A home of their
own
The idea of the 'half-way hostel' where psychiatric patients can find their feet after a period in hospital is gaining increasing favour among psychiatric workers. Now Severalls Hospital, Colchester, is experimenting with the 'three-quarter-way home' where ex-patients are
living virtually independent lives in groups. Dr. Richard Fox, Consultant Psychiatrist at the hospital, reports.
It is often said that there are many people in mental hospitals who do not need to be there?so often said, indeed, that this rather appalling truth tends to lose impact. How many people are thus wrongly housed is a moot point: some say 30 per cent, but such estimates are likely to presuppose the removal of senile patients, say, to another form of institution, which does not help anyone much. But it is clear that where unemployment is high and social provisions low, more fit people will remain 'inside'. In Colchester neither obtains, though we are still hard-enough worked in making community provisions for patients ready to leave, but with nowhere to go. Up and down the country, the number of these 'redundant' patients must number thousands, however one draws the lines. Adequate social functioning can take place alongside residual psychotic disturbances?even quite gross ones. Even now, I am occasionally rung by a doctor who says: 'This man is hearing voices; he must be very dangerous.' This is not so. A lady in her late forties was discharged three years ago, after an eightyear admission, to work as a resident domestic in a general hospital. Throughout that time, she has been aware of and heard 'projectors' playing on her. These were started, it seems, by the retired medical superintendent, and do not interfere with a useful and
adequate working life.
Spectrum of facilities lady, now 40, has worked for three years machinist, living most of that time in a half-way hostel. She is a bit shy, but quite normal until one
A second as a
touches on the nuts and bolts which she believes were introduced into her body some time ago, and which she can localise for you. Most striking of all is a paranoid schizophrenic gentleman, never in hospital, whose delusional system embraces every single aspect of every waking day. Every object he touches, every article he buys, every person who approaches him in the street, has been influenced by 'them'. He sleeps in a mask because of the poison he believes is coming off the ceiling, has lived for long periods on vitamins and tea and engages himself in a lone struggle against 46
'
the 'forces of Evil', with occasional help from his therapist and the royal family. And he has not lost a single day's work during the 20 years of his illness. To meet the needs of recovered or partially-recovered patients (none, obviously, as disturbed in thought as 'the last case) Severalls Hospital has created a spectrum of facilities, such that each individual patient's needs can be met. Some work out from a ward and some from the hostel in the grounds, staffed by hospital nurses. Two half-way hostels in the town, purposebuilt for the Mental Welfare Department, represent the next stage. There is a hostel for our patients, run as commercial venture by a private individual, and for the elderly there is an enormous day hospital (over 200 on the books) along with a fostering scheme and small hostel.
Three-quarter-way house The next stage after the hostel is the group home or 'Three-quarter way house', where selected groups of patients can live an independent life together, without help or interference other than an occasional visit from social worker or assistant matron. My experience with two such homes, all for elderly ladies in whom physical as much as mental disability is relevant, suggests that a weekly afternoon visit is best. This is the story of the first of these homes which celebrates its third anniversary in February next. The small old house was rented privately at ?4 10s. 0d. per week through a local agent. Furnishing was by courtesy of the WVS and friends of the unit staff, and soft furnishings were bought by the ladies themselves on hire purchase. The total cost of getting the place going was only ?4 10s. Od.?the price for a second-hand electric cooker. No authorities were consulted, no committees informed, so it was possible to open the place within about eight weeks of the original idea. It appears that we may have been in breach of the Town and Country Planning Act, but no one seems
to
mind.
Of the five ladies chosen, one failed to fit in, relapsed and has found her niche in a mental after-care home. The fact that she had been in hospital for only a
A home of their
L
own
sail
jr
to right, are Miss Constance Brown, Mr. Leslie McWhirter, Senior Tea-time at the group home. Pictured, from left to Photo: John Brooke Nursing Officer, Miss Emily Hardy and Mrs. Evelyn Porter
couple of months, against
an
average of
over
20 years
for the others, may have had something to do with her relapse. The person who replaced her and the other four women have remained since. Their average age is 67, with a range from 57 to 74. Continuous Periods in hospital ranged from two to 34 years. Three
?f the
patients
had suffered from
schizophrenia, one one a typical relapse rate, including the
had manic-depressive psychosis and
depressive psychosis. The lady who proved unsuitable,
50 per cent in the one lady has needed psychiatric treatment. Occasional spells of illness are dealt with by a short course of in- or outpatient electrical treatment. The selection of this lady ^as to some extent an error of clinical judgment but, ?nce she had become a member of the group, it Proved impossible to consider her replacement. The others have shown great love, care and concern, and nursed her through spells when she would, for example, rise at 2 a.m. and say she was going out to buy the onions. was
first six months but since then, only
Physical health has been better than expected for a group of this age, which pays an oblique psychosomatic tribute to the quality of life. Only one lady has been admitted to a general hospital?with obstruction of long-standing inoperable hernias. The pattern of life has been appropriate to the rural Essex background of most of them, with a bit of gardening, wine-making and visiting with the neighbours. Housework is shared (though one lady does almost all the cooking) and all contribute from their pensions to funds for rent, lighting, coal and food. Several go for regular walks and attend Church, but there has not been much integration with local activities. The running out of the original lease made a move from the small seaside town to a large flat over a shop in the heart of the Constable country necessary. After initial disappointment, the compensations of the new site are now recognised. During the first two years, problems of an interpersonal kind were minimal, far less, one supposed, than with most groups of five old ladies, selected at 47
random and living closely together. Since then, difficulties have arisen due partly to the blossoming of one somewhat institutionalised person into a more determined and self-willed woman. A second factor is that most of them do not have enough to do. Our aim for the future is to introduce one or two old gentlemen into group homes for the ladies to fuss over. A new charity has now been created, Phoenix Group Homes, to extend and experiment with the group home idea. Primed with a large grant from the Calouste Gulbenkian Foundation, the charity will be able to buy houses and experiment with groups of different age and sex structure. One of the most pressing needs now relates to half-way hostellers who have had a year or more at work from the hostel, but who have no home, or an inadequate home, and who are likely to break down again in digs. A suitable house has been voted to us now by the Colchester Borough Council and our new group should be wellestablished by Christmas.
Need for
supervision
Summarising, one can say that the Group Home has an important contribution to make in the community care of the recovered elderly woman patient?and probably of men, and women of other ages, too. A high relapse-rate in the early stages of settling-in underlines the need for some trained psychiatric supervision. Group homes require no staff and the minimum of visiting, so they are easy to set up and run. The saving to the hospital (at about ?12 per bed per week) has presumably been over ?3,000, against
which must be set a much smaller amount in respect of the larger pension and national assistance payable to those in the community. But the human benefit to the people concerned is incalculable.
Photo: Brooke Photo:John JohnBrooke sun in in the thegarden home are, are, the afternoon the home of the afternoon sun garden of Enjoying the Enjoying Mrs Winifred Mr. to right, Miss Brown, Brown, Mrs Carter, Mr. Winifred Carter, left to right, Miss left Miss Hardy and Mrs. Mrs. Porter Porter McWhirter, Miss Hardy and McWhirter,
own
The idea of the 'half-way hostel' where psychiatric patients can find their feet after a period in hospital is gaining increasing favour among psychiatric workers. Now Severalls Hospital, Colchester, is experimenting with the 'three-quarter-way home' where ex-patients are
living virtually independent lives in groups. Dr. Richard Fox, Consultant Psychiatrist at the hospital, reports.
It is often said that there are many people in mental hospitals who do not need to be there?so often said, indeed, that this rather appalling truth tends to lose impact. How many people are thus wrongly housed is a moot point: some say 30 per cent, but such estimates are likely to presuppose the removal of senile patients, say, to another form of institution, which does not help anyone much. But it is clear that where unemployment is high and social provisions low, more fit people will remain 'inside'. In Colchester neither obtains, though we are still hard-enough worked in making community provisions for patients ready to leave, but with nowhere to go. Up and down the country, the number of these 'redundant' patients must number thousands, however one draws the lines. Adequate social functioning can take place alongside residual psychotic disturbances?even quite gross ones. Even now, I am occasionally rung by a doctor who says: 'This man is hearing voices; he must be very dangerous.' This is not so. A lady in her late forties was discharged three years ago, after an eightyear admission, to work as a resident domestic in a general hospital. Throughout that time, she has been aware of and heard 'projectors' playing on her. These were started, it seems, by the retired medical superintendent, and do not interfere with a useful and
adequate working life.
Spectrum of facilities lady, now 40, has worked for three years machinist, living most of that time in a half-way hostel. She is a bit shy, but quite normal until one
A second as a
touches on the nuts and bolts which she believes were introduced into her body some time ago, and which she can localise for you. Most striking of all is a paranoid schizophrenic gentleman, never in hospital, whose delusional system embraces every single aspect of every waking day. Every object he touches, every article he buys, every person who approaches him in the street, has been influenced by 'them'. He sleeps in a mask because of the poison he believes is coming off the ceiling, has lived for long periods on vitamins and tea and engages himself in a lone struggle against 46
'
the 'forces of Evil', with occasional help from his therapist and the royal family. And he has not lost a single day's work during the 20 years of his illness. To meet the needs of recovered or partially-recovered patients (none, obviously, as disturbed in thought as 'the last case) Severalls Hospital has created a spectrum of facilities, such that each individual patient's needs can be met. Some work out from a ward and some from the hostel in the grounds, staffed by hospital nurses. Two half-way hostels in the town, purposebuilt for the Mental Welfare Department, represent the next stage. There is a hostel for our patients, run as commercial venture by a private individual, and for the elderly there is an enormous day hospital (over 200 on the books) along with a fostering scheme and small hostel.
Three-quarter-way house The next stage after the hostel is the group home or 'Three-quarter way house', where selected groups of patients can live an independent life together, without help or interference other than an occasional visit from social worker or assistant matron. My experience with two such homes, all for elderly ladies in whom physical as much as mental disability is relevant, suggests that a weekly afternoon visit is best. This is the story of the first of these homes which celebrates its third anniversary in February next. The small old house was rented privately at ?4 10s. 0d. per week through a local agent. Furnishing was by courtesy of the WVS and friends of the unit staff, and soft furnishings were bought by the ladies themselves on hire purchase. The total cost of getting the place going was only ?4 10s. Od.?the price for a second-hand electric cooker. No authorities were consulted, no committees informed, so it was possible to open the place within about eight weeks of the original idea. It appears that we may have been in breach of the Town and Country Planning Act, but no one seems
to
mind.
Of the five ladies chosen, one failed to fit in, relapsed and has found her niche in a mental after-care home. The fact that she had been in hospital for only a
A home of their
L
own
sail
jr
to right, are Miss Constance Brown, Mr. Leslie McWhirter, Senior Tea-time at the group home. Pictured, from left to Photo: John Brooke Nursing Officer, Miss Emily Hardy and Mrs. Evelyn Porter
couple of months, against
an
average of
over
20 years
for the others, may have had something to do with her relapse. The person who replaced her and the other four women have remained since. Their average age is 67, with a range from 57 to 74. Continuous Periods in hospital ranged from two to 34 years. Three
?f the
patients
had suffered from
schizophrenia, one one a typical relapse rate, including the
had manic-depressive psychosis and
depressive psychosis. The lady who proved unsuitable,
50 per cent in the one lady has needed psychiatric treatment. Occasional spells of illness are dealt with by a short course of in- or outpatient electrical treatment. The selection of this lady ^as to some extent an error of clinical judgment but, ?nce she had become a member of the group, it Proved impossible to consider her replacement. The others have shown great love, care and concern, and nursed her through spells when she would, for example, rise at 2 a.m. and say she was going out to buy the onions. was
first six months but since then, only
Physical health has been better than expected for a group of this age, which pays an oblique psychosomatic tribute to the quality of life. Only one lady has been admitted to a general hospital?with obstruction of long-standing inoperable hernias. The pattern of life has been appropriate to the rural Essex background of most of them, with a bit of gardening, wine-making and visiting with the neighbours. Housework is shared (though one lady does almost all the cooking) and all contribute from their pensions to funds for rent, lighting, coal and food. Several go for regular walks and attend Church, but there has not been much integration with local activities. The running out of the original lease made a move from the small seaside town to a large flat over a shop in the heart of the Constable country necessary. After initial disappointment, the compensations of the new site are now recognised. During the first two years, problems of an interpersonal kind were minimal, far less, one supposed, than with most groups of five old ladies, selected at 47
random and living closely together. Since then, difficulties have arisen due partly to the blossoming of one somewhat institutionalised person into a more determined and self-willed woman. A second factor is that most of them do not have enough to do. Our aim for the future is to introduce one or two old gentlemen into group homes for the ladies to fuss over. A new charity has now been created, Phoenix Group Homes, to extend and experiment with the group home idea. Primed with a large grant from the Calouste Gulbenkian Foundation, the charity will be able to buy houses and experiment with groups of different age and sex structure. One of the most pressing needs now relates to half-way hostellers who have had a year or more at work from the hostel, but who have no home, or an inadequate home, and who are likely to break down again in digs. A suitable house has been voted to us now by the Colchester Borough Council and our new group should be wellestablished by Christmas.
Need for
supervision
Summarising, one can say that the Group Home has an important contribution to make in the community care of the recovered elderly woman patient?and probably of men, and women of other ages, too. A high relapse-rate in the early stages of settling-in underlines the need for some trained psychiatric supervision. Group homes require no staff and the minimum of visiting, so they are easy to set up and run. The saving to the hospital (at about ?12 per bed per week) has presumably been over ?3,000, against
which must be set a much smaller amount in respect of the larger pension and national assistance payable to those in the community. But the human benefit to the people concerned is incalculable.
Photo: Brooke Photo:John JohnBrooke sun in in the thegarden home are, are, the afternoon the home of the afternoon sun garden of Enjoying the Enjoying Mrs Winifred Mr. to right, Miss Brown, Brown, Mrs Carter, Mr. Winifred Carter, left to right, Miss left Miss Hardy and Mrs. Mrs. Porter Porter McWhirter, Miss Hardy and McWhirter,
