Category: Mental Health Treatment

An Overview of the Ladywell Unit

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Introduction

University Hospital Lewisham (formerly known as Lewisham Hospital) is a teaching hospital run by Lewisham and Greenwich NHS Trust and serving the London Borough of Lewisham. It is now affiliated with King’s College London and forms part of the King’s Health Partners academic health science centre. It is situated on Lewisham High Street between Lewisham and Catford.

Facilities at University Hospital Lewisham

The hospital offers a wide range of services including adult and children’s Emergency departments and specialist services including neonatology, paediatric surgery, cystic fibrosis treatment, haemophilia treatment and Ear Nose and Throat (ENT) services. The hospital provides teaching and training for medical staff and gained university status in 1997.

The Ladywell Unit is an inpatient unit of South London and Maudsley NHS Foundation Trust but physically located at University Hospital Lewisham and managed by Lewisham and Greenwich NHS Trust.

Overview of the Ladywell Unit

Departments

  • Adult mental illness.
  • Community mental health services.
  • Inpatient mental health services.
  • Old age psychiatry.
  • Older people’s services.
  • Perinatal community mental health service.
  • Psychiatric intensive care unit.

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An Overview of the National Psychosis Unit

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Introduction

The National Psychosis Unit is a national treatment centre for patients with schizophrenia and other psychotic disorders, in the United Kingdom. The unit is a tertiary referral centre in the National Health Service. It is located at the Bethlem Royal Hospital, part of the South London and Maudsley NHS Foundation Trust. It is closely affiliated to the Institute of Psychiatry, King’s College London, and forms part of the Psychosis Clinical Academic Group of King’s Health Partners.

Brief History

The Unit was set up in the early 1990s. It was one of the first units in the UK to offer the antipsychotic drug clozapine, following its reintroduction in the UK in 1990.

Staff

The service has a multidisciplinary team of doctors, nurses, pharmacists and psychologists, many of whom work part of their time as clinical scientists and researchers, investigating the causes of psychotic disorders, and the effectiveness of both existing and new treatments.

Sir Robin Murray, Professor of Psychiatric Research at the Institute of Psychiatry at King’s College London, is a prominent member of staff at National Psychosis Unit.

Treatment

The National Psychosis Unit specialises in evidence-based treatment for people with schizophrenia, bipolar disorder and other similar disorders, particularly where local treatment has been unsuccessful or only partially successful in relieving symptoms. Anyone receiving NHS treatment can access the service free of charge following a referral by the person’s psychiatrist or general practitioner

The service provides second opinions on medication, diagnosis or any other aspect of care. The service has an outpatient clinic and 24-bedded inpatient facility. As well as pharmaceutical treatments, there is a strong focus on psychological treatments, rehabilitation and recovery, and reducing the risk of readmission through exploring what has led to breakdowns in the past and how to avoid this happening in future. The Unit also hosts research into the treatment of psychosis, including clinical trials of new treatments for psychosis. The National Psychosis Carers’ Group, which meets monthly, supports the carers and families of people with psychosis and allows them a forum for discussion.

Links with Other Organisations

The National Psychosis Unit has strong links with the Department of Psychosis Studies at the Institute of Psychiatry, King’s College London. The Unit also has longstanding links with mental health charities, including Rethink and SANE.

Awards

The Unit won the Hospital Doctor Psychiatric Team of the Year Award in 1997.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/National_Psychosis_Unit >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Lambeth Hospital

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Introduction

Lambeth Hospital is a mental health facility in Landor Road, South London. It was previously known as the “Landor Road hospital” and is now operated by the South London and Maudsley NHS Foundation Trust and is affiliated with King’s College London’s Institute of Psychiatry. It is also part of the King’s Health Partners academic health science centre and the National Institute for Health and Care Research (NIHR) Biomedical Research Centre for Mental Health.

Brief History

There were originally two hospitals on the site:

  • The Stockwell Smallpox Hospital, which opened in 1871; and
  • The Stockwell Fever Hospital, which opened shortly thereafter.

These two hospitals combined in 1884 to form the South Western Fever Hospital.

It joined the National Health Service in 1948 as the South Western Hospital and contained an out-patient facility, known as the “Landor Road Day Hospital” for psychiatric patients. It closed in the early 1990s and, following demolition in 1996, was replaced by a new mental health facility known as Lambeth Hospital. The new mental health facility was named after a previous Lambeth Hospital, which had opened on the site of Lambeth Workhouse in Renfrew Road, in 1922.

In 2014, the Triage ward of the new hospital was featured in an episode of the Channel 4 documentary series Bedlam.

The NHS South East London Clinical Commissioning Group announced in May 2020 that Lambeth hospital would close with the services moved to a new building on the Maudsley Hospital site. South London and Maudsley NHS Foundation Trust announced a consultation in July 2020 on proposals to sell land so that 570 houses could be built on the site.

Services

Lambeth Hospital is situated in Stockwell, within walking distance of Clapham High Street railway station and Clapham North tube station. The hospital site includes the following buildings:

  • Bridge House: Spring Ward (Female Forensic, Medium Secure Service)
  • Oak House: Luther King Ward (Male Acute), Nelson Ward (Female Acute), Rosa Parks Ward (Mixed Acute) and Eden Psychiatric Intensive Care Unit (Male PICU)
  • Reay House: Early Intervention in Psychosis Unit and Tony Hillis Unit
  • Mckenzie House (Ward in the Community)
  • Orchard House (Outpatient Services)
  • Landor House

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An Overview of the Institute of Psychiatry, Psychology and Neuroscience

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Introduction

The Institute of Psychiatry, Psychology and Neuroscience (IoPPN) is a research institution dedicated to discovering what causes mental illness and diseases of the brain. In addition, its aim is to help identify new treatments for them and ways to prevent them in the first place. The IoPPN is a faculty of King’s College London, England, previously known as the Institute of Psychiatry (IoP).

The institute works closely with South London and Maudsley NHS Foundation Trust. Many senior academic staff also work as honorary consultants for the trust in clinical services such as the National Psychosis Unit at Bethlem Royal Hospital.

The impact of the institute’s work was judged to be 100% ‘world-leading’ or ‘internationally-excellent’ in the Research Excellence Framework (REF 2014). The research environment of the institute was also rated 100% ‘world-leading’. King’s College London was rated the second for research in Psychology, Psychiatry and Neuroscience in REF 2014. According to the 2021 US News Ranking, King’s College London was ranked second in the world in Psychiatry and Psychology.

Brief History

The IoPPN shares a great deal of its history with the Maudsley Hospital, with which it shares the location of its main building. It was part of the original plans of Frederick Mott and Henry Maudsley – inspired by the Munich institute of Emil Kraepelin – that the hospital would include facilities for teaching and research in 1896. In 1914, London County Council agreed to establish a hospital in Denmark Hill and Mott’s plan began to take shape. The Maudsley Hospital was opened in 1923 as a result of a donation by Henry Maudsley.

Originally established as the “Maudsley Hospital Medical School” in 1924, it changed its name to the Institute of Psychiatry in 1948, with Aubrey Lewis appointed to the inaugural Chair of Psychiatry (which he held until his retirement in 1966). The main Institute building was opened in 1967 and contains lecture theatres, administrative offices, library and canteen.

In 1959 a group of genetic researchers led by Eliot Slater were given Medical Research Council funding to establish themselves as the ‘MRC Psychiatric Genetics Unit’. Although this closed down in 1969, psychiatric genetics continued, eventually as the MRC Social, Genetic and Developmental Psychiatry Centre (SGDP Centre) which moved into new purpose-built building in 2002.

In 1997, the institute had split from the Maudsley and become instead a school of King’s College London. The Henry Wellcome building was opened in 2001 and houses most of the IoPPN’s psychology department. In 2004, a new Centre for Neuroimaging Sciences (CNS) was opened which provides offices, lab space, and access to two MRI scanners for neuroimaging research. In 2014 the institute was renamed to the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), as the remit of the institute was broadened to include all brain and behavioural sciences.

Departments

Addictions

The Addictions Department specialises in research into tobacco, alcohol and opiate addiction policy and treatment. In March 2010 the addiction research unit and the sections of alcohol research, tobacco research and behavioural pharmacology were brought together to form the current The Addictions Department, also known as the National Addiction Centre (NAC).

Biostatistics

This department provides advice in the interpretation and use of statistical techniques in psychological research. They work closely with members of the Neuroimaging section in their work using brain scanners.

The Biostatistics department opened in 1964, then as the Biometrics Unit. The department holds particular expertise in multivariate statistical methods for measurement, life-course epidemiology and the analysis of experimental, genetic and neuropsychiatric data.

The department provides both introductory and advanced training in applied statistical methodology, collaborate on studies of mental health based here and internationally, and undertake research in relevant applied methodology.

The department also hosts the UKCRN accredited King’s Clinical Trials Unit which provides randomisation, data management, analysis and trial management – all of which are available to researchers across King’s Health Partners. The CTU provides support to both medicinal and non-medicinal clinical trials assisting researchers in the conduct of carrying out clinical trials.

Child and Adolescent Psychiatry

The department is dedicated to the study of developmental disorders such as ADHD, clinical depression, autism and learning difficulties. The department has close links with the Michael Rutter Centre for Children and Young People at the Maudsley Hospital which has a number of specialist services for children and adolescents.

Forensic Mental Health Science

Forensic Mental Health Science is the study of antisocial, violent, and criminal behaviours among people with mental disorders. The department’s research focuses on antisocial behaviour as it appears in people with either major mental disorders or personality disorders. The department is closely allied to the Forensic Psychiatry Teaching Unit.

Neuroscience

Researchers in this department carry out a range of studies into diseases such as Alzheimer’s disease and motor neuron disease. The Institute of Psychiatry now houses the Medical Research Council Centre for Neurodegeneration Research, where pioneering research is conducted investigating disease of the CNS. The Department of Clinical Neuroscience in Windsor Walk also contains the MRC London Neurodegenerative Disease Brain Bank.

Department of Neuroimaging and Centre for Neuroimaging Sciences

The Centre for Neuroimaging Sciences (CNS) is a joint venture of the King’s College London Institute of Psychiatry and the South London and Maudsley NHS Trust (SLAM). Completed in early 2004, the centre provides an interdisciplinary research environment.

The Clinical Neuroimaging Department, situated at the Maudsley Hospital, provides a full range of neuroradiographic imaging services, including Magnetic Resonance Imaging (MRI). Within the CNS, the academic Department of Neuroimaging’s Major Research Facility (MRF) manages a range of MRI facilities for research studies. The Department of Neuroimaging also runs an EEG laboratory, re-launched in 2010.

Psychology

The IoPPN Psychology department was founded in 1950. The department conducts research in neuropsychology, forensic psychology, and cognitive behavioural therapy. Hans Eysenck set up the UK’s first qualification in clinical psychology in the department, which has now evolved into a three-year doctoral ‘DClinPsych’ qualification.

Clinically, members of the department offer expert services to the Maudsley Hospital, Bethlem Royal Hospital, King’s College Hospital, Guy’s Hospital and community mental health teams in the South London area. Members of the department also teach psychology to undergraduate medical students from the United Medical and Dental Schools of Guy’s and St Thomas’ Hospitals. Psychiatric geneticist Peter McGuffin was awarded a fellowship at the institute.

Psychological Medicine

The Department of Psychological Medicine, chaired by Professor Ulrike Schmidt, addresses many of the commonest mental disorders which affect adults including depression, anxiety, post traumatic stress disorder, eating disorders, somatoform disorders, and medically unexplained symptoms and syndromes. Its research spans basic science, experimental medicine, epidemiology and public policy. It includes the King’s Centre for Military Health Research, led by the department’s former chair, Professor Simon Wessely, and is responsible for studying the psychological impacts of the 2003 Iraq War. The department also contains a programme of work on liaison psychiatry and studies the many complex interactions between mental and physical illness.

Social, Genetic and Developmental Psychiatry

The SGDP centre is a multi-disciplinary research centre devoted to the study of the interplay between “nature” (genetics) and “nurture” (environment) as they interact in the development of complex human behaviour. Research at the SGDP acknowledges that there is no simple solution to the “nature versus nurture” debate; instead, expertise is combined across fields such as social epidemiology, child and adult psychiatry, developmental psychopathology, development in the family, personality traits, cognitive abilities, statistical genetics, and molecular genetics. In this way it is hoped that a greater understanding can be achieved in risk factors that might predispose an individual to depression, ADHD, or autism.

Brief History

The MRC Social, Genetic and Developmental Psychiatry (SGDP) Centre was founded in 1994 by the Medical Research Council, in partnership with the Institute of Psychiatry (now a school of King’s College London).

The research in social, genetic and developmental psychiatry have already existed at the Institute of Psychiatry since its establishment in 1948. However, the streams of research were not integrated and there have even been times when genetic researchers and social psychiatrists were in a state of hostility. The intellectual warfare between nature and nurture reached its peak in the 1960s and 1970s.

Aubrey Lewis, who was the first Professor of Psychiatry at the institute and the director of the MRC Social Psychiatry Research Unit (first MRC unit at the institute), noticed that social psychiatry was a broad field that included both biological substrate of disorders and social causes. Eliot Slater, the ‘founding father’ of psychiatric genetics in the United Kingdom, was encouraged by Lewis to study genetics in 1930s. In 1959, Slater established another MRC unit at the institute (MRC Psychiatric Genetics Unit), but the unit was closed in 1969 on Slater’s retirement. In 1984, MRC Child Psychiatry Unit was established at the Institute of Psychiatry by Michael Rutter, a member in the MRC Social Psychiatry Research Unit led by Lewis. The unit brought together experts in many overlapping fields, and the mix proved highly successful as the unit had a major impact on child psychiatric research throughout the world.

The MRC Social Psychiatry Research Unit was closed in 1993. The MRC and the institute found that there was a need for refocusing and reintegration with other strands of research including psychiatric genetics and disorders of adult life. Rutter and David Goldberg discussed with the MRC about the establishment of an interdisciplinary research centre that could comprehensively study the interplay of nature and nurture in the development of psychiatric disorders. In 1994, MRC SGDP Centre was established in Denmark Hill, and Rutter was appointed as the first director of the centre. The SGDP Centre has moved into its new purpose-built building in 2002.

Psychosis Studies

The department is the most highly cited group of scientists working on schizophrenia and related disorders. Work focuses on integrating cognitive measures and multimodal neuroimaging techniques, with perinatal, genetic and developmental data. The central aim is to characterise the core pathophysiological dimensions of schizophrenia and bipolar disorder. The section has initiated or participated a number of such treatment studies of new atypical antipsychotics and potential mood stabilising medication and is also developing computerised and web-based applications for disease self-management.

Maurice Wohl Clinical Neuroscience Institute

The Maurice Wohl Clinical Neuroscience Institute is a centre for neuroscience research opened by The Princess Royal in 2015. It is one of the leading neuroscience institutes in the world. The centre is named after British philanthropist Maurice Wohl, who supported many medical projects and had a long association with King’s College London, and was funded by several philanthropic donors, organisations and King’s Health Partners.

The Maurice Wohl Clinical Neuroscience Institute focuses on the development of new treatments to patients affected by neurodegenerative diseases (such as Alzheimer’s disease, Parkinson’s disease and motor neurone disease), mental disorders (depression, schizophrenia) and neurological diseases (including epilepsy and stroke), and the understanding of disease mechanisms. The research institute has 250 clinicians and research scientists from neuroimaging, neurology, psychiatry, genetics, molecular and cellular biology and drug discovery.

The current three major goals of the institute is to determine the underlying genetic and environmental risk factors for disease, to identify tests for early diagnosis and biomarkers that measure disease progression, and to develop informative cellular and animal disease models of disease to accelerate drug discovery.

Funding

Approximately 70% of the IoPPN’s income comes from the research it conducts. Approximately 20% is from clinical work performed for the South London and Maudsley NHS Foundation Trust. Approximately 10% of gross income is from taught courses offered to postgraduate students.

Sources include the government’s National Institute for Health and Care Research (NIHR) and Higher Education Funding Council for England, grant-giving bodies such as the Medical Research Council (UK) and the Wellcome Trust, as well as other governmental, charitable and private-sector organisations. Individual research teams secure around £130 million of funds for their projects each year. Many projects are carried out in partnership with other university and health services, charities and private companies.

The IoPPN and the pharmaceutical company Lundbeck are led one of the largest ever academic-industry collaborations in research, known as NEWMEDS – Novel Methods leading to New Medications in Depression and Schizophrenia. The project is part of the Innovative Medicines Initiative developed by the European Federation of Pharmaceutical Industries and Associations and the European Commission. NEWMEDS aims to facilitate the development of new psychiatric medications by bringing top scientists and academics together in partnership with nearly every major global drug company.

Another key project is the KCL and Janssen led pre competitive public private consortium RADAR-CNS (Remote Measurement of Disease and Relapse in Central Nervous System Disorders), which uses smartphones and wearable devices to track clinical outcomes in disorders like depression, multiple sclerosis and epilepsy.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Institute_of_Psychiatry,_Psychology_and_Neuroscience >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of South London and Maudsley NHS Foundation Trust

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Introduction

South London and Maudsley NHS Foundation Trust (also known as SLaM), is an NHS foundation trust based in London, England, which specialises in mental health. It comprises:

SLaM forms part of the institutions that make up King’s Health Partners, an academic health science centre. In its most recent inspection of the Trust, the CQC gave SLaM a ‘good’ rating overall, but a ‘requires improvement’ rating in area of safety. In 2019, Southwark Coroner’s Court ruled that SLaM was guilty of “neglect and serious failures” in relation to the death of a patient in 2018. In 2020, a further investigation into the Trust’s conduct was opened following the death of a patient in its care.

Overview

Each year the South London and Maudsley NHS Foundation Trust provides about 5,000 people with hospital treatment and about 40,000 people with community services. In partnership with King’s College London, the Trust has major research activities. This academic partnership enables the Trust to develop new treatments and to provide specialist services to people from across the UK such as the National Psychosis Unit at Bethlem Royal Hospital. The Trust forms part of the King’s Health Partners academic health science centre and together with the Institute of Psychiatry, Psychology and Neuroscience at King’s College London and University College London is host to the UK’s only specialist National Institute for Health Research Biomedical Research Centre for mental health. In 2009/10 the Trust had a turnover of £370 million.

The Trust’s work on promoting mental health and well-being, developed in partnership with the new economics foundation, has featured in the national media.

It was named by the Health Service Journal as one of the top hundred NHS trusts to work for in 2015. At that time it had 4218 full-time equivalent staff and a sickness absence rate of 3.74%. 58% of staff recommend it as a place for treatment and 59% recommended it as a place to work.

As of 2018, the trust employed 5,328 staff.

Select Chronology

The following are some important historical dates:

  1. The Priory of St Mary of Bethlehem, Bishopsgate, was founded on land given by Alderman Simon Fitzmary. It later became a place of refuge for the sick and infirm. The names ‘Bethlem’ and ‘Bedlam’, by which it came to be known, are early variants of ‘Bethlehem’. It is first referred to as a hospital for ‘insane’ patients in 1403, after which it has a continuous history of caring for people with mental distress.
  2. In 1867, the Southern Districts Hospital (or Stockwell Fever Hospital as it became known) opened on the site which is today known as Lambeth Hospital.
  3. Henry Maudsley wrote to the London County Council offering to contribute £30k towards the costs of establishing a “fitly equipped hospital for mental diseases.” The Maudsley initially opened as a military hospital in 1915 to treat cases of shell shock and became a psychiatric hospital for the people of London in 1923.
  4. Bethlem Royal Hospital moved to a new site at Monks Orchard, where it has been situated to this day.
  5. With the introduction of the National Health Service in 1948, the Bethlem Royal Hospital and Maudsley Hospital were merged to form a postgraduate psychiatric teaching hospital. The Maudsley’s medical school became the Institute of Psychiatry.
  6. Sister Lena Peat and Reginald Bowen became the first community psychiatric nurses, following up patients at home who had been discharged from Warlingham Park Hospital in Croydon.
  7. The Ladywell Unit, located at University Hospital Lewisham, was refurbished for use by adult inpatient mental health services. The development brought together inpatient services which had previously been spread across other hospital sites (Hither Green, Guy’s and Bexley).
  8. South London and Maudsley NHS Trust was formed – providing mental health and substance misuse services across Croydon, Lambeth, Lewisham and Southwark; substance misuse services in Bexley Greenwich and Bromley; and national specialist services for people from across the UK.
  9. South London and Maudsley became the 50th NHS Foundation Trust in the UK under the Health and Social Care [Community Health and Standards] Act 2003.
    2007 The Maudsley Hospital closed its 24-hour emergency mental health clinic, amidst protest from patient groups and politicians who continued campaigning for several years for a promised replacement at nearby KCL Hospital.
  10. South London and Maudsley is part of one of the five Academic Health Sciences Centres (AHSCs) in the UK to be accredited by the Department of Health. King’s Health Partners AHSC consists of SLaM, King’s College London, and Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts.
  11. South London and Maudsley is fined by the Parliamentary and Health Service Ombudsman for its failure to properly assess mental capacity.

Governance

The Chief Executive appointed in 2013 is Matthew Patrick, a psychiatrist with a background in psychoanalysis who was formerly head of the Tavistock and Portman NHS Foundation Trust.

Former Member of Parliament Sir Norman Lamb was appointed chair of the trust in December 2019.

Services

The Trust provides a wide range of mental health and substance misuse services. The Trust provides care and treatment for a local population of 1.3 million people in south London, as well as specialist services for people from across the country. The Trust provides mental health services for people of all ages from over 100 community sites in south London, three psychiatric hospitals (the Bethlem Royal Hospital, Lambeth Hospital and the Maudsley Hospital) and specialist units based at other hospitals.

In March 2016 it established a joint venture with the Macani Medical Centre in Abu Dhabi to provide child and adolescent services with specialisms in autism, Obsessive Compulsive Disorder and eating disorders. Maudsley International also signed an agreement with the Ministry of Public Health in Qatar for expert advice to help advance Qatar’s national mental health strategy.

It established a joint venture limited liability partnership with Northumbria Healthcare Facilities Management, run by Northumbria Healthcare NHS Foundation Trust in 2019. This will run its private and international work, develop its capital assets and employ its facilities staff. It will initially employ 192 existing staff. It plans rapid growth in the United Arab Emirates (UAE) and China.

Performance

255 patients were injured in 2016-17 through use of restraints on psychiatric patients in South London and Maudsley NHS Foundation Trust. This was the third largest number in England, There were more injuries in Southern Health NHS Foundation Trust and Mersey Care NHS Foundation Trust. Critics say restraints are potentially traumatic even life threatening for patients.

Research

The Trust’s research activities take place in close partnership with the Institute of Psychiatry, King’s College London and University College London. In the 2008 Research Assessment Exercise the Institute was judged to have the highest research power of any UK institution within the areas of psychiatry, neuroscience and clinical psychology.

Biomedical Research Centre

The Trust manages the NIHR Maudsley Biomedical Research Centre, the UK’s only Specialist Mental Health Biomedical Research Centre, in partnership with the Institute of Psychiatry at King’s College London. The Centre, which is based on the Maudsley Hospital campus, is funded by the National Institute for Health and Care Research (NIHR). Its aim is to speed up the pace that latest medical research findings are turned into improved clinical care and services.

The team at the Centre are working towards ‘personalised medicine’ – developing treatments based on individual need. The aim is to diagnose illness more effectively and much earlier, assess which treatments will work best for an individual and then tailor the care they receive accordingly.

The BRC’s development of an advanced computer programme to accurately detect the early signs of Alzheimer’s disease from a routine clinical brain scan was reported in the media in 2011. The ‘Automated MRI’ software automatically compares or benchmarks someone’s brain scan image against 1200 others, each showing varying stages of Alzheimer’s disease. Another study has concerned the reduced life expectancies of people diagnosed with different mental illnesses.

In 2011 the Department of Health announced that the Trust and the Institute of Psychiatry, King’s College London would receive a further £48.8m to continue running the Biomedical Research Centre for Mental Health for a further five years from 01 April 2012. An additional £4.5m was awarded to the Trust to launch for a new NIHR Biomedical Research Unit for Dementia.

King’s Health Partners

The Trust is a member of the King’s Health Partners academic health sciences centre, together with King’s College London, Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospital NHS Foundation Trust.

In December 2013 it was announced that a proposed merger with Guy’s and St Thomas’ and King’s College Hospitals had been suspended because of doubts about the reaction of the Competition Commission.

National Addiction Centre

In partnership with the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, the Trust runs the National Addiction Centre (NAC), which aims to develop new treatment services for alcohol, smoking and drug problems. This work ranges from trials of new therapies and preventative treatments, to studies seeking to understand the genetic and biological basis of addictive behaviour. An example of research conducted is the Randomised Injecting Opioid Treatment Trial (RIOTT).

Media

The services provided by the Trust feature in a four-part observational television documentary to be broadcast on Channel Four in Autumn 2013. Produced by the makers of 24 Hours in A&E, Bedlam focuses on the work of the Anxiety Disorders Residential Unit at Bethlem Royal Hospital, the Triage ward at Lambeth Hospital, adult community mental health services in Lewisham and services for people over the age of 65.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/South_London_and_Maudsley_NHS_Foundation_Trust >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Cassel Hospital

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Introduction

The Cassel Hospital is a psychiatric facility in a Grade II listed building at 1 Ham Common, Richmond, Ham in the London Borough of Richmond upon Thames. It is run by the West London NHS Trust.

Brief History

The Hospital

The hospital was founded and endowed by Ernest Cassel in England in 1919. It was initially for the treatment of “shell shock” victims (aka combat stress reaction). Originally at Swaylands in Penshurst, Kent, it moved to Stoke-on-Trent during the Second World War. In 1948 it relocated to its present site at No. 1 Ham Common, Ham.

The Building

The present hospital was originally a late 18th-century house known as Morgan House after its owner, philanthropist and writer, John Minter Morgan. Morgan died in 1854 and is buried in nearby St Andrew’s Church, Ham. In 1863 it became home to the newly married Duc de Chartres. In 1879 it became West Heath Girls’ School. The school moved to its present site in Sevenoaks, Kent in the 1930s, and the building became the Lawrence Hall Hotel until its purchase by the Cassel Foundation in 1947. The building was Grade II listed in 1950.

Facilities

The hospital developed approaches informed by psychoanalytic thinking alongside medicinal interventions, techniques of group and individual psychotherapy. It was here that Tom Main along with Doreen Wedell pioneered the concept of a therapeutic community in the late 1940s. Together they pioneered & developed the concept of psychosocial nursing. By promoting and being proud of the role of the nurse – rather than try to imitate therapists; working alongside the patient in everyday activities, Weddell & Main developed a whole new way of working that reduced dependence upon services and fostered patient’s working collaboratively. Nurses were supported and taught to understand their reparative need, to challenge their sense of omnipotence and to rely on the patient group as the most useful resource. In 1948 Eileen Skellern came for her training and joined the staff in 1949.

The hospital formally established a research department in 1995 and has collaborative relationships with University College London, Imperial College and the Centre for the Economics of Mental Health at the Institute of Psychiatry, London. It is now a psychotherapeutic community which provides day, residential, and outreach services for young people and adults with severe and enduring personality disorders.

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What is Milieu Therapy?

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Introduction

Milieu therapy is a form of psychotherapy that involves the use of therapeutic communities.

Outline

Patients join a group of around 30, for between 9 and 18 months. During their stay, patients are encouraged to take responsibility for themselves and the others within the unit, based upon a hierarchy of collective consequences. Patients are expected to hold one another to following rules, with more senior patients expected to model appropriate behavior for newer patients. If one patient violates the rules, others who were aware of the violation but did not intervene may also be punished to varying extents based upon their involvement.

Milieu therapy is thought to be of value in treating personality disorders and behavioural problems, and can also be used with a goal of stimulating the patient’s remaining cognitive-communicative abilities.

Organisations known to use milieu therapy include:

  • Cassel Hospital, in London, UK.
  • Forest Heights Lodge in Evergreen, Colorado, US.
  • The United States Veteran’s Administration, US.
  • The Kansas Industrial School for Girls in Beloit, Kansas, US.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Milieu_therapy >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is a Therapeutic Community?

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Introduction

Therapeutic community is a participative, group-based approach to long-term mental illness, personality disorders and drug addiction. The approach was usually residential, with the clients and therapists living together, but increasingly residential units have been superseded by day units. It is based on milieu therapy principles, and includes group psychotherapy as well as practical activities.

Therapeutic communities have gained some reputation for success in rehabilitation and patient satisfaction in the UK and abroad. In the UK, ‘democratic analytic’ therapeutic communities have tended to specialise in the treatment of moderate to severe personality disorders and complex emotional and interpersonal problems. The evolution of therapeutic communities in the US has followed a different path with hierarchically arranged communities (or concept houses) specialising in the treatment of drug and alcohol dependence.

Brief History

Antecedents

There are several antecedents to the therapeutic community movement. One of the earliest is the change in treatment of institutionalised patients in the late 18th century, continuing throughout the 19th century. A major contributor to this change is Philippe Pinel, a French physician who advocated for a more humane treatment of psychiatric patients. In the UK William Tuke founded the Retreat where patients were treated according to humanitarian principles, called moral treatment. Tuke based the treatment of mentally ill people partly on the Quaker ideology. The influence of Quaker principles continues through out the development of the therapeutic community.

Moral treatment focused on a more humane treatment of patients and a stimulating environment that engages them in healthy behaviour. An important distinction between the later therapeutic community is the strong hierarchy in moral treatment facilities. The superintendent had authority over and responsibility of the patients. The patients followed a strict schedule to promote obedience and self-control.

After the First World War, multiple varieties of living-and-learning communities for young adults were established. Examples are the Little Commonwealth school run by Homer Lane and the Q camps initiated by Marjorie Franklin. The Q camps were based on Planned Environmental Therapy, which focused on normally functioning parts of a patient’s personality and use them to deal with difficult social situations. These projects all emphasized shared responsibility and decision-making and participation in the community. What influenced the establishment of these projects were, among others, the developments in psychoanalytic theory in the UK.

United Kingdom

The work conducted by pioneering NZ plastic surgeon Archibald McIndoe at Queen Victoria Hospital and others at Northfield Military Hospital during World War II is considered by many psychiatrists to have been the first example of an intentional therapeutic community. But this story is prone to adopt a origin myth approach. The principles developed at Northfield were also developed and adapted at Civil Resettlement Units established at the end of the war to help returning prisoners of war to adapt back to civilian society and for civilians to adapt to having these men back amongst them.

The term was coined by Thomas Main in his 1946 paper, “The hospital as a therapeutic institution”, and subsequently developed by others including Maxwell Jones, R.D. Laing at the Philadelphia Association, David Cooper at Villa 21, and Joshua Bierer.

Under the influence of Maxwell Jones, Main, Wilmer and others (Caudill 1958; Rapoport 1960), combined with the publications of critiques of the existing mental health system (Greenblatt et al. 1957, Stanton and Schwartz 1954) and the sociopolitical influences that permeated the psychiatric world towards the end of and following the Second World War, the concept of the therapeutic community and its attenuated form – the therapeutic milieu – caught on and dominated the field of inpatient psychiatry throughout the 1960s.

The first development of therapeutic community in a large institution took place at Claybury Hospital under the guidance of Denis Martin and John Pippard. Beginning in 1955 it involved over 2,000 patients and hundreds of staff. The aim of therapeutic communities was a more democratic, user-led form of therapeutic environment, avoiding the authoritarian and demeaning practices of many psychiatric establishments of the time. The central philosophy is that clients are active participants in their own and each other’s mental health treatment and that responsibility for the daily running of the community is shared among the clients and the staff. One phrase commonly used to summarise this treatment philosophy is ‘the Community as Doctor’. ‘TC’s have sometimes eschewed or limited medication in favour of group-based therapies.

The Henderson Hospital first established in 1947 by Maxwell Jones and named after David Henderson evolved the specific concept of Democratic Therapeutic Community (DTC). Admission to and early discharge from the one year of residential treatment was by majority vote and residents of the DTC always held the majority in these votes. No psychotropic medication or one to one therapy sessions were available and so all the work of the DTC was pursued, on the one hand, in small or larger therapy groups or work groups and community meetings, which could be called (by the residents) day or night; and on the other hand, in the unstructured time in between these more formal spaces, in which belonging in and membership of a living community could become in itself a healing experience. The Henderson Hospital DTC became an international centre of excellence for the care of survivors of severe trauma who did not fall under conventional psychiatric classifications and towards the end of the twentieth century it was funded to replicate the treatment model in two other DTCs: Main House in Birmingham and Webb House in Crewe.

The availability of the treatment on the National Health Service in the UK came under threat because of changes in funding systems. Researchers at the University of Oxford and King’s College London studied one of these national Democratic Therapeutic Community services over four years and found external policy ‘steering’ by officials eroded the community’s democratic model of care, which in turn destabilised its well established approach to clinical risk management (this had been jointly developed by clients and staff). Fischer (2012), who studied this community’s development at first hand, described how an ‘intractable conflict’ between embedded and externally imposed management models led to escalating organisational ‘turbulence’, producing an interorganisational crisis which led to the unit’s forced closure. The three ‘Henderson’ DTCs had all closed their doors by 2008.

However, development of ‘mini’ therapeutic communities, meeting for three or fewer days each week and supported out of hours by various forms of ‘service user led informal networks of care’ (for example telephone, texting and physical support), now offers a more resource and cost effective alternative to traditional inpatient therapeutic communities. The most recent exponent, the North Cumbria model, uses a dedicated out of hours website moderated by service users according to therapeutic community principles. This extends the community beyond the face to face ‘therapeutic days’. The website guarantees a safe group-based response not always possible with other systems. The use of ‘starter’ groups as a preparation for entry into therapeutic communities has lowered attrition rates and they now represent a cost-effective model still aimed at producing durable personal and intergenerational effects; this is at odds with the current trend towards the defensive needs of service providers, rather than service users, for less intensive treatments and management of pathways to control risk.

United States

In the late 1960s within the US correctional system, the Asklepion Foundation initiated therapeutic communities in the Marion Federal Penitentiary and other institutions that included clinical intervention based upon Transactional Analysis, the Synanon Game, internal twelve-step programmes and other therapeutic modalities. Some of these programmes lasted into the mid-1980s, such as the House of Thought in the Virginia Correctional system, and were able to demonstrate a reduction of 17% in recidivism in a matched-pair study of drug-abusing felons and sex offenders who participated in the program for one year or more.

Modified therapeutic communities are currently used for substance abuse treatment in correctional facilities of several US states including Pennsylvania, Washington, Colorado, Texas, Delaware, and New York. In New York City, a programme for men is located in the Arthur Kill Correctional Facility on Staten Island and the women’s programme is part of the Bayview Correctional Facility in Manhattan.

Main Ideas

The therapeutic community approach aims to help patients deal with social situations and to change perceptions they have about themselves. Difficult situations are re-enacted and experienced and patients are encouraged to examine and try to learn from them with the help of group and individual therapy. The communities function as a living-and-learning situations, where every interaction can serve as a learning moment.

There is no encompassing definition of what a therapeutic community should be. Some have therefore also argued that it follows a family resemblance. A common conception of therapeutic community is a group of people living together in a non-hierarchical, democratic way that brings psychological awareness of individual as well as group processes. Furthermore, the community has clear boundaries of place, time and roles of the participants. They are democratic because the patients are involved in decision-making to encourage a sense of responsibility. This is fostered by the non-hierarchical structure that tries to minimise dependency on the staff.

A key principle is the creation of a culture of enquiry. Everyone within the community is encouraged to reflect and ask question about themselves and others. In this way the participants are supported by continuous feedback to create better self-awareness.

The therapeutic community approach is informed by systems theory, organisation theory and psychoanalytic practice.

Effectiveness

As an intervention model for drug-using offenders with co-occurring mental health disorders, therapeutic communities may help people reduce drug use and subsequent criminal activity. Research evidence for the effectiveness of therapeutic community treatment is substantial and a demonstration of the cost efficacy of a year of residential therapeutic community treatment was instrumental in funding being granted in the late 1990s for the replication of the Henderson Hospital DTC.

In Popular Culture

  • The Alfred Hitchcock film Spellbound takes place within a therapeutic community called Green Manors.
  • Leonard Cohen and his touring band The Army gave an impromptu concert at the Henderson Hospital DTC in August 1970, just before the Isle of Wight Festival, after being invited by one of the residents.

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A Brief Overview of Hollymoor Hospital

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Introduction

Hollymoor Hospital was a psychiatric hospital located at Tessall Lane, Northfield in Birmingham, England, and is famous primarily for the work on group psychotherapy that took place there in the years of the Second World War. It closed in 1994.

Refer to Group Analysis.

History

Construction and Expansion

The hospital, which was designed by William Martin and Frederick Martin using a Compact Arrow layout, was built as an annexe to Rubery Lunatic Asylum by Birmingham Corporation and opened 06 May 1905. During the First World War, Hollymoor was commandeered and became known as the 2nd Birmingham War Hospital.

The Northfield Experiments

During the Second World War, the hospital was again converted to a military hospital in 1940. In April 1942 it became a military psychiatric hospital and became known as Northfield Military Hospital. In 1942, while Northfield was serving as a military hospital, psychoanalysts Wilfred Bion and John Rickman set up the first Northfield experiment. Bion and Rickman were in charge of the training and rehabilitation wing of Northfield, and ran the unit along the principles of group dynamics. Their aim was to improve morale by creating a “good group spirit” (esprit de corps). Though he sounded like a traditional army officer Bion’s means were very unconventional. He was in charge of around one hundred men. He told them that they had to do an hour’s exercise every day and that each had to join a group: “handicrafts, Army courses, carpentry, map-reading, sand-tabling etc…. or form a fresh group if he wanted to do so”. While this may have looked like traditional occupational therapy, the real therapy was the struggle to manage the interpersonal strain of organising things together, rather than simply weaving baskets. Those unable to join a group would have to go to the rest-room, where a nursing orderly would supervise a quiet regime of “reading, writing or games such as draughts… any men who felt unfit for any activity whatever could lie down”. The focus of every day was a meeting of all the men, referred to as a parade.

“.. a parade would be held every day at 12.10 p.m. for making announcements and conducting other business of the training wing. Unknown to the patients, it was intended that this meeting, strictly limited to 30 minutes, should provide an occasion for the men to step outside their framework and look upon its working with the detachment of spectators. In short it was intended to be the first step towards the elaboration of therapeutic seminars. For the first few days little happened; but it was evident that amongst patients a great deal of discussion and thinking was taking place”

The experiment had to close after six weeks as the military authorities did not approve of it and ordered the transfer of Bion and Rickman (who were members of the Royal Army Medical Corps). The second Northfield experiment, which was based on the ideas of Bion and Rickman and used group psychotherapy, was started the following year by Siegmund Foulkes, who was more successful at gaining the support of the military authorities. One of the military psychiatrists involved in the project was Lieutenant Colonel T.F. Main, who coined the term therapeutic community, and saw the potential of the experiments in the development of future therapeutic communities.

Northfield Military Hospital was the setting for Sheila Llewellyn’s novel Walking Wounded, published in 2018.

Decline and Closure

Poet Vernon Scannell was a patient at the hospital in 1947. By 1949 Hollymoor Hospital was recognisably distinct from Rubery Hill Hospital. It held 590 patients, falling slowly to 490 by 1984, and then dropping rapidly to 139 by 1994. After the introduction of Care in the Community in the early 1980s, the hospital went into a period of decline and closed in July 1994. It was subsequently largely demolished.

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What is Journal Therapy?

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Introduction

Journal therapy is a writing therapy focusing on the writer’s internal experiences, thoughts and feelings. This kind of therapy uses reflective writing enabling the writer to gain mental and emotional clarity, validate experiences and come to a deeper understanding of themself. Journal therapy can also be used to express difficult material or access previously inaccessible materials.

Like other forms of therapy, journal therapy can be used to heal a writer’s emotional or physical problems or work through a trauma, such as an illness, addiction, or relationship problems, among others. Journal therapy can supplement an on-going therapy, or can take place in group therapy or self-directed therapy.

Brief History

Ira Progoff created the intensive journal writing programme in 1966 in New York. The intensive journal method is a structured way of writing about nature that allows the writer to achieve spiritual and personal growth. This method consists of a three-ring, loose-leaf binder with four colour-coded sections: lifetime dimension, dialogue dimension, depth dimension and meaning dimension. These sections are divided into several subsections. Some of these subsections include topics like career, dreams, body and health, interests, events and meaning in life. Progoff created the intensive journal so that working in one part of the journal would in turn stimulate one to work on another part of the journal, leading to different viewpoints, awareness and connections between subjects. The intensive journal method began with recording the session in a daily log.

The field of journal therapy reached a wider audience in the 1970s with the publication of three books, namely, Progoff’s At a Journal Workshop (1978), Christina Baldwin’s One to One: Self-Understanding Through Journal Writing (1977) and Tristine Rainer’s The New Diary (1978).

In 1985, psychotherapist and journal therapy pioneer, Kathleen Adams, started providing journal workshops, designed as a self-discovery process.

In the 1990s, James W. Pennebaker published multiple studies which affirmed that writing about emotional problems or traumas led to both physical and mental health benefits. These studies drew more attention to the benefits of writing as a therapy.

In the 2000s, journal therapy workshops were conducted at the Progoff’s Dialogue House, Adams’ Centre for Journal Therapy and certificates were given through educational institutions. Generally, journal therapists obtain an advanced degree in psychology, counselling, social work, or another field and then enter a credentialing programme or independent-study programme.

Effects

Journal therapy is a form of expressive therapy used to help writers better understand life’s issues and how they can cope with these issues or fix them. The benefits of expressive writing include long-term health benefits such as better self-reported physical and emotional health, improved immune system, liver and lung functioning, improved memory, reduced blood pressure, fewer days in hospital, fewer stress-related doctor visits, improved mood and greater psychological well-being. Other therapeutic effects of journal therapy include the expression of feelings, which can lead to greater self-awareness and acceptance and can in turn allow the writer to create a relationship with his or herself. The short-term effects of expressive writing include increased distress and psychological arousal.

Practice

Many psychotherapists incorporate journal “homework” in their therapy but few specialise in journal therapy. Journal therapy often begins with the client writing a paragraph or two at the beginning of a session. These paragraphs would reflect how the client is feeling or what is happening in his or her life and would set the direction of the session. Journal therapy then works to guide the client through different writing exercises. Subsequently, the therapist and the client then discuss the information revealed in the journal. In this method, the therapist often assigns journal “homework” that is to be completed by the next session. Journal therapy can also be provided to groups.

Techniques

Journal therapy consists of many techniques or writing exercises. In all journal therapy techniques, the writer is encouraged to date everything, write quickly, keep writings and always tell the complete truth. Some of the journal therapy techniques are as follows:

TechniqueOutline
SprintCatharsis is encouraged by allowing a writer to write about anything for a designated period, such as for five minutes or for ten minutes.
ListsThe writer writes any number of connected items in order to help prioritize and organize.
Captured MomentsWriter attempts to completely describe the essence and emotional experience of a memory.
Unsent LettersThis attempts to silence a writer’s internal censor; it can be used in a grieving process or to get over traumas, such as sexual abuse.
DialogueThe writer creates both sides to a conversation involving anything, including but not limited to, people, the body, events, situations, time etc.
FeedbackImportant to journal therapy as feedback makes the writer be aware of his or her feelings; it also allows the writer to acknowledge, accept and reflect on what they he/she has written before (thoughts, feelings, etc.).

Setting

A quiet and private environment must be created and provided throughout the entire journal writing process. This environment should contain features or elements that can make the writer feel good such as music, candles, a hot drink etc. This environment works to empower the writer and for him/her to associate good feelings with journal writing. To transition into writing, a journal writing session can be started with a drawing or sketch. After journal writing, something active should be done, such as running, walking, stretching, breathing etc. or something that is enjoyable like taking a bubble bath, baking cookies, listening to music, talking to someone, etc.

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