Friday 31 October 2014

Debby's Story on the importance of local treatment

I would line to send a huge THANK YOU to Debby for sharing her story for the campaign.  Her letter below where she compares and contrasts the difference between local treatment and care out of the area is an amazing example of why what we are doing is so important.

Hello, my name is Debby and I am diagnosed with bipolar disorder. When I took a massive OD and ended up on ICU for 2 weeks, I was admitted afterwards to psychiatric hospital. I live in Morecambe which is right next door to Lancaster. There were no beds at the old unit, Ridge Lea in Lancaster, so I was moved to Chorley which is an hour's drive away. I have no problem in my treatment there, but I was isolated from my husband, children and extended family and friends. Most of the time they could not afford to visit very often to see me.

This increased my distress a great deal and meant that at a highly vulnerable time, I had no advocate who could help me express my wishes and needs. A psychiatric patient often can't talk, or think clearly or be articulate by the nature of their problem. So decisions were made which worried me, such as changing my anti depressants which entailed coming off the other ones. This made the severe depression become far more dangerous and suicide was a clear risk.

I was alone with no-one I knew to support me. When my family visited, no psychiatrist was available to question what had happened to cause my recent break down, what stresses I was under, how I had behaved in the run up to this, and any number of other issues that were vital to my care. I can't stress this enough, this proved to be very dangerous and a major impact on how I was treated.

As I slowly improved enough, I was permitted off the ward. But I didn't know the place or any person around me. It held back my recovery. My husband was severely ill, in hospital, and eventually died whilst I was in hospital. When at Chorley, I couldn't visit him or support him at all. This was devastating emotionally and my fear for his safety was terrible, increasing my depression, if that was possible.

Eventually, I was transferred to Ridge Lea in Lancaster and the difference was astonishing. My daughter could be my advocate, explain how I was when normal, that I tended to smile a lot and be concerned for others welfare, but for staff to not believe that. She stood up for me when the medication changed and helped me to be able to engage with my own care. She also explained that I hallucinated but hid this – which came as surprise to the professionals, as that hadn't been passed over to them from Chorley. If there were any issues, she could get there very quickly and help to resolve them.

Ridge Lea was almost all communal, apart from the bed rooms, but there was nothing to stop males wandering into the female area. I saw men who were very ill and aggressive, but never once felt at risk or in danger. The staff were more than able to manage this. Not once did a man wander into the women's bed area - not once.

I could now visit my husband daily as I had family to be with me whilst out of the unit. This was vital as he was dying and I would have been unable to be with him in his last days if I had stayed in Chorley. The horror of that is beyond words. He died whilst I was on the unit. The despair not only of the patient, but also the family, if they cannot see each other regularly cannot be stressed enough.

When discharged, I was able to be cared for in the community immediately with a full handover and liaison between the hospital and the community. If I had been far away from Lancaster, this could have compromised my care as there wouldn't have been the connection between the hospital consultant and the community one, who meet often and discuss patients they have in common. This is vital.


The system in the hospitals is that once information has been transferred from one to the next, the computer prevents them adding anything to it and the system closes down that connection. I learned this when Ridge Lea tried to ask an OT who had spent a long time with me in Chorley, to send them her report. It wasn't possible, so all that information was lost. This will happen every time if women are bussed to other units in Lancashire. If the community psychiatrist needs to ask specific details later, it will rely on a member of staff in the other unit firstly remembering the patient and secondly being able to find that information. The chance of this is remote.

Having been in the situation of being in two units, I can give a very clear example of what happens when a woman is separated from their community. I cannot believe that the women's beds have been removed, it is a ridiculous situation, imposed from on high, without any consultation with professionals, but more importantly, patients themselves. This is dictatorship and a cruel thing to implement – utterly cruel!

I was four months in hospital and never once had an issue with male patients in either unit. I also saw two thirds more women to men during that entire stay and talking to other women who had spent time in the units, this was very common.

This is sexist. If it was about race, there would be an outrage, quite rightly. But its OK to do it based on gender? Yet again women are being punished, treated like second class citizens with this action. I am wondering if it comes under the sex equality legislation and is illegal. Its a step which the even the Victorians would not have done! I can't think of a more obvious example of discrimination against women. If men are violent, they should be on a medium secure unit anyway. By the way, the vast majority of staff in these units are women – or has that point escaped anonymous pen pushers at the top of system?

Is 'Based on Need' a self-fulfilling prophecy?

A source close to the trust revealed today that the decision to close the female inpatient beds was based on a need for more male beds.

We know that there is a high demand for female beds, with women already being sent out of the area, often to Private Hospitals, such as The Priory in Manchester due to lack of capacity and a FOI request has already been sent to the Lancashire Care Trust about the number of female admissions.  Even without this information there are questions that have to be asked about this statement.

Firstly, why are there not enough male beds?  It is the responsibility of the Trust to ensure there is some slack in the system, but the planned cuts of 25% to the services provided by this trust in the coming year would suggest that inpatient care is not being covered properly.

Secondly, this looks strongly like discrimination based on sex.  Why should women be denied local access to inpatient psychiatric care due to a lack of male beds?  Are the needs of women with mental illness less important than the needs of men?  Are the needs of women to be close to their families, children and support networks less important than the needs of the men?

Moreover, is the damage caused to female inpatients by removing them from the local area, less important than providing 8 beds for male patients?   I would suggest it isn't.

This brings me onto the point of this post.  If you reduce the number of female beds, it will reduce the number of admissions, skewing the assessment of 'need'. The closure of the female inpatient service in Lancaster will also...

a. Discourage women from accepting voluntary admission, reducing the number demanding a bed.
b. Discourage women from seeking help knowing that they will be sent long distances from home, reducing the demand for a bed.
c. Discourage families from seeking help for their female relatives, knowing they will be sent away from home.

The need for local female psychiatric inpatient care is as important as the need for male beds.  Reducing access is a self-fulfilling prophecy.

I want to make some noise about this! Who can I contact?

There are lots of people and organisations that you can contact about this decision.  The Beds in the Orchard campaign will be getting the press involved soon, but until then...

Contact your MP

David Morris - Morecambe and Lunesdale
Email: david.morris.mp@parliament.uk
Mail: Office 201, Riverway House, Morecambe Road, Lancaster LA1 2RX

Eric Ollerenshaw - Lancaster and Fleewood
Email: Eric.ollerenshaw.mp@parliament.uk  OR use the form on his website - http://www.lancasterandfleetwoodconservatives.com/contact/
Mail: 59 High Street, Great Eccleston, Lancashire, PR3 0YB

Contact the Lancashire Mental Health Commissioning Network

Ask them for information about why the service for women has been decommissioned.  Ask to see the assessment of clinical benefit to women from the closure of the unit.
Email: customercare@lancashirecsu.nhs.uk.

Contact Lancashire County Council

The County Councill has a Health and Wellbeing committee that you can petition to look into the closure of the beds. 
Email: healthandwellbeingboard@lancashire.gov.uk

Contact Lancaster City Council

The City Council has a scrutiny committee that you can petition to scrutinise the decision, based on it causing a negative impact on the local community.

If for any reason you would like someone to contact these people on your behalf, get in touch on the comments form below.


Freedom of Information Part 2

How many psychiatric beds have been closed since 2011?  Are there more female than male beds closed?

I've asked england.contactus@nhs.net - the NHS FOI request email address for England.


Dear Sir/Madam,

Please can you provide me with the following information.

1. How many male psychiatric beds have been closed Nationally in 2011, 2012, 2013 and 2014 to date.

2. How many female psychiatric beds have been closed Nationally in 2011, 2012, 2013 and 2014 to date.

3. How many male psychiatric beds have been closed in Lancashire in 2011, 2012, 2013 and 2014 to date.

4. How many female psychiatric beds have been closed in Lancashire in 2011, 2012, 2013 and 2014 to date.

Best regards,

Can the closure of female inpatient psychiatric beds lead to increased detentions?

The Mental Health Act allows for the compulsory admission and detention of people with mental health disorders against their will when its thought to be in their best interests.  More details about this can be found on the MIND website -

http://www.mind.org.uk/information-support/legal-rights/mental-health-act-the-mind-guide/about-the-mental-health-act/#.VFNg2hYasqM

Many people choose to go to hospital as informal or voluntary patients when they know they need help. So why may closing the inpatient beds in Lancaster lead to more women being admitted and detained against their will?

The Husband of a Service User had this to say.

"When my wife last got ill, I persuaded her to go into hospital as I was concerned about her well being.  I'd be very reluctant to do that now, knowing that she'd be sent miles away from me and her family. That would make it even worse."

A female service user said,

"There's no way I would go in hospital voluntarily now.  I couldn't face the thought of being ill and miles away from everyone I knew.  The thought makes my stomach sink and I just couldn't do that to the children and my parents."

If families and women are reluctant to ask for help as they don't want to be sent out of area, or they won't go into hospital voluntarily, then the medical professionals may have no choice but to admit and detain them under a section.

If women are less likely to ask for help for fear of being admitted, its possible that their condition will deteriorate to the point where detention is inevitable.

When women are in hospital miles away from their children, families and friends, they are more likely to press for early discharge.  There is plenty of research that shows that patients discharged from hospital are more likely to relapse and be readmitted.

Closing female beds puts women at increased risk of sectioning.

Thursday 30 October 2014

Freedom of Information - facts and figures

A request has been sent to the Lancashire Care NHS Trust under the Freedom of Information act to get some hard facts for the campaign.  The request sent asked the following questions in order to gauge previous use of resources and the needs of the women in the community.  If you can think of other questions that could be asked the address to use is -
FOIRequests@lancashirecare.nhs.uk

1. Total number of female admissions, regardless of length of stay, to Ridge Lea Hospital, The Orchard, or other psychiatric units in Lancaster, Morecambe or Heysham for the following years.  2011, 2012, 2013 and 2014 to date.

2. Total number of female patients from Lancaster, Morecambe, Heysham and villages within a 5 mile radius of those places, admitted as inpatients to other hospitals or units outside Lancaster, Morecambe or Heysham in 2011, 2012, 2013 and 2014 to date.

3. Total number of female patients from Lancaster, Morecambe, Heysham and villages within a 5 mile radius of those places admitted as inpatients to psychiatric hospitals or units further than 20 miles from their home in 2011, 2012, 2013 and 2014 to date.

4. Total number of female patients from Lancaster, Morecambe, Heysham and villages within a 5 mile radius of those places admitted as inpatients to psychiatric units or hospitals in Manchester in 2011, 2012, 2013 and 2014 to date.

5. Total number of female patients from Lancaster, Morecambe, Heysham and villages within a 5 mile radius of those places admitted as inpatients to psychiatric hospitals or units 50 miles or more from the above mentioned places, excluding Manchester in 2011, 2012, 2013 and 2014 to date.

6. Number of formally reported cases of attacks/violence by male patients to/on female patients at Ridge Lea or The Orchard, Lancaster, in 2011, 2012, 2013 and 2014 to date.

7. Number of female service users treated by the Crisis Team in Lancaster, Morecambe, Heysham and villages within a 5 mile radius of those places in 2011, 2012, 2013 and 2014 to date.

8. Number of female services users under the care of the Complex Care and Treatment Teams in Lancaster, Morecambe, Heysham and villages within a 5 mile radius of those places in 2011, 2012, 2013 and 2014 to date.

9. Details or documentation outlining the assessment of the clinical benefit to women from the closure of female inpatient services at The Orchard in Lancaster.

10. Details or documentation outlining the assessment of the negative consequences of closing female inpatient services at The Orchard in Lancaster and the plan put in place by the trust to minimise any such consequences.

11. The current number of FTE in Crisis and Home Treatment services covering Lancaster, Morecambe, Heysham and the surrounding area.

12. The current number of FTE in the Complex Care and Treatment Teams covering Lancaster, Morecambe, Heysham and the surrounding area.

13. The number of FTE planned to be cut from Crisis and Home Treatment covering Lancaster, Morecambe, Heysham and the surrounding area in the current and following financial year.

14. The number of FTE planned to be cut from the Complex Care and Treatment Teams covering Lancaster, Morecambe, Heysham and the surrounding area in the current and following financial year.

What is behind the closure of the female ward at The Orchard?

Lancashire Care NHS Trust closed The Orchard psychiatric unit to women this week.

Before the closure there were 10 male beds and 8 female beds in the unit.  The male and female areas were separate and could only be entered via key-card access, so the men and women could only access their own bed areas.  Individual rooms in the unit were also locked via key-card, providing extra security.  A single sex lounge was available in both the male and female areas of the ward.  In addition to these areas, there were communal areas, including a dining room, games room, lounge and inner courtyard.

While information about why the decision was made to close the unit to women is sparse, there have been two reasons given by the Trust.  The first is that the ward should become single sex to protect vulnerable women from the male patients.  The second is that there is a greater need for male beds than female.

Anecdotal evidence, based on the personal experiences of female patients, is that the female beds were always at 100% capacity.  Frequently, the rooms were filled within hours of a woman being discharged from the hospital.  This would suggest that there is absolutely a need for female beds in the area and an FOI request has been sent to the trust asking for the number of female admissions to the Unit and the previous psychiatric unit at Ridge Lea hospital for confirmation.  A further request for the number of women in the area who are under the care of home treatment teams has been requested so that an accurate appraisal of how many women this closure will impact.

The first point is of greater concern as it appears to be a case of victim blaming to say to women, "You may be vulnerable, so to protect you, we are going to deny you access to local inpatient care."

Sending women 30-70 miles away from their home for treatment means that they won't have access to their families, friends or support networks.  Research on isolating women from their support networks is well documented as having negative effects.  Women are also still overwhelmingly the primary care givers to children and carers for older adults.  Treating women 30+ miles from their home means less opportunities for contact with their children and people they care for, causing additional distress on both sides.

Moving women out of their local area will not protect them, it will make them more vulnerable.

If there as been a problem with male to female aggression in the communal areas, then the trust should address how that is managed.  There are single sex units available for men who are seriously ill, and therefore at risk of harming others and otherwise aggressive males.  A better solution would be for staff to ensure that known aggressors or those shown to be aggressive are moved to male wards, able to deal with those problems, rather than place the blame on women's vulnerability and deny them access to the local services that they need.

What's all this about then?

Who are we?
Beds In The Orchard is a campaign to reinstate access to psychiatric inpatient care for women at The Orchard hospital in Lancaster after provision was withdrawn with no notice or consultation with  Service Users or the wider community.

Why Does This Matter?
Female patients or service users from Lancaster, Morecambe, Heysham and the surrounding towns and villages will now be sent between 30-60+ miles away from their homes if they need inpatient care.  This means separating them from their children, families, friends and other support networks when they are at their most vulnerable. 

Why you should care.
You may not live in this area and you may not have a mental health problem, but with 1 in 4 people experiencing a mental health issue in their lifetime, the chances are that you will know someone who does.  Lancaster is just the tip of the iceberg of severe cuts to psychiatric services across the UK, where patients are sent miles away from their homes to access treatment. The story of Beds In the Orchard is one that is repeated across the country.

What we are doing
This blog is part of a coordinated campaign by local service users, their family and friends to reinstate the female inpatient beds at The Orchard in Lancaster.  Updates on the campaign, details of how to get involved and press releases will all be added to the blog as the campaign is first launched and progresses.  Please check back for updates!