Permission to cut

Sitting and watching calmly while a young woman deliberately cuts herself with a knife or razor blade cannot be easy. But it is what the staff at Aire Valley Clinic near Keighley, West Yorkshire, have to be prepared to do. And it is an approach that contrasts strongly with their patients’ previous experience in psychiatric hospitals and secure units.

The patients are often taken aback to find that, rather than preventing them cutting themselves, the staff will simply say, “OK, if it’s something you feel you need to do” or “When you feel ready to have that treated, come and talk to us about it”.

“Sometimes it feels as though the staff here don’t care because they don’t act like nurses and attempt to stop our behaviour with physical methods,” says one client. Another says: “I cut in front of the staff to get a reaction – but I didn’t get criticised.” Some have been in care for a long time, have been victims of abuse and display behaviours associated with borderline personality disorder.

“There’s a lot of cutting, a lot of swallowing – batteries, razor blades, pens and spoons. There are some serious cuts and some overdoses,” said acting clinic manager Kevin Taylor. The clinic’s approach is based on the social therapy model, pioneered in the Netherlands, which involves non-judgemental, positive regard and balancing the rights and dignity of the individual with the risks inherent in their self-harming behaviour.

“To a certain extent the self-harming is inevitable. What we’ve got to do is make sure the self-harming doesn’t become life-threatening,” says Taylor. “We get the client to recognise the causes and then, in a supportive setting, try to transfer the feelings from the direct self-harm so that eventually they will try to seek help before the self-harm occurs.”

As one client says: “They try to get me to talk after I want to harm myself and then, over time, get me to talk before, which sometimes means that I don’t have to harm myself.”

There are two mental health nurses and three social therapists as well as an activities co-ordinator on duty daily. The pressure on each individual therapist is reduced because social therapy is very much a team approach with decisions made collectively by the staff with the client concerned.

Taylor says: “A characteristic of this client group is that they will drive a wedge through the staff group – they will look for an individual to make a different decision from the one that has already been made in order to exploit those differences.

“So communication has to be really accurate – not only the message, but also the context. Any phrase can be taken out of context and patients can be good at doing that.”

The social therapists come from a variety of backgrounds and are recruited for their life experiences. Taylor says: “We look for a set of personal characteristics, intelligence and common sense rather than someone who is a bit more clinically regimented – we might be inheriting a set of institutional behaviours that we really don’t want to adopt on this site.”

The activities co-ordinators set up a programme of activities to suit each individual’s needs, including courses at the local college, sport and hobbies as well as a local gardening project and alcohol awareness group.

Craegmoor Healthcare opened the clinic in 1999, seven years after Sir Louis Blom-Cooper’s report into the needs of women in secure care.

Apart from the small number of patients whose behaviour becomes too dangerous or for whom Aire Valley Clinic is unsuitable, most tend to stay around for two to two-and-a-half years.

Taylor estimates that, at the end of their stay, about 30 per cent have to return to an NHS hospital, while the rest can progress to an independent living scheme and, it is hoped, to a life outside institutions.

– For more information, contact Kevin Taylor on 01535 657350 or e-mail airevalley@craegmoor.co.uk 

Background

Scheme: Aire Valley Clinic, a privately-run unit for up to 12 women who have challenging and self-harming behaviour.

Location: Near Keighley, Yorkshire.

Staffing: Ten mental health nurses, 13 social therapists and other staff, including activities co-ordinators, an RMO (responsible medical officer) and a visiting psychologist and psychiatrist.

Inspiration: To provide specialised treatment in a supportive environment which is unrestrictive as possible.

Cost: About £1,800 a week a patient – the exact cost depends on the level of care.