on your feet as soon as possible. And that’s not going to happen unless we work together to unpick this crisis and see how we can empower you to stop it from happening again.” This makes sense.
“Since you’re only with us for a few days we use brief solution focused therapy to help residents identify any practical problems that may be contributing to your mental distress right now. Our goal is to help you identify the problem solving skills you already have and work out which issues are going to need specialist help. Our counsellors can refer you to benefits advisors, housing support workers, substance misuse services, parenting support, debt counselling – whatever you need. And if you’re not already receiving psychological treatments we’ll also ensure you’re assessment for longer-term therapy.
“The other thing we ask of you is a medication review. We don’t believe in making people take drugs, but we do believe that our residents should be informed about what drug treatments are available, the pros and the cons, so they can make good choices for them. We insist that our doctors view residents holistically, not just as a collection of symptoms. Meds need to work for you and your work or family responsibilities. It’s never an easy balance but we’re aiming to get the best possible symptom control with maximum functioning in the real world outside Hope.
“We’d also like you to work with one of our Occupational Therapists, again with the focus very much on how you manage once you leave us. Your OT will initially see you here at Hope but will continue to see you in the community to help you manage your time, find activities that are meaningful to you, and support you back into the workplace if that’s what you need.
“Are you ready to begin?”
All staff names have been chosen because they mean ‘hope”