A sojourn at the villa

More women than men live in social isolation and poverty, and
women are more likely to experience childhood sexual abuse,
domestic violence and sexual violence. The result: low social
status and value. So said the government in Women’s Mental Health:
Into the Mainstream.

“That paper looked at why women’s services were failing,” says
Tracey Dann, director of London Cyrenians Housing, which provides
housing, care and support to people in west London, including those
with mental health needs, young care leavers and ex-offenders. “It
was practical and gave blueprints of the services that should be
provided.”

It also provided the impetus for setting up Ella Villa – a high
support community home for difficult-to-place women with complex
mental health needs, who had previously known either hospital or
secure units. Dann says: “We wanted to begin with a blank sheet of
paper. People always say ‘don’t re-invent the wheel’. But do, and
re-invent it every time because each time you do something new
happens and you find out something different.”

Finding out the something different that women service users wanted
from a high support residential service led to cherry-picking
aspects of existing approaches. Dann says: “We knew the women we
were looking at wouldn’t cope with a 24-hour therapeutic regime but
did like some of the structure such as knowing there would be a
group meeting a 6pm and so on, so we nicked some of that. We stole
from assertive engagement models because people like having
services taken to them. They like one-to-one – and don’t always
want to share their heart and soul with 16 strangers.”

There was also another – somewhat surprising – source of
inspiration for Dann, who recalls: “In our arrogance we hadn’t
thought hospitals could offer anything useful. But a lot of these
women have been in hospital for 10-15 years. Shame on us that they
have, but they have. Some have been there so long they are invited
to staff parties. Patterns of the past show that if you take
hospital away from them and move them into the community, they will
sabotage that move because they want to go back to what they know.
So we wanted our model to use some of the things that hospital gave
in terms of feeling safe.”

To prevent women bouncing between community and hospital the
service had to be “immensely tolerant and completely wraparound”.
Dann says: “So, the first time somebody got smacked or did
something wrong or difficult it wasn’t, ‘right, you’re going back
to hospital’. It was, ‘we’re going to work through this crisis’. We
needed specialist staff who could do that and not see hospital as
the only answer.”

The eight-bed service has 14 full-time equivalent posts. Its
multi-disciplinary team includes a psychiatric nurse, two social
workers, an art therapist, a women’s counsellor, a housing
specialist, people with probation, legal and moving people on
experience and a general nurse.

Ella Villa strives to look and respond like no other service in the
UK. Interestingly, each day has a 9pm diary session. Dann says: “In
services we spend hours in offices writing about service users, and
we wonder why people feel paranoid. Our staff sit with them but the
women write their diaries about what’s happened to them – rather
than what we think has happened to them. There are things we have
to write about as part of our duty of care but, by and large, these
can be drawn out of the diaries, which the women give us permission
to use.”

It’s early days but Dann is confident. “We’re not arrogant to think
‘this is it’, but it’s a good start. We’ve asked ourselves
questions with this new service and in a year’s time we’ll probably
have more to ask – but as long as we keep on doing it then that’s
fine. It’s been really exciting stuff: I’ve been running to work
each day!”

• Contact London Cyrenians Housing on 020 7938 2004

Lessons Learned 

• Talk to the people who are going to use your service and don’t
  presume that you know what will work. 
• The scheme provided an impetus for Dann to review all other
  services. “I learned so much doing Ella – by beginning from scratch
  to designing a bespoke women-only service – that I can’t wait to
  review our operational policies for other services, particularly
  our men-only scheme.”
• Often it is the “little” things that can make all the
  difference. But one of the little things here is quite big:
  everyone has a double bed. “Women in hostels have single beds,”
  says Dann. “I don’t know any adult women, regardless of their
  status with partners, who have single beds.”