A “kitchen cupboard on wheels” sounds an unlikely way to help adults with mental health problems in acute in-patient units. But the idea has recently won its creator Kathryn Smith the 2007 College of Occupational Therapists’ occupational therapist of the year award.
Smith, consultant occupational therapist at Cornwall Partnership NHS Trust, was originally asked by her line manager to develop a sensory room for one of the trust’s “section 136” suites. These are used when assessing whether someone who has been detained by the police needs to be sectioned under the Mental Health Act 1983.
Finding it difficult to develop a sensory room that fulfilled safety requirements, Smith instead came up with the Be SMaRT (Sensory Modulation and Regulation Therapy) Cart, a joint project with her husband, who is a joiner. The aim of the sensory-room-in-a-box is to create a comforting, calming environment for those in mental distress.
Smith contacted a local design firm for help and held mini-focus groups with service users so that the cart looked and felt the way they wanted, and to make sure it couldn’t be used to self-harm.
The next step was funding, so Smith applied for the 2005 Medical Futures innovation award, where the SMaRT Cart was runner up. Medical Futures recommended she patent the idea, and this is now pending.
Smith’s employer then saw the potential and decided to invest in building the first two prototypes. Those two carts are now at the trust’s two main in-patient units for adult acute admissions, Longreach House at Camborne Redruth Community Hospital, and Bodmin Hospital.
The carts are made from hardboard sections and laminate ply, so they are easy to fill, sand down, and touch up – an important point for Smith who didn’t want a product that would quickly look old. They are also coated in industrial paint so are easy to keep clean.
“I wanted it to be like my granny’s jewellery box,” says Smith. “It’s plain on the outside but, when it’s opened, it sparkles.”
Inside the cart is a computer with CD and DVD drives and the facility to plug in an MP3 player so that users can play their own music, watch relaxation DVDs or films, and load photos that they find comforting. The computer is also used to help people write their own sensory self-management strategy. There are also a range of light colours and settings.
Sensory-based therapy uses the seven senses, rather than the more commonly known five of taste, touch, smell, sound and sight. The additional two are balance and muscle stretch.
“We use all seven senses to change a client’s arousal levels. For example, when someone is agitated or distressed and could self-harm, the cart is used to calm them with smoothing light colours and sounds. In the drawers there are stress balls, chewing gum, cereal bars, fruit teas, and hot chocolate and a battery operated candle – everything you need to create a comforting, calming environment.”
For those in a dissociated state, citrus smells, peppermint tea and chewing gum can be used with upbeat music. Clients who are likely to self-harm are taught to use surgical brushes in a brisk movement on their arms instead of cutting.
The SMaRT Cart’s success in calming people who would otherwise need to be restrained or given sedative medication has brought it to the Department of Health’s attention, which is now showing an interest.
Given some of the outcomes, this is unsurprising. Smith has worked with one person who was regularly admitted to hospital for more than 200 days a year. Since using the sensory programme, which includes the SMaRT Cart, the service users have been admitted to hospital for only five days over the past two years.
The service user is one of several who have been helped by Smith to make a mini-self soothe kit that they can keep in a bag to use whenever they feel the need, or in the boot of their car in case they end up on top of nearby cliffs feeling suicidal – which did happen to the individual in question.
Service user Lisa Solheim says about the SMaRT Cart: “It’s not just an all-singing, all-dancing MP3 player it’s much more than that. The whole sensory programme, and the range of sensory experiences the SMaRT Cart can provide, help me get control over my environment when I feel dissociated.”
Meanwhile, orders for several more SMaRT Carts have come in from around the country and they should be in production by June.
Turning a good idea into reality
Kathryn Smith’s advice to others who want to develop their own idea:
● Never ever give up. Be creative when it comes to solving tough problems. Find champions to support you when the going gets tough.
● Invest in good antivirus software and always backup your computer regularly – and paper copies are always useful.
● Never ever write your own patent.
● Surround yourself with a few good people who like your idea almost as much as you do.
● The internet is a great way to find out how to do all things entrepreneurial, but then find someone who’s done it before you and learn from their mistakes and successes.