When Karen East first began training in mental health services 20 years ago the term “wet brain” was commonly used to describe sufferers of alcohol-related brain injuries (ARBIs). While terms such as these are now confined to the 1980s unfortunately their treatment has largely failed to evolve with the times.
“People with ARBIs tend to be put into older people’s care homes even though many are under 55,” says East, clinical manager for Champion Crescent ARBI unit, run by Dukeries Healthcare. “They tend to fall under the responsibility of the mental health team and end up being diagnosed with dementia with the implication that they will never recover.”
ARBIs, such as Korsakoff’s syndrome, are caused by prolonged and excessive alcohol abuse. Heavy drinking can leave sufferers with a Vitamin B deficiency which is an important ingredient in limiting the ageing process. As a result, people with ARBIs show traits associated with old age: confusion, short-term memory loss, poor attention span, apathy, depression and irritation.
Until recently, clinicians believed there was little chance of recovering from these symptoms. But research carried out in 1999 reported that a quarter of sufferers could make a full recovery and another quarter would recover most of their functions. These findings led to Champion establishing its – and England’s – first dedicated ARBI residential unit in May 2005.
This facility, in Worksop, Nottingham- shire, can cater for 21 people and has since been joined by an eight-bed facility in Leeds. East explains what makes its service ground-breaking. “We cater only for people with an ARBI. They are not housed in the same facility as people with dementia or mental health problems.”
The units have received referrals from as far afield as Cornwall and Surrey and are often full. Unlike some care homes where residents will be allowed alcohol, the units are an alcohol-free environment, because “if they drink even one glass they will do more damage”, explains East.
Residents usually have to be dry for three months before being accepted into the unit and most will have undertaken some form of detoxification course. Their stay will typically last 18 months.
“We focus on providing person-centred care. There are three residents to one worker and everyone who enters the unit gets a discharge plan that defines what they want to achieve by the end of their treatment.”
East says residents are taught to live life without alcohol. “We need to get them to run their own alcohol-free life. We try and get as many interests out of people – residents have set up a rambling and fishing group – and some go to college. One 40-year-old man who had drunk from the age of 15 said he didn’t have any hobbies apart from going to the pub so we had to start from square one with him.”
Two years into the programme, results are proving encouraging. Of the 30 service users to have completed a stay, 28 have made some form of recovery and two have gone into residential care. In fact, East believes half of sufferers will make a full recovery, twice the rate suggested by research.
Despite this, scepticism remains. “We get letters from authorities saying ‘we have funded this man for three months why hasn’t he got better?’ And I have had psychiatrists saying you can’t do anything with these people,” East says.
She adds that they are a rewarding client group to work with. “We had one 32-year-old man in a wheelchair who had been put in an elderly mentally infirm unit but after a few months with us was walking again.”
One 34-year-old man from Stoke is about to leave the unit after 18 months. He explains how it has helped transform his life. “I was living in a hostel with people who were mentally ill and I was going nowhere. I can’t remember much about when I first came in – I was a total wreck. I can vaguely remember staff helping me make my own brew.
“All the staff have been brilliant. I have learned how to cook more than spaghetti bolognese and how to manage my money, and it’s great that I can now look forward to starting my life again and seeing my son.”
At nearly £800 a week, the cost of a place at the unit is nearly twice the price of a care home bed, but East says it is cost-effective. “We keep people with us for one or two years before they go home whereas someone could be in a care home for decades.”
Champion is building six new studio flats in Worksop that residents will transfer to once they are ready to live more independently and hopes to open a new facility in Peterborough. The decision to expand has been taken with one eye to the future.
“Our clients are getting younger,” says East. “People are drinking heavily from a younger age and more frequently – when you go out every weekend and drink above the recommended levels it’s going to catch up with you.”
● Have high aspirations for ARBI clients – recovery is possible and they should be given a chance to be rehabilitated.
● Set out goals at the beginning of the therapy programme and ensure they are reviewed.
● Keep to a structured routine – it makes it easier for the brain to recover.
● The focus of any programme should be for clients to live an alcohol-free life.
● Younger adult clients should not be placed inappropriately otherwise they will deteriorate even further.
➔ For more information on Champion Crescent’s ARBI units: www.dukerieshealthcare.co.uk/champion/ridings/index.htm Karen East can be contacted by e-mail: firstname.lastname@example.org
This article appeared in the 18 October issue under the headline “Reversing the damage”