Take a tour of the St Aubyn Centre – a new £9m inpatient complex in Colchester for 11- to 18-year-olds with severe mental health problems – and you are left with a nagging sense of familiarity.
Then, Lizzy Melless, the centre’s operational manager, pins it down. “A lot of them [the young people] have referred to it as the Big Brother house,” she says. “It’s quite modern and the environment is very colourful. We joke and they say it’s like the Big Brother house and I say you know you’re being watched – by staff, not by cameras.”
Opened in June, St Aubyn, a project of the North Essex Partnership NHS Foundation Trust, could not look less like a hospital. It is slightly jarring to be informed that the building contains two wards, with a total of 25 beds.
Longview is one – an “acute” ward for young people in crisis with sudden or suddenly worsening mental health episodes such as depression or an eating disorder that cannot be dealt with at home. Larkwood, for those with more chronic conditions, is the other – an intensive care, low-security environment containing disturbed young people who are a danger to themselves or others.
You have to be very ill to get into St Aubyn. Although mental illness is estimated to affect 11.5 per cent of all 11- to 16-year-olds, St Aubyn is, in Melless’s words, for “very unwell, very disturbed young people”.
The two wards flank the communal areas of St Aubyn. Connecting them lies “The Street”, a wide, dark corridor featuring a pool table, vibrantly shaded seats and two “pods” – cylindrical rooms dedicated to meditation, drama and music.
Beyond “The Street” is a courtyard boasting an outdoor, multi-purpose sports pitch, and located on its far side is St Aubyn’s school. A stay at St Aubyn does not exempt residents from the national curriculum and there are two classrooms. The centre employs a head teacher, deputy head and four qualified teachers.
Each ward contains its own open-air courtyard with a water feature. Abundant use of pinewood gives St Aubyn a distinctly Scandinavian look. Bedrooms are en-suite and their windows tinted in shades of blue, purple and green. Meeting rooms for families are similarly shrouded.
Darkness and light alternate at St Aubyn. Quite consciously, although a “low-secure environment”, St Aubyn displays no fences. The centre seems to embody the concept outlined in the government’s “Call to Action” mental health strategy, that people with severe mental health problems should be treated in the “least restrictive environment”. The Department of Health itself provided £2m of the £9m it cost to build the centre.
Seventeen-year-old Lisa and 15-year-old Lewis were patients at St Aubyn’s predecessor, a 1970s flat-roof building close to Colchester General Hospital. Not aesthetically pleasing, the building was likened to “a block of old public toilets” by one young resident.
“It’s a lot more spacious than it was before,” comments Lisa, who is a patient in Longview ward because of an eating disorder and suicide attempts. “You get more time to be on your own. You are not all on top of each other like you were before.” Lewis says there was “limited outdoor space” in the old building. “The sports court is cool here,” he says.
The contrast with the new surroundings is striking but Melless admits that the move has provoked a mixed response.
Some preferred the old, smaller surroundings. Their misgivings might have something to do with a new no-smoking policy at St Aubyn. You cannot nip out for a quick smoke, after all.
St Aubyn’s real medical innovation is the intensive care ward, Larkwood, which contains 10 beds, although referrals have been staggered and only five are currently occupied.
“It’s a model that doesn’t really exist in the NHS,” says Melless. The old set-up offered accommodation only to young people with acute mental health problems. Young people in Essex considered in need of intensive mental health care had to be transferred to private sector institutions in Surrey or Birmingham. But now that has changed. Larkwood takes young people considered a risk to themselves or others. Referrals come not just from the North Essex locality but throughout the Eastern region.
“The young people are very disturbed and have been traumatised and abused,” says Melless. “They often have post-traumatic stress disorder, depression or psychosis. Trauma can develop into a psychotic episode.”
Referrals to St Aubyn
They can be referred to St Aubyn from the youth justice system, by police under Section 136 of the Mental Health Act because they are suffering from a mental disorder and are judged to need to be in a place of safety, or by A&E after having taken an overdose, for example.
“We had a young boy the other day admitted from a bordering county who had taken a serious overdose and not told anyone for three days,” says Melless. “Lots of young people do sadly overdose. In Essex, we see five overdoses a week across three general hospitals.”
One group that St Aubyn is hoping to reach is young people with mental health problems in young offender institutions. “Even though they had mental health problems they would end up going to young offender institutions, whereas they may be better placed here having their mental health needs met,” says Melless.
It is estimated that 95 per cent of imprisoned young offenders have a mental disorder.
Despite the quiet atmosphere evident at the centre, violence does erupt. “We’ve had a difficult week,” says Melless on the day we meet. There have been two assaults on staff by young patients.
But St Aubyn’s main purpose is therapy, not restraining patients who from time to time, to use the mental health jargon, “act out”.
“A lot of mental health units have nurses and unqualified staff to contain people,” says Melless. St Aubyn is not like that. Staff greatly outnumber patients, by a ratio of about four to one, and those staff are therapists from a variety of disciplines.
There are nurses, social workers, two psychologists, a psychotherapist, a family therapist, two consultant psychiatrists, a cognitive analytic therapist, two occupational therapists and the teachers.
St Aubyn practices a new therapeutic model known as the collaborative multi-modal approach. All patients are placed on six-week programmes and see a therapist every day. “It’s very intense,” says Melless. “What we are aiming for is that somebody is in hospital for the briefest period possible and then returns to their family and community rather than being institutionalised for a long time.”
Like the Big Brother TV programme, whose surroundings it resembles, St Aubyn tries to evict its tenants after short stays.
Lisa, who is now 17, and has been in treatment for the past six years for her eating disorder and suicide issues. She says her condition has “massively” affected her and “took over” her life. She was at the former unit and was a patient at a specialist eating disorder unit for five months before being transferred to St Aubyn. “It’s more structured,” she says of her current abode.
“I prefer it here because it’s generalised rather than being focused on one thing. They [the eating disorder unit] didn’t know much about self-harm and suicide and things like that.”
Young people have been closely involved in determining the look of St Aubyn and its methods of treatment. A group of young consultants decided on the colour scheme for the walls and furnishings and worked with First Site, a Colchester art gallery, in selecting art works.
A young person’s forum meets weekly and has designed the summer programme, activities that take place during the six weeks of the school summer holidays. There are self-care, film and reading groups. Young residents are taken out by staff for swimming, shopping or going to the cinema.
Independent living
One of the major activities is cooking. On many days young people are given a budget and have to prepare a shopping list, go to the shops to buy the ingredients and then prepare the meal. Two occupational therapists help out. It seems popular. “Some nights we cook our own food with staff,” says 17-year-old Alice.
“I don’t like hospital food”. But it also has a practical purpose. Although St Aubyn admits young people from the ages of 11 to 18, the most common age range is 15 to 17.
“We do a lot of social skills work in terms of promoting their independence because we work with a lot of young people who are 17 and don’t return home,” says Melless. “They go on to independent living because it’s not safe to return home.”
St Aubyn is only three months into its existence, so it is far too early for firm judgments to be made. When they are made, they will not be based on St Aubyn’s popularity. Despite the plethora of conditions that the centre treats – from anxiety, depression and eating disorders to drug-induced psychosis – the aim is not the for the inpatient setting to be the preferred location of treatment.
Melless is clear that her ambition is to reduce the frequency of admissions, and for young people not to be taken out of their home unless strictly necessary. The very pleasantness of the surroundings at St Aubyn is intended to speed the recovery of the very few young people who need to rely on it.
THE ST AUBYN APPROACH
The method of treatment developed by St Aubyn is known as the collaborative multi-modal approach (CMA). The approach has been devised by consultant clinical psychologist Dr Kevin Beardsworth and therapist Matthew Ganda.
Both work for the North Essex Partnership NHS Foundation Trust. Under CMA, patients are placed on one of six “care pathways”. The pathways are emotional externalising; emotional internalising; neuro-developmental; psychosis; eating disorder; and forensic (for young people who are a danger to others).
Treatment, encompassing individual and group therapy, occupational and creative therapies and relaxation and recreation, lasts initially for six weeks. Then the young person may leave St Aubyn, and be given over to the care of the Trust’s “crisis team”, or undergo another round of treatment.
“We are hoping to publish a paper setting out the theory and practice to share with other inpatient units,” says St Aubyn’s operational manager, Lizzy Melless.
