Rooms for improvement

The National Centre for Mental Health is quiet. Indeed, for anyone who is used to mental health units consisting of open-plan wards that echo with daytime TV, it is unsettlingly quiet. This is no accident: the lack of privacy and risk of users upsetting each other inherent in an open plan layout has been shunned in favour of individual rooms and treatment suites which better suit users’ needs.

“A lot of people ask where all the patients are when they first get here,” says Natalie Willetts, a nurse consultant at the recently opened centre. “But there’s the same number as in the old site. The design is just more effective.”

The rediscovery of doors in hospital design may seem relatively insignificant, but it is the sort of minor change that constructing a centre from scratch has allowed to be built in – minor changes that add up to a big difference. Combining the building design with organisational changes has resulted in more patient-centred care at what is hailed as the UK’s leading mental health hub.

The £70m NCMH was built near the sprawling Queen Elizabeth Hospital complex in Edgbaston, Birmingham. It’s been up and running since the Queen Elizabeth Psychiatric Hospital was vacated in May. But in contrast to its massive neighbour and its overcrowded predecessor, the NCMH is a low-key sanctuary.

Relaxation is built into the fabric of the centre, with the three units that comprise the 137-bed service named after relaxing herbs. The Barberry unit provides specialist services, including a mother and baby centre, neuropsychiatry and a centre for eating disorders. Next door, the Oleaster provides acute in-patient care. And the 32-bed Zinnia is in the Sparkhill area of the city to engage hard-to-reach groups.

The development process involved users and staff. Pat Fleetwood-Walker’s daughter used the old hospital, and Pat participated in the planning of the new one. “One of the most dramatic changes is the individual rooms. Before, there were no rooms, just mixed wards,” she says. “The women were often scared. We were concerned about the security both in the wards and in acute care. That, and the fact there was nothing to do, were the biggest concerns.”

An activity worker now focuses on providing events in the evenings and weekends. There are individual rooms in the Barberry and the Oleaster is split into male and female wards. Willetts says the separate wards add security and allow for the different care needs of men and women.

Such responsive development means that the staff are proud of the centre, and praise both the architects and Birmingham and Solihull Mental Health Trust. Surprisingly, the old hospital was just 15 years old when it was demolished. But Kate Phipps, who was the hospital’s project director, says the site was not built for purpose and wasn’t working.

“When the national services framework for mental health was launched, it caused everyone to look differently at their services,” she says. “The trust began to question the relevance of the old hospitals.

“We’ve had an 18-month transformation process to see what people wanted when they came into care. For example, we now have doctors who work only with in-patients, home treatment or in the community.”

Before the changes, there could be up to 18 consultant psychiatrists admitting people to a single 24-bed ward. Staff time would be sucked up dealing with the bureaucracy of handling so many people. Now, dedicated doctors allow staff to spend more therapeutic time with patients.

Another change is the relocation of south Birmingham’s two home treatment teams into the Oleaster building. Then project manager Suzanne Bramall oversaw the move to the site, and says that it has allowed more efficient working with centre staff too.

“We now have daily contact with the wards without fail. By being here we can be involved from when someone comes in and we can be planning their discharge. If there is someone who has not been claiming benefits and not maintaining their property, we can get those sorted at an earlier stage and discharges aren’t held up,” she says.

Each specialist unit is tailored to specific needs. Take the 12-bed Jasmine Suite in the Barberry, which is one of the UK’s few deaf services for mental health. Door buzzers and vibrating pillows let staff contact users when they are in their suites. Massive windows let in light, in contrast to the dark corridors of the old hospital. Users don’t stay in their rooms, but can visit the unlocked art room and the two courtyards. An impromptu photo shoot seems to draw most of the unit to the lounge in double-quick time. This is a unit that works.

It’s also a centre that engages with current national mental health issues. Drivers in patient-centred care are being followed – most notably for protected meal times that allow users to eat their meals in peace. For example, despite being accompanied by Willetts, we were blocked from entering a ward on Oleaster during dinner.

All staff are being trained in basic talking therapies. Willetts says: “We have a designated in-patient psychologist who teaches everyone what we call psychological ­mindedness, which is about working with users from their point of view, rather than seeing everything as a medical diagnosis. All staff have the same starting block, whether they are a domestic or a ward clerk.”

It is perhaps testament to these changes, however, that users barely even notice the nuts and bolts of what’s going – they are simply seeing an improved level of care.

Gene Needham, who has used the old hospital and the new centre, thinks the most effective improvements are the most straightforward ones. “The new suites are unbelievably beautiful – light and bright, with lovely furniture.

“Before, if you were ill, it was dreadful to be in a ward with people you couldn’t get away from. Now if you are in your room, it’s your choice whether to go and mix with others. The rooms are lovely, staff morale has lifted, and the service user is listened to,” Needham says. “It is, simply, conducive to better healthcare.”

Centre of excellence: local project with a national outlook

The title of National Centre for Mental Health may be grand, but in terms of the services, the NCMH isn’t that different from the old hospital.

The site is using the title in recognition of the services that are provided beyond south Birmingham – neuropsychiatry and the deaf service, for example, take on patients nationally.

The idea for the £70m centre came locally and is funded through a 35-year deal under the private finance initiative.

The PCT, says project director Kate Phipps, is also committed to a £2.6m investment that funds an extra 170 staff and the development of older people’s services.

This article is published in the 4 September issue of Community Care magazine under the heading Rooms for improvement