Contents -

Editorial

Attitude Survey IV

Social Therapy II

Industrial Therapy at Friern Hospital

Around the Hospital

Warrington's New Hospital

Miscellany

Nursing News

EDITORIAL

We are continuing to research the distribution of The Standard. One result of this will probably be to fix the number of copies produced, and firmly establish the areas covered. Place your orders now.

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PSYCHIATRIC HOSPITALS VIEWED BY THEIR PATIENTS -
Report of an Attitude Survey by W. Raphael and V. Peers

PART 4

Day Room

Percentage critical: Whole group 10
short-stay 12
long-stay  9

The low level of criticism about the day rooms shows how successful attempts have been to make them modern and cheerful, changing them often from vast Victorian spaces into friendly lounges. Many patients made such remarks as, 'newly-painted, wonderfully improved', 'splendid room like an hotel', 'comfortable, clean and warm', 'nice colouring' 'spacious'. Attractive, bright carpets and curtains were specially liked, also 'modern' pictures.

The layout was often mentioned. 'We have three rooms and a free run of the place.' 'The door opens into the garden.'

Room dividers and plants helped to make a large room look less forbidding and institutional and, as already reported, a second or quiet room was much appreciated. The provision of enough comfortable armchairs meant that each patient could have his 'own' armchair as in a club - an important asset in making people feel at home. Of course, many people said how they enjoyed the television and radio.

The criticisms came mainly from people in wards which they described as 'dingy', 'shabby' or 'depressing', where the walls and ceilings needed painting or even repairing and where the carpets were missing or worn out. Paint of a very unusual colour was often disliked. People spoke of 'purple coloured ceilings' and 'navy blue paint on walls horrible'.

Remarks were sometimes made about the pictures. 'Our pictures should be more cheerful.' 'Pictures not up to date,'

Very few criticised the temperature or the lighting but some deplored the lack of facilities for interesting activities: 'No ping-pong table', 'should have ward library'

Typical criticisms of the seating arrangements were, 'only comfortable chairs for 60 people', 'the chairs are arranged in rows instead of groups', 'arrangements rigid'.

Dormitory and Bedroom

Percentage critical: whole group  9
short-stay 10
long-stay  6

There was less criticism about the sleeping accommodation than about any other topic, and this held for patients both in short-stay and long-stay wards. This seems surprising when most people are not used to sleeping in dormitories. However, a few patients disliked it. 'Don't like sleeping dormitory, people wander in', 'not normal, sleeping with others'.

Very favourable comments came from people who were lucky enough to have a single room. 'The independence of having a room to oneself', 'I can have my books.' 'I have my own ornaments and eiderdown'. Nevertheless, some people praised the dormitory; 'beautifully warm, spacious, pleasing'. And a few positively enjoyed living with other people. 'I like company'. 'there is a warm, friendly feeling about it'.

The advantage of having curtains between adjacent beds was mentioned, but few wards had them, although in some wards a wardrobe and chest of drawers were placed between beds to act as a 'divider'.

Beds were said to be 'comfortable' with 'plenty of blankets' and 'sheets and pillowcases clean every week'. Some patients suggested having coloured bedspreads instead of clinical white. A few patients mentioned the lighting, 'centre light too bright', 'need bedside lamps'.

Lockers and Cupboards

Percentage critical: whole group 24
short-stay 26
long-stay 18

Many patients have a fairly long stay in psychiatric hospitals and, naturally, like to have their own clothes and other possessions, such as writing materials, toilet articles, photographs. However, in many hospitals, patients are only supplied with small bedside lockers similar to, or even less roomy than those supplied in general hospitals where most patients stay for only a week or so. In a few cases, patients had to share a locker or did not have any at all. The result was that many patients did not bring or buy their own clothes but used those supplied by the hospital and had pitifully few other possessions. Those patients who brought their own clothes had to keep then in suitcases under their beds or hung on communal rails or locked in the ward store room. 'Have to have carrier bag and case under bed.' 'Everything gets creased' 'Locker not tall enough for coats and frocks.' 'Won't take hanger'.' 'Keep suits at home.' There were many similar complaints.

Another source of difficulty was that often the lockers belied their name by not locking. 'Clothes and slippers get stolen', 'Things vanish, especially cigarettes and undies'. People 'borrowed' clothes from the communal rail or wardrobe and patients hesitated to ask busy nurses for their possessions locked in the store room.' Sometimes they won't give them out'.

It can be seen that there were more complaints about storage space than about any aspect of the physical environment except noise and lack of privacy. The only people who expressed appreciation were those in single rooms, who usually had chests of drawers and often wardrobes or hooks on the door as well, and those few who had individual tall lockers in the ward, sometimes as room dividers.

PC

INDUSTRIAL THERAPY AT FRIERN HOSPITAL

Many hospitals caring for the mentally ill have industrial workshops, of which the style. size and degree of sophistication vary with the type of problem that particular hospital unit faces. Again the way in which the industrial unit is staffed varies according to local conditions and management's wishes. However, most units are run by occupational therapists or nursing staff possibly in conjunction with an industrial officer. The team involved work to one end - the rehabilitation of the patient. Closely supporting the team are the medical and administrative staff. It is instructive to look at the structure of the Friern industrial complex. First is the Patients' Bureau, which acts as an internal employment exchange. Here the selection and initial assessment of a patient is carried out. This is a very important first step and occupational therapists, nursing staff, junior medical staff and consultants are deeply involved. Assuming that the assessment team decide industrial therapy is the right treatment, the next step will be for the patient to be placed in the north workshop.

North workshop is an initial industrial assessment unit where light, simple industrial work is carried out, together with more advanced and skilled types of work. It caters for around 100 patients. During a patient's stay in the workshop he is shown how to use tools and make up various boxed games, pack toys, wire up electrical apparatus and sort and grade rejected components (which an outside firm does not have either the labour or time to do). The work is a means to an end. It enables the staff to make skilled judgements and it also enables the head occupational therapist to decide if a particular person is ready to be moved to the south workshop.

South workshop is a complex of three buildings. Number one building is brand-new and was erected by the generosity of the King Edward VII Fund. This workshop has allowed the industrial therapy unit not only to accept many more patients for rehabilitation but to take in far more interesting and complicated work. Number one building has a lathe, eight drilling machines, capable of being used as tapping machines, a grinder, and a first-class riveting machine, plus a very large work assembly area, all fully wired to take other equipment, The workshop also has six machines for making polythene bags as well as a small electronic wiring unit.

There are three instructors and the work within this shop varies from adjusting the vanes of alternator fans by means of the lathe, to the making of very fine standard and table lamps. The making of the standard lamps involves the use of drilling machines (using 2½ inch counter-bore bits), tapping cf centre barrels and wiring of the complete lamp. The final stage is, of course, packing. These two jobs alone need a high degree of accuracy and speed of production, and. they assist in the rehabilitation of the patient. In fact so impressed was one manufacturer by the way in which the patients worked that he immediately offered a position in his own factory to one of the trainees and is willing to take on more.

Numbers two and three workshops, although they do not possess power tools, are an integral part of the south workshop. Here the work may be split into different sections, each section employing perhaps eight to ten patients who are looked after by a staff member. Work can be quite varied in both number two and number three shops from making seed boxes, skipping ropes, air filters for dry cleaning plants, table lamps, wiring bulbholders and making dish mops. Many more industrial jobs are available, Some sections are in fact run by a charge-hand patient, for every encouragement is given to those who wish to take responsibility.

The industrial unit deals with 25 different companies and handles about as many contracts. With a large variety of work the occupational therapy department is able to fit the patient to the job, which is both helpful for assessment purposes and rehabilitation. Somewhere in the region of 120 patients are employed in the south workshop which, when added to the north workshop. makes about 220 patients employed in industrial rehabilitation work. This figure varies from week to week according to admission/discharges from the unit.

Ward involvement

Industrial work at Friern does not stop in the workshop - it goes out into the wards. Some patients are now doing simple packing that would have seemed impossible a few years ago. Furthermore, a new concrete blockmaking division is to be started under the direction of another nursing officer. A project to make a pottery coffee set a commercial proposition is in its early stages. These schemes and many more projects are in the pipeline, for it is not the policy of the industrial therapy unit to stand still.

Resettlement

The aim of all industrial work is rehabilitation of the patient and a return to normal working life. Therefore, a link is needed between the hospital and outside employers and, once again, the Patients' Bureau provides this link in the form of the resettlement officer, who is responsible for liaison with potential employers. He visits the personnel managers and endeavours to ensure that the correct job is offered to the person concerned. The resettlement officer also assists in obtaining national health insurance cards and tax forms, and generally helps with the problems that face everyone when starting new employment. Once the patient is actually working the resettlement officer will still continue to watch his or her progress and will be in continual touch with the employer. To sum up, the officer's function is a 'back up' or supportive role. This service helps to give the ratient a genuine chance to make good in our highly-competitive industrial society.

This account of Industrial Therapy at Friern Hospital was recently submitted to the 'Nursing Times' by Mr Kenneth Toombs NAITM, AMISW. Mr Toombs, previously in commerce, recently joined the hospital team as Industrial Officer.

PC

SOCIAL THERAPY
PART II

The first real developments took place in mid-1969, with the realisation of the need for a programme to concentrate on increasing evening and weekend activities. This, in turn, necessitated an increase in staff.

The enlargement of the staff establishment was justified by a rapidly expanding general programme, and the marked increase in the numbers of patients taking part in the social activities provided.

By this time, the area covered by social therapy consisted of three main fields:

Ward-based activities, which included integrated socials and entertainment by individuals and groups of artistes. More individual involvement in reading and letter writing sessions (which led directly to the utilisation of voluntary help from members of the community). Inter-ward activities, mainly recreational competitions - whist drives, dominoes, chess and dances. Central activities, including dancing classes, dancing, bingo and concerts, provided by both the Social Therapy staff and community organisations.
Inter-hospital activities - mainly sporting fixtures; in summer, cricket for the men and rounders for the women, and in winter, football and netball. these fixtures took patients to hospitals throughout the Region.

In all these areas of involvement, increasing efforts were made to move away from the traditional attitude of simply providing more and more directed activity, and to concentrate rather on enlarging the patients' capacity for self-development. It soon became clear that the Department could, and should, devote more effort to the neglected majority - neglected, that is, in the socio-recreational sphere. This necessitated using the comparatively slack time i.e.. mornings, to the re-education and re-motivation of the chronic long-stay patients, in a progressively phased programme, culminating in their absorption into the more sophisticated activities already established.

By this time, the demand for the services offered by the Social Therapy Department was becoming so great that, as satisfying as this was to the team, new sources of assistance were obviously required. This was a two part development.

Firstly, it was decided to fill three existing vacancies held over from the original Physical Education Department. There is little doubt that the principles of modern management teaching regarding multi-disciplinary teams is sound., especially in the areas of ancillary services. By these further appointments, the Department achieved a fifty-fifty balance of nurses and Physical Training Instructors - all functioning as Social Therapists, and accepted as such by the greater part of the hospital. Secondly, it was considered that the now established Therapists were sufficiently experienced to accept the additional responsibility of supervising a corps of young voluntary helpers. (This was one of the terms of reference in the Social Therapy Officer's job description). Small numbers of voluntary helpers had been working in the Department from as early as mid 1969 mainly senior school boys who were qualifying for the Duke of Edinburgh's Award (Gold Standard), Student Teachers and Police Cadets.

The Department have, for some time, been keen to encourage young people to come and help in the hospital. It was felt that here was a section of the community unhampered by prejudice and bias who, by becoming involved in, and learning to understand, the problems of these suffering from mental illness, would not only bring in a breath of fresh air to the previously stagnant areas, but would perhaps help dispel some of the stigma associated with large mental hospitals still held by uninformed sections of the community at large.

Many of the schools in the locality grasped this opportunity of public service, and, in turn, invited Social Therapists to talk to senior pupils about the work of the Department (it should be added that this has proved of value in aiding nurse recruitment). By the end of 1972, this voluntary help force had grown to over one hundred youngsters per week, taking part in social activities and adopting the role of junior hosts and hostesses.

It is hardly possible to over-stress the enduring value of this development of the Social Therapy Department's activities. Not only did it release experienced members of the team for involvement in more intensive therapy, but the ease with which these voluntary helpers overcame initial difficulties and tensions showed clearly that the lines along which the Department had been developing were realistic and ultimately effective.

AROUND THE HOSPITAL

Congratulations to:	:	Welcome back:
Margaret O'Neill		Ellen Daniels
Trevor Hasleton		Jim Bartholomew
Joan Llewellyn		after their recent illesses
Barbara Walker
Peter Taylor

on passing their Hospital Intermediate Exams.

Last Sunday a fire broke out on the Farm, extensively damaging a hayshed and its contents in spite of prompt attendance by Warrington and Newton appliances as well as our own fire-fighting force. Some firemen remained for quite a time during the sorting out of the remains, to guard against possible new outbreaks.

PC

Re-organisation Talk

Mr E. Fox, Group Secretary, was the speaker at the monthly 'Professional Hour' for Charge Nurses and Ward Sisters, held in the In-service Training Room on Thursday, February 9th.

The talk was on the Re-organisation of the NHS and Mr Fox outlined the new structure of health service administration, effective from April 1974 and answered questions from the audience.

PC

Joint Consultative Staffs Committee

The February meeting of the JCSC was held on Thursday, February 8th. The items on the Agenda were:

1) Extension of the Portering Service
2) Toilet facilities for Occupational Therapy Staff.

Also discussed were two items from last month's meeting: the enforcement of fire precautions - which is being dealt with by a multi-disciplinary group - and the future of Joint Consultation after April 1974 which is to be placed on the Agenda for the March meeting.

A full account of the meeting is contained in the minutes, which can be seen on the staff notice boards.

The next Staff Side meeting will be held on Tuesday February 27th.

P.S. May we remind staff that the elections for the Joint Consultative Staffs Committee are little more than a month away. Further details will appear in the magazine shortly.

Chess Club 1973 Competitions

There will be three of these - each with a handsome trophy and £1 prize money for the winner, and 50p for the runner-up.

Tournament A

Open to any hospital employee or Chess Club member.

Tournament

As above, excluding Allen, Bayliss, Bromley, Bruton, Gilmore, Jolley, McKendrick, Minshull.

Both these are on a K.O. basis.

Lightning tournament
(5 mins each)
Open to all hospital employees or Chess Club members. Exact form off tournament to be decided.
Rules -
No need to announce check.
King may be captured.
Move and operate clock with same hand.
If a player makes an 'impossible' move his clock is re-started until he makes a possible one.
Game ends -
With mate
With capture of King
When a flag falls.
ALL ENTRIES TO BE IN BY 26.2.73.

R. Bruton

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WARRINGTON'S NEW HOSPITAL

The following is a note of decisions reached by LIVERPOOL REGIONAL HOSPITAL BOARD at a meeting held on Thursday, 1st February 1973.

Hopes for an October start on Warrington's new £12½ million District General Hospital moved a little nearer when Liverpool Regional Hospital Board heard that tenders are expected to be invited this month for the first half of the scheme.

This will be a £5 million service block which will include 270 surgical beds and it is expected to take four years to complete.

It will be followed by the remaining £7½ million part of the hospital which will then have some 1,100 beds.½ The new site takes in the town's Monk Street and one side of Goulden Street and 45 houses will have to be demolished to make way for the new building.½ No compulsory purchase orders were involved over the clearance and the families concerned are being found accommodation elsewhere in the town. Already half of the houses concerned in the two streets have been vacated.

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MISCELLANY

Twelve Months ago

The Knotty Ash Players regaled us with their production of 'Toad of Toad Hall'...

Both of our chiropodists took to their heels...

The Staff Side of the J.C.S.C. were reading the Hospital Advisory Service's Report...

Mr G.A. Royle, Director of Social Services, spoke on the Reorganisation of the Warrington Social Services Department

Sports news from the Social Club featured prominently in our pages...

And..sssh..a certain competition was drawing to a close.

PC

NURSING NEWS

On Friday 23rd February 1973 a party of 3rd year Students from the Royal Albert Edward Infirmary, Wigan will be visiting the hospital.

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