Loads more practical ideas for

improving the daily experiences

and treatment outcomes of
mental health inpatients
INSIDE
Hundreds of new ideas from members for making the
most of inpatients time
Thirty pages of features on mutual support, medication,
safety, ward design and much more!
Reports and experiences from wards throughout the UK
How you can become part of Star Wards

Join Star Wards!

Star Wards is a project which works with Mental Health Trusts to enhance mental health inpatients daily
experiences and treatment outcomes. We discover, celebrate, share, publicise and inspire excellence
in inpatient care and there is plenty of that all round the country. Our members use and adapt our
resources to stimulate and structure therapeutic and enjoyable daily programmes for inpatients in the full
range of wards including elderly, rehab, learning disability and secure.
Over 300 wards have already joined Star Wards. Heres why:
This has been the easiest initiative I have ever had to implement and has been extremely positively
received by patients, staff and visitors alike.
The impact on the wards ranges from reduction in incidents and use of PRN medication to service users
leading groups and activities.
Created a tidal wave effect amongst staff and patients to develop ideas further.
Its what I came into nursing to do.
Better client feedback, increased staff satisfaction, less
aggression and violence, more therapeutic contact.
No management instructions!!!!
Why join?
Here are just a few reasons...
Become a member of a dynamic community of
mental health wards.
Share your best practice and challenges with
other members of the network.
Learn from others best practice and challenges.
Members are eligible for exclusive schemes
including: the Star Awards achievement initiative
for healthcare assistants; the Full Monty Award
for implementing all relevant 75 ideas; arts
projects such as Book Sanctuary and attending
the Star Wards Festival
Receive (and contribute to!) the regular
e-newsletter.
Its free to join!
Interested? For more information, see page 11.

The fabulous Star Wards Full Monty Award. This, stunning object,
six foot high and made of pure kryptonite, is given to wards who
implement all 75 Star Wards core ideas or as many as are
relevant to them. (Actually, its about eight inches high and made
of shiny metal. But its still jolly nice.)
Star WardS
3
Introduction: Ivan Lewis MP ............................................................... 4
Editorial: Marion Janner ...................................................................... 5
Mighty things from small beginnings grow: Paul Rooney ............. 6
Section 1. The story so far... .............................................. 7
Star Wards: the FAQs .......................................................................... 8
Joining Star Wards .......................................................................... 11
Star Wards: at a glance guide ......................................................... 12
Section 2. Features ............................................................ 13
Mutual support: Marion Janner and Steph Beale-Cocks ................ 14
Creating therapeutic acute care environments: Paul Rooney ......... 17
Ensuring the safety of service users, staff and visitors: Colin Dale .. 20
Psychology on the wards the sequel: John Hanna..................... 23
Self-medication: Steph Beale-Cocks and Marion Janner .................. 26
We had a dream: Debi Anns ............................................................ 28
Using humour: Malcolm Rae ............................................................. 29
Section 3. Best practice .................................................... 31
1. Recreation and conversation ........................................................ 32
2. Physical health, activity and well-being ...................................... 40
3. Visitors, volunteers and carers. (And pets) .................................. 44
4. Care planning ................................................................................ 48
5. Talking therapies and self-management ...................................... 50
6. Ward community ........................................................................... 52
7. Patient responsibility .................................................................... 58
Activities list...................................................................................... 60
Contents
Section 4. From the wards ............................................... 63
Arts for health .................................................................................. 64
Stonefeld House .............................................................................. 65
Health of the nation audit .............................................................. 66
Developing Star Wards in Bedfordshire and Luton ....................... 68
Bevan Ward PICU service user activities .................................... 71
Steering Star Wards........................................................................... 72
Community Bridge Building Service ................................................. 74
Star Wards Champions ...................................................................... 75
Star Wards Collaborative ................................................................... 76
Busy Bites: enhancing the experience ............................................ 78
Castle Lodge 24hr Nurse led Unit ................................................... 80
On being faced with a blank piece of paper ......................... 81
Families are fun ................................................................................ 82
Llwyn-y-Groes Psychiatric Unit ......................................................... 83
Creating a real buzz on the wards ................................................. 84
Star Wards at Sandwell ..................................................................... 85
Prepare and share ............................................................................ 86
A Star Ward in the making? ............................................................ 87
Joint therapeutic working ................................................................. 88
Improving access to psychological skills ........................................ 90
Working collaboratively .................................................................... 91
Voluntary work on acute mental health wards .............................. 92
Small changes big difference ....................................................... 93
Creating a Star Ward ........................................................................ 94
User, Carer and Advocate Leadership Programme ........................ 97
Star Wards at Wotton Lawn: 1 year on .......................................... 98
The Acute Care Collaborative ......................................................... 100
Talking Therapy Group ................................................................... 102
Dear Patrick... .................................................................................. 103
Section 5. Extra bits ....................................................... 107
Useful contacts ................................................................................ 108
NAPICU ....................................................................................... 109
Notes and ideas ..................................................................... 110114
Thanks and acknowledgements .................................................. 115
Star Wards 2: The Sequel
Edited by Marion Janner and Nick Page
Star Wards 2: The Sequel
Copyright Bright 2008
Star WardS
+
Introduction
I am delighted to be asked to contribute this
foreword to the Star Wards sequel.
I have read and heard about the Star Wards
initiative on many occasions. Star Wards is
an excellent initiative; its simple, practical and
upbeat. Its different, as its inspiring, rather
than instructional. Its unique, as ward staff
have a strong sense of ownership of the Star
Wards project, resulting in very impressive and
imaginative new therapeutic opportunities for
patients. There is also evidence of a range of
staff revealing and extending their skills and
experiences and talents.
What is commendable has been the
overwhelming response; over 300 wards in 18
months, including some welcome outposts in
New Zealand and Australia. Also noteworthy is
that the initiatives have now been extended to
specialist mental health wards as well as the acute
setting. Star Wards has made immediate and real
impacts on patients and staff, and increased the
motivation of both. An important element of Star
Wards has been the publicising and celebrating
of existing great practice, not just developments
arising from participating in Star Wards. All too
often there is a focus on the negative. Star
Wards provides an effective counterbalance and
showcases the work of so many hard-working,
caring and creative staff.
A further key factor is that Star Wards illustrates
the benefts of effective partnerships. It is well
know that projects can only work effectively if
there is closer collaboration. With the Star Wards
project, collaboration has demonstrated a terrifc
spirit of working together at service level, between
service users and staff, between wards themselves
and nationally with other organisations such as
CSIP/NIMHE, The Royal College of Nursing, MIND
and the Royal College of Psychiatry.
Another notable feature of Star Wards is the
extent of resonance the initiative has with both
staff and patients. This is probably enhanced
because the project was set up by a service
user, who has shown intelligence, enthusiasm
and courage in being openly appreciative of the
support she received as a detained in-patient. She
used her experience as a spur to enhance support
for others.
Star Wards quirky, humorous and personable yet
robust approach is made possible partly thanks to
the generosity of the charitable trusts which fund
Star Wards and make its independence palpable.
In addition, the recent success in securing Section
64 funding from the Department of Health will
also help to support the ongoing development
of the Star Wards initiative.
It seems to me that Star Wards possesses
all the necessary ingredients for further
achievements, namely: ownership, partnership,
a willingness to share positive practice and a
desire to improve the experiences of service
users. I commend the initiative and look
forward to hearing of further successes over
the coming months.
Ivan Lewis MP
Parliamentary Under Secretary of State
Star WardS
5
Editorial
Welcome to Star Wards 2 The Sequel. We could
have written Star Wards 2 before Star Wards 1,
not just to keep up with the strange chronology
of the flms whose name was adapted from ours,
but because so many of the fabulous examples
of great inpatient mental health care have been
in place long before we were set up. Many, many
thanks to all of you who have made Star Wards
2 possible all the authors, everyone who has
invited me to visit wards to see and enjoy their
fabulous services and the colleagues who have
shared resources and ideas. Members generosity,
warmth, creativity and energy in relation to Star
Wards mirrors the qualities of ward staff so
appreciated by patients.
It has been an amazing, exhilarating 18 months
since we launched Star Wards. Weve discovered
so much excellent practice that we havent been
able to ft it all in this publication and are already
planning Star Wards 3. Louis Appleby, enthusiastic
supporter of Star Wards (and also managing to
fnd time to be the Mental Health Tsar) described
Star Wards 1 as a recipe book for doing things
right. Star Wards 2 could be regarded as more of a
travel book. And heres the thing. Discovery hasnt
meant intrepid exploration through the British
psychiatric system. All Ive had to do is hop on a
train with Buddy (and a double chocolate muffn)
and visit wards in action. As regular, or even
irregular, readers of our fortnightly e-newsletter
will know, Im constantly blown away by the quality
of services I visit.
Sometimes its huge things, like transforming
a ward with low morale and high aggression
into one where signifcantly increased safety is
both a result and illustration of the new culture
of constructive patient engagement and staff
satisfaction. Or it may be just a brief, warm
exchange between a patient and nurse, capturing
the mutual respect and trust which characterises
so much inpatient care. Or, sometimes, the
experience of a ward whose enthusiasm for Star
Wards makes ours look half-hearted!
One of the many ways in which inpatient care has
been mistreated (in addition to appalling under-
funding) is in how it is usually portrayed. This was
exemplifed by the illustration on the front cover
of the Mental Health Act Commissions recent
biennial report. They galvanised their collective
post-modern irony and humour, with Psychotopia,
a super-gloomy, gothic horror movie parody of an
institution.
Were a mellow bunch here at Bright, but seriously
dislike the damage thats caused by the relentlessly
unbalanced publicity about inpatient care. All thats
needed is to look at the picture of the fabulous
new Sandwell Park Hospital on page 18-19, and
indeed read any of the hundreds of examples of
great practice in the next few chapters, to see
just how innovative, therapeutic and often even
pleasurable so many services are. In a Guardian
article, David Brindle perfectly captured what has
happened: Star Wards has unleashed a deluge of
creativity, energy and goodwill that was there all
the time in the mental health in-patient system,
but was kept stifed by the sapping negativity that
surrounds it.
I set up Star Wards following my very healing
time as a detained patient at St Anns hospital
in Tottenham, three years ago. Conveniently for
refreshing my professional development (and also
for keeping me alive), I returned to St Anns for
nine days this Easter. Not an impressive voyage
for a travel guide (its 10 minutes down the
road from my home). But it has allowed me to
refect on how even wards facing overwhelming
pressures with underwhelming resources can
succeed in the single most important element
of inpatient care. Equitable, trusting, healthy
relationships between patients and staff and
among patients ourselves.
Yes, warm human relationships. So important.
Almost as important as relationships between
humans and dogs.
Marion Janner
Director, Star Wards
Star WardS

Mighty things from small

beginnings grow Paul Rooney
provide evidence that participation in Star Wards
activities helps create more therapeutic and
interactive inpatient environments that reduce the
potential for disturbance, violence and boredom.
Participation also helps to motivate, recruit and
retain good staff in acute inpatient services.
One of Star Wards most important achievements
is that it is an optimistic counterblast to the
unbalanced, overtly pessimistic and negative
reporting on acute mental health services that has
characterised so much media attention. All of us
involved in acute mental health care are grateful
to Star Wards in redressing this imbalance with
positive media coverage. While there is much that
still needs improving after decades of disinterest
and neglect, Star Wards is a lesson that says
encouraging best practice and getting involved
will achieve better results than criticising from
the sidelines about problems without recognising
progress.
The uptake of Star Wards since its launch has
been phenomenal and its impact a wholly positive
enrichment of the acute care environment and
therapeutic dynamic. The majority of acute wards
have now joined. If your local service is not yet
participating it is missing out! Find out why and do
something about it.
Star Wards would not exist at all without the
vision, dynamism, and courage of its creator and
director, Marion Janner who not only had the
good idea but brought it to life. She with her
colleagues in the associated charity Bright, (and
of course Buddy) has successfully developed
the initiative beyond all expectations. We value
her input to the CSIP Acute Mental Health
Programme and are pleased to have been able
to support the development of Star Wards,
particularly through the active support of Malcolm
Rae. However, a key aspect of this second-stage
Star Wards 2 is we now all need to ensure this
special initiative is sustained and embedded and
that Marion and her colleagues are supported and
resourced to make the next stage of development
as successful as the frst one.
Paul Rooney
Joint National Lead CSIP/NIMHE Acute Care Programme
Who would have thought when Star Wards was
launched in October 2006 that just 18 months
later the majority of acute mental health wards in
the country would be enthusiastically participating,
with a number of other health services keen
to adapt the initiative. Why, when the NHS
is reportedly overburdened with targets and
initiatives, is this so ?
Its because Star Wards, like most really good
ideas, is essentially simple. The initiative is based
on service user insight that recognises, taps into
and spreads the wealth of innovative practice
that occurs in so many local acute mental health
services. Star Wards builds on the realisation
that the same, everyday, practical things that are
important to everyones sense of mental health
and well-being become more, not less important
when someone is admitted to mental health
inpatient services and that to achieve this small
things make a big difference. Things like being
listened to, feeling a part of things, having something
meaningful to do. Star Wards emphasises the
positive, conveying messages of engagement ,
inclusion, involvement, fun and success.
Change has to be owned by those using and
working on acute wards if it is to be delivered
there and the input of all those involved whether
service user, carer, professional or ancillary staff or
volunteer needs to be appreciated..
Key to the enthusiastic uptake of Star Wards is
that it is owned by the staff and service users on
the wards. Star Wards is an acknowledgement
that staff working on acute mental health wards
are allies of positive change who deserve better
recognition of their efforts and achievements
which are too often undervalued or under the
radar of Trust Boards and commissioning bodies
and that failure to recognise these achievements
has negative consequences for both staff and
service users.
Star Wards conveys a message that not only
promotes and reinforces a who but us and yes
we can attitude amongst the local participants
but also what you are doing is important - build
on what you are already doing here, share it and
learn from elsewhere. The results of the website
survey and feedback from the 160 participants
at the Star Wards Momentum Meeting, last July,
Star WardS
7
Section 1. The story
so far...
We start with bringing you up to speed on
the story of Star Wards so far. And speed is
the word: since its launch in October 2006
hundreds of wards have joined as members.
Many more are taking on Star Wards ideas
without joining. (Which given that joining is
free and easy (see p.11) is pretty surprising.
Still good on them for joining in.)
Anyway, this section will bring you up to date
and introduce you to the 75 core ideas that
we published in Star Wards 1.
Heres whats in this bit...
Star Wards: The FAQs ...............................8
What weve done so far, and what were
hoping to do in the future.
Joining Star Wards .................................11
More information on the benefts of
becoming a Star Wards member
Star Wards: At a Glance Guide ..............12
A full-colour guide to the initial 75 ideas.
If youre into tweaking, turning and
transforming, this is the place to start.

...Louis Appleby, the Mental Health Tsar,
has voiced his exasperation at the
relentlessly negative portrayal of
psychiatric care. Publications about it,
he says, are too often another list of
what is wrong.
Hurrah, then, for Star Wards. This
grassroots initiative, set up by the dynamic and
irrepressible Marion Janner, has in just over
a year succeeded in doing more for positive
thinking and self-respect in the acute mental
health sector than any number of offcial
schemes and makeovers that preceded it. The
impact has been extraordinary.
Star Wards set out not with a list of what is
wrong, but of 75 things that are right and could
very simply improve the quality of life in mental
health units. It is things such as keeping a good
stock of board games with no pieces missing.
Units have piled in with their own ideas:
comedy nights, prepare-and-share food events,
even chilli-growing contests. More than 200 of
the countrys 550 psychiatric wards are now
members of the network.
Janner, who cheerfully admits to having been
detained under the Mental Health Act (a
very healing and benefcial time) and to still
attending St Anns hospital in north London
for regular psychotherapy, visits other units and
reports on good practice with all the infectious
enthusiasm of a restaurant reviewer sated by
a Michelin-starred dining experience. A visit
to another amazing hospital, she writes of
Wotton Lawn, in Gloucester. It can be done!
But dont think this is just one persons
achievement. Janner may have been the catalyst,
but Star Wards has unleashed a deluge of
creativity, energy and goodwill that was there
all the time in the mental health in-patient
system, but was kept stifed by the sapping
negativity that surrounds it.
David Brindle is the Guardians public services
editor
Excerpt from Guardian Jan 30th 2008
Star WardS
8
Star Wards: the FAQs
(Fabulously Astute Questions)
Whats happened in the 18 months since SW
was launched?
Its really taken off! We were hoping that at least
30 wards would pilot some of the ideas during
this period, but in fact over 300 are now
members, which is more than half the wards in
the country! Not forgetting our distant cousins
in Sydney, Tasmania and Holland. A particularly
exciting development early on was that South
Staffs immediately decided to introduce Star
Wards across all its mental health wards, not just
acute admission. We now have members ranging
from learning disability wards to the special
hospitals.
South Staffs initiative pretty much exemplifes
both what our members fnd attractive about
Star Wards and why its making such a difference.
Wards are able to fully harness staff s amazing
creativity and skills to make changes which really
work for their particular circumstances and
patients. The crucial factor is that we collect and
share ideas rather than impose standards. This
gives wards complete, motivating freedom to
use their own ingenuity and wisdom to make the
most of the ideas and resources.
While Star Wards is characterised by informality
and we hoped that wards would try out quite a
few ideas, in practice most member wards and
trusts have set up Star Wards steering groups,
carried out benchmarking exercises and have
action plans for implementing all 75 ideas relevant
to them! The frst hospital to win the Star Wards
Full Monty Award for having all the relevant 75
ideas in place was Huntercombe Roehampton.
Huntercombe is a (very impressive) independent
hospital, but at least three NHS hospitals are now
also lined up to receive the glamorous Full Monty
star statuette.
The area that is slowest to develop is
psychotherapy. This is predictable but regrettable
as it is completely unacceptable that for most
inpatients, medication is the main psychiatric
treatment provided. It is, however, the only group
of our 75 ideas which has considerable cost,
personnel, training and time implications, and
we appreciate that the priority is for wards to
build up further momentum in more general
constructive engagement of patients.
Why do members join when they can simply
download everything from your website?
When wards join they get many additional
benefts, such as:
a fortnightly best practice e-newsletter
being able to contact other wards who
have similar (or even very contrasting)
experiences, successes and challenges
networking events, especially our annual
members event, like the fun-flled Festival.
Theres now a lot happening with tackling
the stigma and discrimination faced by
mentally ill people. Are you contributing to this
development?
Were very exercised by the additional stigma
of psychiatric hospitalisation. We feel that the
single most important factor in combating this is
the deeply heartening improvement in services
that is now so evident around the country. But
wards achieving this is very different to the
public knowing about it. Its nice for our egos, and
good for Buddys modelling career, to get media
coverage for Star Wards. But mainly we see this as

From the Mental Health Act Commission

Biennial Report:
We welcome initiatives such as Star
Wards, which promulgate solutions to the
problems of patient care that we have
highlighted in our reports. Star Wards
has been developed by Marion Janner, a
service user with experience of detention
under the Act that she describes in her
report as unusual in its positive aspects,
largely due to the care of two nurses who
were approachable, concerned and good
company, patient and non-judgmental
Recommendation 6: All acute inpatient
mental health service managers should be
familiar with the Star Wards initiative and
the Sainsbury Centre report The Search
for Acute Solutions, and should consider
their proposals for improving patients
experience in hospital.
Star WardS
9
a vital element in improving sector, government,
service user, carer and public recognition of
the excellence of so much current inpatient
practice. We regularly have articles in the mental
health press including a bi-monthly 4 page Star
Wards supplement in Mental Health Today, and
sometimes in the national media. Radio 4s All
in the Mind programme broadcast a fantastic
piece about Sandwell Park Hospital in Hartlepool,
including some very affrming comments from
patients eg Its more of a spa than an institution.
We regularly give presentations at conferences,
mainly about Star Wards but sometimes straying
into issues such as the smoking ban (a very bad
thing) and safety on wards (a very good thing.)
OK. So what are you planning for the next year?
Lots. Lots and lots and lots. Loads.
Care to give a little more detail?
Oh, OK. Here you go...
Star Wards Festival
We had our frst national members conference
in July 2007 our Momentum Meeting. This
was a highly inspirational day full of examples of
outstanding practice on inpatient wards. Were
very grateful to Malcolm Rae whose idea it was
and to South Staffordshire and Shropshire who
generously and super-effciently hosted the event.
(Many thanks to Lisa Agell and colleagues.)
It was obviously a highly strategic decision by
Marion to agree to many more people coming
than there was room for, and in no way a sign of
disorganisation or under-assertiveness. The venue
holds 140 people and we had 160. This strategy
of modelling the impact of over-occupancy was
highly successful; and the shortage of seating
resulted in only one person fainting. Backwards.
Out of the fre exit into the garden. Oops.
Completely unreasonably, and still subject to
complex litigation in the European court, Marion
has been relieved of the task of allocating places
for this years event.
The 2008 gig needs to be in a much bigger venue,
not just because of some rather, over-protective
views about people fainting backwards through
fre exits, but because we are likely to have over
350 members by September. Were such a groovy
crowd (some of us have met people who have
visited the American state right next to the one
where Woodstock took place) that were planning
a Festival rather than a conference. Being held in
the funky Arts Depot in Finchley (sic), its going to
be like Glastonbury, but without the mud or drugs.
And indoors.
TalkWell
In partnership with the College of Occupational
Therapists, were producing a resource for
healthcare assistants on therapeutic conversation
underpinned by some of the techniques of
mentalising. Mentalising is a surprisingly
helpful, unique term for the fundamental
psychotherapeutic (and human!) practice of being
aware of whats going on in our own and in other
peoples minds. TalkWell will provide practical ideas
for starting, sustaining and ending conversations,
and information about managing particularly
diffcult conversations, eg with patients who are
experiencing psychosis.
Star Awards
This will be a relaxed but highly validating
achievement (not accreditation) scheme for
healthcare assistants, with three levels of awards.
Following consultation with staff, including
healthcare assistants, and service users, we will
set out eligibility criteria for each level. Ward
The frst
Star Wards
Momentum
Meeting, held
in Stafford,
summer 2007
Star WardS
10
managers themselves will decide on the Awards
for their own staff, and give certifcates which well
produce.
London Bridges
The London Development Centre (part of the
Care Services Improvement Partnership) has
funded us to run a short-term project to fnd out
how we can adapt our approach and resources
to better meet the needs of London wards who
currently dont feel able to take part in Star
Wards.
Where do you get your money from?
Weve been amazingly fortunate to have our
main fnancial support from progressive charitable
foundations. This has enabled us to have both the
fexibility and the independence for our work to
be informed by the available evidence base (e.g.
from social marketing) but also risk experimenting
with quirky, innovative approaches.
Conversely, we feel its essential that the
Department of Health, directly and through
NIMHE/CSIP, continue to contribute to the costs
and practicalities of a project which so clearly
helps them towards their goal of more actively
therapeutic inpatient care. For example, it has
been invaluable having the enthusiastic support
of NIMHEs regional acute care leads whose
substantial contributions include arranging for
copies of our publications to arrive on the desk of
every ward manager in the country.
Running one of the best hospitals in the country
hasnt prevented Wotton Lawns modern (and
modest and magnifcent) matron, Alan Metherall
from setting up a fund-raising and promotional
initiative for Star Wards. Nothing simple like a
sponsored paper-work shredding exercise, but a
Lands End to John OGroats cycle ride.
All of which means that this is a good place to
acknowledge the contributions of:
Allen Metherall and team at Wotton
Lawn Hospital
Allen Lane Foundation
Comic Relief
Department of Health
Department of Health Section 64
Esme Fairbairn Foundation
Goldsmiths Charity

John Ellerman Foundation

LankellyChase Foundation
London Development Centre
NIMHE/CSIP
We cant help noticing that were not doing a
great job of getting support from organisations
whose names begin with second half of
the alphabet. Lucky were not a charity for
radiographers, Swiss mountain singers or wild
animals.
Is it right that members create as many Star
Wards resources as you do?
Do you mean right as in correct? Or right as in
appropriate?
Both.
Oh, well, in that case, its right in both senses! The
wards are the ones with the expertise and also
the detailed knowledge of what they need. But its
still amazing how much time and ingenuity wards
are willing to invest to produce new resources.
Its also very impressive how generous wards
are about freely sharing their creations with all
the other members and how unprecious, indeed
enthusiastic, they are about others adapting and
then sharing these. Members have, for example,
initiated and produced Star Wards:
benchmarking tools (about 7 trusts have
made or adapted and shared these)
activities training manual (Huntercombe
Hospital, Roehampton)
promotional and training DVD
(Northamptonshire Mental Health Trust)
newsletters
features for their trust websites
Is that it?
Pretty much. But Ill squeeze in another couple of
great developments, happily both from my local
trust Barnet, Enfeld and Haringey. The Barnet
part of the trust has appointed the countrys frst
Star Wards co-ordinator, a fabulous OT, Suzanne
Clinton-Davis. And their dynamic and super-lovely
head of clinical effectiveness, Sylvia Barry, is setting
up a Star Wards collaborative, which she describes
on page 76.

Star WardS
11
Over 300 wards have already joined Star Wards.
Heres why:
Staff on Regency ward have enthusiastically
and creatively been implementing Star Wards.
The results have included better client feedback,
increased staff satisfaction, less aggression and
violence and more therapeutic contact.
Nicky Lambert, Clinical Development Nurse
Why its good for members
Its free, fun and effective. Members :
love taking part!
experience morale-boosting quick wins in
ward changes which they introduce
are part of a dynamic group of acute wards,
sharing best practice ideas and information
resources
get inspiring examples of great practice
through regular e-newsletters
take part in stimulating regional and national
events
are eligible for exclusive schemes including:
the Star Awards achievement initiative for
healthcare assistants; the Full Monty Award
for implementing all relevant 75 ideas; arts
projects such as Book Sanctuary
Why its good for wards
Wards have found that being members of Star
Wards has meant:
happier, more fulflled and energised staff
patients are less frustrated, more involved in
their treatment and recovery, and enjoying
better relationships with staff and each other
carers are appreciative of their relatives
mental health treatment and daily activities
safer experiences for all 50% of pilot sites
had a reduction in violence
What members need to do
All thats needed is a commitment to:
trying out some of the 75 ideas
sharing your own best practice examples,
and challenges with other members of the
Star Wards community
keeping us up-to-date with your progress
1.
2.
3.
4.
5.
6.
1.
2.
3.
4.
1.
2.
3.
Other than that there are no requirements from
us. Most members have found it benefcial to
carry out a baseline measurement with patients
and carers and then measure regular progress. This
sounds rather heavy-duty but has invariably been
found to be a really morale-boosting exercise
for staff, as it shows how much good practice is
already taking place. Members have created some
great benchmarking tools, all available from our
website (www.starwards.org.uk).
What it costs
Nothing. Nada. Zilch. Zero. Nowt. (Are you getting
this yet?) Star Wards is mainly funded by charitable
trusts and were incredibly appreciative of their
support. But what it means for you is that its free.
Gratis. Costless. (Thats enough, now Ed.)
Starting up
Most members start by setting up a Star Wards
steering group, with nursing and other staff
(including from the domestic and catering teams)
and service users. And most have chosen to carry
out a benchmarking exercise.
In terms of which of the 75 ideas to try out frst
(see p.12), our advice would be to go for some
small changes at frst, as this is a great way of
making a real difference and raising team spirits.
Management support
Technically, no management support is needed,
although outright opposition would be tricky.
(But seriously improbable as theres nothing to
lose by joining Star Wards.) Almost all members
have found that managers at all levels are deeply
enthusiastic about Star Wards as it makes such an
impact on patients and staff experiences. It seems
that the key members of staff whose support to
ward managers helps implement Star Wards are
nurse consultants and modern matrons.
And its free.
Or have we mentioned that already?
To join, go to: www.starwards.org.uk
Joining Star Wards
your questions answered
Star WardS
12
Section 2. Features
In this section weve put together some, well, features actually.
(The clue was in the title.) Contributors include not only expert
practitioners, but also service-users.
Heres whats coming up...
Mutual support ......................................................................... 14
The importance of support and encouragement from those
around you. Marion Janner and Steph Beale-Cocks refect on
their experience as service-users.
Creating therapeutic acute care environments ...................... 17
Paul Rooney looks at how we can learn from hotels, rather than
hospitals.
Ensuring the safety of service users, staff and visitors ........ 20
Colin Dale explores the need to balance safety, autonomy and
liberty, while still ensuring a therapeutic rather than custodial
culture.
Psychology on the wards; the sequel ..................................... 23
John Hanna looks back at his article in Star Wards 1 and
refects on the changes in psychology service provision to acute
wards.
Self-medication ......................................................................... 26
Queuing for medication remains one of the biggest issues in
mental health care. Marion Janner and Steph Beale-Cocks talk
about their diffculties, while a case study from Castle Lodge
provides an entirely self-managed medication.
Using humour ........................................................................... 29
This bloke walks into a locked ward... Malcolm Rae explores
the role of humour in a therapeutic environment.

Star WardS
1+
Mutual support
Marion Janner
When I was doing a stint at The Priory, I met
someone clever, funny, multi-talented, great
company. She more than made up for the absence
of A or even J list celebrities that were presumably
the main reason why BUPA paid so many
thousands of pounds a week to have me there.
There are similarities between being in any 24/7
set-up, whether its summer camp or a psychiatric
hospital, and intensity of relationships is of course
one of these. Theres only so much boundary
maintenance thats possible when people see
you in your Spongebob Squarepants pyjamas, or
having a nurse clamped to your side day and night.
Steph (see p.15) converted my frst hospitalisation
from being undilutedly miserable to a month
with unexpected fun and the start of a deep
friendship. In some ways it diminishes the sheer
normality of our Priory relationship to couch
it in terms of mutual support, but it certainly
included that and has made me fairly evangelical
about the importance of inpatient mutual
support. The evidence base for this is suffciently
if not extensively documented (and Ive cobbled
together an A-Z list on p.16). Most of the research
is based on established self-help groups rather
than a motley group of inpatients sharing coping
strategies, horror stories, tales of heroic staff, fags,
CDs and deodorant. But the benefts are the
same.
Of course, there are also considerable demands
within mutually supportive relationships. Perhaps
the most diffcult is coping with the other persons
pain, especially at a time when we ourselves
have low levels of emotional immunity. This can
be compounded by the lack or permeability of
boundaries. Issues of confdentiality and assessing
the accuracy of information shared can also be
tricky. But these are simply heightened versions of
features of all friendships, and in these internet-
informed times, assessing the relevance and
credibility of information is something that were
getting pretty good at.
Things will go wrong, as they do with all treatment
and relationships. A minority of very vulnerable
patients will be exploited. Theres a recognised,
very damaging phenomenon among some
patients with eating disorders where support can
mutate into starvation competitiveness, including
on a collective basis.
Nevertheless, the risks are small compared to the
gains, and can usually be mediated by skilled staff.
Wards can, and should, nurture patient mutual
support, however this may feel like contriving
what is in many ways a spontaneous, individualised
process. My strongest experience of a service
actively cultivating reciprocal, warm, potentially
post-hospital relationships between patients
was when I gatecrashed The Priorys Addiction
Treatment Programme (ATP) for a week.
(As someone who was there for a perceived
addiction to self-harming, the hippest experience
of my life was going to a Cocaine Anonymous
meeting.) The ATP is based on 12 Step
practices e.g. abstinence, higher power, accepting
powerlessness etc, all of which I regard as highly
problematic, but the mutual support component
is excellent. The ways in which they develop this
on the ATP are through:
Group activities, whether addiction-focused
or treatments such as drama therapy.
Facilitating the painful process of patients
being very open about their addictions and
the impact on their lives and other peoples
Continuous physical proximity. The ATP
programme takes place in a separate part of
the hospital, complete with bedrooms and
lounge, and group members eat together on
one long table in the dining room.
This proximity reinforces group identity, as
do various 12 Step rituals such as saying the
AA mantra after each meeting.
Buddying people up. This really helped me
when I frst joined the group, and having
contact details and commitments from
at least two other people seemed to be
regarded as the single most important factor
in helping people stay drink/drug-free when
back home.
Making the need explicit. For example,
among the people coming to give us a talk,
a former patient gave a harrowing statistic
about the very high rate of death among
ex-patients who reverted to their addiction.
The need for mutual support, from group
members and also through 100 [AA or
equivalent] meetings in 100 days became
that much more compelling after this.
1.
2.
3.
4.
5.
6.
Star WardS
15
There is a special connection between people
who are all lost; they are all searching for an
answer to their problems. Unfortunately, there
rarely is just one answer; there is, instead, a series
of little steps forward until you suddenly realise
your feet are back on frm ground.
In hospital these steps are hard to take, but having
someone you know is going through the same hell
by your side, gives you the confdence to be that
bit braver, that bit stronger. When I was on an acute
ward I found it overwhelming at frst. I had real
trust issues and was angry to be there. It took me a
long time to realise the staff were on my side and
to open up to them. To reach that point I talked to
those I knew were hurting too: my fellow patients.
At frst it was just the odd smile and nod of the
head, but after a while I was making group cups
of coffee I could even tell who had one sugar
or two! We had a room we would all gather in;
yes, it was the smoking room, but it was a great
atmosphere through the thick yellow fog! Whenever
I felt particularly alone or afraid I would wander in
there and sit down. Almost immediately another
resident would leap up and say, Hey Steph... black
coffee, no sugar, not too strong. Conversations
would start and we would go on to discuss all sorts
of things, such as our visits, or who was going to OT.
Often we would talk about our feelings, our hopes,
our fears, our collective wish to recover.
This is something just as important as staff input.
The ability to have a collective voice and a
collective strength made up of the people who
can relate better than anyone else. The staff are
so valuable but somehow it is different when
a patient gives you a hug and says this will get
better. I think it is because they know. They are
experiencing the pain. And if they can have faith in
you then you can have faith in yourself.
We would discuss about going out, we would
each voice our opinion something that is so,
so vital. To have the space, with people who you
feel comfortable around, to express an opinion,
to assert yourself, eventually leads you down the
path of being able to do so on the outside. It is
one of the frst steps. If one of us was particularly
upset we would know how best to help. We
spent twenty four seven together and could tell
what to say and what not to. We are all individuals
and it is crucial to remember that. A hug for one
person would be
another persons
worst nightmare;
thats something that
patients can pick up
on very quickly, partly
from their own
understanding of
mental ill health and
partly because we
spent so much time
together.
We began to learn one anothers routines, we
could spot when someone was in trouble, we
could gently lead them towards the staff when
they didnt have the strength to do so themselves.
We didnt have shifts; we were the constants.
Continuity of care is personally extremely
important. When all else in your life is spinning
around like a whirligig, a stable group keeps you
grounded. You feel like you have a place, a network,
a purpose. We were all equals. Some patients had
issues around authority fgures and had particular
diffculty in approaching staff for them, we were
that frst step, from which they felt safe enough to
then engage with their keyworkers.
One of the most heart-warming experiences was
seeing someone blossom, grow, become more
confdent, more sure of themselves, until eventually
they were discharged; seeing someone who felt
just like you, achieve what often felt unachievable. I
cant explain the feeling that comes from knowing
someone who has been at rock bottom is now
ready to go out and embrace life. It is an immense
emotion which I have never forgotten. Fellow
patients I thought I would never see smile, I saw
laughing as they said their farewells. The hope it
gave the group as a whole was stunning. We would
all take one step closer to realising that there was
a future for us. We would all talk about what we
had to go back to or what we needed to put in
place. We would get feedback from one another
about what support could be set up and the
whole idea of life outside became more tangible,
less daunting and all together more precious.
The three musketeers say all for one and one for
all. I think they have it spot on!
Steph Beale-Cocks
stephi@bealoid.co.uk
We could spot when someone was in trouble...
we didnt have shifts; we were the constants.
Star WardS
1
Mutual support: why it matters
It would be slightly more glamorous to dedicate a bestselling novel to Steph, but in the meantime, Id like to
dedicate this list of why mutual support is so valuable to inpatients.
Acceptance
Advice
Advocacy
Sense of belonging and group identity
Personal change
Confdence and self-esteem
Flexibility of contact e.g. time and place
Coping strategies
Cost
Empathy
Equality of power and status
Friendship
Removes sense of guilt in burdening friends who dont have this experience or need
Honesty
Hope
Improved identity
Sense of infuence on others in group and professionals or organisations
Reduced isolation
Increased knowledge
Men can be more self-disclosing and vulnerable than gender stereotyping or conditioning can allow
Monitoring progress and set-backs
Non-hierarchical reduces sense of inferiority and disempowerment
Non-judgmental
Normalises what is seen to be pathological or at least unusual
On-going
Improves ability to beneft from, rather than replaces, professional help
Range of experiences, views and coping strategies
Reciprocity
Recommendations for local services
Reduces stigma
Role models
Self-effcacy feel effective, skilled, valued, appreciated by helping
someone else
Skills
Support
Trust
Feeling understood
Everyone valued for their contributions
Voluntary

References
Bright, J.I., Baker, K.D., & Neimeyer,
R.A. (1999). Professional and
paraprofessional group treatments for
depression: a comparison of cognitive-
behavioral and mutual support
interventions. Journal of Consulting
and Clinical Psychology, 67(4), 491-
501.
For a summary of outcome of
research studies of self-help mutual
help groups, go here: http://www.
spring.org.uk/2007/08/effectiveness-of-
mutual-support-groups.php
Star WardS
17
Creating therapeutic acute care
environments Paul Rooney
When I was asked to write a piece on what
is important in designing good acute care
environments for mental health services, I started
by listing some of the traditional key components;
the ward, day unit, team base, etc. But, despite
the need to re-defne what we mean by such
terms as the ward, in a twenty-frst century
service, I felt there was something missing with
this approach. I realised that, rather than starting
with what is needed for those who are mentally
unwell, we need to start with and keep to the
forefront of planning those things which would
be key requirements for any of us, if we had to
stay away from home.
Most of us have a pretty clear idea of the essential
requirements, because we stay in hotels! Thinking
about the key attributes of a good hotel is a good
starting point to designing and facilitating a good
psychiatric unit. These include:
Being easy to get to
A welcoming and informative reception
Feeling my possessions and I are safe and
secure
Being warm, clean and bright
Respect for my privacy and dignity
An uninterrupted nights sleep
My own bedroom with decent
bathroom /shower
Food and drink availability
Friendly and attentive staff
There are, of course, some key differences
between a hotel and an acute mental health unit.
Acute mental health buildings need to be both
containing and therapeutic. You are not confned
to the hotel, nor do you feel stigmatised by
having stayed in a hotel. But these are not reasons
why any of the above should be compromised.
Indeed they make paying close attention to these
aspects more not less important. Yet somehow,
despite investing more than is usually spent on the
equivalent sized hotel we, too often, fail to achieve
or protect these crucial elements in a number
of our psychiatric units. In part this is because
we sometimes let other considerations override
these basic essentials either at the commissioning
stage or when the building is in use.
The CSIP National Acute Care Programme is
currently working with Department of Health

Estates and Facilities to produce new guidance

on the planning and commissioning of new acute
mental health services and accommodation. A
workbook to inform and assist local services
Laying The Foundations will be published later this
spring. This work has highlighted that, in addition
to good hotel features, issues of social inclusion,
engagement and integrated working are key to
effective service delivery and that we need to
be designing or re-organising our mental health
buildings to enhance these aspects.
Social inclusion and stigma
Our buildings are the biggest and most powerful
advertising hoardings we have to convey
positive (or reinforce negative) messages about
mental health. It is when people are admitted
as inpatients that their social inclusion (jobs,
tenancies, education.) can be most at risk. More
attention needs to be given to design and service
arrangements that actively assist inclusion and
community engagement and to address rather
than avoid issues of nimbyism. Developments
should be used as a positive catalyst for engaging
the local community and addressing stigma.
Mental health units need to be outward looking
and be designed to consciously build positive
working relationships with the community served.
Build for practical partnership working. Invite the
community in. Your local community are also your
customers and potential allies.
The redevelopment of many of the large old
mental illness hospital sites gives a useful insight
into the ill-informed nature of most objections to
nearly all proposals to site mental health facilities
in local communities. When the mental health
facilities are there frst, there is no shortage of
developers wanting to acquire adjoining sites for
housing and no shortage of buyers for the houses.
If the housing was there frst, the same people
would object to the mental health development.
Engagement
As Star Wards has so successfully championed,
acute inpatient provision needs to be designed
to maximise the opportunity for therapeutic
engagement and to protect service users support
networks and community connections. Boredom
and lack of anything to do is an oft-cited
complaint about inpatient care by service users;
the consequences of which include untoward
incidents and impeded recovery. Adult acute
inpatient units need to include multi-purpose
large and small group activity spaces that can
accommodate a varied timetable of therapeutic
and recreational activities, including evenings and
weekend activities with opportunities for activities
to take place both on and off the ward. Particular
attention needs to be paid to ensuring good
access to and the design of gardens and outdoor
spaces.
In addition to the implications for size and
location of services, providing accommodation for
evening and weekend activities and encouraging
community in-reach suggests a need to rethink
such traditional acute unit accommodation as
the day hospital and the occupational therapy
department towards development of more
fexible activity provision that can be a catalyst
for community use and partnerships. I would
favour the provision of an activity centre (readily
accessible from the ward) that operates in the day,
in the evenings and at weekends. With sensible
scheduling of key staff such as OTs , alliances
can usefully be developed with local community
organisations to help provide activities at these
out of offce hours times. Such arrangements
would reduce the potential for untoward incidents
and provide stepping stones for service user
reintegration when discharged from acute care
Integrated working
In the same way that it is important to ensure
the mental health unit is not isolated from the
community it serves, it is important that inpatient
services are not detached from the rest of the
mental health system. Where this happens it
amounts to a sort of system exclusion based on
outmoded notions that fail to recognise that the
inpatient unit is as much an integral part of any
modern mental health service as the new range
of community services.
Particular attention needs to be paid to the
interdependency of acute inpatient and crisis
resolution home treatment services (CRHT)
to ensure continuity of care, admissions are
appropriate, discharges are not delayed and
care planning is fully informed. As the recent
National Audit Offce report on The Role of
Crisis Resolution Home Treatment Services
recommends there is a need to maximise
effective collaboration and communication
between inpatient services and CRHT service
and that this is best facilitated by co-locating
these services together on the same site where
possible. Within existing services consideration
should be given to how closely integrated
working between CRHT and inpatient services
might be enhanced by co-location.
Reviewing your provision
Ask yourself (or your Acute Care Forum) are
we using our facilities to best effect? Are current
building use arrangements primarily driven by staff
or service user/carer concerns? When did we
last review them together? How could they be
improved?
While well designed and spacious buildings play a
key part in facilitating a therapeutic environment,
buildings are tools that in the end depend on
the skills, attitudes and operational arrangements
of those using them. To get the best from our
buildings we need skilled staff, involvement of all
the stakeholders and constant review that these
tools are being put to best use in changing
times.
When reviewing the use of your existing
accommodation, or developing a brief for
new accommodation, it is very important
to spend enough time getting it right and
gaining ownership by all those who will
use and infuence the use of the building
- service users, carers, clinical and ancillary
staff, neighbours and local community
organisations. In many instances design briefs
are strong on generalities such as the need
for a domestic, therapeutic milieu without
any explanation about how this is going to be
achieved in practice. There is a need to focus
Patients room with
en-suite bathroom:
Sandwell Park,
Hartlepool.
Star WardS
19
on how the buildings are really going to be used.
This can be assisted by stakeholders analysing
some of the key events to see how current
arrangements might be improved such as:
An admission - from leaving home to
admission to the ward
A day on the ward - including evenings
and weekends
Routines such as meal times, dispensing
medication and ward rounds
Discharge home and follow up
Inter team working and communication
arrangements
And here is one made earlier.
As Star Wards has highlighted, contrary to
popular misconception, there is a lot of excellent
practice and some very good acute care
environments being developed. Common features
of some of the best of the new units (such as
those in Lowestoft, Worthing and Hartlepool)
seem to include that they are small, local and have
well integrated service arrangements.
Tees, Esk and Wear Valleys NHS Trusts Sandwell
Park unit in Hartlepool has rightly been a Star
Wards best practice exemplar. One of the key
lessons to be learnt from this service is not just
the fnished product but the process undertaken
to create it. It is an outstanding example of how
high levels of involvement help develop meaning
in and ownership of a building by those who
use it. Workshops were held with a wide range

of staff, service users and carers to contribute

to the design process and directly infuence the
proposed new facilities. One of these workshops
identifed a Top 10 aspirations for the new unit.
These were
Multi-functional rooms/availability
Flexibility of recreation rooms and choice of
activities
Single-sex, en-suite bedrooms
More use of natural light
Better garden areas
Artwork including space to exhibit user/carer
works
Information areas
Good access and secure parking
Clear welcoming reception area
Caf area /24 hr beverage availability.
As suggested at the beginning of this piece, not
that different from the equivalent key features for
a hotel!
Paul Rooney
Joint National Lead CSIP/NIMHE Acute Care Programme
prooney51@blueyonder.co.uk
1.
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10.
The entrance to
Sandwell Park Unt
in Hartlepool
Star WardS
20
In the middle of the 19th Century, Florence
Nightingale said, It may seem a strange principle
to enunciate as a frst requirement in a hospital,
that it should do the sick no harm. One and a
half centuries later it is diffcult to escape the
fact that health services established to alleviate
health-related problems can fail to keep people
safe during the period of treatment. Acute care
staff face the complex task of managing acutely
ill individuals at a critical stage in their lives when
they are most vulnerable and in need of help.
Symptom severity, risk to themselves and others,
unclear diagnosis and deterioration in their mental
state and capacity to reason and make judgements
are all likely features in their presentation.
Adherence to treatment or compliance to the
ward care regimes, routines and expectations
may be inconsistent. Also services continue to
receive concerns expressed by coroners and
distressed relatives who highlight what they see
as shortcomings in systems and procedures in
ensuring the safety of seriously at risk people.
Striking a balance between safety and maintaining
autonomy and liberty and ensuring a therapeutic
culture rather than custodial environment is clearly
a major challenge.
The Health Care Commission (HCC) calls for
acute mental health services to be sources of
comfort and help, and states that service users
and staff should experience safety of person,
particularly in inpatient settings. Preservation
and promotion of dignity, safety and safety for all
service users should be a primary consideration.
However, data from MINDs Ward watch in
2005 found that the majority of patients recently
experiencing inpatient care had been involved in
or witnessed a patient safety incident.
Unsafe wards: contributing factors
Boredom and a lack of therapeutic activity has
long been recognised as a side effect of hospital
admission. In one survey 30% of service users
said they werent involved in any therapeutic or
recreational activity at all during their hospital stay.
As well as the nulling effect this has on recovery,
boredom and frustration is a known precursor to
violence.
A number of other factors have been identifed
as contributing to the instability and the sense of
feeling unsafe; I place these issues in no hierarchy:
Staffng
Unflled staff posts; staff absences and the overuse
of bank and agency staff have all been cited as
potential destabilising factors. The absence of
regular staff with the skills to build trust and
understanding is problematic.
Attitudes
Lack of respect and dignity; poor cultural
sensitivity; overuse of containment methods; and
even harassment or assault perpetrated by staff
have been cited as experiences by service users.
Poor or absent ward leadership
The HCC audit identifed lack of senior nursing
staff at ward level and a high percentage of wards
without an identifed consultant psychiatrist
leading the clinical care of the patient.
Increased acuity
One of the effects of the introduction of Home
Treatment Services and Assertive Outreach is
that those admitted to the ward are more acutely
ill; in some areas there is poor or no access to a
Psychiatric Intensive Care Unit (PICU); more units
report a pressure on beds and high throughput.
Poor environment
Ward environments have improved in recent
years. Many examples of high standard new units,
both in the public and independent sector, have
replaced archaic environments. However, relics of
the Victorian era continue to exist with mixed sex
wards, poor surroundings, no access to outside
space, poor observation and unsafe designs.
Substance misuse
The single most common factor associated with
violence is substance misuse. Services have seen
major increases in substance misuse in recent
years for both illicit substances and alcohol.
Self harm
Self-harm can generate a sense of helplessness
amongst staff and it is impossible to control all
access to things that harm.
Ensuring the safety of service users,
staff and visitors Colin Dale
Star WardS
21
Achieving a safe environment
Safety can be achieved in a mental health service
by the means of dynamic and passive measures.
Dynamic safety may be promoted by:
Treatment and care programmes
Good inter-personal relationships
Effective procedures and operations.
Passive safety may be promoted by:
Physical and structural elements
Technological systems.
The degree of safety achieved will rely upon
a combination being made between the
passive safety measures providing a supportive
framework to the dynamic safety measures. All
of these features, however, are interactive and
mutually supportive.
Treatment and care programmes
Studies have repeatedly shown that effective
treatment and care programmes play a signifcant
part in enhancing safety. Key factors include
the level and type of contact between staff and
patients, the ward milieu and how the patients
spend their day (Davis 1992). Within health care
all professions have adopted codes of practice,
which have as their basis, the principles that the
health of the patient will be the frst consideration
and that human dignity will always be respected.
(Dale et al 1999).
The legal rights of patients are protected
by bodies such as the Mental Health Act
Commission but their moral rights seem less
clear. The consent of patients is necessary for the
majority of healthcare interventions (McLean
1989). In mental health care, however, an element
of coercion may be suggested, as patients may
feel compelled to cooperate with treatment
programmes for pragmatic reasons in relation to
the prospect of earlier discharge or transfer from
hospital (Chaloner 1998)
The patients recovery depends on the
maintenance of a safe, calm, therapeutic
environment, and this is only possible if medical
and nursing staff can control violent behaviour.
However, there must be no malice, no ill
treatment or wilful neglect and any force used
must be reasonable in the circumstances (Mental
Health Act Commission 1999).

Good inter-personal relationships

Relational safety is concerned with developing
good interpersonal and sound professional
relationships between the clinical team and the
patients. Building up trust will enable the staff to
get to know and understand their patients, their
moods and problems, to facilitate interventions
before these become major problems, or lead to
incidents of a safety nature (Kinsley 1998).
Effective procedures and
operations
Procedural and operational issues are crucial
in underpinning safety and include dealing with:
emergencies; incidents; searching; patrolling;
escorts and movements; and by training
programmes. Recent studies have shown that
policies, procedures and standards are often not
made known to patients, and that they have little
input into their development.
Physical and structural elements
Inpatient units need to be safe, containing and
therapeutic with proper attention paid to reducing
the risk of service users harming themselves or
others and to overcoming some of the design and
space limitations of past provision. While safety
is not primarily an issue of physical provision,
particular attention needs to be given to:
Provision of circulation space
A sense of space by generous provision of
circulation space (some architects recommend
40% of total foor space) is particularly important
in helping to reduce the potential pressure cooker
atmospheres often associated with inpatient units.
Gender separation
Specifc good practice guidance on the
requirement to achieve effective gender
separation has been produced by the Department
of Health. Key components include individual,
preferably en-suite, bedrooms, separate sleeping
and bathing areas accessed without passing
through mixed areas and women only lounges.
Appropriate zoning of accommodation offers
an alternative to separation on the scale of a
whole ward and may facilitate effective gender
separation in smaller units. In some cultures a
mixed sex environment outside the family is alien
and additional specifc women only provision may
need to be in place to meet the cultural needs
identifed from the catchment areas population.
Star WardS
22
Points of entry to and exit from the
unit and the wards
Careful consideration is needed to achieve
a satisfactory balance between preventing
patients going missing and trespass by outsiders,
while avoiding the creation of too custodial an
environment. Helpful guidance on how best to
achieve this has been produced by Malcolm Rae
and is available on www.virtualward.org.uk. Much
good practice in the provision and management of
restricted yet therapeutic environments has been
developed by Psychiatric Intensive Care Units .
Technological systems
Electronic aids to safety and security have
continued to emerge in recent years and are
now accepted by many as a useful contribution
to mental health services such as: the use of
person-to-person communications; door alarms;
motion detectors and other electronic means of
perimeter awareness; the use of pin-point infra-
red, ultrasonic and radio personal alarms systems;
electronic health records and information systems
(Dix, 2002).
Within the Health Service there is a wide debate
on extending the use of electronic systems such
as CCTV to the direct monitoring of patients
and units, focusing on the confict between
possible opportunities to reduce risk, the privacy
of the individual and the clinical potential of TV
monitored records. However, no clear association
with the use of closed circuit television; the
observation of patients and reduction in violence
and incidents has been conclusively demonstrated
in inpatient services.
The increasingly risk orientated attitude towards
mental health services, with hostile media and
anxious services, makes it diffcult to avoid the
feeling that mental health services will need to use
technology to enhance practice. Dix (2002) states:
While mental health clinicians must remain open
minded and creative with regard to practices, a
high degree of caution is necessary to ensure
that one of the institutions great strengths being
the development of a trusting relationship, based
on the principles of interaction and proximity
with the staff, should not be superseded by the
cold face of technology.
Summary
A safe environment for care should be seen
as a partnership between service users, their
families and staff. What units should strive for
is a balance between the measures available to
ensure that the environment is as least restrictive
as possible whilst offering appropriate levels of
safety and security for all. It is inevitable that some
curtailment of freedom will be a consequence
of safety measures but in contemporary society
it would be undefendable for services to ignore
the potential risks posed in operating an inpatient
service.
Dr. Colin Dale
Chief Executive, Caring Solutions (UK) Ltd
colindale@caringsolutions.fsnet.co.uk
References
Rae. M Review Of Open Doors In Acute Inpatient
Wards http://www.virtualward.org.uk/admission/
admission-process.html
Star WardS
23
Psychology on the wards; the sequel
John Hanna
The NHS is undergoing tremendous change, not
least in the area of acute inpatient mental health
care. Since my contribution to Star Wards 1, much
has happened with regard to psychology service
provision to acute wards thankfully, in the main,
for the better. We have far to go before inpatients
and their carers across the country can be
assured of good quality psychology training and
supervision for all ward staff, and provision of a
specialist psychological intervention service when
needed, but I hope readers will draw confdence
from recent developments in this area.
My original piece highlighted the needs of
service users for improved therapeutic and
psychologically relevant contact from service
providers, and, specifcally in many cases,
sophisticated psychological interventions
provided by appropriately trained and supervised
practitioners. It also indicated the extremely
limited availability of both, as indicated by poor
service user satisfaction as noted in reports by
Mind and the Sainsbury Centre for Mental Health.
Since then, Prof. Len Bowers City 128 report
showed that a mere 17% of acute mental health
wards have a dedicated clinical psychologist. The
Lancet has recently described inpatient access to
psychological therapies in the UK as pitiful. Most
wards participating in reviews by Accreditation for
Acute Inpatient Mental Health Services (AIMS)
have struggled to meet basic standards for access
to psychological services. We (those relatively
few psychologists and psychological therapists
working on wards and serving as members of
the Inpatient Psychological Practitioners Network
[IPPN]) now think we know why and we are
trying to fx it.
Firstly, we must address reticence within our
own professional groups. Psychologists and
psychological therapists have been divided over
whether training and supervising ward staff and
delivering a service to inpatients represents good
value for money, clinically effective outcomes and
a rewarding work opportunity. As a group, we
have had to consider the challenges in adding
cost to an already expensive service area and
in investing ourselves in an area dominated by
other professions with their own traditions of
working. We have debated how best to adapt
clinical best practice guidance, based on therapy
research conducted with relatively more settled
individuals over long treatment episodes, to
more acutely distressed service users taking
part in much briefer inpatient episodes of care.
But we are fnding ways forward. Managers and
commissioners who have employed psychologists
have remarked, across a variety of service
delivery models and employing trusts, on our
facilitation of improved therapeutic contact and
formulation-driven care planning by ward staff,
as well as our contribution to reducing length of
stay and rate of re-admission through provision
of specialist services. Inpatient psychologists now
actively debate, and increasingly converge toward
consensus, on what constitutes best practice with
regard to evidence-derived interventions. Those
of us who work on wards know that, nowadays
at least, the professions which have historically led
acute inpatient services are keen to develop their
skills as psychological therapists, are reassured
to refer on to us in circumstances where we are
most needed and perhaps most crucially invite
us around the table when developing services.
Those who would discourage a psychological
service provision to inpatients and ward staff
groups fnd themselves increasingly in the minority,
especially as services adopt a meaningful recovery
and social inclusion agenda as rightly demanded by
the service user movement.
A second principle reason for a delay in progress
is a lack of national standards specifc to inpatient
psychology. Simply put, where the Department
of Health (DoH) has drawn up guidance for
minimum clinical
psychology staffng
for community
mental health
teams and other
essential services,
there are as yet no
similar prescriptions
for acute wards.
Increasingly, however,
governing bodies
such as the DoH
and the Healthcare
Commission
(HCC), are offering
explicit direction
on psychological
interventions for
inpatients, which will
Dr. John Hanna is a Consultant Clinical
Psychologist with the Camden and Islington
NHS Foundation Trust
Star WardS
2+
of course require further staff development. AIMS
and Star Wards have both infuenced the situation
by maintaining a strong focus on psychological
assessment and formulation, brief psychological
therapies/interventions and, through training,
broad psychological thinking in planning care and
discharge. The IPPN and colleagues from the
Policy Unit of the Division of Clinical Psychology
have been active in working with the HCC to
further develop their review standards and are
currently in contact with the National Institute
for Clinical Excellence (NICE) with a proposal
to develop NICE guidance on psychological and
psychosocial interventions in acute inpatient and
crisis resolution care contexts.
Finally, a third reason hindering us is an historic lack
of clear, workable service models which ensure
consistent delivery of training, supervision and
direct clinical care. We have heard disappointing
stories about how psychologists have been
employed with little guidance or support, perhaps
too early in their careers, and left to fend for
themselves, only to soon move on to more
tried and tested felds of work. It is no wonder,
then, that the vacancies they left behind were
often frozen, or deleted, with funding going back
to the status quo. Within the IPPN, we have
now developed a variety of road-tested service
delivery models which we widely circulate to
managers and service leads who are newly
introducing (or re-introducing) psychology to
their wards. These service models range from
community team psychologists working into their
sector wards, to small teams of psychologists
covering a set of wards within a single hospital,
to individual psychologists providing dedicated
sessions to single wards. Depending on the needs
of the overall inpatient service, psychologists
might be employed primarily to provide direct
care to patients, or consultation, training and/or
supervision to staff, or some combination of
each of these roles. To promote these models
further, we have contributed a chapter to the
New Ways of Working for Applied Psychologists
Working Psychologically in Teams document
and are currently submitting content for the
upcoming Care Service Improvement Partnership
(CSIP) document on acute inpatient workforce
development. In 2008, we plan to complete a
psychology service implementation toolkit (which
we hope to link to the NICE guidance we are
proposing) to assist Mental Health Trusts in
delivering truly multidisciplinary and psychologically
therapeutic care to acute inpatients.
When writing for the frst edition of Star Wards,
I presented a rationale for why acute inpatients
deserve to have clinical psychologists (or otherwise
suitably trained and qualifed psychological
practitioners) involved in both their direct
care and the development of the service they
receive. It seems to me, now, that increasingly few
stakeholders in mental health fail to recognise this
rationale and I am relieved that, through the
efforts of the IPPN, AIMS and Star Wards, Mind
and the Sainsbury Centre, those who remain
resistant or reluctant are fnding themselves
(perhaps shamefully so!) in the minority. More
inpatient psychology posts are being created
every month (I know of a handful that are directly
attributable to AIMS and Star Wards, as wards
participating in AIMS reviews or Star Wards bench-
marking exercises seek to establish congruence
with defnitions of excellence). More professional
leads in psychology are being tasked with
developing strategy for psychological skills training
of inpatient staff, and for comprehensive specialist
psychological service provision for inpatients.
And as ever, the steady drumbeat from the
inpatient service user community calls for deeper
understanding, better coping strategies and more
self-determination and community re-integration. It
is important to remember that clinical psychology
began on inpatient wards, then transferred and
proliferated in the community when the long-stay
wards were closed seeming never to return. But
it appears the return has begun.
Dr. John Hanna
Consultant Clinical Psychologist
Camden and Islington NHS Foundation Trust
John.Hanna@candi.nhs.uk
Star WardS
25
Psychology in practice: Camden and Islington Mental
Health and Social Care Trust
well as concerns about restriction of liberty, choice
and responsibility and social stigma and exclusion.
The group is a good place to fnd answers or
clarifcation, but unlike community meetings rooted
in the here-and-now, Leaving Hospital is pitched
in the near future: what can you do in the coming
days to move towards health and a less restrictive
living environment? Participants discuss various
means by which individuals might improve their
health; their potential to take leave and how to
make the most of leave taken; and what is available
locally to re-develop social networks and secure
meaningful work-related activity. Group members
share strategies to shed self-defeating habits and
infuences and to enhance their self-worth and
potential to contribute to their network and
community. At the end of each session, participants
are encouraged to suggest at least one goal they
will attempt in the coming week, and to offer ideas
and advice to fellow members. Goals such as family
re-connection, registration for college courses and
destruction of drug dealers contact details have all
been realised since the group started nearly three
years ago, with hundreds of individuals passing
through in that time.
Service users have commented that the group
provides a valuable opportunity to think realistically
ahead and to begin to take back responsibility and
control in their lives. Staff members have recognised
co-facilitation as a useful in-vivo training exercise
and all of us involved do our best to make the
discussion safe, practical and, hopefully, fun. We are
now looking at various methodologies of evaluation
(beyond the service user satisfaction views we
collect) so that we can improve what appears to
be a very helpful intervention. All acute inpatient
mental health centres struggle with continuity of
care, discharge planning and social inclusion as areas
of care provision; Leaving Hospital is designed to
provide regular, set-aside time to refect, with both
professional and peer support and expertise, on
moving forward from hospital with purpose and
determination.
In the future, resources and time allowing, we want
to start a sister group, Coming Home. Based in the
community this would welcome ex-inpatients for
up to six months or a year after their discharge. If
anyone has any ideas to contribute either for this
group, or for the development of Leaving Hospital,
please get in touch.
Dr. John Hanna
My work over some three years as a consultant
clinical psychologist at Highgate Mental Health
Centre (Highgate) has involved a variety of
service development projects and psychological
intervention. When my post and that of my junior
colleague were created, Islington inpatients received
something they had not had for years: a specialist
psychology service responding quickly to priority.
Staff also received psychology training in areas such
as basic cognitive behavioural therapy, and working
with self-harming behaviours and post-traumatic
stress. Camden (the other borough covered by
the Care Trust) is rapidly extending its inpatient
psychology posts; only a few wards remain without
service provision. Two general acute wards in
North Camden, alongside the womens ward,
now have a strong level of psychology cover,
with provision of staff consultation and support
as well as group and individual therapy. Inpatient
psychologists across the two boroughs are planning
strategy around service user involvement in
psychology service development.
What I want to illustrate here is psychologys
contribution to discharge planning or as I
would like it called, community re-integration. At
Highgate, all acute inpatient wards have access to a
weekly Leaving Hospital group therapy session, led
by myself and my clinical psychologist colleague,
alongside members of the multidisciplinary staff
team and, on occasion, other service leads as
well as service user consultants from Mind and
other local voluntary sector services. Leaving
Hospital is hosted by a different ward every
month and is open to all inpatients able and ready
to attend. Most participants choose to come
along when they are beginning to feel prepared
to take unescorted leave, but we also welcome
attendance from people who are newly admitted
to the ward, or who are anxious about leaving.
The discussion is free-ranging for the frst half,
with the second half dedicated to establishing a
central, shared concern related to moving on from
the ward. Individual problems are linked, as far as
possible, to a broad area of challenge, which is
explored by the group for potential solutions to
the central concern.
Since both topics and participants vary greatly,
every group differs in both focus and outcome. We
have discussed the role of isolation and absence of
meaning or purposeful direction in the maintenance
and possible onset of mental health diffculty, as
Star WardS
2
Self-medication
I have to be one of the worst people for taking
meds. It doesnt matter what it is I will either
forget, not care, fear it, hide it, take too much, etc.
and for so many different reasons. Even when I
almost lost my foot I still couldnt take antibiotics,
because I absolutely dread them. I had to have the
crisis team come in three times a day to monitor
me, and had to have them in liquid which also
eased my fears. Only recently have I completed
my frst ever course of antibiotics and I am
relatively stable at the moment so this policy is
absolutely essential to get right.
I recently spoke to a charge nurse who said the
biggest difference he ever saw to the positive
sleep hygiene of his patients was when they all
took their night meds at unique times. There is no
point someone taking them only to be woken up
by someone else who wasnt tired. Zopiclone, for
example, has a 10 min effect period where you are
advised to be in the dark, still and silent hard to
do when other patients are bouncing off the walls!
Medicines and tablets are one of the factors of
mental illness that you cannot get away from.
They are not often the cure but can give patients
a much easier time and the stability to work on
their illnesses. Use of medicines was found to be
approximately 98 to 100% for all types of wards
except CAMHS [Child and Adolescent Mental
Health Services] according to the Healthcare
Commission. It is therefore something that is
essential to get right. The Healthcare Commission
also states that effective management of
medicines reduces lengths of stay and rates of re-
admission to hospital by 55 to 60%.
Enabling patients to be confdent enough to take
responsibility for and comply to their administering
of medication is a vital step towards sustainable
recovery. The BST outlines some easy stages that
a patient can work through with support with the
goal of having little or no staff input for medicine
management. This skill is one that will hopefully stay
with the service user when they leave hospital. It
will enable the individual to fnd out along the way
where the problem areas are and how they can
be tackled, with support, structure and guidance.
Leaving hospital is often daunting and being able to
have the stress of taking your medicines by yourself
reduced can only be a good thing. It leaves one
less thing to worry about and concentrate on and
gives the patient a better chance of success on the
outside right from day one.
Taking medication can always throw up fears,
doubts, anxieties, but with some simple steps
the patient can gain a better understanding of
what these may be about. I, for example, am
fne with compliance to almost all of my tablets.
But olanzapine and anti-biotics were always the
exceptions. I hated the side-effects and grew more
and more devious in how to avoid taking it whilst
as an inpatient. Thinking back, if I had sat down
with someone and told them exactly what the
problem was and had a discussion on possible
alternative viewpoints or even treatments I may
have been able to avoid the whole pill in the side
of the cheek experience.
The Healthcare Commission says there is still
more to be done in this high priority area, for
example, ensuring that people have access to a
supply of medicines after discharge and increased
opportunities for inpatients to manage their own
medicines where appropriate. I believe this is the
way forward. If we dont enable a person to try
looking after their medications while in a highly
supportive environment what chance have we
got expecting them to do this cold-turkey when
discharged.
Having 91% of inpatients taking two or more
medicines, some up to 21 different tablets, means
that this is not a subject to be put on the back-
burner. This is something essential to overall
care, and future development of mental health
sufferers. I mean, I cant even remember to take
the washing out of the machine when it is done
until about three days down the line and it all has
to be re-spun and I am a pretty self-reliable and
functional person. Imagine if on top I was taking
21 different medications... an extreme example
but not implausible. The simple suggestions such as
compliance aids and continual assessment forms
for how the person is progressing through the
stages of self-medicating are ones that can make
such a dramatic improvement to medication
compliance and overall confdence.
With the suggestion that medicines were a
clear factor infuencing the admission for one in
every 33 people using services getting on top
of this issue is vital. Now, if only they can make a
compliance aid for my washing...!
Steph Beale-Cocks
Service-user and consultant
stephi@bealoid.co.uk
Steph Beale-Cocks and
Marion Janner
Star WardS
27
At the moment, in most hospitals, it seems that
patients need take no responsibility for managing
their medication all the time theyre there. But
as soon as were back home, were in charge
and theres plenty of scope to forget to order
it, to take it at the wrong times, or in the wrong
combination, etc.
The following summary of self-medicating stages
for inpatients leaves out essential details e.g.
assessment process, meaningful consent, recording
processes, storage, reviews etc. Stages 1 and 2
are essential, but trusts organise the other steps
differently, some sub-dividing these into formal,
separate stages.
1. Assessment
Staff and patient collaboratively assess the
patients ability to manage their medication,
taking into account both their previous
methods and effectiveness with medication,
and their needs and situation when they
return home. They agree any training and
practical needs.
2. Preparation: supervised
administration
Pharmacy supplies to the ward one weeks
medication for the patient.
The medication is kept in the ward trolley for
administration in front of nursing staff.
The patient asks for their medication when
due. The nurse asks which medications they
need, then gives to the patient
3. Self Administration
Pharmacy supplies the patients medication
(initially, perhaps, with each days medication in
individual containers) to be stored in a lockable
drug cupboard in the patients bedroom.
After the agreed period of time when the
patient has successfully taken their medication,
the number of days supply they self-manage
a.
a.
b.
c.
a.
b.
can be increased to, for example,
three days supply recurring, then
one weeks supply.
As a fnal stage, the patient could
collect their weekly medication
supply from the pharmacy, perhaps
initially accompanied by a member
of staff.
Safeguards
Random checks should be made
after the appropriate dosing times
Staff should occasionally discreetly
watch the patient taking the
medication so theyre not acting
as a prompt. This is particularly
important if the patients condition
may be deteriorating or if theres
concern about their ability to
sustain self-medication at this time.
Of course, patients also need the
opportunity to talk about how
they are managing.
A revised risk assessment should
be undertaken if the patients
circumstances change or, for
example, another patient poses
a risk to the safe handling of the
patients medicines.
Progression through the stages
should be at the individuals pace.
Patients may move back a stage if
required.
An important component of the
self-medication regime would
be having the alarmingly named
psychoeducation sessions ideally with a pharmacist
where patients:
Learn about the purpose of their medication,
its side-effects and how to cope with them, the
consequences of not taking it as prescribed or at
all. (The Mental Health Act adds an extra twist to
not taking our medication.)
Ask questions about their medication or simply air
their feelings about it
Discuss strategies for remembering to take the
right doses at the right times
Learn about other aspects of medication, e.g. the
effects of combining it with homeopathic treatments
or with drink/street drugs; safe storage, etc.
c.
a.
b.
c.
d.
e.
a.
b.
c.
d.
I dont have nearly the extent of barriers to taking
medication that Steph does, but after 5 years am
still not exactly competent with the stuff. I take, for
example, a red pill and a pink pill every morning.
And yet, at the end of each month I invariably have
something like 3 pink ones and 1 red one left over.
Ive tried being more systematic about this. I have a
set of pill boxes, a different coloured cube for each
day, but somehow I dont have the Friday yellow box
so Friday is regularly pill-free. (Note to my GP and
my psychiatrist/therapist I am trying my best...)
Marion
A scale of self-medication on
wards could look something
like this, with the later
options being reserved for
those patients whose state
of mind or nearness to
discharge allows.
You can fnd links to paper outlining the specifc issues of
medication for people with mental health problems, and the very
worrying report from the Healthcare Commission about medication
on acute wards here: http://starwards.org.uk/?page_id=200
Star WardS
28
We had a dream...
Debi Anns
In the beginning there was
the dream, centred round
a client infuenced, nurse-
led unit, within the local
community. It would be
designed to be close to home and allow patients
freedom of movement, freedom of choice and full
input for families and carers. It would not be based
entirely on medical intervention, but embrace
alternative therapies and a higher level of client
education about the illnesses they have to endure.
It would be focused on destroying the myths
surround mental health facilities and integration.
Castle Lodge has been open as an alternative
to hospital for four years. We offer various
groups and interventions and have close links
with voluntary as well as statutory services. We
have developed good working links with our
neighbours and slowly some of the fear from the
community is abating. Those who use the unit give
positive feedback through many forums.
Before we opened, we considered the area of
medication particularly how to support the
medication management of our clients. Feedback
from clients shows that upon admission to a ward,
medication and the responsibility for taking it
was removed from the client. It was not discussed
except for changes via the consultant, (and
even these would not always be decided with
the client). Changes made during the admission
would also be unfamiliar to the patient, leading
to confusion and reduced concordance following
discharge. This had the effect of de-skilling patients
and undermining confdence and trust.
Following much discussion with service users, we
agreed that the unit would not hold any stock of
medication. As a low risk unit, we would not need
stocks of rapid tranquilisers. This relies heavily on
our initial risk assessment, but so far has proved
reassuring for both clients and staff, and invaluable
in the genuine rapport between the two.
Castle Lodges ethos is to work in partnership
with clients to agree what care is to be provided.
So, before admission, discussions takes place
with the client (and carers when available) to
ascertain current medication methods. If, for
example, a clients carer ordinarily takes care
of administration, we would take over this role
during their stay. On the other hand if there
are issues around concordance, education, fear,
or distrust of medication we would create a
programme to develop medication skills and
reduce anxiety. Well-documented evidence shows
that when a clients concordance is poor they are
more prone to relapse, leading to readmission
and often to changes in medication. The personal
cost to the client is high (as is the fnancial cost
to the organisation). By working with client we
can identify problem areas, request reviews and
support them in the administration of their
medication. Most clients choose to self medicate
and maintain control.
All clients are expected to bring medication in
with them, which is kept in a locker in their own
room. Staff check with the clients GP and their
consultant to ensure the prescription is up to date
and a medication care plan is formulated with the
client for its administration. Should clients require
additional medication for physical complaints
this is arranged via the units GP. Mental health
medication is still controlled by the consultant,
although the onus is on improving concordance
and understanding, rather than change. Clients
who pay for their medication continue to do so
throughout their stay, and as much normality as
is usual is maintained.
When a client is admitted to any facility they
have a certain amount of anxiety and may need
to have their key to the locker held by staff for a
short period of time; this, again, is mutually agreed.
All clients have the opportunity to hand the key
back to staff at any point, which would instigate
a discussion, and revised care plan written in
conjunction with the client and signed by both
parties. Some clients may be admitted because
they have increasing thoughts of self harm. To
support recovery their key is held until the client
feels safe enough to self-medicate. Daily reviews
of this process are held with the named nurse. The
client could reach the point where they hold their
key for an hour or two; this time is gradually built
up until they are more confdent.
So far the dream remains intact with a mutually
agreed recovery pathway being established which
promotes trust and confdence between clients
and staff. To treat people as the adults they are,
and support and enable them to maintain as much
independence as possible throughout their stay
and in the future.
Debi Anns
Deputy Manager, Castle Lodge
Debi.Anns@shropshirepct.nhs.uk
Castle Lodge is a slightly
unusual case-study, because
staff never manage medication
in the unit (which is halfway
between a crisis unit and an
admissions ward). However, we
thought it important to share
their experience.
Star WardS
29
Humour is largely an unexplored art in health and
social care, so in what at times may be a hostile
world, I will begin by making a case for its use.
Science opens the book of nature, humour the
book of human nature. Timely and appropriate
humour and laughter, can be an escape from
despair, and ease the strain of adversity. Laughter
is often said to be the best medicine (Although
it youre asthmatic, its probably best to stick with
the ventolin inhaler). Laughter is also said to be a
tranquilliser without side effects.
Where it is real, laughter can be a feature of the
healing and protective process. Humour has the
power to change peoples perceptions of the
surrounding world for the greater good. It is a
civilising infuence. There are no language barriers
when you smile. I believe humour prevents
hardening of the attitudes. Genuine laughter is
the vent of the soul, the nostrils of the heart,
and just as necessary for life as water is for a
trout. Humour opposes directly those emotions,
which evidence shows are associated with the
precipitation of heart attacks, rage and fear.
Humour acts to relieve fear. Rage is impossible
when mirth prevails.
There is evidence that humour contributes
to physical, emotional and mental health by
enhancing the immune system. Humour can raise
spirits, breakdown barriers, relieve tension, anger
and stress, and ignite hope. Humour is more than
jokes, it is an uplifting presence in the world, and
can make the work place enjoyable.
Which is one of the reasons why a sense of
humour is part of the art of leadership. Managing
to have a sense of humour makes it a lot easier to
manage people. Pointing out the comic elements
of a situation, can bring a sense of proportion and
perspective to what otherwise, might seem an
overwhelming obstacle.
Humour and optimism are the grease and glue of
life without both of them we wouldnt survive.
So we need to think more deeply about humour.
We need to use it as part of our therapeutic
approaches; it keeps people interested, diverted
or enjoyably occupied. Perhaps we need to
include more humour in our personal strategies
for leading and infuencing others; maybe we can
use it to enhance our contribution as a team
member.
In particular, clinical staff can beneft from humour
as it can provide powerful safeguards in dealing
with diffcult situations, crisis and avoiding burnout.
Humour, in verbal, written or pictorial forms,
can also be useful in getting messages across to
service users, carers and colleagues, in either,
clinical, teaching, and social activities. It will help
illustrate points and enable people to more easily
recall information. You can always quote other
people: the famous humorist, Dorothy Parker,
once said, that she has a humorous quotation for
everything - it saves time and original thought!
As someone once said, Laughter is like changing
a babys nappy it doesnt permanently solve any
problems, but it makes it acceptable for a while.
Using humour therapeutically
When we laugh, muscles are activated; when
we stop laughing muscles relax. Since muscle
tension magnifes pain, its reported that patients
with arthritis and rheumatism and other painful
conditions, beneft from a healthy dose of fun and
laughter. Its also a good way of boosting energy
levels. Creating fun and laughter can be a powerful
way of breaking up hopelessness and creating
energy smiling is a no cost remedy, and a
necessary frst step on the road to recovery.
For health workers, humour can be an effective
way of reaching and engaging with individuals,
and building and strengthening empathic
relationships. If handled properly, by respecting
the clients feelings and diffculties, and in the right
context, and at the right time, humour can be an
affrmation of respect and dignity. Laughing with
others may give comfort, safety and feelings of
belonging to a group.
Humour and laughter can be a powerful tonic,
it can make people feel better, lighten the
perspective, raise their spirits and mood, release
frustrations and provide resilience and coping
mechanisms to endure diffculties. It can be of
value in encouraging an individual to be more
cheerful and develop positive thinking, to help
with realistic self-perspective and acceptance, and
assist in restoring to good health.
The art of medicine consists of amusing the
patient, whilst nature cures the disease
Voltaire
Using humour Malcolm Rae
Star WardS
30
I once read the observation that humour may not
always diminish pain, but it may make the space
around it bigger, and the padding softer. Humour
is like food, and people need food when they are
ill. So an adequate share of laughter is an essential
part of a balanced diet. Enlightened practitioners
recognise that service users should be supported
and encouraged to use humour as part of their
personal social skills and relationships development.
As part of the continuous assessment, practitioners
should also seek out the individuals sense of
humour, help them to view it as a strength, and
encourage them to capitalise on it.
Using humour as a leader
I read that the problem with being a leader in
the NHS today is that you dont know if people
are following you or chasing you! Humour
appropriately applied can be a rich and versatile,
source of power and infuence, and a spiritual
resource. An effective leader is a dealer in hope,
because humour engenders hope and optimism.
Hope motivates to persevere on the long haul to
recovery or achievement.
An organisation or team that has fun, or laughs,
is likely to be spirited, creative, effective and
successful. If you can laugh together, you can work
together. Its important to note, that whilst reason
can sort out perceptions, humour can change
them. A spirit of fun in a meeting can help people
participate and learn. I like the wise chinese
proverb: Make happy those who are near, and
those who are far will come. Its common sense, if
you get people to laugh / smile with you, you are
likely to get them to like you better, which makes
them open to your ideas. A wise teacher makes
learning a joy and the next best thing to solving a
problem is fnding some humour in it.
At interview, if you really want to glimpse inside
a persons character, dont just rely on analysis of
what they say, you will get better results if you
watch them laugh.
Some dos and donts
A sense of humour is a gift, and like any gift it can
be abused. There may be times when it is totally
inappropriate and insensitive, for example, being
sarcastic, making fun of, and undermining people.
Like practically everything else in life, moderation
is usually the key so, relax dont push it.
Humour can be an appetiser or dessert,
sometimes the main course, but never the whole
meal remember, no one wants cake or steak all
of the time.
A cardinal rule of humour is, never say anything
about anyone, which you wouldnt have said
against yourself.
Use the AT&T test for stories and jokes
make sure its appropriate, timely, and tasteful.
Remember in humour what is appealing to one
person, might be appalling to another.
Start with yourself self-deprecation, self-parody
and humility can win people over. The real wit tells
stories to make others feel superior, those without
wit tell stories to make others feel small. Our
aim should be able to take ourselves lightly, whilst
taking our work seriously.
Plan your spontaneity. Prepare, do your research,
and use humour in your repertoire of skills. (And
rehearse your adlibs! Mark Twain said it took him
3 weeks to write a good impromptu speech.)
Have a toolbox of humorous, therapeutic or
situational interventions, for a range of clients, or
different set of circumstances. Assess what types
of humour the patient enjoys and their ability to
accept humorous interventions.
Be prepared to accept and respond to the clients
own sense of humour. The English language is full
of ambiguities, and when I spot something, I write
it down for reference. (The clich, There you go,
for example. A nurse gives a suppository to a
patient. There you go she says. The patient replies,
I hope there will be a short delay.)
Use humour in meetings, speeches, or interviews
when it can be of value in settling people down.
A ward in the Oxleas Trust, have established a
comedy room, with magazines, books, videos, cds,
tapes and cartoons, while the Hartlepool service
have organised comedy nights.
Remember too, its OK to exaggerate a little a
tall tale in the service of humour is a noble thing.
A sense of humour can help you overlook
the unattractive aspects of life, tolerate all the
unpleasant, cope with the unexpected and smile
through the unbearable. Laughter is contagious,
you might start an epidemic!
And fnally, keep smiling it makes people wonder
what you have been up to!
Malcolm Rae
Joint National Programme Lead, NIMHE Acute Inpatient
Care
malcolmrae@blueyonder.co.uk
Section 3. Best practice
In this section 30 pages of fantastic ideas to make your ward a
Star Ward. Youll fnd them listed under these headings:
Recreation and conversation ............................................ 3239
Physical health, activity and well-being ......................... 4043
Visitors, volunteers and carers. (And pets). ...................... 4447
Care planning .................................................................. 4849
Talking therapies ............................................................... 5051
Ward community ............................................................. 5257
Patient responsibility ....................................................... 5859
In the now legendary Star Wards 1 we listed 75 ideas. This time around there are literally
hundreds of them.
No, dont thank us, were just doing our job. In fact dont thank us at all, because the wards
below are the ones who have contributed all this fantastic best practice.
Whos Who
5BP 5 Boroughs Partnership NHS Trust
BCK Bracton Centre, medium secure unit, Kent.
BHC Bowmere Hospital, Chester
B&L Bedfordshire and Luton Mental Health and
Social Care Partnership NHS Trust
DMHT Derbyshire Mental Health Trust
EB Eastbourne
CCC Caludon Centre, Coventry
CLT Castle Lodge, Telford
D&SS Diamond and Sapphire Suites, Grimsby
DH Denmark House, Birmingham
DM Derbyshire MHST
DPH Dorothy Pattison Hospital, Walsall
DPU Derby Psychiatric Unit, Derbyshire MHST
ECH Edgware Community Hospital
ELS Older Peoples Mental Health Services, East
Locality, Sussex Partnership Trust
GPH Green Parks House, Oxleas Trust
HCH Highcroft Hospital, Birmingham
HHR Huntercombe Hospital, Roehampton
HMHC Highgate Mental Health Centre
HSH Hallam St Hospital Sandwell
HUC Hartington Unit Chesterfeld, Derbyshire
MHST
KVB Kemple View, Blackburn
LnM LavendernMind Richmond Minds
project on Lavender Ward, Queen Marys
Hospital
LYG Llwyn-y-Groes Psychiatric Unit, North East
Wales NHS Trust
MC Merseycare
MSC Margaret Stanhope Centre
MVH Mill View Hospital, Hove
NEW North East Wales
NHT Northamptonshire Healthcare NHS Trust
ONT Oxleas NHS Trust
S&B Surrey and Borders
SHL Springfeld Hospital London
SM Solent Mind, Hampshire
SMH Sandwell Mental Health NHS & Social Care
Trust
SPH Sandwell Park Hospital, Hartlepool
SPT Sussex Partnership Trust
SSS South Staffordshire and Shropshire
Healthcare NHS Foundation Trust
TSM The Spinney, Manchester
WLH Wotton Lawn Hospital, Gloucester
Recreation and conversation
Recreation and conversation
Recreation and conversation
Recreation and conversation
Star WardS
32
Making a start
Getting people talking
Protecting time for activities
Producing an activities pack
Having fun with Playstation
Holding a flm night
Make it more like a hotel
Tailoring activities to groups of
patients
Get a bit dramatic
Going on a holiday
Creating a Caf Culture
Have recreational equipment
Getting people talking
We have conversation/thought starters
on noticeboard, e.g. On this day in history,
Davids quote of the day. HUC
A fve-day structure was recently agreed with
the involvement of patients. This involves
using a different theme for each day of the
week to talk about. HHR
Protecting time for activities
Health Care Support Workers as ward based
activity champions who are ensuring that
activities take place on the wards during the
evenings and weekends. LYG
Producing an activities pack
A recreation worker has done resource pack for
each ward with quizzes, origami, word searches,
plus one for self-help groups. HUC
Having fun with Playstation
Playstation used by men and women. SHL
Holding a flm night
Friday night, 79 is a video evening, with snacks
and a widescreen TV. SHL
DVD nights. DPU
All patients currently have access to an extensive
video library run by the therapy department. It
is our aim to have the patients themselves run
this service for the Hospital. HHR
Make it more like a hotel
Leisure sessions, making everything from dolls
houses to greetings cards WLH
The activities club is held in our Gymnasium.
Past and present service users run the club on
a rota basis as volunteers and are supported by
an activities co-ordinator and staff accompanying
service users from the wards. Refreshments are
available, board games, pool, table tennis and in
the summer months bowls on green just outside.
Not all service users either want or are able to
attend, so we have built up our volunteer base
so we can do more ward based activities. This
includes weekly card making sessions, a flm club,
bingo board games, etc. BHC
Tailoring activities to groups of
patients
Women only group. Want to get in outside
speakers. Discussions, manicure, music. DPU
To meet communications needs of deaf
patients, sub-titles on TV are permanently on.
English literacy problems makes weekly See
Hear programme (for deaf people) particularly
popular. DH
Get a bit dramatic
Patients wrote and performed
their own play a version of
Taming of the Shrew! A service
user knew the play and designed
ward production of it. DPU
Going on a holiday
Holidays for patients on secure units. WLH
Creating a Caf Culture
The Busy Bite Caf provides a relaxed, friendly
space for service users, friends and
family at the Hartington Unit, and
has become the hub of the entire
inpatient unit. The venture also
offers service users an exciting
opportunity to work on a voluntary
basis in a supported environment in
the caf. HUC
Have recreational equipment
The Star Wards group have purchased CD
walkmans, DVDs, two computers, board
games, giant connect 4, and giant Jenga. MC
1. Recreation and Conversation
Recreation and conversation
Recreation and conversation
Recreation and conversation
Recreation and conversation
Star WardS
33
All things green and
beautiful
Organise a plant-growing
competition
Go to the garden centre
Digging the garden
Growing your own food
Start your own gardening business
Get into compost...
Get into compost...One of our wards has
an impressive green philosophy. Even tea-bags
go to the composter. Plastic cups get used to
grow seeds. WLH
Start your own gardening business
The Low Security Unit is setting up not just a
gardening group, but a social business based on the
gardens produce. Theyve transformed the over-run
area that was previously used for horticultural therapy
and its an obviously great opportunity for the men to
channel their strength and time. A former service user
who handily is a gardener helps out. WLH
Organise a plant-growing
competition
The Great Chili Off 2007! Each patient has
been given a chili plant to love and nurture in their
room, or wherever else they like. As the plants produce
their fery fruit there will be a competition, prizes for First
Ripe Chili, Most Chilies and Biggest Chili. WLH
Go to the garden centre
Patients go to the local garden centre to choose plants,
books, brochures, etc. while folders about gardening
have been resourcefully sought from local gardening
clubs. Theres a sheet on the noticeboard where patients
have written their ideas for their sensory garden. WLH
Digging the garden
The Princes Trust have also been involved with the
development of a therapeutic garden space, even raising
funds for the materials required. NHT
Patients and staff are designing and developing a sensory
garden. WLH
Growing your own food
We have secured some land that will be
used as allotments for patient, to grow the
vegetables that they can then cook back at
the unit. SPH
Recreation and conversation
Recreation and conversation
Recreation and conversation
Recreation and conversation
Star WardS
3+
Getting out and about
Devolve budgets to patients
Patients can be visitors
Whats on locally?
Accessing a vehicle for trips
Devolve budgets to patients
Patients on the ward have a weekly budget which they
decide how to spend on weekend activities, such as
bowling, cafes, flms. S&B, DPH
Current ward recreational budget of 35 a month to
be discussed at the Patients Forums to facilitate service
user input into how it is spent. MC
Whats on locally?
Community Bridge Building facilitates links
between service users and community
resources and organisations such as
employment (including voluntary work),
education, faith and spirituality, sports and
leisure and arts and culture. 5BP
The KIM Project, is a project for female
service users, in-reaching into hospital and
continuing their fne work in the community
after discharge. LYG
Once a week patients can attend a user-led
community arts group called Atrium. This
is an integrated resource its not just for
mental health service users. Patients might
decide to continue going there when they
leave hospital. SPH
The hospital has carefully built relationships
with the nearby womens centre for
complementary therapies as well as
supportive contact with other women. Hull
Our Integrated Day Service takes patients
into the community for activities including
detained patients wherever possible, on
s17 leave. The team also supports assertive
outreach team. SPH
Explore Leisure:- enabling the patients
to understand the benefts of leisure in
maintaining mental wellbeing and explore
new leisure pursuits for the future. WLH
Accessing a vehicle for trips
The wards have access to a 7 seater car and a mini-
bus, which really helps with outings. S&B
The ward has its own car, and driver. Very effcient
and supportive way for patients to visit or return
home, go on errands, outings etc. MSC
Patients can be visitors
Despite being a Medium Secure Unit, The Spinney
makes sure that whenever possible its patients get
community leave. Its like a mini-housing estate in
the middle of a larger housing estate, with all the
usual shops and facilities. TSM
Visit local places of interest including museums,
arboretums, and a lovely Buddhist centre which has
a caf and grounds. MSC
Seven days a week, there are visits to places
such as local sports venues, the library etc. The
popular visits to the local farm will in future include
opportunity to help with grooming and caring for
animals. SPH
Recreation and conversation
Recreation and conversation
Recreation and conversation
Recreation and conversation
Star WardS
35
Start a stand-up venue
Comedians come and do gigs. TSM
Humour
Start a regular comedy evening
Putting the fun into fundraising
Throw a party
Teaching some fun skills
Start a stand-up venue
Set up a comedy room
Set up a comedy room
Oxleas House, in Londons Queen Elizabeths
Hospital, has a comedy room! The room has CDs,
tapes and videos of great comic performances as
well as humorous magazines. ONT
Throw a party
Birthday cakes are provided for patients and
leaving parties are arranged. HHR
Patients spending their birthdays with us can
choose (within reason!) how they would like to
celebrate. eg a sixties night included non-alcoholic
cocktails, lots of sixties food favourites (yes, we
even had Spam sandwiches!), groovy music and
lots of black eye-liner and back-combed
hair, with a prize awarded for the
most fabulous outft! NHT
We hold regular social evenings
on and off the wards, with
events such as BBQs, Caribbean
evenings (with themed food)
and very popular DVD concerts,
including special Elvis and ABBA nights!
Using a large screen projector and sound system
we project the concerts onto large walls in the
garden areas and belt out the sound, making for a
real concert feel. Staff and patients dress up for
the occasions and all take responsibility for the
planning and preparation of food. NHT
Start a regular comedy evening
We have a comedy evening every Wednesday as
decided by the ward patients (at present videos but
looking into local comedians). SPH
Putting the fun into fundraising
Hairy head day to raise money for Children in
Need. Patients and staff wore fake eyelashes, wigs,
plaits, false moustaches, hairy chests. DPH
Teaching some fun skills
Patients can learn to juggle. DPH
Sixties Night at Northampton. Groovy.
Recreation and conversation
Recreation and conversation
Recreation and conversation
Recreation and conversation
Star WardS
3
Art and Music
Help patients discover their inner
artist
Wards can look like galleries
Paint the hospital
Have artists work with patients
Making it touchy feely
Exhibit art outside the hospital
Listen to music
Bring music to patients
Making personal stereos private
and safe
Have a sing-along
Jamming and song-writing sessions
Music as therapy
Learning to play
Putting on concerts
Make your own recordings
Help patients discover their inner
artist
Two volunteers have worked with occupational
therapists in the creative group on our two
acute admission wards, which has been a great
experience for all. One co-facilitator was an ex
service user, and the other is an artist. SSS
Arts activities include crafts, textiles and writing.
CCC
The artwork done achieves numerous
objectives, ranging from an opportunity for
a non-intrusive, relaxed OT assessment to
producing truly high quality products which
are used on wards or can be taken to patients
homes or given to their families. WLH
Wards can look like galleries
Display of a series of art pieces in the
recently re-designed dining room. SSS
The Art Psychotherapist is looking into
borrowing artwork from local galleries
and libraries to display throughout the
hospital. HHR
Planning an Art Exhibition in the Reception
Area of the Broadoak Unit. MC
Patients were involved in choosing which artist
to commission for the displayed artwork. SPH
Lovely art in corridors, and immediately as you
come in front entrance. BHC
12 week art project with local artists producing
photography, storytelling and textile pieces.
Local historian ran an activity about Burton, and
liaising with the textile artist. Art MA student is
working with a service user on a project. MSC
A local Arts in Health Initiative, guided by an
Arts in Health Coordinator, and local Unit-
based Arts Projects in creating and displaying
the work of service users within local Units/
Wards. B&L
Paint the hospital
Staff and patients created a mural in the PICUs
smoking lounge. SPT
Have artists work with patients
A freelance artist from the Tate Gallery
has provided workshops and produced a
publication aimed at increasing female service
users self-esteem. MC
Making it touchy feely
We provide art activities for people with
dementia, for example sensory pictures, a hat
stand with bygone era clothing, quilted pictures,
etc. ELS
Exhibit art outside the hospital
The OT Department have worked alongside
Liverpool Community College to produce a
piece of service user art work to celebrate
the link between Liverpool and Stavanger,
Norway as part of the celebrations to mark the
2008 Capital of Culture. The art work will be
exhibited in various locations across Liverpool,
to include the Central Library. MC
9 paintings by inpatients were exhibited in the
Art & Soul exhibition in Richmond Riverside
Gallery and one of these was chosen for the
exhibitions publicity poster. LnM
Women service users have contributed to
creating a Womens Wisdom Quilt to be part of
a womens conference. SPT
Recreation and conversation
Recreation and conversation
Recreation and conversation
Recreation and conversation
Star WardS
37
Make your own recordings
The hospital has its own recording studio
where patients can make their own CDs or
demo tapes. People can make one copy and the
hospital is exempt from the Performing Rights
Society license because the CD is used for
therapeutic purposes. HSH
Creating music on the computer using samples
in Garageband it is possible even for someone
that is not musical to enjoy creating an original
piece of music, and they then can add their
vocals to this track to make their own hit. SSS
Listen to music
Music appreciation sessions with people
bringing their own music. SHL
Music groups, which focus on a particular era of
music at each group ELS
Bring music to patients
The hospital is visited each month by Music in
Hospitals BHC
Inviting friends who are musicians to provide
entertainment. SPT
Making personal stereos private
and safe
A simple solution to the friction caused by loud
music at night bought 18 radio cassette/CD
players, with headphones. Equipment has the
name of unit and number on them. Patients
sign a simple contract and have to return
the equipment if they breach the agreement.
18 months into the scheme all units are still
present and correct! Hull
Blue-tooth technology, so that patients can use
head phones without the risk that accompanies
wires. S&B
Have a sing-along
Christmas carols were arranged with ex-
patients being invited. ELS
Patients and staff join in fabulous themed
Christmas parties with elaborate decorations,
costumes and of course carols. HCH
Jamming and song-writing sessions
At our musical jamming sessions, there is a
drum machine, keyboard, electric guitar and
vocal recording equipment, available to use at
whatever the musical level of the service user.
There is also an opportunity to sing or rap over
backing tracks, either with written lyrics or in
a free-style format. Facilitated by an OT and a
sessional worker, the group has created both
individual songs and collaborative pieces with
everyone playing instruments. SSS
For patients who want to do serious practice
and composition, the computer room has a
keyboard connected to a computer. HSH
There are song-writing sessions, where
participants look at how songs are structured
and then learn to write them. SSS
A drum work shop is regularly and well
attended. DM
Music as therapy
A recent introduction in the OT Department is
a therapeutic music group run by Music Spaces,
a national charity which provides music therapy
to adults and children. MC
Therapeutic Drumming has also been
established and proves very popular with our
younger population. WLH
Learning to play
Guitar lessons. SSS
Piano lessons. SSS
Rapping sessions. HCH
Putting on concerts
Bands play gigs. TSM
Music in Hospitals putting on concerts MC
Concerts. SSS
Therapeutic
drumming at
Wotton Lawn
Hospital
Recreation and conversation
Recreation and conversation
Recreation and conversation
Recreation and conversation
Star WardS
38
Setting up a library
The social activities room has a library with
novels, travel, health, wildlife books, etc. Also
easy read books. TSM
Books on prescription using a mobile library,
patients and staff can order the books they want.
A visiting librarian talks to patients about their
interests, then suitable books are delivered. SPH
Staff bring in their good condition, once-read books
for patients. EB
Large print books. BHC
Books and reading
Setting up a library
A nice cup of coffee and a
good book
Writing some poetry
Run a reading group
A nice cup of coffee and a good book
There are future plans to forge a partnership with
the local library to deliver monthly supplies of
interesting books to the Caf. DM
Writing some poetry
Poetry readings from a service user. MSC
Published poets running creative writing groups. SPT
Run a reading group
The Reader in Residence for
Merseycare has been involved
in the development of Reading
Groups for inpatients. MC
Recreation and conversation
Recreation and conversation
Recreation and conversation
Recreation and conversation
Star WardS
39
Blag some computers
We are liaising with the IT dept. to see if there
are decommissioned computers that patients
could use on the wards. ELS
Computers
Blag some computers
Create an e-ward
Create your own DVDs
IT training by IT experts
Create your own computer room or
even IT centre
Create your own computer room
or even IT centre
The nearby Learning Resource Centre was
grant funded by BT a number of years ago
for service user and staff usage. It has 12
terminals and offers all things to do with
computers, ranging from basic to advance
courses. Service users use it as individuals,
while OT have set sessions there on a
weekly basis. BHC
There is a computer room with an expert
member of staff. Some patients can use PCs
and want to expand their computer literacy.
Patients can use their photos to create
personalized gifts such as plastic photo
coasters, keyrings and magnets. HSH
In the computer room patients use the
internet to research their medication. There
is a booking system for the PC, which is
sorted out at breakfast meeting. SHL
Create an e-ward
Computers and internet access allow patients
access to their bank accounts, etc. SPH
The Oasis is an internet-caf style area. There
is a second terminal in our reception area used
as an information resource. The wards have internet
access and service users can, and do, access the internet
for specifc queries with staff. BHC
The Internet is mostly used for communication, patients
own research (including into their illness, its management
and treatment), fnding a stimulus (e.g. a walk through
the virtual Tate gallery, exploring a hobby, etc.) SM
A computer whiz came into the ward with 8 lap-
tops and printer and as well as learning how to use
computers, patients were able to design and print their
own Xmas cards. MSC
IT training by IT experts
Information Technology taster sessions on the
unit in partnership with the local college. MSC
Patients in acute wards receive computer
training through three sets of wireless laptops.
The recovery courses focus on using Word as a
medium for CVs, letter writing etc. The qualifed
tutor and learning support assistant take in digital
cameras and then show learners how to e-mail
pics taken to friends and family, and even how to
design Powerpoint presentations. Some learners
take their newly found Internet skills into the local
libraries after they leave hospital. SMH
We hope to link with Tresham Colleges M-
Learning scheme, which uses the exciting art of
mobile technology to improve English, maths
and basic IT skills through mobile phones, pocket
computers and the internet. NHT
The local FE college comes in to interview
patients and enroll those who want to join. And
when ex-patients start at college, they feel less
thrown in the deep end because they have had a
foundation in hospital. HSH
Create your own DVDs
Come on Over to Our Place was the frst of a series
of DVDs created by service users. They are not
just shown how to do it, they do it all themselves,
using video cameras and software. Theyve also
created their own interactive website for the
animations, flms and music theyve made. SSS
Star WardS
+0
Health, activity and well-being
Star WardS
+0
Looking good, feeling good
Give out bags of toiletries
Start the day with exercises
Pamper the patients
Offer complementary therapies
Promoting physical health
GPs as Great Practitioners
Making medication more manageable
Give out bags of toiletries
Small bags of toiletries are offered to
patients on admission. Feels very hospitable
and saves giving big bars of soap, and
shampoo, so also saves money! DM
Start the day with exercises
Wake and shake start to the day with the
sports therapist and/or physio. WLH
The day starts after breakfast and medication
with exercises. This has been hugely popular
with the group led by OT or nursing staff and
occasionally by service users. Service users
often choose the music ranging from Madonna
and 80s music to trance! GPH
Offer complementary
therapies
One of our Staff Nurses is a qualifed
reiki therapist, and we also provide
aromatherapy for our clients. LYG
Patients can enjoy refexology and
aromatherapy at the local womens
centre. Hull
Refexologist, reiki therapist and nail
technician. MSC
Patients learn relaxation techniques
in the afternoon, then have relaxation
session 10pm, half hour before bed. CLT
We offer relaxation, once following
lunch and then in the evening to aid a
healthy sleep pattern. BHC
OT assistant runs sleep preparation
group. MSC
Were looking for a volunteer yoga
instructor for group sessions. HHR
GPs as Great Practitioners
GP referral scheme, linked to GP
practice for free yoga, exercise in
community. GPs report on how
discharged patients are doing. DHU
Pamper the patients
Make-over sessions are spectacularly successful, with female
patients enjoying each others attention and physical contact as
well as their new look nails, hair etc. Foot spas for men are very
popular. S&B
A make-over session included clothes donated by Paul Smith,
Vivienne Westwood and other designers! CCC
We aim to fnd a volunteer beautician for the female ward. HHR
We plan to develop a ladies pampering room, which will
provide hairdressing, manicuring, hand massage, etc. ELS
2. Physical health, activity and well-being
Star WardS
+1
Health, activity and well-being
Star WardS
+1
Promoting physical health
Total well-being sessions. WLH
We have trained 2 OTs to offer things such as
Clozaril weight gain support and personal plans
for patients. DHU
Advice to clients on quitting smoking is readily
available, as well as nicotine replacement
therapy and advice on diet. We also have the
support of Sandwell Stop Smoking who offer
one to one or group support. Several staff also
attend training on supporting clients to stop
smoking. SMH
The completion of optional physical health
checks and physical health promotion with all
acute inpatients. B&L
Making medication more
manageable
The pharmacist provides monthly clinics
on the unit to answer any questions or
concerns about medication that patients/
carers may have. ELS
Pharmacist visits wards daily and
attends ward rounds. Information about
medication for psychosis is put on
noticeboard. SHL
Medication Q&A sessions with local
pharmacist. MSC
Weekly drop-in medication clinic. HMHC
Concordance training, including
motivational interviewing. Bookmark
with motivational rhyme was produced,
designed by a service user. DPU
Pharmacy technicians support to wards.
Saves a lot of ward staff time - ordering,
checking, arranging pharmacist to talk
to patients, and do training themselves.
Refresher training very useful. On ward
every day. DPU
Medication manager. Award-winning
scheme. Role includes contacting GPs
about patients pharmacological and
medical history; ordering drugs; liaising
with pharmacy; meeting with patients
individually; and overseeing accurate
dispensing and recording. HCH
Star WardS
+2
Health, activity and well-being
Star WardS
+2
Physical exercise
Get exercise equipment
Walk the talk
Take your partners
Armchair exercise
Outside exercise even in tiny spaces
Go to the gym
Have the gym come to you
Link with local sports teams
Sports therapists
Eastern exercise
7 days of exercise
Create your own gym!
Get exercise equipment
An exercise bike has been purchased for each
inpatient ward. MC
Table tennis outside on special concrete table
tennis table. SHL
Therapeutic Trampolining - Providing patients
with the opportunity to learn a new sport,
taught by staff with a qualifcation in trampolining
and experience physical and sensory benefts.
WLH
There are gym mats, exercise balls and a small
stepper for use. BHC
Walk the talk
Seasonal walks have been arranged by our head
gardener and as part of our stop smoking
campaign. BHC
Walks in woods and felds, with friendly
chats with Viv (OT assistant) creatively
called Walky Talky! MSC
Patients go for a nice walk around the local
area with the Strides programme. SMH
A number of our inpatient staff, following training,
will be able to act as walk facilitators, as well
as developing local risk assessed walks that
our service users will be able to access whilst
inpatients. MC
The Therapy Department facilitate group and
individual walking and jogging sessions in the local
area and parks (with Kiera the therapy dog for
company!) HHR
Take your partners
Dance Movement students are always looking
for placements on units. ELS
We linked with a local creative dance artist to
provide a series of 10 weekly creative dance
sessions to one of the female wards. Staff
were also encouraged to attend no passive
observers were allowed! NHT
Line dancing sessions. WLH
Dance exercise. DM
Armchair exercise
Staff member has undertaken
training in armchair exercises for
the elderly and frail, run by local
College. ELS
Outside exercise even in
tiny spaces
Courtyard has basketball hoop,
enjoyed by patients with each other,
visitors and staff. D&SS
Go to the gym
Membership for service users
has also been agreed with the
local council for use of the gym
where our staff also undertake the
induction in that facility with the
service user. WLH
Lifestyle Gym Instructors will be
providing 5 gym sessions through
the local authority, including
signposting service users to
community provision. MC
Have the gym come to you
A gym instructor visits twice a week
and they use a personal trainer
model. S&B
Have been able to provide
placements for student sport
therapists from local university. WLH
Star WardS
+3
Health, activity and well-being
Star WardS
+3
Link with local sports teams
The NHT Saints Rugby Ground played host
to a complimentary tour of the ground and
stadium for some service users and staff. The
tour was to promote interest in local sport,
active lifestyles and the importance of physical
ftness. NHT
Link with Hartlepool football club (they
are only 600 yards from the unit) to raise
awareness about stigma etc and arrange
reciprocal visits and tours. SPH
Sports therapists
Sports therapists interventions include
individual and group sessions of health
education and promotion, healthy eating,
individual and group sessions of circuit training,
trampoline, badminton, walking groups,
canoeing, cycling, swimming WLH
Eastern exercise
The sports therapists and occupational
therapists are all trained in basic Tai Chi skills
which is offered individually or in groups. HHR
We hold a monthly Qi Gong session which is
increasingly popular and may now be offered
more frequently. BHC
7 days of exercise
OT organised a Get Active week of
inspirational activities to promote physical
health and wellbeing. Highlights include
free cycle hire to do a circuit of a beautiful
reservoir; a guided tour of the local rugby
ground including seeing famous players, the
trophy cabinets, ice room etc. Also lots of
inductions to our on-site gym, health walks
and sessions on the importance of physical
activity a very positive week. NHT
Create your own gym!
A deconsecrated, unused church on
site has been converted into a gym, with
lots of exercise machines, and space which
is sectioned off for activities club, including pool,
table tennis and football tables. Patients can
use the gym as out-patient for months after
discharge, including choice to just join in the
non-hospital, i.e. community-based exercise
activities e.g. swimming and badminton. They
also get exercise referral which enables them
to go to local sports and leisure centre for 1 a
week for 6 weeks. BHC
Trampolining at
Wotton Lawn
Hospital
Cycling round
the reservoir,
Northampton
Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Star WardS
++
VISITORS AND
CARERS
Making it easy to visit
Visitors welcome
Inviting friends and family to
events
Visitors for the visitor-less
Help patients to phone home
Provide toys for children
Caring for the carers
Partnering with carers
Visitors for the visitor-less
We have a number of volunteers who visit the
visitor-less. Our chaplaincy service also helps in
this regard. BHC
Caring for the carers
Carers Information board in ward. ELS
We are liaising with local Care for the Carers
organisation regarding setting up Carers
Groups. A staff nurse has been identifed who
has experience in facilitating Carers Groups
previously. ELS
Partnering with carers
Provide psychoeducation in partnership with
Hartlepool Carers. SPH
Making it easy to visit
Meeting the needs of frail elderly relatives
having to travel great distances to visit their
elderly relatives e.g. by car sharing; provision of
group transport by voluntary agencies ELS
Visitors welcome
We want carers, family and friends to feel as
welcome as possible, so patients and staff have
together created a bright new welcome sign,
with each person producing one letter to their
own individual design its hard to miss the
message! NHT
Inviting friends and family to events
Comedy evenings are continuing. They are
being extended to include relatives and carers.
ELS
Birthday parties are perfect occasions to invite
carers and other family and friends and we
plan to invite visitors to join in low key activity
groups. NHT
Help patients to phone home
Patients can use the hospital phone for calls to
family overseas. HRH
Provide toys for children
There is a Conservatory for family
visiting room with lots of big plastic
toys, donated by League of Friends.
The room gets booked, partly to
monitor kids visiting and a nurse
will usually sit outside for safety.
Nappy change facilities in loo next to
family room. DPU
3. Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Star WardS
+5
Wonderful volunteer projects
A group of students from the university spent a
day redecorating a former ward smoking room
into a bright and useful activity space. NHT
A male volunteer is running a Mens Activity
Group. ELS
In addition we are working towards volunteers
working into each ward environment to
support the coordination of ward based
activities, particularly during the weekends and
evenings. DM
VOLUNTEERS
Finding volunteers
Supporting volunteers
Wonderful volunteer projects
Supporting volunteers
A short registration form is followed up with
an informal chat with an existing volunteer
and the volunteer co-ordinator. Once
volunteers skills have been identifed, and a
suitable location matched with them, they are
supported and supervised by the occupational
therapy staff. OTs aim to hand over support
and mentoring to nursing staff once volunteers
are established in their roles on the wards. NHT
Monthly two hour training sessions in the
early evening covering the basics of mental
health, group skills and discussion / engagement
skills. Volunteers attend staff mandatory
training and have access to the full education
and development prospectus if they wish to
complete further appropriate training to their
role. NHT
We have a quarterly Valuing Volunteers forum
for networking, informal discussion and support,
and as an important venue for staff to say thank
you to the volunteers for their commitment.
NHT
Finding volunteers
We recruit volunteers to specifc tasks. Four
volunteers work in our activity club, two run
card making sessions, one organises a flm club,
visits the local shops for service users and
manages our library. BHC
Volunteers from local deaf association go out
with deaf patients. DH
We successfully recruited new volunteers
through publicising volunteering opportunities
via BBC Radio NHT, local press, etc. NHT
We have increased links with local
volunteer bureaus and having a stand at
the University of Northamptons annual
volunteers fair. NHT
Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Star WardS
+
PETS
Visiting time for dogs
Borrowing pets
Encounter unusual pets
Keep pets on the ward
Going horse riding
Visiting time for dogs
The Head of Therapies brings in her dog
Keira which the patients take for walks
and practice training techniques. HHR
A member of staff s guide dog Tom is a
regular visitor to the ward. BHC
Borrowing pets
Ward has visitors from Pets As Therapy. WLH,
NHT
Encounter unusual pets
A hugely popular animals day was held, with
visitors ranging from reptiles to rodents.
Patients bravely and enjoyably cuddled even the
slithery snake. HHR
Visiting birds of prey have proved very popular.
TSM
Keep pets on the ward
There is a hamster which plays
an important role in enabling
patients to regain their equilibrium!
HHR
We have for the past few years
now had rabbits, guinea pigs, fnches,
cockatiels and peacocks and we have
currently 4 rabbits and 8 guinea pigs.
Patients take turns to clean out and
feed, etc. Rabbits have been taken to
other wards for holds and fuss etc. BCK
Going horse riding
The patients have also started having horse
riding lessons which has been very popular and
a great mood lifter. HHR
Snakes, hamsters and Keira the
therapy dog at Huntercombe
Hospital
Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Visitors, volunteers and carers. (And pets)
Star WardS
+7
Care planning
Care planning
Care planning
Care planning
Star WardS
+8
4. Care planning
CARE PLANNING
Shifting the power
Why keep the ward round?
Tame the paperwork
Creative advocacy
Personalised information and
recovery fles
Easing the return home
Helping with work
Helping with benefts
Shifting the power
Recovery plans took the place of nursing
controlled care planning and a welcome
pack was developed to ensure all clients get
information on Recovery working, relapse
prevention and crisis planning. SPT
Helping with benefts
Employment offcer helps with patients
benefts. DPH
Members of staff with specifc role of and
expertise in helping patients with their DSS
benefts. EB
Derbyshire Coalition for Inclusive Living
support patients with Direct Payments. HUC
Why keep the ward round?
Abolished ward rounds. Very successful
new arrangements of consultant
appointments, co-ordinated by nurse.
Patients have information about other times
when consultants are available. SPH
We provide individual appointment times for weekly
service user care review meetings, reinforced
through the use of a local protocol. B&L
Groups that are running at the same time as reviews
are open so patients can come and go. MSC
Creative advocacy
DSS beneft information is provided from our
independent advocacy workers who have a
specialist benefts worker. Leafets are available
and there is internet access. BHC
We are in the process of arranging formal
advocate training for a volunteer who is an ex-
patient. HHR
Rethink Advocacy are involved. SHL
Personalised information and
recovery fles
Are developing Personal Recovery File including
a photo sheet of staff (rather than on poster on
wall), information about the aims and benefts
of each activity and a security plan risk
management including how patients can
support their own safety. SPH
Patients have folders given to them for
homework and handouts from therapy
sessions, but the hospital is working on
providing one folder to contain all the
patients paperwork, including information
on their diagnosis, Mental Health Act status,
Therapy Department timetable and ftness plans.
We will also include general information on
drugs and alcohol and plain paper to encourage
patients to journal their experiences. HHR
The provision of personalised information
folders for service users as soon after admission
as possible, which are most likely to include the
service user Unit information brochure, helpline
numbers, a satisfaction survey, the service
users care-plan (upon completion) and health
promotion information. It is planned to further
develop this practice in offering service users a
personalised recovery folder. B&L
Care planning
Care planning
Care planning
Care planning
Star WardS
+9
Tame the paperwork
The Trust is moving towards an electronic
system that two of our fve wards are currently
using. This cuts down on paperwork. BHC
If we introduce new paperwork, we take
something away. As nurses we are doing a huge
amount of paperwork, so we developed a new
role of ward administrator which will take away
lots of admin from nurses. DM
Service user self-management, crisis planning
highlighting strategies and resources to prevent
relapse as well as advance directive forms, i.e.
information about how service users wish needs
to be met in a crisis, have all been standardised
so offering ease of location in case notes. SPT
Easing the return home
Pre-discharge groups will initially be informal
groups facilitated by a nursing assistant on a
rolling 6 week programme and will discuss
patients worries/concerns regarding going
home. ELS
Two post-discharge staff. Community in-reach
- care co-ordinators work on wards with
patients. SPH
Service users on discharge can continue to
return to use the gymnasium and activities club.
BHC
The Prepare and Share weekly cooking
group includes patients whove been recently
discharged, enabling someone to come back for
a burst of contact and an enjoyable event. We
also involve patients who arent able to leave
the ward, by them preparing some food for the
group on the ward before the session HMHC
All units can refer to OT as required specifcally
around issues relating to planning and
supporting elderly patients return home. ELS
OT works for up to 8 weeks post discharge
which is more satisfying for patients and staff.
DM
Helping with work
Work Matters:- A practical and education
based session enabling people to validate and
explore their experiences and aspirations for
work roles. WLH
With Job Centre, employment offcer liaises
with employers e.g. re: sick notes. Paid for by
trust. And helps with patients benefts. DPH
Talking therapies
Talking therapies
Talking therapies
Talking therapies
Star WardS
50
5. Talking therapies and self-management
Creative therapies
Art therapy. CHCMH, NHT
Music therapy. MC
Drama therapy. BHC
Dance and movement. WLH
Talking therapies and
self-management
Provide self-help resources for
patients
Recovery groups
Provide self-help resources
for patients
We have set up 5 core central
patient library areas in adult and
older peoples services that will have self
help resources for service user, carer and staff
reference. These hold the MIND booklets,
19 relevant NICE guidelines for patients and
additional self help text books. NHT
The hospitals advice and information centre
includes a library thats well used by patients as
well as staff. ECH
Daily diaries and personal recovery packs; self-
help books and tapes /DVDs. SPH
Wellness Recovery Action Plans are available.
DM
Recovery groups
Chaplain runs regular recovery groups for
patients. WLH
Recovery groups, enabling people to share
personal experiences of recovering from
mental illness and to hear how others have
coped. WLH
We run a weekly 45 minute talking therapy
group. The style of our group is undergirded by
principles of Group Analysis and Irvin Yaloms
tried and tested approach to inpatient group
psychotherapy. But in practice it sometimes
looks more like a drop-in group for a startlingly
diverse mixture of people to come and talk
about whatever is on their mind. SPT
Emotional Skills and Mindfulness: enables people
to fnd ways of managing intense feelings in a
safe and supportive environment. WLH
A range of individual and group therapies
including cognitive behavioural therapy,
dialectical behavioural therapy, trauma focused
counseling. SPH
All acute inpatient wards have access to a
weekly Leaving Hospital group therapy session,
led by clinical psychologist, and members of the
multidisciplinary staff team and, on occasion,
other service leads as well as service user
consultants from Mind and other voluntary
organisations. We hope to set up a sister
support group, Coming Home, based in the
community and welcoming ex-inpatients for
at least up to six months or a year after their
discharge. C&I
Further partnership developments include the
development of a support group for patients
which is delivered on site but supports service
users both pre and post discharge in order to
facilitate a smoother and supportive transition
from hospital to home. DM
Dance and movement - WLH
Creative Expression Group was originally for
patients who had spent long periods in medium
and high secure care, and who appeared to
possess a stultifed range of expressive skills,
and uses Tai Chi theory and a Person First!
approach to underscore the value of achieving
balance in life. KVH
Talking therapies
Talking therapies
Talking therapies
Talking therapies
Star WardS
51
Other emotional
support groups
Food and mood group
Relapse prevention
Offer a choice of groups
Harnessing service users time
and skills
New skills for staff
New skills for patients and carers
Addressing abuse
Food and mood group. EB
Relapse prevention.
GPH
Addressing abuse
As one of the Department of Health pilots,
were undertaking a baseline audit of staff
and people who use our services views
/experience of abuse, helping staff to cascade a
training package on sexual abuse, developing a
forum that can offer advice/support/signposting
with a focus on sexual abuse and violence and
abuse. S&B
New skills for patients and carers
Run a service users and carers leadership
programme. SPH
New skills for staff
Staff have received psychology training sessions,
among others, in basic cognitive behavioural
therapy, and working with self-harming
behaviours and post-traumatic stress. C&I
Clinical psychologist runs drop-in consultations
for staff. SPH
Nursing staff trained in psychotherapy and
alternative therapies e.g. aromatherapy. SPH
Harnessing service users
time and skills
Hearing Voices self-help group with
local support organisation. DM
Patients contributed to making a
stress management CD in local
studio, e.g. relaxation techniques. SPH
Offer a choice of groups
Richmond Mind ran an evening and
weekends recreation service on
a ward at Queen Marys Hospital.
Opportunities included relaxation,
mental health discussion group, anxiety,
stress and anger management, art and craft,
creative writing, storytelling, voice development,
Reiki, stretching and posture awareness, music
appreciation, grooming & fashion, relationship
skills, proverbs and spirituality, Tai Chi and
current affairs. LnM
Ward community
Ward community
Ward community
Ward community
Star WardS
52
6. Ward community
Patients
Preparing patients
A community start to the day
Enhancing community meetings
Hold the front page!
Individualised choices/decisions
Make it easy for community groups
to contribute
Peer support
Preparing patients
Patients get pre-briefng being alerted to possible
tricky things that might happen on the ward.
Research suggests this reduces PTSD etc. SPH
Service users are encouraged to buddy up with
new users to the ward in order to show them
around the ward, Oasis Caf etc. BHC
A community start to the day
The clients have a daily forum to express
their views and shape their experience of
the ward, from fully engaging in identifying
their own needs and planning how to
manage their care and deciding how to
spend their time. There is more engagement
as the focus is on activity, positivity and enjoyment,
rather than containment and service led
assessment (what do you have problems with?
etc). MVH
Breakfast meeting to plan day. Patients chair and
take notes. Each patient in turn is asked if they
have issues to discuss. Then reads activity choices
for day. Protected time during meeting. SHL
At the daily morning meeting, multi-disciplinary
team and service users discuss full therapeutic
programme available on the ward MVH
The service user consultant chairs daily meeting
once a week. CLT
Enhancing community meetings
Weekly community meeting. Patients bake nice things
for it. SHL
We are considering whether it would be benefcial
for domestic and catering staff to be involved in
attending ward forums, as well as current training
initiatives available for inpatient staff. MC
Writing up a protocol for their weekly community
meeting that would involve all staff and patients
including domestic and catering personnel. MVH
We hold weekly community meetings with guest
speakers. This is a classic example of an opportunity
that people might not get when they are back
home and provides endless possibilities for inviting
interesting people to talk. CHMHC
Hold the front page!
Bevan Truth is a very popular weekly newsletter
put together in the group room. It includes poems,
raps, articles, thoughts, quotes, word search, quizzes,
etc. Some patients from other wards even deliver
their quiz answers to Bevan ward! CHCMH
Individualised choices/decisions
Women can eat in the women-only lounge if they
dont want to eat with men. SPH
Flexibility re: upper age so patients can stay on past
65 if their situation requires this. SPH
Make it easy for community
groups to contribute
Alcoholics Anonymous and CHAPTER
(an employment charity) meet regularly
within the hospital. BHC
Citizen Advice Bureau clinics on ward.
HUC & DPH
The CAB have their own offce on the
ward as well as a debt specialist in town
who the patients can go and meet. MSC
Mind run joint meeting A Plus (Activity
Plus). Includes specialists who give
information about their service. MSC
Park rangers and library staff visited. MSC
The hospitals advice and information
centre includes a suite of meeting rooms
used on a time-share basis by local
voluntary organisations (for example Black
and Minority Ethnic groups providing
counselling in mother tongue languages).
ECH
Peer support
In contact with Queer Notions - local lesbian
and gay mental health support group. MC
Peer supported substance misuse groups. HHR
A service user has set up and runs a clients
support group CLT
Extending community culture when back in the
community. Service users support other users
on discharge from hospital on an informal basis.
BHC
Partnership with Rethink - ex service users
mentoring patients to support them when
they leave. Rethink has gardening project in
community. DM
Ward community
Ward community
Ward community
Ward community
Star WardS
53
Spirituality and cultural
connections
Be aware of spiritual diversity
Meeting minority needs
Create a peaceful room
Space beyond rooms
Still time

Be aware of spiritual diversity
Posters of religious festival dates are displayed on each
ward, all patients are encouraged to celebrate these faiths,
which are often demonstrated in the cooking sessions.
HHR
We are collecting information on different cultures to
create a new notice board. NHT
The chaplaincy team also offer a wealth of knowledge
about different faiths and religions, acting as a resource for
staff. NHT
There has recently been a Spiritual Awareness open day to
encourage other faiths to be aware of our hospital and use
the facilities. BHC
Meeting minority needs
Arrange for prayer mats for Muslim
patients. DPU
At Denmark House, specialist unit
for acutely ill deaf patients, Anglican
Chaplain who can use British Sign
Language attends once a month but it is
a considerable challenge with regards to
other faiths and denominations. DH
Fasting at Ramadan accommodated
access to meals out of hours.
Microwavable meals, takeaways and
family bring in. DPU
Muslim patients can go to mosque down
the road. SHL
We are hoping to facilitate cultural
evenings where patients can prepare
their traditional dish to share with other
patients and staff. HHR
Create a peaceful room
Setting up of a Faith Room in collaboration with
Social Services. ELS
The prayer room has beautiful stained glass
window, with scene of trees, sun etc. The centrally
placed crucifx is movable, and we are going to get
stencils of symbols of different faiths for walls. 98% of
patients are Christian but hospital has good links with
leaders from other faiths. BHC
Space beyond rooms
Developing concept of sacred space provision of
spiritual care rather than the provision of a room for
people to pray in. MC
Still time
A Meditation Time session is provided by a chaplaincy
worker on a weekly basis. The session is publicised to
service users as a contemplative place to be still. NHT
The prayer
room at
Bowmere
Ward community
Ward community
Ward community
Ward community
Star WardS
5+
Staff
Respecting needs rather than
traditions
Everyone joins in
Staff dont just have clinical skills
New approaches require new skills
Supporting staff as well as patients
Staff dont just have clinical
skills
Did audit with trust audit team,
referenced but wasnt restricted to
Essence of Care. Asked staff what skills they
have that could be valuable to engaging with
patients. MSC
At the weekly Prepare and Share cooking
group, the modern matron not only makes the
coffee and washes up, but also does decorative
serviette folding. The group is led by a ward
manager who is a trained chef including the
skill of decorative pineapple carving! HMHC
New approaches require new skills
Serve to Care professional development programme.
Change management, fnance, political awareness.
Action Learning Set, enhancing skills. Developing
action plans, e.g. protected time, ward evaluation
tool. Each ward sister has a Trust board mentor. Chief
executive is also a mentor. Looking at accreditation
with RCN. DM
Planning to pilot an Action Learning Set to assist
ward staff in the implementation of the Star Wards
initiative. MC
Healthcare assistant training ranging from ethics,
gender issues and recovery models to the Mental
Health Act and de-escalation. The training process is
impressive. It includes structured, supportive training
sessions, mentoring, observation of work practice,
written assignments, discussion and projects. WLH
Phase 2 was building nurses confdence in running
groups. We protected time so that nurses could co
facilitate OT groups. They had the opportunity to
see how groups are structured and pick up tips on
running their own group. GPH
Staff have been given time out of the numbers to
work alongside and learn from other disciplines
and it has promoted better communication and a
greater understanding of each others roles. Staff
have been able to develop their interests from CBT
and psychological input, to activity, pampering, and
relaxation groups. This has been a particular beneft
for unqualifed staff who may struggle to fnd a
meaningful role in some circumstances. SPT
All Bank staff are required to undertake the same
2-day induction programme that substantive staff
complete. HHR
One man and
his pineapple.
Prepare and
share meal
at Highgate
Mental Health
Centre
Ward community
Ward community
Ward community
Ward community
Star WardS
55
Respecting needs rather than traditions
The implementation of a hospitality nurse system, which has particular value in greeting, meeting,
orientating and supporting the newly-admitted service user. B&L
All reviews are managed by our Admissions and Discharges Liaison Nurse - who organises the info,
educates the service user, distributes the agreed plan and enables the service user to debrief. And we
have just created an assistant role to the ADLN - who carries out planned escorts (having been trained in
assessment and support for escorts) She will take people to sort their money out, to check their property,
to prepare for discharge anything the customer requires really HCH
Our Matron manages the Ward Housekeeper who attends to all the hospitality issues - and our aim is
hotel standard welcome. HCH
We have a Practice Development Nurse who organises the learning environment and deals with students
on placement and the needs of our more junior staff. HCH
And the three Medicines Management Nurses organise all of issues relating to storage and administration.
HCH
Our Entertainment Offcer provides fun and recreational activities on our dedicated activity centre and
this allows the OTs to focus on more specialist intervention. HCH
We have all calls to the ward managed by our central receptionist, rather than immediately going through
to the ward, which dramatically curtailed the phone ringing and could you just do this or that type of
enquiries which disrupt plans for the day. We have created an Inpatient Administrator role - which does all
the paperwork, data inputting, organising reports, dealing with complaints, preparing rotas, annual leave and
liaison with our partner organisations re: environmental issues. On the ward itself, the shift lead allocates
service users to a designated nurse for the shift - and a minimum standard of one meaningful 1: 1 per day.
Without having to worry about all the things they would have to in the traditional model, they have huge
amounts of time to spend with the customers with very little interruption. HCH
We have one Manager for the two wards - to promote consistency and fexibility. This gives our manager a
lot of clinical capacity to be on the ward supporting and being highly visible. HCH
Have registered nurse additional to the staff on rota, so freed up to run activities. MSC
Because many patients fnd it hard to get involved with anything before about 11AM, and most are
felt to be at their best by early evening, the Trust is looking at ways of organising staff (eg OTs) hours
around this. S&B
Shift patterns have addressed group facilitators being pulled back into ward numbers and preventing
cancellation by having a 12-8pm shift. SPT
Employ linen services to put it away rather than nurses doing it. DM
Everyone joins in
The domestic staff, when less busy,
spend a considerable amount of time
on the ward talking to patients. It is a
common sight to see the domestic staff
playing games of table tennis with patients on
the wards or board games. HHR
The Financial Administrators Assistant visits the
wards to help patients manage and access their
fnances. HHR
Supporting staff as well as patients
Case formulation group is forum for qualifed
nurses to get support re: clients emotions and
behaviour. SPH
Ward community
Ward community
Ward community
Ward community
Star WardS
5
Hospital and ward design
Make the ward look great
Put up some photos
Change the lighting
Change the ward names
Making the most of The Room
Formerly Known as The Smoking
Room, and other group rooms
Chill out room
Have music rather than muzak!
Keeping living areas private
The lovely green outdoor room
Make the ward look great
Challenged the Estates Dept. by having non-
prescription fooring and rejecting magnolia paint.
There are lovely colours on walls and seating. HUC
Instead of dull, standard NHS ward signs ones, the
ward names are in a lively, attractive font chosen by
patients painted directly onto the walls above doors.
HUC
The ward has a smart, chic, hotel-like feel, with large
pieces of stylish art, from specially commissioned
local photos of nature. SPH
Put up some photos
A nursing assistant is talented photographer and
ward is decorated with beautiful water-themed
photos. HUC
The frst thing that greets you is a lovely framed
local photo, with an accompanying narrative
about the photo. There are cleverly designed
transparencies (taken from the commissioned
photos) on some of the glass external doors and
a few windows to increase privacy. SPH
Change the lighting
The lighting in the ward uses new technology,
while as much natural light as possible is allowed
into corridors. The ceiling of the relaxation room
has fbre-optic lights, which change colours gently.
The sounds and visuals can be personalised. HUC
Change the ward names
Refreshingly, wards arent named after
trees, but after local ships (the marina
is right by the hospital). The ward doors
have a photo of the ship and a short
description of it. SPH
Making the most of The Room
Formerly Known as The Smoking
Room, and other group rooms
Relaxation room has lava lap and colour
changing globe. MSC
Aromatherapy room! Treatment bench, relaxing
pictures and astutely the framed diploma of the
nurse who is a qualifed aromatherapist. MSC
Chill out room
The Sanctuary is a dedicated relaxation
room. The window has a photo of
water transposed on it. There is a
plasma screen TV for relaxation DVDs,
etc. Wall includes glass brick cubes. HUC
The relaxation room on our ward has
been tastefully furnished and is very
popular with patients. BHC
A de-escalation room with resources
for self-soothing including care bags
which appeal to the senses of sight,
touch and smell. The room includes a
rocker, light projection and body-sized
bean bags. S&B
Have music rather than muzak!
Music in unit reception area! Lovely. Very
welcoming. HUC
Keeping living areas private
The only staff to go on the living areas are now
nurses and OTs. This reduced the traffc and
made the environment feel less frenetic. HCH
The lovely green outdoor room
Garden like a mini, landscaped park, backing
onto woods. Big pergola, funded by local Toyota
plant. Also the frst kennel Ive seen on a visit,
with a plaque for George Junior above the door.
The eponymous part-time resident is a whopping
Great Dane, whose human is a member of staff
and who enjoys taking patients for runs around
the garden and nearby. Occupational therapists
Pets as Therapy registered dog. MSC
Ward community
Ward community
Ward community
Ward community
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Food
Patients eat what they want, when
they want
Homely mealtimes
Special mealtimes
Healthy eating
Get cooking
The Great British Breakfast
Go to a caf
Patients eat what they want, when
they want
Ward kitchen open 24/7. SHL
we are in discussions with the hospital caterers
about the provision of sandwich and salad ingredients
for optional do-it-yourself lunches and dinners too. NHT
Being able to order exactly the sort of baguette, or
whatever you fancy for lunch, with or without piccalilli/
peanut butter/banana... EB
The Catering Department are running an initiative called
Just for You where the patients are invited to design a
meal themselves and the catering department will cook it
for them. HHR
Meals which are pre-tested by members of the Patients
Council EB
Homely mealtimes
Providing china rather than plastic mugs has made
patients feel trusted and better about themselves. NHT
A small thing like a tablecloth can make mealtimes feel
much more like home. NHT
Staff eat with clients not just in same room at same
time, but sharing tables. CLT
Special mealtimes
For the curry night all the staff wore saris. DPU
Patients have chosen to have Beans on Toast
night! DPU
Healthy eating
We have asked for clearer labelling of ingredients,
and for a menu to be provided with every meal,
fagging up the healthier options. NHT
Menus are now in a much more user-friendly style
with clear symbols to help identify healthy options,
vegetarian and low sugar meals. SPT
Protected Mealtimes are also in place to promote
proper patient nutrition. DPU
Theres a food and mood group being planned as
well as the opportunity to discuss healthy eating
directly with catering staff. EB
Get cooking
Some of the catering budget is ring-fenced for
OTs use for cooking activities, e.g. the breakfast
groups or weekend activities. EB
Despite not having an oven, the creative ward
manager from regular cooking sessions for
patients. They use bread-making and smoothies
machines, make microwave and freezer cakes
and harness the relaxed sociable potential of
communal meals there. WLH
Saturday and Sunday baking and cook one
meal. Patients have 50 for shopping. SHL
The Great British Breakfast
Breakfast no longer involves queuing
at the kitchen hatch to be served by
a member of staff. Patients can now
make their own breakfast at a table in
the dining area. NHT
The simple act of moving the toaster
out of the kitchen and providing
self-service fresh flter coffee (in
the aforementioned china mugs!)
has altered the whole feeling of the
breakfast routine. NHT
On Fridays, a grill and microwave
are provided so that patients can
cook themselves up a full English,
which usually goes down well with
everyone. This is a self-fnancing
initiative, as staff who want to join
in (usually most of them!) make a
donation for their food, which pays
for the next weeks supplies. NHT
Go to a caf
The residents of Kingsholm Ward have
responded to requests from patients, relatives
and staff alike to re-open Caf Kingsholm on
Wednesday afternoons. A staggering six hours
of patient activity took place in Kingsholms
kitchen last Tuesday with patients and staff
chopping a plethora of fresh vegetables in a
quest to produce a healthy hearty vegetable
soup. And as if this wasnt enough they also
baked homemade bread rolls in our new
convection microwave. WLH
Patient responsibility
Patient responsibility
Patient responsibility
Patient responsibility
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7. Patient responsibility
Patient responsibility
and autonomy
Help patients to understand
Use creative ways to give
information
Checking customer satisfaction
Not chores but choices
No more queuing for medication
Involve service users in managing
the ward
Get some help from PALS (Patient
Advice and Liaison Service)
New technology, new independence
Help patients to understand
Denmark House, Birmingham one
of three specialist mental health acute
units in the country for deaf people.
As well as training hearing staff about
deaf culture and BSL, one of the two
communications offcers is also very
skilled at communicating with deaf
people who either are not themselves
fuent with BSL or use a different form of
sign language e.g. Irish or American Sign
Language or even something developed
within a family. Hands-on signing with
deaf-blind patients. Denmark House
translates important documents into
printed BSL. DH
Use creative ways to give
information
The Design a Placemat competition challenged
users to design a placemat with useful
information, such as local resources, 5 a day,
puzzles, TV listings, etc.. DPH
Leafets and other information are on display
on sideboard to prevent stylish hotel feel of
ward being dented by rather institutionalized
noticeboards. SPH
The timetable and information board is now in
place and is proving very positive, and patients
are now asking regularly for drinks, and to have
their hair done etc. now the information is
displayed. ELS
The whiteboard gives daily info such as who is
each patients shift nurse that day. BHC
Interactive weekly activity time table - so that
both service users and any member of staff can
write on the board what activities they would
like to do. NHT
A hotel type pack is accessible on each ward
with available resource information. BHC
Working with PALS worker on updating service
user and Carer Information. MC
An activity folder has been developed for
service users to access and see what is available
and the aims and objectives of each group. SPT
Making freely available written information and
health promotion materials widely accessible
through the provision of an Information Centre
within a central location in the unit / ward, such
as within the unit dining room. B&L
The production of unit / ward information
brochures for service users & carers, in making
available key information about the unit / ward
and explicitly stating a set of expectations of
the care process. B&L
We would like to have patients participate in
our hospital newsletter. HHR
Not chores but choices
We have a patient Jobs Board so that patients
volunteer for tasks which contribute to the daily
running of the ward, such as laying the tables,
watering the plants, keeping the lounge/garden
tidy, washing up the mugs and so on, thereby
taking back some of the responsibility for their
own environment. NHT
Get some help from PALS
PALS contribute to Patient Forums
around the service and we are going
to look at the possibility of setting up
Monthly Surgeries on the Inpatient units
for patients and carers. ELS
Health Promotion and PALS are a good
source of ideas and support. ELS
Patient responsibility
Patient responsibility
Patient responsibility
Patient responsibility
Star WardS
59
No more queuing for medication
None of our patients queue for medication.
Some of the patients have dosset boxes,
which we keep, in the clinic room. HHR
A number of patients have started self-
medicating which has positive outcomes as it is
identifying those patients that may need help with
their medication after discharge e.g. Dossett boxes
etc. ELS
Weve introduced automated dispensing, using
a machine stocked with individual service users
medication which is pre packed on a dose by dose
method. It is computerised and time set. A code is
inserted and the meds are released and given to
the person, giving the potential for greater self-
medication by patients. BHC
Proposal to think about pharmacy technician to do
drugs round with an unqualifed staff member. Frees
up qualifed nurse time and better for patients who
could access more experienced staff in relation to
medication. DPU
Medication rounds take place in quiet room with
easy chair, patients come in one at a time. Chance to
talk to patient at start of day. HUC
We have now managed to secure a working policy,
the correct equipment and appropriate training for
staff so that all wards should soon have inpatients
who are self-medicating prior to discharge. This is
something that 10 years ago would never have even
been considered in this part of the country! LYG
Checking customer satisfaction
Quality audit included an evaluation tool for
service users which allowed us to capture not
only their thoughts on what we had done, but
also what they felt we could be doing instead/as
well. MSC
If a service user has had rapid tranquilization then
there is a process for them to write about their
experience. BHC
Service users writing their experiences is
something new to us and has been incorporated
in the Rapid Tranquillisation Policy, following RT
and when able service users are asked if they
wish to comment on the experience. BHC
The hospital manager makes regular visits to the
wards for general discussions with patients and
their relatives. HHR
Service user involvement in various aspects
of how the hospital is run is facilitated via the
assorted service user and carer groups, as well as
complaints and suggestions making an impact. An
example of this is the talkback box on each ward.
At their own leisure service users put suggestions
in the box which are in turn looked at fed back to
local community meetings. All the suggestions are
taken to the monthly service user meeting. There
is also a monthly PALS talkback newsletter. BHC
Our service representative are very active in all
areas including Star Wards, AIMS (Accreditation
for Acute Inpatient Mental Health Services),
National Audit of Violence, Acute Care Forum,
Patients Council and representing our service
users on various committees and interview
panels. LYG
Suggestion box, satisfaction surveys. CLT
Involve service users in
managing the ward
Recruiting a service user to be involved
in attending the Star Wards and Acute
Care Forum, for which theyll be paid. A
person specifcation has been produced and the
post will advertised through a mailing list of service
users and carers. The successful applicant will
attend the Patient Forums on the wards and act
as a conduit for communication between service
users on the wards and the 2 groups. HHR
Patients also have the opportunity to attend the
Clinical Improvement Groups on each ward as a
representative. HHR
Recruitment done with service users. CLT
Service user consultant working as part of the
team. CLT
Annual Reports - last one compiled by service
users. CLT
Hospital shop is staffed by patients. (Its a
medium secure unit so patients are there for
some time.) TSM
New technology, new
independence
Wards - patients have fobs to open their
(ensuite) bedrooms and these can be
programmed to open ward main door. BHC
Ward has combined fnger-print and code
entry system. DPH
Individual rooms have door bells and alarms
with fashing lights, and communal room has
minicom, textphone, fax and internet use for
deaf patients. DH
Star WardS
0
Activities list
Art
Arts competitions
Producing art for display at local galleries
and/or in hospital
Partnership with art gallery with workshops
and printed resource on modern art
Drawing
Calligraphy
Painting
- using oils, acrylics, water colours, pastels,
graphic pencils and gouache
- painting by numbers
- painting on your t-shirt, fabric painting
- glass painting
- spray painting
- having paintings exhibited in local galleries
Collage
Sensory pictures for sight-impaired patients
Stone carving, sculpture
Mixed media project with professional artists
Crafts
Pottery, ceramics
Card making
Balloon modeling
Mosaics
Bead work
Model making
Wood-turning
Wood-carving
Fret work
Pyrograph (putting designs on wood)
Making a guitar
Aircraft modeling
Writing and literature
Poetry
Creative writing
Journals
Storytelling
Reading groups
Patients writing and performing own play!
Weekly newsletter
Books on prescription
Library including novels, reference books,
picture/photo books, easy read books, large
print books
Textiles
Sewing
Embroidery
Crocheting
Knitting
Quilt making

Ward community
Participating in management groups/meetings
Patients councils
Breakfast community meetings
Weekly community meetings, with or without
outside speakers
Chapel group
Therapy
Talking therapies:
- cognitive behavioural therapy
- brief solutions therapy
- dialectical behavioural therapy
- trauma focused counseling
- counseling
Solutions group
Art therapy
Music therapy
Drama therapy
Food and mood group
Drug and alcohol group
Peer supported substance misuse groups
Mental health discussion group
Anxiety, stress, hearing voices and anger
management groups
Self-help group with local support
organisation
Personal recovery fles which include sections
for patients to fll in e.g. by journaling
Wellness action recovery planning
Self help resources
Creative
Drama group
Artists in residence
Music
Walkmans (men??)
Music appreciation
Drumming, samba drumming, percussion
Using musical instruments, including drum
machine, keyboard, electric guitar and vocal
recording equipment
Singing
Rapping
Bands playing gigs
Concerts, including through music in hospitals
Karaoke
Guitar club
Guitar lessons
Piano lessons
Song-writing
Recording music on computers
Musical jamming session
Therapeutic music group run by local music
therapy charity

Star WardS
1
DIY
Domestic DIY
Furniture making (eg, book shelves, coffee
tables, dolls houses, computer desks)
Bicycle restoration and maintenance
Woodwork
Building rabbit sheds, bird tables and pigeon
lofts, dog kennels for gardens & pet therapy
centre
Joinery work
Furniture restoration
Picture framing
Food
Weekly cooking group
Breakfast cook and eat group
Weekend cooking of patients meal, with
patients doing shopping
Bread-making and smoothies making with
machines
Healthy eating
Social and recreational
Games
Puzzles
Pool
Table football
Pool
Board games
Pictionary
Juggling
Playstation
Social
Service user run hospital caf
Movie night
Comedy night
Take-away night
Buffet evenings
Bingo
Discussion groups
Points of view
Newspaper group
Current affairs
Conversation/thought starters on
noticeboard
Activities group run by service user
volunteers
Disco
Social evenings on and off the wards eg:
- BBQs
- cultural evenings e.g. Caribbean evenings
- DVD concerts including specially themed
Elvis and Abba nights!
Birthday parties
Celebrating festivals of different faith
communities
Themed days e.g. Hairy head, green living,
Red Nose Day
DVD library

Humour
Comedy room with CDs, tapes, videos,
magazines
Comedy gigs
Comedy evenings
Animals
Visiting animals, including snakes, falcons, cats
and dogs
Horse riding locally
Resident animals including rabbits, guinea pigs,
fnches, cockatiels, peacocks and day-time
dogs (members of staff bring and then take
home after work)
Health and well-being
Get active week
Medication info sessions
Drop-in medication clinic
Medication concordance training
Stop smoking group
Healthy living group
Health education and promotion
Benefts of exercise sessions
Diet/health
Tai chi
Mens/womens group
Moving on group
Fruity friday (and fruitilicious friday!)
Smoothies + mens group
Pampering
Fingernail fashion
Grooming & fashion
Voice development
Stretching and posture awareness
Relationship skills
Proverbs and spirituality
Relaxation
Relaxation circle
Relaxation session before bed
Meditation
Massage
- head massage
- hand massage
- aromatherapy
Reiki
Yoga
Foot spas
Meditation time with chaplain
Outdoor exercise
Walking:
- grounds
- village/local
- nature rambling
- treasure trails
- staff trained as walk facilitators
- seasonal walks arranged by head gardener
- walks as part of smoking cessation
programme

Star WardS
2
Gardening
- growing seeds indoors
- sensory garden
- going to the local garden centre
- gardening group
- allotment
- plant growing competition
Sports:
- football
- tennis
- putting
- fshing
- canoeing
- cycling
- swimming
Garden games:
- frisbee
- croquet
- bowling, boules
- quoits
- chalks
Indoor exercise
Wake and shake start to the day
Dance:
- creative dance
- line dancing
- dance exercise
Badminton
Table tennis
Bowls
Table tennis
Volleyball
Exercise equipment e.g. Bikes, rowing
machines
Space hopper races!
Individual and group sessions of circuit
training,
Trampoline
Hospital community
Citizens Advice Bureau clinics/advice sessions
DSS beneft advice including internet access
Advocacy
Employment offcer
Local lesbian and gay mental health support
group
Information group
Exploring leisure sessions
Religious services
Local community
Cinemas
Cafes
Bowling
Shops
Library
Sports facilities
User-led community arts group
Local farm including opportunity to help with
grooming and caring for animals

Museums and places of interest

Local womens centre
Visits to local places of worship including
temples and mosques
Guided tours round local football and rugby
teams grounds
Project linking service users with community
resources and organisations
Computers and technology
In reception area as an information whats on
resource
Internet:
- games
- research including into patients illness, its
management and treatment
- managing fnances
- exploring local resources
- hobbies
- emailing
Basic to advance courses e.g. ECDL
(European Computer Driving Licence)
Word processing, including for letter-writing
and CVs
Desk top publishing
Powerpoint presentations
Digital photographs and e-mailing photos
Updating your mp3 player
Using mobile technology to improve english,
maths and basic IT skills through mobile
phones, pocket computers and the internet
Recording studio where patients can make
their own CDs or demo tapes
Making a stress management CD in local
studio
Making creative DVDs
Creating websites
IT taster sessions in partnership with the
local college

Star WardS
3
Section 4. From the wards
In this section...
Ideas, examples and tales of Star Wards heroism from wards around the
country.
Arts for Health ......................................................................... 64
Health of the nation audit ..................................................... 66
Developing Star Wards in Bedfordshire and Luton .............. 68
Bevan Ward PICU Service User Activities ........................... 71
Steering Star Wards.................................................................. 72
Community Bridge Building Service ........................................ 74
Star Wards Champions ............................................................. 75
Star Wards Collaborative .......................................................... 76
Busy Bites: enhancing the experience ..................................... 78
Castle Lodge 24hr Nurse led Unit .......................................... 80
On being faced with a blank piece of paper ....................... 81
Families are fun ....................................................................... 82
Llwyn-y-Groes Psychiatric Unit ................................................ 83
Creating a real buzz on the wards ........................................ 84
Star Wards at Sandwell ............................................................ 85
Prepare and share ................................................................... 86
A Star Ward in the Making? ................................................... 87
Joint Therapeutic Working ....................................................... 88
Improving Access to Psychological Skills................................. 90
Working collaboratively ........................................................... 91
Voluntary work on Acute Mental Health Wards ..................... 92
Small Changes Big Difference ............................................. 93
Creating a Star Ward ............................................................... 94
User, Carer and Advocate Leadership Programme ............... 97
Star Wards at Wotton Lawn: 1 year on ................................. 98
The Acute Care Collaborative ................................................ 100
Talking Therapy Group .......................................................... 102
Dear Patrick ........................................................................... 103
Star WardS
+
Margaret Stanhope Centre
A Taste of the Arts
This is a mixed-media art project at the adult
acute ward in partnership with East Staffs BC,
Community Arts Team and Arts for Health at
South Staffordshire Healthcare NHS Foundation
Trust.
Comments from participants include:
It was good, interesting. It made me feel
cheerful and happy, I was enjoying myself.
It was the frst time Id ever taken a
photograph.
I thought it was a good story. I enjoyed
listening it helped me relax.
Really enjoyed the session. Found it very
therapeutic.
It made me see there was another side to life.
There is a new project underway involving
a creative artist, a creative writer and a local
historian to create a piece of art work for display
focusing on personal histories and memories of
Burton.
Sculpture Project George Bryan
Centre West Wing
This was a taster session in stone carving which
took place in January 2007 with a view to
extending the project at a later date. Quotes
from clients that took part include:
The man was very skilled at helping people at
different levelsI want to do more please
I enjoyed doing this craft as I would never
get a choice to try something like this out in the
community.
Brilliant!
Valuable and rewarding.
I think that todays event was good for the
patients as they really enjoyed it and it kept
their brain stimulated and gave them something
different to do.
Good tuition at a sensible basic level.
Informative and enjoyable.
Norbury House - Enhancing the
Healing Environment
Amazing redesign and refurbishment of the
communal area at Norbury House, which is the
Intensive Care Unit for adult acute mental health
patients at St. Georges Hospital, Stafford. There is
a full report, complete with photos, at:
http://www.southstaffshealthcare.nhs.uk/
goodPractice/arts/docs/FinalReport.pdf
one client painted one or two pictures as a
gift for the Kings Fund, purely to thank them for
giving him the opportunity to pursue his art
within the project.
Chebsey Ward
Art group being led by volunteer artist Clare
Lord. Due to the success of this project funding
has been secured for Clare to start another
art group at Brocton Ward. The service users
from Chebsey and Brocton House have been
absorbed in the project which has given them
opportunities to learn new creative techniques,
to express themselves, to increase their self
esteem and socialise with one another in a
relaxed yet focused environment. Comments
from service users include:
I have been working on this project for three
weeks and found it really exhilarating.
Im really beginning to express myself.
There was also a music concert in July and
another in December. These have been very
successful on other wards too.
What a sheer delight! Classics at its best from
Elgar to the Beatles. Made a drizzly afternoon
a sunny afternoon. Thats what makes music an
international language.
Debbie Moores
Debbie.Moores@ssh-tr.nhs.uk
Arts for Health
South Staffordshire Healthcare NHS Foundation Trust
Star WardS
5
Stonefeld House
Stonefeld House is a developmental neuroscience and learning disabilities unit, which provides
a multi-disciplinary approach to the treatment and rehabilitation of service users who display
challenging behaviours. There is a dynamic, creative OT department, complete with its own
website. The centrality of service users interests and needs are refected by the inclusion of
service users own micro-sites on the website. www.stonefeldot.nhs.uk
1. Film
Service users have the opportunity to learn how to create their own flms using video cameras
and software. The facilities available include a video camera, Apple Mac with editing software,
music and voice recording equipment and even the opportunity to do green screening. Come on
Over to Our Place was the frst of a series of DVDs to be created by service users.
www.stonefeldot.nhs.uk/activities/flm.html
2. Music
Music sessions are run for service users, whether it is learning an instrument, or creating
music, or just enjoying listening. At Stonefeld House we have the facilities to record songs
and music, including using samples which is a new area for a lot of people. Usually these
take place as a one-to-one session, created to suit the needs of the service user and using
surroundings in which they are comfortable. Service users are encouraged to do as much as
possible for themselves in the music sessions, so if they were recording themselves they would
be encouraged to learn how to set up the equipment and run the program for the recording.
Currently the areas of music we offer are:
Guitar and Piano lessons
Recording sessions - learning how to record music using Garageband on the Apple Mac
Song-writing sessions - looking at how songs are structured and then learning to write
them
Creating music on the computer using samples. (Using music samples in Garageband it is
possible to create an original piece of music that even someone that is not musical can
enjoy creating, and then can add their own vocals to this track to make their own hit.)
Update your MP3 player - these sessions show how to put favourite music onto an
MP3 player
http://www.stonefeldot.nhs.uk/activities/music.html
3. Web design
Stonefeld House now has a website, primarily housing
the service users own web sites that they create in web
design sessions. Like other activities such as flm and music,
it is the service users that do all the hands-on work, using
the computer program and designing the look of their
site and deciding on the content. Each site is unique,
containing original material such as photographs, flms,
music and artwork. There are many creative people residing
at Stonefeld House and web design gives them the
opportunity to share their talents and work with the world.
www.stonefeldot.nhs.uk/serviceusers.html

Star WardS

Health of the nation audit

Auden Unit Learning disability service
Introduction
The Auden is a 15 bedded forensic learning
disabilities medium secure unit. We have 5 female
beds and 10 male beds. The age range is 18 to
65; they must have a learning disability and be
subject to the mental health act with a forensic
history. The patients diagnosis includes mental
impairment, psychosis, functional mental illness,
aggressive and sexual behavioural disorders.
Therapeutic activities on offer on the unit include:
Information technology
Drug and alcohol awareness
Cookery
Arts and crafts
Anxiety management
Literacy and numeracy
Cognitive rehabilitation
Problem solving
Life skills/social skills
Anger management
Social activities
Community assessment
The Auden Unit introduced the Health of
the Nation Outcome Scales (HONOS) in
October 2007, to enhance care planning and
delivery. HONOS measures the health and
social functioning of people with severe mental
illness. The initial aim was to provide a means of
recording progress towards the Health of the
Nation target to improve signifcantly the health
and social functioning of mentally ill people
The patients are assessed on a continuous basis via
the HONOS, which allows us to accurately track a
patients condition from admission and throughout
their stay, highlighting the areas or problems
that require attention at any given time. This
information is used as the basis of the care review
team meeting, affording more effcient care for the
individual. Although it is early stages, I felt that an
early audit of the recorded scores would show the
staff how useful this system of care can be.
The results (See table opposite)
Problem 1. Overactive, aggressive, disruptive or
agitated behaviour
The results suggest that most aggressive incidents
are minor or mild in nature. These aggressive
occurrences are categorised within HONOS as:

Some irritability, quarrels, restlessness, disruptive

behaviour, etc.
Includes occasional aggressive gestures, pushing,
pestering or provoking others; threats or verbal
aggression; lesser damage to property (e.g., broken
cup or window, cigarette burns); marked over-
activity or agitation.
Problem 2. Non-accidental self-injury
Most non-accidental self injury incidents do not
seem to be a problem within the current inpatient
population. We have only one or two individuals
who have attempted self harm, but these have
been quickly resolved.
Problem 3. Problem drinking or drug taking
One or two individuals did have a problem prior
to admission, and this is refected in the chart, as
the problem was identifed on the patients frst
HONOS score sheet on admission.
Problem 4. Cognitive problems
The results suggest that the clients mainly suffer
from minor and mild cognitive impairment. This
is an accurate refection of the unit, as we are a
learning disabilities unit. The scores are categorised
within HONOS as;-
Minor problems with memory and understanding
(e.g., forgets names occasionally).
Mild but defnite problems (e.g., has lost the way
in a familiar place or failed to recognise a familiar
person); sometimes mixed up about simple
decisions; major impairment of long term memory.
Problem 5. Physical illness or disability problems
The majority of patients either have no problem
or mild physical health problem. Mild health
problems are defned in HONOS as: Physical
health problem imposes mild restriction on mobility
and activity (e.g., sprained ankle, breathlessness).
Problem 6. Hallucinations and delusions
The results suggest that the majority of patients
have no problem in this area.
Problem 7. Depressed mood
Most of the clients have no problem or a mild
form of depression, defned in HONOS as:
Gloomy or minor changes in mood (not regarded as
depression).
Problem 8. Other mental and behavioural problems
The results show that the main problem areas
regarding this section are anxiety and sexual
behaviours. The sexual behaviours are common
1.
2.
1.
2.
Star WardS
7
amongst our clients and are one of the reasons that they
are on a forensic medium secure.
Problem 9. Problems with relationships
The results show that the majority of clients have a mild
problem as regards relationships, defned in HONOS
as: Defnite problems in making or sustaining supportive
relationships; patient complains and/or problems are evident
to others.
Problem 10. Problems with activities of daily living
The results show that the majority of our clients have
a mild problem in this area. Regarding HONOS, mild
problems are defned as: Self-care adequate, but major lack
of performance of one or more complex skills (activities of
daily living (ADL) (e.g., problems with basic activities of self-
care; eating, washing, toilet), also complex skills; budgeting,
organizing where to live, recreation, mobility, use of transport,
self-development, etc. Include any lack of motivation for using
self-help opportunities, as this contributes to a lower overall
level of functioning. Do not include lack of opportunities for
exercising intact abilities and skills (e.g., in secure settings),
rated at levels 11 and 12); needs occasional prompting.
Problem 11. Problems with living conditions
The results suggest that the majority of patients have no
problem or minor problems in this area. It appears that the
staff have scored this area in respect of the patients being
appropriately placed at the moment to receive assessment
and treatment. Where a percentage are having problems
in this regard, it indicates inappropriate placement for a
patient and delayed discharges.
Problem 12. Problems with occupation and activities
The majority of patients have a minor problem regarding
occupation and activity. The clients like activities, but the
units problem is lack of personnel and time. The HONOS
defnition of this problem is: Limited choice of activities; lack
of reasonable tolerance (e.g., unfairly refused entry to public
library/baths; lack of day areas); lack of facilities in large
establishment; handicapped by lack of permanent address;
insuffcient carer/professional support; or helpful day setting
available but for very limited hours.
Summary
This is a very early audit, done mainly to demonstrate the
uses of HONOS to staff. If the trends shown in this audit
continue, we could establish something like a relaxation
group, or anxiety management group. We also need to
continue to look at the problems surrounding relationships.
This small demonstration shows that the work the
staff have been doing with HONOS is appropriate and
accurate, as the results are what one would expect from
our client population.
Anthony Appleton,
Ward Manager Auden Unit
AUDEN UNIT HONOS AUDIT SCORE SHEET
Date: October 12th 2007 to November 7th 2007 No problem Minor Mild Moderately Severe Severe to very severe
1 Overactive, aggressive, disruptive or agitated 0
11%
1
35%
2
30%
3
19%
4
5%
2 Non-accidental self-injury 0
82%
1
11%
3
7%
3 Problem drinking or drug taking 0
94%
2
3%
3
3%
4 Cognitive problems 0
16%
1
28%
2
34%
3
22%
5 Physical illness or disability problems 0
36%
1
18%
2
46%
6 Problems with hallucinations and delusions 0
94%
1
6%
7 Problems with depressed mood 0
43%
1
38%
2
19%
8 Other mental and behavioural problems 0
38%
1
19%
2
31%
3
12%
Specify problem or disorder
A Phobia B Anxiety 38% C Obsessive-Compulsive D Stress 8%
E Dissasociative 15% (The dissociative aspect is thought to be a coping mechanism -- the person literally dissociates himself from a situation or experience
too traumatic to integrate with his conscious self.)
F Somatoform G Eating 8% H Sleeping I Sexual 31% J Other
A patient may have more than one of the above, but the nurse scores the problem most relevant at the time.
9 Problems with relationships 0
15%
1
6%
2
53%
3
6%
4
20%
10 Problems with activities of daily living 0
13%
1
13%
2
61%
3
13%
11 Problems with living conditions 0
33%
1
47%
3
20%
12 Problems with occupation and activities 0
27%
1
47%
2
6%
3
20%
Star WardS
8
Developing Star Wards in
Bedfordshire and Luton
Inspired by a presentation by Marion Janner, it was agreed that the Trusts three working age acute
inpatient wards would join the network. Using the practical Star Wards resource, a local benchmarking
audit tool was developed to capture good practice for each of the Trusts three working age acute
inpatient wards. Many of the ideas in the Star Wards resource were already being implemented, but there
were other ideas which had particular merit in advancing local practice. There were also additional good
practices already being implemented which were not mentioned within the Star Wards resource.
Methodology
We developed a local benchmarking tool, incorporating the 75 good practice ideas from the Star Wards
resource and an additional 27 ideas based upon local ideas and standards, or recommendations from
other sources, or recognised as existing good practices. Time was spent with each Unit / Ward Manager
working through the benchmarking tool, identifying areas of existing good practice, Star Wards practice
ideas which had particular merit to the Unit, and areas for focused action. Each practice idea was graded
using a simple traffc light scale:
GREEN = fully achieved;
AMBER = partially achieved OR implementation planned;
RED = not achieved and no plan for implementation OR not considered applicable.
Findings
This local base-line
benchmarking exercise
showed that each Unit
/ Ward was already
implementing a signifcant
number of positive
practices, as highlighted in
Tables 1 & 2.

Table 1: Baseline Benchmark of Star Wards Positive

Practice Ideas
Grading of Practice Ideas Unit 1
% (no. of items)
Unit 2
% (no. of items)
Unit 3
% (no. of items)
GREEN 43% (44) 59% (60) 44% (45)
AMBER 46% (47) 30% (31) 41% (42)
RED 11% (11) 11% (11) 15% (15)
Table 2: Excerpt from Baseline Benchmark section on physical health and activity
Description of Practice Idea Link to Guidance Unit 1 Unit 2 Unit 3
Physical Health & Activity
Ward has an exercise bike and/or treadmill Star 16; HCC A G R
Patients can meet individually with Pharmacist and Dietician Star 17; HCC A G G
Walking Groups Star 18; HCC G G A
Half an hour exercise daily, led by suitably trained person Star 19; HCC A A G
Advice available on healthy eating and smoking cessation Star 20; HCC G G G
Ward has a gardening / grow your own group adapted Star 21; HCC A G R
A health promotion / ftness instructor runs group / individual exercises Star 22; HCC A A A
All patients who want one, leave hospital with a community exercise plan Star 23; HCC A A A
Optional physical health checks are completed (physical exam, blood
testing, ECG (if risk factors), lifestyle assessment (diet, BMI, smoking,
exercise), allergies, physical observation, other investigations (if needed)
Star 24; HCC G G G
Access to sports facilities and activities (e.g. badminton, table tennis, use
of local leisure centres)
HCC G G G
Star WardS
9
Positive Practices: ten local practices
Whilst many of the practice ideas were being progressed by the service prior to the local Star Wards
initiative, Star Wards helped to provide a framework for the recognition, planning and implementation
of positive practices. The benchmarking exercise and review of the Star Wards practice ideas assisted in
highlighting a series of existing and recently implemented positive practices, which include:-
Refocusing acute day intervention. This has led to the launch of The Lighthouse at the Luton-based acute
inpatient unit and the implementation /review of 7-day therapeutic intervention programmes for acute
inpatients and day-patients at both the Luton and Dunstable based Units.
Providing personalised information folders. These are given out as soon after admission as possible, and
include such items as the service user unit information brochure, helpline numbers,
a satisfaction survey, the service users care-plan (upon completion) and health
promotion information. We plan to develop this further by offering service users a
personalised recovery folder.
Implementing protected therapeutic time initiatives. Time is prioritised for individual
and group therapeutic intervention and activity, whether by closing the unit / ward for
a set time or by planning protected time for named nurses during each shift.
User satisfaction surveys. The concurrent use and six-monthly reporting of a two-
part Acute Inpatient Satisfaction Survey informs planning and maintenance and is
used to enhance service standards within the three acute inpatient units/wards.
Widely accessible information. Written information and health promotion materials
are widely accessible through the provision of an Information Centre within a
central location in the unit / ward, such as in the dining room.
Individual appointment times. The provision of individual appointment times for
weekly service user care review meetings, reinforced through a local protocol.
Producing information brochures for service users and carers. These contain key information about the
unit/ ward and explicitly state a set of expectations of the care process.
Implementing a hospitality nurse system. This has particular value in greeting, meeting, orientating and
supporting the newly-admitted service user.
Optional physical health checks and health promotion. Optional physical health checks and physical health
promotion for all acute inpatients, with further plans for the provision of exercise equipment in all units
and sessions facilitated by a qualifed health promotion/ftness instructor at Oakley Court in Luton.
An information
centre on display
in the dining area of
Oakley Court
Star WardS
70
A local Arts in Health
Initiative. Guided by
an Arts in Health
Coordinator, and Unit-
based occupational
therapists, service-users
are involved in creating
and displaying their art
work in units/wards.
Art has been displayed
in key locations around
the unit, such as the
recently re-designed
dining room of Weller
Wing, the Bedford
Mental Health Unit.
It is important to recognise that such practice developments are not all achieved without signifcant
challenge. Some are straight-forward to introduce and merely require tweaking (for example: the
information centre), others require some planning in turning practice (for example: the hospitality
nurse), and still others require considerable planning, resourcing or the commitment of others in
transforming local practice (for example: refocusing acute day intervention; protected therapeutic time
initiatives; the implementation of a service user care review protocol). It is the transforming initiatives
of using protected time ideas and focusing weekly care reviews upon the needs of the service user
that continue to present considerable challenges, but the Star Wards initiative clearly supports such
developments.
Conclusions & Planned Actions
Following the base-line benchmarking exercise, local Star Wards groups are being established within all
three units/ wards and the Star Wards practice ideas are gradually being discussed with service users
during a series of weekly patients meetings in some of the units/ wards. Furthermore, those practice
ideas that have been rated as amber are being integrated into the specifc personal objectives of team-
members as a part of the ongoing staff appraisal and personal development planning process by the
unit / ward Managers.
It is hoped to continue to progress the implementation of the Star Wards concept in this way and
other wards and teams within the Trust
are being invited to participate.
John Butler
Consultant Nurse
John.Butler@blpt.nhs.uk
References
Butler J (2006) Protected Therapeutic and Engagement Time: an
evaluation of a service improvement initiative. Advancing Practice
in Bedfordshire 3(1): 27-39. http://www.advancingpractice.co.uk
CSIP (2007) A Positive Outlook: a good practice toolkit to improve
discharge from inpatient mental health care. York: CSIP / NIMHE
Healthcare Commission (2007) Acute Inpatient Mental Health
Service Review: fnal assessment framework. London: HCC
Janner M (2006) Star Wards: practical ideas for improving the daily
experiences and treatment outcomes of acute mental health
inpatients.
Pereira S & Woollaston K (2007) STEPS (Successful Team
Engagement in Inpatient Psychiatric Services): a positive practice
handbook. London: NE Mental Health NHT Trust / NIMHE
On display in the
reception area of
Townsend Court,
this was created by
a group of service-
users.
Star WardS
71
Bevan Ward PICU
Service User Activities
We want to publish a newsletter, which gives
us the credit for the people we are. . creative,
intelligent, original, inspiring and who have a lot
to say!!!
Pick up a copy available on most wards in the
hospital!
Jamming Music Group
Each Wednesday afternoon, the service users
on the ward are invited to a musical jamming
session. There is a drum machine, keyboard,
electric guitar and vocal recording equipment,
available to use at what ever musical level
the service users may be at (professional or
experimental!!). The group is facilitated by an
occupational therapist and a sessional worker who
makes the recordings happen. The service users
are encouraged to utilise the instruments at the
level they know or they can learn how to play an
instrument. There is also an opportunity to sing
or rap over backing tracks, either with written
lyrics or in a free-style format. The group has
created both individual songs and collaborative
pieces with everyone playing instruments.
The group has been running for 6 weeks and
already the service users have recorded around
20 songs! Feedback from the service users has
been very positive. They enjoy the process of
playing and recording music and it empowers
them to get out their feelings in a supported and
productive environment. Service users can take
away a copy of their own music, to feel a sense of
achievement or a record of the learning process
they have engaged in. The facilitators are currently
thinking of producing a collaboration CD with
the service users permission, which could be
distributed around the centre to highlight their
achievement.
Suzanne Smith
Suzanne.smith@eastlondon.nhs.uk
Bevan Ward tells the truth!
Bevan Ward PICU has been publishing a weekly
service user led newsletter, The Bevan Ward
Truth since January 2006. Service users chose
the name and it is produced in a weekly group
where the service users and staff on the ward
contribute songs, poems, points of view and
summaries of current news stories or health
issues and a weekly quiz. They can choose to
have their names printed or remain anonymous.
The service users format and print the
newsletter on the ward computers and it is then
photocopied and distributed to all the wards in
the City and Hackney Centre for Mental Health.
The newsletter has had very positive feedback
not only from those service users who publish
the newsletter but also from staff on the ward
and service users from other wards some even
delivering their quiz answers to Bevan ward!
The occupational therapist started the newsletter
with support from two charge nurses. The ward
manager stated:
It is an excellent thing for patients to have the
opportunity to encourage their creativity. It also
increases patient empowerment and promotes
cohesiveness and co-operation between the
patients on the ward.
One service user fed back I enjoy being part of
the newsletter, where being creative is part of
my day to day living as I have a design and art
background. Another added Its something we
can all be proud of .
The OT aims behind the newsletter are to engage
all the service users on the ward at whatever
functional level they are at and empower them
by giving them a voice to express their opinions
and feel proud of the achievement of the fnished
newsletter.
The newsletter ethos is:
Through publishing our poems, stories, raps or
song lyrics, we hope to promote a positive view,
make people think, inform and educate them on
current issues and test their knowledge in the
weekly quiz!
City and Hackney
Mental Health Centre
Star WardS
72
Valuing volunteers
Star Wards has given impetus to develop processes
around the recruitment and retention of volunteers
for the acute inpatient units. We set up a steering
group with the volunteer co-ordinator, occupational
therapists, and a volunteer representative. Although
the OT department had longstanding volunteers,
we identifed that volunteers specifcally for the
wards would enhance the patient experience and
provide opportunities for more engagement and
interaction.
We developed processes for publicising ourselves
as a volunteering opportunity, appearing on BBC
Radio Northampton, in the local press, increasing
links with local volunteer bureaus and having a
stand at the University of Northamptons annual
volunteers fair. This has been extremely successful,
seeing responses from the local secondary school,
community residents and university students.
We now have volunteers involved in weekly
creative sessions such as art, creative writing,
pampering, and card making, as well as volunteers
within the patient library, shop and Art Therapy
group. A group of students from the University
of Northampton gave their time for a day to
redecorate a former ward smoking room into a
bright and useful activity space. The Princes Trust
have also been involved with the development of
a therapeutic garden space, even raising funds for
the materials required. The chaplaincy service also
has a group of volunteers to assist in their role
within the Trust.
To ensure that engaging volunteers is as easy
as possible, we reduced the questions required
from the old application form and designed a
short registration form which is followed up
with an informal chat with an existing volunteer
and the volunteer co-ordinator. Once volunteers
skills have been identifed, and a suitable location
matched with them, they are supported and
supervised by the OT staff. In time, the OT staff
aim to hand over support and mentoring to
nursing staff once volunteers are established in
their roles on the wards.
Once our volunteers are recruited we dont stop
there. We hold a quarterly Valuing Volunteers
forum for all to come along to. This is a space
for networking, informal discussion and support,
as well as an important opportunity for staff
to say thank you to the volunteers for their
commitment. Every month we hold two-
hour, early-evening training sessions covering
the basics of mental health, group skills and
discussion/engagement skills. Volunteers attend
staff mandatory training and have access to the
full education and development prospectus if they
wish to complete further appropriate training to
their role.
We have still some way to go before our
processes are fully water tight, but Star Wards has
provided the means to review and develop our
volunteer strategy. We believe volunteering helps
de-stigmatise mental health services, brings the
outside in to the wards, provides new people
to interact with, uses the communitys valuable
resources and for some volunteers may even
promote a career in mental health, so it can only
be benefcial to all involved.
Improving access in meeting
spiritual and faith needs.
The chaplaincy team felt their existing approach
dropping into the wards to ask if service users
wanted to speak to someone from chaplaincy
was too directive and unproductive; so, after
discussion with the OT team, they decided to
take a gentler and more open approach. They
introduced a Meditation Time session, provided by
a chaplaincy worker on a weekly basis. The session
is publicised to service users as a contemplative
place to be still a rare opportunity for the
majority of the week on an inpatient ward.
The session is sensitive to individuals faiths
and needs, however Wendy the chaplaincy
facilitator is Christian, and she openly identifes
and acknowledges that she cannot remove her
faith completely from her persona. She starts the
session with quiet meditation, focusing on breathing
techniques to instrumental music. The session is
entirely fexible depending on who attends, and
Wendy is happy to provide prayer time at the end,
or invite individuals to say their own prayers if they
wish. She is aware of not embarrassing participants,
so very much plays it by ear.
Wendy has found that this session provides
a starting point for individuals to get a sense
of whether they would like further links with
chaplaincy, which can be provided on a 1:1 basis.
Steering Star Wards
Northamptonshire Healthcare Trust
Star WardS
73
She has found that individuals report being
re-connected with their spiritual side, and that
many fnd it extremely healing to be still and
contemplate. The OT team take service users to
the open chapel session on Friday afternoons, and
there is also the opportunity for individuals to
attend the Sunday Service. The chaplaincy team
also offer a wealth of knowledge about different
faiths and religions, acting as a resource for staff.
Self-help books
We have set up 5 core central patient library
areas in adult and older peoples services that
will have self help resources for service user,
carer and staff reference. These hold the MIND
booklets, 19 relevant NICE guidelines for patients
and additional self help text books. There are
reference copies only, with information provided
for individuals to order their own personal copies
of the MIND and NICE publications, which can be
done whilst they are in hospital.
Community groups involvement
We linked with a local creative dance artist to
provide a series of 10 weekly creative dance
sessions to one of the female wards. Individuals
could attend any of the sessions, and completed
evaluations pre and post each session. Staff
were also encouraged to attend no passive
observers allowed! Increases in energy, self
esteem, confdence, social interaction and lots of
fun were reported by participants. Funding for
future sessions is being considered, with the aim of
holding a session on a monthly basis throughout
the year.
Regular social events
Regular social evenings are planned on the wards,
with events such as BBQs, Caribbean evenings
(with themed food) and very popular DVD
concerts including Elvis and ABBA. The use of a
large screen projector and sound system means
that we can project the concerts onto large
walls in the garden areas and belt out the sound,
making for a real concert feel. Staff and patients
take the opportunity to dress up for the occasions
and all take responsibility for the planning and
preparation of food. These events are a real boost
to the ward calendar, and bring a sense of unity to
the ward environment.
Staff understanding and sign up to
Star Wards
In order to keep Star Wards close to everyones
attention, we have developed quarterly
newsletters that go out to the whole of the Trust
by e-mail, with paper copies sent to all of the
wards for service users. The design is bright and
funky, providing up to date information about
national Star Wards developments and also
showcasing what is happening within the Trust
wards and departments. Each quarter, readers
of the newsletter have the chance to nominate
the development they most like, and the winning
team/ward/ initiative will win 100 to put towards
future Star Wards developments.
Star Wards now has a slot in the monthly staff
induction programme for all mental health
workers. This enables the Star Wards message
to be sent out right from the start, alerting new
staff that they can become involved and providing
them with the motivation to fnd out more about
what is happening in their own areas and how
they can become involved.
We have flmed a resource DVD about Star
Wards, starring Marion during a visit to our wards,
to send her message to the masses! The DVD
was a collaborative effort, starring staff, service
users and volunteers, as well as Marion. It explains
the background to Star Wards, highlights positive
practice in the Trust relating to the 75 suggestions
and more, shares peoples experiences of being
involved and features additional resources that
can be used on a computer. The DVD is used in
staff training and induction, within ward settings
to show to new service users and carers, and for
students and volunteers. Its a creative, motivating
and inspiring resource.
Sarah Wilson and the Star Wards Steering
Group
Professional Lead Occupational Therapist, Pendered
Centre, Northamptonshire Healthcare NHS Trust.
sarah.wilson@nht.northants.nhs.uk
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Star WardS
7+
Community Bridge Building Service
Widnes and Runcorn
team Admin Support Offcer. A future role for
this group will be to challenge cultures and stigma
around people with disabilities and social inclusion.
These are a few quotes taken from some
questionnaires and completed by service users
and stakeholders following three months of the
service:
The worker treats me as normal.
The Bridge Builder gives me a good time.
Very happy with the service and cannot fault it.
Helped me to reach my goal.
To give me a purpose in life.
Not to be a wreck of a woman.
The team are truly interested in the work they
do.
At nine months the team had received a total
number of 183 referrals, with the most popular
community links being made in these areas:
Employment/Voluntary 64
Education 88
Faith and Spirituality 4
Relationships 32
Sports and Leisure 91
Arts and Culture 28
Evaluation
The project is being fully evaluated by the
National Development Team, who during a day
visit were very impressed the progress that the
team and Halton have made in championing
social inclusion across all service areas. The NDT
have completed an interim and fnal report on
the service in its frst nine months and copies are
available if required.
Sue Rothwell
Principal Manager
Mental Health Provider Services
Halton Borough Council
Sue.Rothwell@halton.gov.uk
The Community Bridge Building Service in Widnes
and Runcorn began in January 2007 and is an
innovative approach to enabling people to live
more meaningful lives and participate fully within
their communities. The service is for people in
the community rather than hospital because the
focus is social inclusion. However if someone
is in hospital and working towards discharge,
the service would get involved to help with
socialisation and recovery. Also if someone had
already been referred to Bridge Building and was
admitted to hospital, BB would remain involved.
It very much depends on whether the person is
able to engage socially at that time. The service
is very person centred so it changes with each
person.
Bridge Building was funded by Supporting People
until March 2008
The Bridge Builders have carried out extensive
mapping of the mainstream services that are
available in the Halton area. The team are also
capacity building within mainstream services to
ensure that they are accessible for the people
we support. This is proving very positive with the
development of some strong partnership working
across a wide range of services within the council
and other organisations.
We provide a pan-disability service to people
aged 18 years onwards with physical and sensory
disabilities, mental health problems, learning
diffculties and older people. Halton is the only
council in the country that provides a Community
Bridge Building service that has a generic
approach across all service areas and domains.
The service has now supported over 200 referrals,
partly arising from 47 presentations given in the
frst nine months to health and social care teams,
mainstream services, service user/carer groups
and voluntary and independent organisations. The
Community Bridge Builders have been assigned
their own locality within the most deprived
areas in Halton super output areas. The Bridge
Builders are working closely with community
development offcers in each area.
A service user forum is in place and the Bridge
Builders will support this group to develop into
a fully independent committee. One service user
is taking a lead in this through his paid role as
Star WardS
75
Dear Star Wards champion,
Thank you and congratulations on either choosing or being nominated to take part in the Star Wards
project. This is your invitation to the half-day induction/training.
The aim, as you know, is to try to increase the numbers of activities for service users in the evenings and
weekends, and also hopefully increase your own personal job satisfaction and skills in co-ordinating a
project.
The role we are proposing for you is as follows:
To do baseline and improvement assessments of agreed goals on inpatient wards (NOT their
own)
With ward manager and OT (if available) identify activity programme in their own area
To plan, organise, resource and advertise agreed activities & goals
To liase with OT (or other) department and agree on site training for activities
To deliver some (not all) of agreed activities
To monitor implementation and delivery of activity programme on their ward
To investigate available skills and delivery of activities from other BEH professionals (e.g. Psych
depts, CMHTs day services)
To investigate activities available in community
To investigate activities that can be delivered on the ward from outside facilitators
To carry out activity satisfaction questionnaire with service users
To attend Activity Champions meetings
We have negotiated that this should not be on top of your normal job and that you should have
protected time to spend a half to a whole day once a week on it. (Shared between two reps from each
ward.) We will discuss this in more detail at the induction half day.
Id like to say at the outset that this is a bit of an experiment, and depending on how it goes it will be
adapted to other areas of the Trust.
It wont be for me to dictate how it should go, I need to be guided by you especially in terms of what is
possible to achieve on a busy ward with limited resources.
Meanwhile I look forward to meeting you all.
Sylvia Barry
Clinical Effectiveness Manager
Sylvia.barry@beh-mht.nhs.uk

Star Wards Champions

Barnet, Enfeld and Haringey Mental
Health Trust
Barnet and Enfeld Mental Health Trust
appoint Star Wards champions to... er...
champion Star Wards, actually. And heres the
letter they send out.
Aims
1. Discuss and agree Champion Role
2. Set up the peer group bench marking
3. Explore and generate Star Wards
ideas
4. Agree their individual plans for the
wards
5. Set up support and supervision
structure
Agenda
9.00 Introduction to the project
9.30 Champion role Expectations
versus reality of whats possible?
10.00 Benchmarking How to do it.
10.30 Star Wards
11.00 Tea break
11.15 Individual plans
12.00 Peer support and future meetings
Star Wards Champions Induction/Training day
Star WardS
7
Star Wards Collaborative
Barnet, Enfeld and Haringey Mental Health NHS Trust
Aims of the project
To increase the number of activities
available on the inpatient wards in the
evenings and at weekends
To develop a role for activity champions
among present staff establishment
To develop skills of nursing staff in
facilitating activities
To create healthy competition between
wards towards achievement of agreed
goals
To share good practice locally and
across the Trust
Measurable Outcomes
Improve service user satisfaction and
involvement on inpatient wards
Reduction of the number of incidents
on inpatient wards associated with
boredom
Compliance with Healthcare
Commission standards for inpatient
wards
Achievement of agreed goals
Proposals
Ward managers to identify an activity
champion from each ward.
Service managers and ward managers to
agree protected time 1 day a week for
activity champion to work on the project
Champions to attend launch day to agree
role, receive training, identify individual
action plans, share practice, identify
constraints, provide mutual support
Activity champions to assess another ward
against the identifed goals
Champions meet locally once a month to
review progress share practice, identify
constraints, provide mutual support
Champions reassess another ward after 6
months
Champions attend half day six monthly Trust
wide activity champions development days.
Role of Activity Champion
To do baseline and improvement
assessments of agreed goals on inpatient
wards (NOT their own)

1.
2.
3.
4.
5.
6.
7.

With ward manager and OT (if

available) identify activity programme in
their own area
To plan, organise, resource and advertise
agreed activities & goals
To liase with OT (or other) dept and
agree on-site training for activities
To deliver some (not all) of agreed
activities
To monitor implementation and delivery
of activity programme on their ward
To investigate available skills and
delivery of activities from other BEH
professionals (e.g. Psych depts, CMHTs
day services)
To investigate activities available in
community
To investigate activities that can be
delivered on the ward from outside
facilitators
To carry out activity satisfaction
questionnaire with service users
To attend activity champions meetings.
Sylvia Barry
Clinical Effectiveness Manager
Sylvia.barry@beh-mht.nhs.uk

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Star WardS
78
Busy Bites: enhancing the experience
Derbyshire Mental Health Trust
towards future employment, paid work or work
experience which can be transferred into the
local community after discharge.
Further objectives met are that service users
now have a friendly environment conducive to
their recovery where they can spend valuable
time with their families and friends during their
admission in hospital.
Currently there are six more volunteers, most
of whom are service users. Service users
volunteering will be able to offer frst hand
support to inpatients in recovery. The opening
hours have been extended from an initial 10am
to 3.30 to 10am to 8pm. This has allowed us to
open during visiting hours, and to facilitate early
evening recreational sessions.
Several groups have been developed in the
evening. A self help group is run which is open
to both inpatient and community based service
users. This is co-facilitated with a community
partner. On a fun basis a dance exercise
group and a drum work shop have both been
established and they are regularly and well
attended. In addition a carers support group
is delivered which is supported by both the
Emergency Care Business Unit, and another
partner, the North Derbyshire Forum for Mental
Health Carers and Families. The Citizens Advice
Bureau attends on a regular basis and offers open
clinics in the area, and also on the wards.
The availability of a computer, TV and DVD, pool
table, table tennis table and table football in
the Caf allows for more informal and relaxed
activities to take place, and these are regularly
used. Friday night is movie night in the caf area,
and additionally seasonal activities are facilitated.
Wellness Recovery Action Plans are available and
support is offered to all service users who are
currently inpatients.
Service user and Carer feedback has been
excellent, and we thank them all for being equal
partners with the project and supporting it to get
off the ground.
What we did and why
In spring 2007 managers in the Emergency and
Forensic Care Business Unit met with Shaw Trust
to explore the possibility of a partnership with
DMHT to create a caf at the Hartington Unit;
an Acute Care Inpatient Unit which supports the
North of Derbyshire.
The idea came from many discussions with service
users and carers about the need to provide an
environment which allowed for welcoming and
supportive visiting, and a relaxed environment
away from the wards which service users could
use on an ongoing basis for recreation.
The proposal
The proposal was that the Shaw Trust would
provide a member of staff to establish the caf,
and a post for a Recreation Worker would be
created by the Mental Health Trust to develop a
much requested recreation service to sit alongside
the Occupational Therapy service available at the
Hartington Unit, and support the implementation
of the cafe. Through staff dedication, and patient
and carer commitment this vision came to fruition
and a Recreation Worker was appointed. On
the 24th July the caf had a grand opening. Our
partners were invited to network and share
resources and the area was renamed The Busy
Bites Caf.
Outcomes
Not only does this venture provide an excellent
service to the service users and carers at the
Hartington Unit, and has become the hub of
the entire inpatient unit, but the venture also
offers service users an exciting opportunity
to work on a voluntary basis in a supported
environment in the caf with a view to working
Star WardS
79
Future Plans
There are future plans to forge a partnership with the local library to deliver monthly supplies
of interesting books to the Caf as well as introducing PAT (Pets as Therapy) dogs to the unit to
enhance the patient experience.
The future action plan also includes working into all three wards in the Unit for those patients
who are unable to leave the ward area, and developing gender specifc activities. In addition
we are working towards volunteers working into each ward environment to support the
coordination of ward based activities, particularly during the weekends and evenings. Further
partnership developments include the development of a support group for patients which is
delivered on site but supports service users both pre and post discharge in order to facilitate a
smoother and supportive transition from hospital to home.
Sarah Carter
sarah.carter@derbysmhservices.nhs.uk
Star WardS
80
Castle Lodge 24hr Nurse led Unit
Telford and Wrekin
Castle Lodge is unique; providing nurse-led
inpatient care and services to service users in the
Telford and Wrekin area. Opened in 2004 as a
community inpatient facility with12 ensuite beds
in single accommodation, we are able to ease the
transition between inpatient care and home.
There is no Responsible Medical Offcer; instead
nurses have developed their skills and taken on
responsibility for formal assessments, admissions
and discharges, using evidence based tools to
assist and evaluate the care we provide. Unlike the
hospital environment where decisions are made
at Ward Rounds, at Castle Lodge, qualifed staff
work closely with service users to make decisions
about care reviews, length of stay, leave and
discharge. Castle Lodge also works very closely
with the Crisis Resolution/Home Treatment Team
based in an adjacent building, ensuring that a
seamless service continues to be provided. In this
way we are able to respond to the needs of our
clients, promoting recovery, earlier integration
back into the community, and maintaining decision
making with service users.
The teams mission statement is:
Castle Lodge is a placement for refection and
recuperation based on mutual trust and respect,
which provides a benefcial experience enabling
people to progress.The Unit provides a fexible
client centred approach in partnership with
carers, families and other agencies to progress
towards recovery through evidence based
interventions that are monitored and audited to
enable clients to achieve their optimum abilities.
Castle Lodge has developed its place within the
community, working closely with community, self-
interest, voluntary and statutory groups. We are
particularly proud of our role as an intermediary
with people who require more intensive forms of
care, who can beneft from a staged return home.
Our clients also beneft from a range of nursing
and psychosocial interventions, such as family
work, medication management, coping with stress
and anxiety and Wellness Recovery Action Plan
(WRAP). As well as a short-stay facility, service
users can access groups such as Healthy Living
Group, Mens Group, Carers Group and drop-in
coffee afternoons. This means that service users
moving on do not feel excluded. To maintain
standards and ensure quality we audit and review
all these types of activity.
What we have achieved
A real alternative to hospital, providing
an holistic therapeutic environment to
promote recovery.
Clients are able to self medicate.
Effective working with clients who self
harm.
Admissions reduced by 32.5% by the end
of the frst year of opening.
Re-admissions down from 20% (May-Dec
2003) to 13% (2004). Latest fgure 5.88%
Improved access to community resources.
Introducing holistic therapies.
Nursing Standard Mental Health Award
2004, (Nursing Standard 3.11.2004).
Service User Involvement
We have a service user consultant working as
part of the team. A satisfaction survey report
devised by service users and other Health Care
Professionals, reported that:
81% of service users happy with
information received prior to admission.
100% of clients reported our meet
and greet procedure made them feel
welcome and comfortable.
92% felt staff were prepared for their
admission.
90.5% had choice relating to dietary and
ethnic food needs.
100% agreed it was therapeutic eating
together, helping to break down barriers.
96% were given care plans and involved
in their reviews, of these 88% said that
they found these reviews useful.
Clients felt self-medicating was
empowering and positive; 92% of clients
appreciated the high levels of staff
support.
96% stated the therapeutic programme
(groups and activities) an integral and
important part of their recovery.
68% felt that family and carers were able
to be part of their care.
Ann-Marie Stokes
Ann-Marie.Stokes@sssft.nhs.uk
Lisa Agell
Professional Head of Mental Health Nursing
lisa.agell@sssft.nhs.uk

Star WardS
81
Can you imagine being faced with a blank piece
of paper and asked to express yourself, after
spending twenty or thirty years in hospital?
Maybe the last time you picked up a paintbrush
was at secondary school, or the last time you
wrote your feelings down or indeed when
anybody was willing to listen you were fourteen.
Would you stare blankly at the acres of white
paper? Or release a torrent of words and images,
and express yourself freely through a whole range
of mediums?
Creative Expression?
The Creative Expression Group was originally
devised to engage patients who had spent long
periods in medium and high secure care, and
who appeared to possess a stultifed range
of expressive skills, eroded by various factors
including institutionalisation and long-term mental
health diffculties. A three-stage model and a
wide variety of modalities are used to generate
ideas, and express and evaluate feelings in the
context of the journey to recovery; along with
Tai Chi theory and a Person First! approach to
underscore the value of achieving balance in life.
The group has proved a valuable tool for
engaging patients constructively and creatively,
breaking down the barriers often erected by
Staff and Patient role-reliance, to promote
recovery. Evaluations to date have confrmed that
it is effective in generating positive mood states
and increasing self-esteem, which
suggest it would prove successful
within a variety of mental health
settings.
Tai Chi and the Longest
Journey
The concept of a journey is universal
in the achievement of personal
growth. We are all on a unique
journey, whether it is the road to
enlightenment, a career path, or
the road to recovery. Within the
Creative Expression Group, this
principal is introduced through
the Chinese Proverb: The longest
journey begins with the frst few
steps. In other words, every
day is an opportunity to take a
step nearer towards recovery
and discharge. Tai Chi theory is used within the
group to promote fexibility and balance, to turn
our weaknesses into strengths and enable us to
continue the rest of our journey.
Person First!
It is stressed within the group that we leave
our staff and patient roles, outside the group,
and become active participants. So before
schizophrenic, nurse, manic-depressive, facilitator
or patient, we are all a Person First!
Sometimes we can become too wrapped up in
boundaries and roles and observation, instead of
engaging with each other as people. This is no
more evident than when witnessing participants
interacting more openly and creatively, and with
less anxiety than before. Are we not all guilty
sometimes of hiding behind our titles or roles? Of
hindering more honest expression, and ultimately
recovery? Sometimes calculated therapeutic risk-
taking can pay huge dividends.
As one participant said:
Ive learnt that Im free to express myself in
more ways than the normal hospital ways, doing
art, painting, Tai Chi and using a camera.
Patrick Doyle
Therapeutic Activity Lead Nurse
PDoyle@partnershipsincare.co.uk
On being faced with a blank piece of paper
Partnerships in Care
Artist retains copyright
Star WardS
82
Families are Fun
Derbyshire Mental Health Services Trust
services at the Acute Hospital to learn from their
environment and apply the principles.
We worked in partnership with ward teams
to develop a culture to safeguard the needs
of the children who come into hospital to visit
their mum or dad. Our multi-disciplinary team
approach involved working outside traditional
professional boundaries, which included
partnership working with the service users and
carers, electricians, plumbers, porters, the League
of Friends, nursing staff, medical staff, service users,
carers, patients council, occupational therapy staff,
health and safety staff, fre offcer, domestic staff,
secretarial staff, general managers, receptionists
and suppliers and contractors.
What We Have Achieved
Every service user and carer who accesses
24 hour emergency care now has the privacy
and dignity of a family visiting room, easily
booked via reception, for varying lengths
of time to suit the needs of their family
circumstances.
Children visiting the hospital are safeguarded
from unnecessary risks and will not be faced
with situations that may impact on them
negatively. We have tried to support children
in reducing perceived stigma attached to
visiting a parent in hospital and to prioritise
their continuing relationship whilst mum or
dad recover.
The controlled environment of care has
been risk assessed in relation to health, safety
and well-being of the children. The family
visiting is a good practice example within
the Essence of Care Clinical Benchmarks for
Safety and Communications
The number of children visiting has reduced.
The children now visit only where it is in
their best interests to do so. Clinical records
evidence the assessment of each family and
their needs.
We have achieved a culture change within
clinical teams through the development
of named nurses undertaking a timely
role in assessment of family circumstances.
Supporting appropriate contact with children
in an environment that is safe and family
orientated has been the priority.
Susan Stocks
Associate Director of Nursing Practice and Standards
sue.stocks@derbysmhservices.nhs.uk
1.
2.
3.
4.
5.
Children Visiting Practice and
Where it All Happens
Approximately 300 children every month visit
the 24 hour Emergency Care Wards within the
Psychiatric Unit. Our aim is to give children the best
experience possible when visiting mum or dad and
to be left with good memories of this time.
Listening to service user, carer and staff
perceptions, we understood that it wasnt in
childrens best interests for their visits to mum or
dad to take place on an open ward, which did not
provide the space to be a family. This motivated
the ward teams to work together to change a
little-used conservatory space into a homely,
domestic style family visiting room, with toys and
activities. We made the room environmentally
safe for children through the choices in furniture,
fxtures and fttings. Examples of this included
sofas that were easily cleaned (those chocolate
biscuits and crisps get everywhere!), socket covers
and fxing the bookcases to the wall. The team
looked at the environment in familiar childrens
Star WardS
83
Llwyn-y-Groes Psychiatric Unit
North East Wales NHS Trust
community after discharge. This continues to go
from strength to strength offering a wide range of
activities for our ladies.
Self Medication
After what has seemed to be a long hard struggle
we have now managed to secure a working
policy, the correct equipment and appropriate
training for staff. We are confdent that in the
new year the wards within Llwyn-y-Groes will be
having inpatients who are self-medicating prior
to discharge. This is something that 10 years ago
would never have even been considered in this
part of the country!
New Unit
One other major development to mention is
that Llwyn-y-Groes will not exist in two years
time! We will in fact be moving to a brand new
purpose built unit where our facilities will be vastly
improved, enabling us to achieve higher standards.
There has been a lot of work undertaken over
the past few months in developing and designing
the unit. The Project Team has consisted of
representatives from nursing, medical, and estates
etc., but most importantly has had a large input
from service users. They have been involved
throughout the design and have visited other
units within Britain to gain ideas etc. This has
empowered the service users to feel that they
have played a major part in the reprovision of
Llwyn-y-Groes, and the standard of care which
will be available in the future in North East Wales.
This is a very exciting time for everyone. Our
present unit has been deemed unft for purpose
some time ago. Despite this, staff have managed
to do an incredible job, ensuring that the unit is
therapeutic and continues to develop. However,
the new unit will give the opportunity to ensure
that we work to the very highest standard for
our service users. Our intention is that their
stay in hospital, although unwanted, is made as
comfortable and enjoyable as possible. The future
is looking exciting, and we believe that we have
the right personnel, and support from both senior
managers / service users to ensure our service
continues to improve and develop.
Wyn Lewis
Unit Manager
wyn.lewis@new-tr.wales.nhs.uk
Activities
As well as a designated Therapies Team, we now
have health care support workers as ward based
activity champions who are ensuring that activities
take place on the wards during the evenings and
weekends. These include events such as Cinema
Nights, Take-Away Nights and Film and Buffet
Evenings, which have all been a great success.
At the opposite end of the day we now have a
Breakfast Club, where clients cook their own bacon
and eggs, which also goes down very well! Our aim
is to continue to extend our activities, and develop
new initiatives and ideas, which will increase activity
time until 7pm each day.
Art
We are now fortunate enough to have an art
therapist working within the unit. Sue is extremely
enthusiastic and is working closely with our clients
to develop pieces of work, which we will be
framing and displaying within the unit. This has
proved very popular with our clients and I am
sure it will impress our visitors.
Alternative Therapies
At present we provide Aromatherapy for our
clients, but thanks to Abi, one of our staff nurses,
we are now also able to offer Reiki therapy. Abi
is a qualifed Reiki therapist and is looking forward
to putting her skills into practice.
Gym
Our gym is fnally up and running. Members
of staff have undertaken training and are now
supervising on a regular basis. This has proved to
be very popular with our younger guests.
Service Representative Groups
Our Service Representative Groups continue
to play an important role within Llwyn-y-Groes.
They are very active in all areas including Star
Wards, AIMS, National Audit of Violence, Acute
Care Forum, Patients Council and representing
our service users on various committees and
interview panels.
Voluntary Projects
With regards to voluntary work, the KIM Project,
is a project for female service users, in-reaching
into hospital and continuing their fne work in the
Star WardS
8+
At Green Parks House we have created a full
programme of activities for our acute wards.
Work began in December 2006. We believe
that activities provide structure, raise self esteem,
counteract boredom and increase motivation.
We have a dedicated occupational therapy
department but wanted to also engage service
users who were unable to participate, in particular
those who are unable to leave the ward due to
their current mental state. In addition we wanted
to create activities for weekends and evenings
where there was no or little provision.
We based our work on the Healthcare
Commissions recommendations for groups and
also consulted a small group of service users.
We met several times to plan the timetable. The
planning group included large numbers of OT and
nursing staff.
In phase 1 we introduced an exercise routine. This
consists of a 15 minute warm up and stretching
routine. This was followed by a planning meeting
where service users could effectively plan their
day.
Phase 2 was building nurses confdence in running
groups. We protected time so that nurses could
co-facilitate OT groups. They had the opportunity
to see how groups are structured and pick up tips
on running their own group.
Phase 3 was running a full programme of activities.
A range of nursing staff got together in smaller
groups, led by a senior nurse to plan a particular
group.
Since July 2007 the group programme has been
up and running. The day starts after breakfast
and medication with the exercises. This has been
hugely popular with often half to two thirds of
service users on the ward participating. The group
is led by OT or nursing staff and occasionally by
service users. Service users often choose the
music ranging from Madonna and 80s music to
trance!
A planning meeting follows; the purpose of this
is to orientate service users to the ward and to
motivate them to join in the activities. It includes:
appointments, OT, ward activities and allocation of
nurses to service users. This has the advantage of
service users being introduced to new staff and
students as a group.
There are three ward groups a day, morning,
afternoon and evening, seven days a week. They
include social groups such as karaoke, games
and flms. There are also informative groups like
relapse prevention and healthy lifestyles and
gender specifc groups. There are more active
groups for mind and body such as relaxation and
a gym group.
OT and nursing staff have also designed individual
activity schedules for each service user. This
enables them to see at a glance what they have
planned for the week. These are flled in with the
service user each week so that changes can be
made. Service users are also able to plan meetings
with their primary nurse. We aim for service users
to have two meaningful one-to-one sessions with
their primary nurse each week. Individual wards
monitor this through audit.
The next phase will be evaluating the work that
has occurred. This will include consulting staff
and service users. We want to fnd out if the
current groups need to change at all and if they
are enjoyable and meaningful. A number of new
staff have started and will need to be trained to
facilitate groups. A couple of the groups may be
changed or enhanced according to service users
views.
It has been a huge project that has required
huge amounts of hard work and dedication. But
it has created a real buzz on the wards and has
engaged service users in meaningful, enjoyable
activities. The hard work continues to make the
programme even better!
Green Parks House is located in Bromley and
is part of Oxleas NHS foundation trust. Oxleas
has been given the highest possible rating in the
Healthcare Commission assessments.
Sarah Wegener
Ward Manager, Goddington Ward
Sarah.wegener@oxleas.nhs.uk
Creating a real buzz on the wards
Green Parks House, Bromley
Star WardS
85
Dear Marion,
Here at Sandwell, Star Wards is still hot on the agenda.
The weekly flm nights are popular with clients and an enjoyable social event which allow the clients to
get together on one ward to watch a good flm, all that is required is the popcorn and ice cream. For any
clients who dont fancy the flm there is always the bingo session with fantastic goodies such as toiletries,
note paper or chocolates for prizes.
For any one wishing to brush up on their singing the Karaoke / music lessons are a good place to start and
the dulcet tones can be heard across the car park. Those wanting wishing to work off the extra pounds can
always join in the Strides Programme and go for a nice walk around the local area or have a good work
out in the well equipped gym. We have even trained some of our excellent support workers to become
trainers to enable clients to access the gym at evenings and weekends.
With each ward now having ward clerk input it was felt important to arrange for Mental Health Awareness
training for our clerical and also domestic staff. We had a willing band of qualifed staff and service user
input for this and it was very well received and more sessions are planned.
Here at Sandwell we pride ourselves on having a good Multi-Disciplinary working relationship. We have
dedicated occupational therapy and qualifed psychology input onto each ward. This gives our clients quick
and easy access to any activities that will help them and also to any psycho-educational groups they need,
both open and closed groups. This helps the clients in several ways; it enhances knowledge, gives them the
necessary coping skills, and aids discharge.
The garden / allotment is a popular activity with some clients and there is still plenty to do at this time of
year. We are hoping to get the gardening activity up and running on each ward in the future. A number of
staff have expressed interest in starting the Carers group; leads have been selected for each ward.
Sandwell is a multi-faith community, so its important for our clients to be able to express their own faith in
a safe and secure environment. The development of the multi-faith Prayer Room enables clients of any faith
to practice their religion accordingly.
The Protected Time initiative was implemented earlier this year with the hour between 1 and 2pm
allocated for staff to be able to spend quality time with the clients. This did prove diffcult to maintain and
it was one area we had to make a compromise with. We therefore decided to allocate a protected time
slot within the shift, rather than at a set time. This has proven to be more successful and all clients now get
protected time within a 24hour period.
As Sandwell was one of the frst trusts to go No Smoking (31/8/06) advice to clients on quitting smoking
is readily available. As well as nicotine replacement therapy and advice on diet we also have the support
of Sandwell Stop Smoking who offer one to one or group support. Several staff have also attend training
on supporting clients to Stop Smoking. But for those clients who do not want to stop smoking we have
provided smoking shelters in the garden.
With weekly community groups taking place, fexible visiting and plenty of information for visitors and
carers Sandwell Mental Health NHS & social Care Trust are making a steady but defnite head way with
Star Wards and we look forward to even more progress
Regards
Susan Byrne
Practice Development Nurse
Sandwell Mental Health NHS & Social Care Trust
Susan.Byrne@smhsct.nhs.uk
Star Wards at Sandwell
Sandwell Mental Health NHS and Social Care Trust
Star WardS
8
When I was invited to join a Prepare and Share
meal, I soon discovered that this is a serious
catering event! The fellow catering assistants
include current inpatients as well as service
users who have been recently discharged. This
enables people to return to the centre for a burst
of contact and an enjoyable event. Everyone
appreciates taking part, getting absorbed in
meticulously preparing the ingredients, enjoying
and sometimes joining the banter, and having
a nice cup of coffee. The creation of the meal
is co-ordinated and coached by Imran (who
handily has chef training among his other skills)
assisted by Jo Spencer, the Modern Matron.
When the meal is fnishing, the table is prepared:
not just a quick wipe and cutlery and plastic
cups all round, but a lovely tablecloth and smart
glasses. The meal sometimes includes extra items
(e.g. samosas) which have been prepared on the
ward by patients not able to take part in the
cooking group itself.
The social value of the occasion is vitally
important. People see the other side of things
even that you can joke with your manager.
And patients who behave very erratically on the
ward, act perfectly conventionally in the group.
No-one has eaten messily or inconsiderately. Its
also an incentive for people to smarten up.
The activity clearly has value beyond the merely
nutritious. Just sitting together and enjoying a
meal like a family is very novel for some patients.
One commented: Ive heard about it, but I
havent done it before.
Preparing and sharing food is a basic human
activity. It allows people to contribute and to
just chat. Its an expression of friendship and
community. Its somethng that everyone can
beneft from, wherever they are.
Marion
Highgate Mental Health Centres Prepare and
Share Group is a group which incorporates
a range of experiences for service users by
preparing and sharing a restaurant-standard meal
together. The aim is to enable patients to improve
their cooking skills and their social interaction with
others. Participants who contribute in any way to
the preparation are encouraged to join in sharing
the meal communally, but special arrangements
can be made for anyone who prefers to return to
the ward.
The group relieves the patients of having to
consider budgets or their own capabilities and
is not strictly time limited. The end time for the
group will vary according to the particular menu
in terms of the time needed to prepare and clear
away. The group has a 4pm start time so that it
replicates more closely the timing of the evening
meal at home with the meal usually being eaten
between 5.30pm and 6pm. Care will be taken
to try and foster a sense of occasion by using
particular types of food or styles of cooking
to honour occasions, festivals and/or culture
whenever this applies.
The objectives are to:
encourage co-operative working with
others

create an environment to enhance social

skills
beneft from role-modeling by others
refne skills in preparing food from fresh
raw ingredients
gain an sense of achievement by
contributing to a successful end product
provide an opportunity to learn about
healthy eating in a practical way
enjoy the experience of eating together
without distractions such as TV.
Participants
The main facilitator will invite inpatients from
Topaz ward based on their current risk assessment
and mental state. Patients from other wards
may also be invited to take part as appropriate.
To encourage the social element of the group,
participants are invited to the kitchen at 4pm in
the same way that anyone would be invited to
a social gathering. The emphasis is on invitation
rather than referral to the group. The menu and
the ingredients will have been planned in advance
using suggestions from the previous week.
Jo Spencer
Modern Matron
Jo.Spencer@candi.nhs.uk

Prepare and share

Highgate Mental Health Centre
Star WardS
87
A Star Ward in the Making?
South Staffordshire and Shropshire Health Care
of-it groups too, were building increasingly
productive community links and tapping into
training and funding thats out there for people
to access. We have an arts project involving a
local historian and various local artists and we
are also offering IT taster sessions in partnership
with the local college. Community links allow
people to experience whats available in their local
communities before theyre actually discharged,
easing the transition, aiding recovery and
preventing relapse.
Other initiatives include medication Q & A
sessions delivered by our local pharmacist and
the implementation of periods of protected
time where the unit is effectively closed off to
outsiders so that time can really be focused on
the people who need it most the service user
group resident at that point. We are now focusing
on the amount of time taken by (and often
disruption caused by) ward rounds on the unit,
and how we might offer an alternative system.
We are currently reviewing indicators from PALS,
Service Relations (complaints), adverse event
forms (type and frequency), medication costs,
use of seclusion, length of stay/readmission rate
and referral and transfer to PICU. All the data
seems to point to the same conclusions; having a
structured programme of activities on an acute
mental health unit has demonstrable benefts in a
number of key areas. It results in cost savings on
relief staff, time taken to investigate complaints,
cost of sickness and absence and, crucially, benefts
for service users in terms of increased satisfaction
and a move towards a quicker recovery. Star
Wards has gone further than simply reinforcing
this message though; it has given us a benchmark
which will assure the quality of care on an acute
inpatient unit for years to come.
Paul Bowers
Ward Manager
Paul.Bowers@sssft.nhs.uk
The Margaret Stanhope Centre
Adult Acute Ward
In late 2005 we embarked on a restructured
programme of activities on the ward. The project
turned into an audit to work out whether what
we were doing worked and, whether it was what
people wanted. Along with baseline questionnaires
for staff, an evaluation tool for service users
allowed us to capture their thoughts on what we
had done, and also what they felt we could be
doing instead/as well.
Rostering a member of staff onto 9-5 shifts
Mon-Fri was crucial as it allowed us to build
some consistency and stability into the often
inconsistent, unstable environment of acute
inpatient care. We also freed up time for a
health care support worker (HCSW) to conduct
massage and aromatherapy sessions which,
although she had trained in, she had never been
able to use at work. As staff vacancies arose we
looked at the skill mix and decided to convert
one of the HCSW posts into a OT assistants post
with the understanding that work would be done
in the evenings and at weekends, as well as during
the working week.
The launch of Star Wards really brought our
project into its own, as it allowed us to measure
ourselves against other exemplary practice.
Reassuringly, we were not a million miles off in our
thinking! As a result of the work we had already
done and the Star Wards audit that the Trust
carried out, we were proud to see that we ranked
highest in terms of our development across the
Mental Health Directorate inpatient units.
Since our audit and the launch of Star Wards,
weve continued to develop the service. Along
with regular visits and walks with our OTs Pets
as Therapy registered dog, poetry readings from
a service user, healthy living groups, psycho-
educational groups and some just-for-the-fun-
We cant say for defnite that the programme we currently have running is directly responsible for the
following facts and fgures, but wed be hard pushed to say it played no part at all. NB we began the
programme in January 2006.
2004-05 2005-06 2006-07 % change 04-05 to 06-07
Bank nurse costs (av. Per mth) 3522 2223 2510 -29%
Agency nurse costs (av. Per mth) 6060 4087 693 -88%
Days lost through staff sickness 637 550 392 -38%
Star WardS
88
Joint Therapeutic Working
Sussex Partnership NHS Trust
are responding brilliantly to creative opportunities
for activity ideas from a mural project in the
smoking lounge on the PICU (Psychiatric Intensive
Care Unit) to inviting friends who are musicians
to provide entertainment, and having published
poets running creative writing groups. Service
users report a welcome structure to evenings and
staff appreciate having an opportunity to do more
interesting and enjoyable activities directly with
service users.
There are less hospital wide groups due to there
being more ward based ones, meaning our service
is now more responsive to the changing service
user mix, collective interest and to the demands
on staff when patient need intensifes and requires
more staff input to address. It has proven a real
opportunity for team building and the blooming
of much talent with knock on effects on individual
confdence as staff share interest, support efforts
and participate in active engagement and feedback
of service users experience. There has been an air
of healthy competition between ward teams which
is being steered into a best practice forum which is
being co-ordinated by our Star Wards lead.
Keeping up momentum
To ensure continuity, there have been reports a
group always goes ahead even if only one service
user attends. Staff feedback has been generally
positive, commenting on opportunities to do
enjoyable activities as part of therapeutic input,
being able to bring their own interests to work
and service users commenting on evenings being
more tolerable and less unstructured. Keeping
up momentum has at times been hard with the
changing face of ward dynamic with individual
and collective need on any particular ward. Also
reports of service users having more autonomy to
decide what groups to do can allow for activities
being often repeated. Continuity has been an issue
too, the need to use temporary staff at times and
rotational staff coming into post requiring time for
induction, acclimatisation and gaining confdence
in group provision when they may have had little
practical experience.
The PICU (psychiatric intensive care unit) has
probably had to be the most creative to maintain
continuity and so theyve been looking at how
Section 17 leave can be used more therapeutically
and having a much more fexible approach to
Heres an update on Joint Therapeutic Working
(JTW) since our last article in April 2007. We
focused then on outlining the project on Regency
Ward where the initiative had been piloted and
in less than a year it is up and running across
the hospital. Many other changes to service
direction have occurred too, including male
and female only wards and associated service
structure changes, plus, in the planning stages are
a refurbishment of two wards over the coming
year, so there is much to contend with for our
energies.
Each ward has its own favour of JTW and has
developed its own strategies for making things
work, from an idea to call the morning meeting
the The Low Down to JTW itself becoming
Doing Stuff: dont be bored on the ward.
Initiating the ideas of JTW has taken different
forms from being charge nurse led on one ward
with a long established ward team getting on
board with training provision, to being led more
by the occupational therapy team, where it has
been recently implemented.
Plans for integrated assessments have been
shelved at present proving to be impractical
due to being overly lengthy to complete. Care
planning has become more structured though
with new forms providing a clearer format and
tying in more clearly with interventions. This
includes the occupational therapists using the
same format to ensure their work is more visible
too, within integrated notes. Service user self-
management, crisis planning highlighting strategies
and resources to prevent relapse as well as
advance directive forms, i.e. information about
how service users wish needs to be met in a
crisis, have all been standardised so offering ease
of location in case notes.
Activity programme overhaul
The overhaul of the activity programme has
probably had the most impact and feedback
has been mostly positive from both service
users and staffs perspective. More activity has
been happening more regularly throughout the
day especially in the evenings where it seems
to have had the most noticeable impact. Shift
patterns have addressed group facilitators being
pulled back into ward numbers and preventing
cancellation by having a 12-8pm shift. Ward staff
Star WardS
89
the interpretation of group
activity to acknowledge
and include any level of
participation. Focus has
moved away from morning
meetings too, with plans to
introduce having breakfast
together every morning with fresh bread and
information about activities.
Caburn was the last ward to take on board JTW
with staff having much support to run groups in
the evening and so far we are have run one every
night for the last six weeks. An activity folder has
been developed for service users to access and
see what is available and the aims and objectives
of each group. As groups are better attended in
the evening we are looking at concentrating on
1:1 input more during the day.
Protected time
Protected time for patients and for staff teams
has also become the norm. Having hour daily
for morning and afternoon shifts to overlap and
discuss any issues, debrief and offoad has helped
tackle daily stress and some wards have bi-weekly
refective group sessions. To encourage more
time spent with service users an introduction of
specifc protected time where the ward offce
is empty apart from one staff member and
everyone is out on the ward actively engaging
clients is happening daily on the PICU.
Ward-based occupational therapy
Following our annual team day the occupational
therapy service is now ward based, having
a positive effect on the ability to be more
responsive, feeling more a part of ward teams
and having increased OT team representation
as support staff have been shared across the
wards too. This has impacted on longer term OT
staff who have had to be more fexible with the
change in role. We ensure regular team contact
apart from weekly business meetings by getting
together as a therapy service for lunch on Fridays
giving a chance for part-time staff to link with the
whole team and art therapists to join us.
Service user information fles are now in place
in most bedrooms providing a comprehensive
guide to hospital services. The catering service
has implemented menus for each ward on a daily
basis in a much more user-friendly style with
clear symbols to help identify healthy options,
vegetarian and low sugar meals.
Spiritual needs
Meeting spiritual needs has also been addressed
we now have a Sacred Space available. There are
regular weekly sessions for prayer, contemplation
and meditation led by the multi-faith chaplaincy
team, as well as the option for individual use by
service users, carers and staff.
Speaking of spirit, a project set in motion by Nicky
Lambert who was jointly instrumental in the
original JTW pilot, dropped a pebble in the pond
in the form of an idea for a Womens Wisdom
Quilt to be part of a womens conference
promoting the services facilitating recovery.
Women service users have been encouraged as
part of 1:1 or group activity to contribute to a
collective effort making patches inspired by words
of wisdom, messages or meaningful images and
providing an outlet for self expression. This has
included staff getting involved and the photos
above give an idea of the extent of the inspiration,
humanity, care and spirit of all participants. It
started very small and we have had over 50
contributions so far with ideas to produce cards
of the work with proceeds being possibly the start
of a hospital charity fund to go towards patient
resources for activities, further projects etc.
The overall energy, organisation, service user
engagement and staff satisfaction has been
positively and noticeably improved. So its looking
forward to a challenging and exciting year ahead
looking at building on what has been achieved so
far and to continually aim at improving service
users experience and recovery.
Michelle Hughes
Occupational Therapist
michelle.hughes1@sussexpartnership.nhs.uk
Nick McMaster
Senior Activities Facilitator, OT Service
nicolas.mcmaster@sussexpartnership.nhs.uk
Two pieces of the quilt
created by service users.
Star WardS
90
Improving Access to Psychological Skills
West Park Hospital, Darlington
The module focuses primarily on understanding,
so activities during the three days are geared to
development of the relevant knowledge, ideas and
concepts staff will need for each area. Staff will be
expected to actively take part in these learning
activities.
Personal actions plans will vary depending on
qualifcations and experience. For those who are
new to these ideas, the plan may consist of ways
to further develop these fundamental concepts,
while for those who are already very familiar with
what is presented, the plan may be to identify
further specialist courses or develop opportunities
for supervision of clinical work.
Staff receive a Module Guide and Workbook
on arrival. Once the Module has fnished staff
will receive a Certifcate of Attendance. These
documents can be use as evidence in their
Personal Development Portfolio.
Supervision
In order to ensure that staff feel adequately
supported in using and developing psychological
skills, they will be strongly encouraged to seek
supervision. It is hoped that each ward will review
and identify their existing supervision structures
and identify any gaps that might exist.
However, two supervision groups will also be
offered to all inpatient staff, by the inpatient
psychology service. These will include:
An assessment / formulation supervision
group this group will aim to help staff to
hone their assessment and formulation skills
and ultimately staff to develop psychologically
informed recovery plans for in patients.
A complex cases supervision group this
group will give staff an opportunity to discuss
diffcult cases, develop helpful formulations
and ward based approaches to dealing with
challenging patients.
Dr Angela Prout
Consultant Clinical Psychologist
Angela.Prout@cddps.northy.nhs.uk
Simon Beaumont
Head of Inpatient Healthcare
Simon.Beaumont@cddps.northy.nhs.uk
1.
2.
One of the main priorities for users, carers, staff
and the trust is access to psychological therapy
on the wards. Nationally several documents have
also made suggestions as to positive practice
in inpatient settings and included the need for
psychological interventions to be available to
patients. The Star Wards publication makes
suggestions as to what should be offered on
inpatient wards and includes various levels of
psychotherapeutic activity.
Service users and carers expect Inpatient wards
to be places where people receive the care and
treatment they need to improve and recover
as quickly as possible. The psychological needs
of a patient are an essential component of any
recovery (care) plan and need to be addressed at
the very least by the patient having access to staff
with some understanding of psychotherapeutic
models (such as CBT) but at best being able to
access therapies they have already engaged in or
would have had access to within the community.
West Park Hospital Inpatient
Training
The inpatient psychology service has developed
a three-day training module for all inpatient staff,
regardless of prior qualifcations or experience.
Andrew Cuthbertson (consultant clinical
psychologist) and Chris Laydon (Nurse Specialist)
were also involved in the setting up and running of
the programme.
The module aims to ensure a common baseline
for everyone. It has fve aims and learning
outcomes, so by the end of the three days staff will:
Understand what is meant by the term
psycho-social culture;
Understand what it means to have a
psychological profle of a person;
Understand what is meant by
psychological assessment and
formulation;
Understand the concepts and
approaches of two therapeutic models:
Brief Solution Focused Therapy and
Cognitive Behavioural Therapy;
Decide how they can become
committed to cultural change in their
place of work and have a personal
action plan to take this forward.

Star WardS
91
Working collaboratively
Mersey Care NHS Trust
Inpatient Services, which will include signposting
service users to community provision. Developing
our partnership arrangements with the Local
Authority has provided us with expert advice,
so that we can use surplus monies to purchase
suitable gym equipment. We are also introducing
access to exercise bikes on all Liverpool Inpatient
Wards.
Liverpool Inpatients are also working alongside
the Liverpool PCT, Walk for Health Initiative, so
that a number of our inpatient staff, following
training, will be able to act as walk facilitators, as
well as developing local risk assessed walks that
our service users will be able to access whilst
inpatients.
As part of the Star Wards initiative the
Occupational Therapy Department have worked
alongside Liverpool Community College to
produce a piece of service user art work to
celebrate the link between Liverpool and
Stavanger, Norway as part of the celebrations
to mark the 2008 Capital of Culture. The art
work will be exhibited in various locations across
Liverpool, to include the Central Library.
The OT Department have also been working with
the Tate Gallery, which involved a freelance artist
from the Tate providing a series of workshops
aimed at increasing female service users self-
esteem and interaction with each other, through
making personal connections with modern art.
Another recent introduction within the OT
Department is a therapeutic music group run by
Music Spaces, a national charity which aims to
provide music therapy to adults and children. We
are also currently working on providing computer
and internet access on each inpatient ward.
Eifon Ingman
Nurse Consultant
Eifon.Ingman@merseycare.nhs.uk
The Adult Mental Healths Inpatient Service, like
many other mental health providers, hopes to
enhance the quality of their inpatient provision
through participation in the Star Wards Initiative.
To achieve this, we are working collaboratively
with service users and key stakeholders in
realizing the recommendations within Star Wards
Prior to our engagement with Star Wards,
Protected Therapeutic Time was adopted as a
means of ensuring a regular time during which
wards were shut to non-therapeutic activity, to
allow nurses time to spend with service users.
However an audit of the service users experience
of Protected Therapeutic Time highlighted
ambiguity about its benefts, with service users
reporting different experiences of the initiative.
Whilst some service users didnt know what
Protected Therapeutic Time was and were unable
to recognise it happening on the ward, others
described a variety of activities being offered.
It was therefore clear that we needed a more
structured, considered approach to the animating
of inpatient wards, which offered a structure and
focus for change
The Star Wards stakeholder groups are multi-
disciplinary and multi-agency, and function in such
a way as to ensure that the staff and services who
will be delivering the activities are on board and
that service users have pathways to feedback
comments. The group also work alongside
external agencies or individuals who have
specialist skills in delivering specifc activities
Some of our initial easily attained successes within
Liverpool Inpatients include the increased display
of artwork within our buildings, the creating of
an accessible DVD library and the purchase of
walkmans for service users on the wards. Some
of our more exciting long term projects consist of,
amongst others, The Creative Wellbeing Initiative,
involving joint work with Manchester Metropolitan
University and Liverpool based artists Steve
Rooney and Sue Williams, from community-based
artistic group TAG, who are working with inpatient
staff to enhance their skills in working creatively
with service users on the wards.
We are also in the fnal stages of entering a
Service Level Agreement with The Local Authority,
which will mean Lifestyle Gym Instructors
providing 5 gym sessions within Liverpool
Improving Access to Psychological Skills
West Park Hospital, Darlington
Star WardS
92
Voluntary work on Acute Mental
Health Wards
South Staffordshire and Shropshire Healthcare NHS Foundation Trust
Over the last two years, two volunteers Carol
Stone and Clare Lord have worked with
occupational therapists in the creative group on
Chebsey and Brocton House in Stafford.
As an inpatient, Carol Stone enjoyed attending
the creative group and found it benefcial. On
discharge, she wanted to use her previous
teaching skills within a mental health setting, so
it was agreed that Carol would be a volunteer
in the group. Initially supported by the OT and
OT assistant practitioner, Carols role progressed
from helping out and talking to service users, to
planning, preparing and co-facilitating the group
with little support. Carol wrote
The OTs feel confdent in my role and regard me
as an integral part of the team and co-worker.
Although I feel more confdent, the support has
been important to me. I have found it a positive
experience, enabling me to demonstrate my
recovery and to offer hope to other service users.
Clare Lord, a volunteer artist, has been involved
in facilitating the group since March 2007. Clare
initially spent some time in the group, getting to
know the service users and their preferences
and needs in regard to art. From May 2007, she
started to facilitate projects. Her frst project
was around the theme of butterfies. Collages,
abstract canvases and mobiles were produced and
displayed on the ward, service users working from
photos and real butterfies, exploring colour and
texture. The next project explored the theme of
self . Abstract paintings have evolved from pattern
making based on service users initials and recently,
they have worked on self-portraits using colour
and shape to express feeling as well as completing
charcoal drawings of each other.
The projects have given service users
opportunities to learn new creative techniques, to
express themselves, to increase their self esteem
and socialise with one another in a relaxed, yet
focused activity. They have gained a real sense of
achievement seeing their work displayed on the
ward and value Clares presence and inspirational
ideas. Service users look forward to the creative
sessions and are very positive about the group.
Here are some comments service users have given:
I enjoyed creating something and doing
something meaningful
I spent a good month doing art and found it
exhilarating and relaxing. Thank you
Im really beginning to express myself
One service user summed up the experience:
Having been here on Chebsey Ward for six
weeks, every Tuesday is a ray of sunshine in my
eyes for the art class comes around. Not only is
it therapeutic and relaxing, it cheers everybody
up and I found myself a new and exhilarating
challenge in life which I mean to keep up after.
Ward manager, Jay Moorhouse, commented:
Since Clare began the art group in May
this year, nothing but positive feedback and
praise has been received from service users
participating in the group. The group provides
many therapeutic benefts. The standard of the
work done in the group is absolutely amazing
and gives tremendous enjoyment to all of those
who are fortunate enough to view it.
Emma Yorke, Arts for Health Co-ordinator and
Julie Barnhouse, Occupational Therapy In Patient
Lead, organised the voluntary work on the ward
and have been involved in meeting with Clare and
reviewing her role. Clare works at all times with
a qualifed occupational therapist. Clare plans the
projects but involves the OT in these plans, gaining
her ideas and experience of working with service
users with acute mental health diffculties.
Since September 2007, Clare has been employed
by the Trust to provide two sessions of art a week
for 14 weeks, working on both acute wards rather
than just the one ward which she started on.
Projects have been around the themes of sunsets
and fowers and as you enter the wards, your eyes
focus on the canvases, sculptures and mobiles that
the service users have produced, transforming the
wards into bright, calm and relaxed environments.
Julie Barnhouse
OT Inpatient Lead
Julie.Barnhouse@ssh-tr.nhs.uk
Star WardS
93
Small Changes Big Difference
Pendered East, Northamptonshire Healthcare NHS Trust
A small thing like a tablecloth can make mealtimes
feel much more like home, so one of the tasks
on our patient Jobs Board is to lay the tables
for lunch and dinner. Patients volunteer for this
and other tasks which contribute to the daily
running of the ward, such as watering the plants,
keeping the lounge/garden tidy, washing up the
mugs and so on, thereby taking back some of the
responsibility for their own environment.
Patients have also told us that the experiences
of their friends and families who come to visit
is important to them, so our units new Carers
Welcome Pack (currently in production) is eagerly
awaited. As a ward, we want carers, family and
friends to feel as welcome as possible, so patients
and staff have together created a bright new
welcome sign, with each person producing one
letter to their own individual design its hard to
miss the message!
These are just a few examples of improvements
which have cost next to nothing, but have had a
big impact on our ward. Star Wards is about the
way we think, not necessarily about resources.
Taking the time to seek patient feedback and
promote their involvement not only makes
patients feel valued, but highlights the fact that the
smallest of changes can make a huge difference.
Sue Munroe and the Pendered East Team
sue.munroe@nht.northants.nhs.uk
Sometimes, its the small things that make the
difference. Our ward has implemented a number
of the Star Wards ideas from each of the
tweaking, turning and transforming categories,
but staff were surprised at a recent community
meeting by the feedback from patients about
what we thought were perhaps the less signifcant
changes. One lady, who was about to be
discharged after a stay of 3 months, said she felt
the ward had really improved, and cited the fact
that she was now able to drink her tea out of a
china mug instead of a plastic one making even
the tea trolley a more therapeutic experience!
- as the most signifcant improvement. Others
agreed, saying that the trust shown in them
through the provision of china mugs made them
feel better about themselves.
Handing back initiative and responsibility to
patients where possible is key to the Star Wards
philosophy, so we have made some small, but
important, changes to allow patients to take more
control of their daily routine and environment.
Breakfast, for example, no longer involves queuing
at the kitchen hatch to be served by a member
of staff. Patients can now make their own
breakfast at a table in the dining area. The simple
act of moving the toaster out of the kitchen
and providing self-service fresh flter coffee (in
the aforementioned china mugs!) has altered
the whole feeling of the breakfast routine. And
on Fridays, a grill and microwave are provided
so that patients can cook themselves up a full
English, which usually goes down well with
everyone. This is a self-fnancing initiative,
as staff who want to join in (usually most
of them!) make a donation for their food,
which pays for the next weeks supplies.
As our do-it-yourself breakfast has been
a success, we are in discussions with the
hospital caterers about the provision of
sandwich and salad ingredients for optional
do-it-yourself lunches and dinners too.
Most people would not usually have
two hot meals a day at home, and our
patients have told us that it makes weight
management diffcult. We have asked for
clearer labelling of ingredients, and for a
menu to be provided with every meal,
fagging up the healthier options.
Small things make a difference. Pendered Easts new welcome sign with its individually designed letters.
Star WardS
9+
Creating a Star Ward
Bowmere Hospital, Chester and Wirral Foundation Trust
Bowmere Hospital is one of four hospitals
under the management of Chester and Wirral
Foundation Trust and is based in Chester.
The Hospital comprises of two wards for service
users with functional mental health problems
(16-65+), a ward for service users with dementia,
an intensive rehabilitation ward and a Psychiatric
Intensive Care Unit. The care is multi-disciplinary,
holistic and patient-centred, with a range of high-
quality therapies and activities, delivered using the
Star Wards format. On each ward, service users
have their own bedroom with en suite facility, a
number of quiet rooms, a TV lounge, craft room,
laundry room and dining area. The hospital has
a caf The Oasis a prayer room and a fully
operational occupational therapy department
Adjacent to the hospital there is a large attractive
and well equipped gymnasium, staffed by three
sport therapists and a volunteer. Service users are
encouraged to use the gym on a daily basis, and
they can continue using it as outpatients.
Background
When service users are asked about their
experiences on mental health wards, words and
phrases such as boring, nothing to do, and its
a long day are not uncommon. However, within
Bowmere Hospital these words and phrases are
now rarely used. Instead service users have made
a number of positive comments about Bowmeres
facilities and environment, for example: Like a fve
star hotel, Its like a holiday camp, Its like a travel
lodge.
Since 1999 staff, service users and carers have
striven to improve leisure activities and quality
time for service users in inpatient wards through
an initiative called the Inpatient Network.
Star Wards has enabled us to continue with this
process and given us a structure to work with,
enabling us to audit our successes and create
action plans where we need to improve. Our
monthly acute care forum service user group,
activities group and regular ward community
meetings are the vehicles to listen to service user
needs and meet the requirements of Star Wards.
As a result, service users are appreciative of the
activities and engagement on the wards. Not
only does this help create a healing environment
but reduces boredom, violent incidents and the
number of service-users leaving hospital without
agreement.
Staff have also responded positively to Star Wards.
There is a champion on each ward and action
plans are regularly audited. Service users are also
given a simple survey to ensure the goals set are
being met.
Recreation and activities
All wards have a selection of board games, TV,
VCR and DVD. Sky TV is available on our P.I.C.U.
and in the OT Centre. All wards have access to
digital free view TV.
Each ward has an activity budget and service users
are included in the decision making on how the
money is spent. There is an activity champion in
each ward and an activity co-ordinator 6 hrs a
week to co-ordinate activities across the hospital.
Weekly acitvities include:
swimming
craft activity
quiz
card making
flm club
guitar club
fshing group
bingo evening.
One-off activities such as baking or art occur
within and outside of protected time. Music in
Hospitals visit Bowmere each month. Occasionally
there are trips out to places of interest such as
Chester Zoo. We intend to increase the choice of
activities that service users can attend to include
dance sessions and beauty sessions.

Bowmere is an exceptional hospital which

demonstrates that it is possible for NHS
hospitals to provide actively therapeutic and
even enjoyable experiences for inpatients.
Space restrictions mean that what you read
here is a (very) edited account of Bowmeres
approach to implementing the original 75
ideas. If you want to see more detail, visit
www.starwards.org.uk
Marion
Star WardS
95
Volunteers
Our volunteer group is growing within Bowmere.
Four volunteers work in our activity club, two
run card-making sessions, one organises a flm
club, visits the local shops for service users and
manages our library. One helps in the gymnasium,
one in our prayer room and two visit service
users who do not usually receive visitors. We also
have volunteers offering beauty sessions, dance
and Qi Gong. The recruitment of volunteers is
within the Modern Matron role and is supported
by the PALS offcer. There is a well-attended
monthly volunteer and activity meeting which
enables the Modern Matron to meet regularly
with the volunteers.
Library
There is a selection of books available in all the
wards, as well as a well-stocked library. The library
is placed between the two adult wards so is
easily accessible. Service user self-help leafets,
and other information leafets are available in the
library and on all the wards. Also, we now have a
fortnightly visit from the County Council mobile
library service.
Art
There are a number of paintings and drawings on
the wards and around the hospital. On occasions
a local day centre displays paintings in the hospital
and some users paintings are also displayed.
There are ongoing discussions with the local
college to attempt to have them display art work.
Food
Trust Health & Safety policies preclude service
users cooking in ward kitchens. However there
are two rehab kitchens within the hospital which
can be accessed by service users. In addition
there is a hot drinks trolley available 24 hrs a day
for service users within our Oasis caf and again
available 24 hrs a day, there are microwave meals
and a microwave.
Visitors
A number of rooms are available on the wards
for visiting. Private visiting is easily arranged.
There is a designated visiting area as well with
magazines and games available, and our Oasis
caf is available 24/7 for visiting purposes. There
are set visiting hours on each ward but these can
be altered to suit service user needs.
There is a Pets in Hospital policy which allows
pets if required. A member of staff s guide dog
Tom is a regular visitor to the ward.
Health and ftness
On admission, all service users will be seen by a
Doctor and will have a physical examination.
Bowmere hospital has a fully equipped gymnasium
which is available for use by service users,
outpatients and staff. Sports trainers are available
within the gymnasium and individual plans for
service users are available. This also involves twice-
weekly visits to the local swimming baths and a
weekly visit to play badminton. There is a multi
sensory room on our older peoples ward for
those with dementia.
Walks are regularly organised from the wards.
Walks may be for an individual service user or
taken as a group. Smoking cessation advice is
available with our sixty staff trained at level 1
smoking cessation and six to level 2.
There are a number of gardens in and around the
hospital. Our PICU has a garden tended by service
users, there is a garden which is part of a 2007
project, and our new rehabilitation ward has two
gardens which are not yet landscaped. Some users
will have input and help in the garden. There are
plans for an allotment for Rosewood Ward.There
is also a garden area that is maintained by service
users via the Occupational Therapy Department
Information
Welcome packs are given to service users on
admission. These packs contain information about
visiting. There is also a hotel type pack accessible
on each ward with available resource information.
Information is available for visitors and carers. This
includes information about services, visiting, bus
times, taxi numbers, etc.
Care planning
Service users are involved in care planning. We are
piloting a care planning initiative which involves the
service user, named nurse and care co-ordinator
meeting on admission, and then on a fortnightly
basis to aid care planning. Care plans are written
jointly with service users and staff, and signed and
stored in the case record. Copies are given to
service users and added to the recovery fles.
Star WardS
9
Protected engagement time occurs for at least
one hour a day on all of the wards in Bowmere,
allowing face-to-face contact for individual work
and also for group work with service users. Group
work is popular within the protected time, with
current affairs debates, quizzes and craft activities
likely to occur.
Therapies
Chester and Wirral Partnership psychologists
work within the community mental health teams.
There is dedicated psychology input of a qualifed
psychologist directly onto the ward and also a
specifc psychotherapy team, consisting of a nurse
and a consultant psychologist.
There is a full team of occupational therapists
working within the hospital. Music therapy has
been offered previously and will be available in the
near future. Drama therapists have been available
previously but not currently.
A member of staff within each ward has a
counselling qualifcation. Nurses are being trained
in Wellness Recovery Action Planning in order
to reinforce recovery management. Student
counsellors via the Psychology Department are
welcomed onto the wards.
Ward community
Each ward has a group meeting once a day.
The day ends with a hot drink and toast in the
dining area of the ward. Domestic staff interact
with service users around keeping the ward and
their own room clean and tidy. A member of
the domestic staff is invited to the local activity
steering group and has recently become involved
in a fshing club.
Within Bowmere, there is a multi-faith prayer
room available 24/7 for private use. There are 3
organised services during the week. There has
recently been a Spiritual Awareness open day to
encourage other faiths to be aware of our hospital
and use the facilities.
Mutual support
Service users are encouraged to buddy up
with new users to the ward in order to show
them around the ward, Oasis Caf etc. They
also encourage each other via the community
meetings, service user groups and other
therapeutic activities that occur within the hospital.
This support continues, on an informal basis, on
discharge from hospital.
Medication
This has been discussed on many occasions
within service user meetings. We have decided
to dispense medication from the clinic, but there
is no need to queue. Medication is dispensed at
agreed times and service users can collect their
medications when they want to.We are piloting
an automated dispensing system which will cut
down individual dispensing time from 4 minutes
to 30 seconds.
If a service user has had rapid tranquilization then
there is a process for them to write about their
experience
Service user involvement
Within the Trust there are over 60 service
users who have been trained in recruitment
and selection and who regularly take part in
all staff interviews. Service user involvement
in various aspects of running the hospital is
facilitated via the various service user and carer
groups. (Complaints and suggestions also make
an impact!) An example of this is the talkback
box on each ward. At their own leisure service
users put suggestions in the box which are in
turn looked at and fed back to local community
meetings. All the suggestions are taken to the
monthly service user meeting. There is also a
monthly PALS talkback newsletter.
Conclusion
Star Wards has helped us create a structure of
activity which is valued by service users and staff
alike. We aim to work on those areas that need
further development.
Colin Jones
Modern Matron
Colin.Jones@cwp.nhs.uk





Star WardS
97
User, Carer and Advocate
Leadership Programme
Tees, Esk and Wear Valleys
Aims:
The aim of the course is to provide an opportunity for users, carers and advocates from across Tees,
Esk and Wear Valleys, to work together on their leadership skills and issues which will have a signifcant
impact on the delivery and organisation of services in the emerging modernisation agenda and within the
context of the NHS plan.
The programme aims to provide you with time and space to refect within a structured approach to
leadership learning. The focus will be upon encouraging users, carers and advocates to be effective in
infuencing and contributing to service improvements.
Anticipated Outcomes:
By the end of the Programme you will be able to: This will be achieved through
1
Demonstrate you are self aware and focused on priority
leadership development activities
Leadership Self Assessment Tool Personal Development Plans
2
Demonstrate political awareness and ways you may be
effective in infuencing agendas.
Structured Learning sets
External speakers
Personal Development
3
Demonstrate Leadership skills that can be applied to
infuencing and contributing to service improvement
Personal Development Plan; Action Learning Sets; Structured Input;
1 : 1 Coaching / Mentoring
4
Demonstrate active involvement of users, carers and
advocates in service development
Discussions with users, carers and advocates, Action Learning and
transfer of learning to practical situations
Leadership Self-Report
This is a questionnaire designed to provide self feedback on your own perspective of yourself as a leader
based upon 10 leadership practices
These are just short extracts from this pioneering, comprehensive, fabulous development
programme created and run by Tees, Esk and Wear Valleys Trust. Participants beneft from a
stimulating mixture of workshops, action leaning sets, masterclasses, mentoring, and supported and
structured self-assessment
An impressive bonus of taking the course is that participants are eligible for an Accreditation
Certifcate with the University of Teesside
Innovative thinking
Self confdence / Integrity
Self awareness
Strategic thinking / political awareness
Infuencing others
Communication
Giving and receiving feedback

Involving others
Achieving results
Challenging rules and hierarchy
By completing this at the beginning and at the end
of the programme, it will help you to focus on
your own personal development.

Ian Trodden
Nurse Consultant
ian.trodden@tney.northy.nhsuk
Star WardS
98
Star Wards at Wotton Lawn: 1 year on
Wotton Lawn Hospital , Gloucester
Activity is everybodys business.
As many of the Star Wards suggestions are linked
to the provision of activity, within the hospital,
activity became everybodys business. Whether an
health care assistant, ward manager or consultant
occupational therapist the expectation is that
when needed all will be involved in providing and
supporting activity to happen in the hospital. To
help build peoples confdence in delivering activity,
on some of the wards staff have been encouraged
to complete an Interest checklist, the same tool
as used with patients, to identify interests of their
own and therefore activities they could deliver
with confdence.
Star Wards in Action
Walking Groups
As part of the many activities happening on
one particular ward, a successful walking group
has been established and runs every Sunday
regardless of the weather. The group evolved as a
result of some very keen staff members who are
ramblers and felt the benefts they experienced in
their own leisure time would beneft the patients
on the ward. Initial problems such as a patients
lack of suitable clothing and footwear were soon
overcome by donations of unwanted outdoor
clothing from staff in the hospital. The walking
group is tailored to meet the needs of those
particular patients involved that day and can range
from a 2 hour ramble in the Gloucestershire
countryside to a short trip and walk around
Gloucester cathedral in the not so nice weather.
Wake and Shake
Thanks to the creative skills of physiotherapy
and sports therapy staff in the hospital, patients
have the opportunity to take part in Wake and
Shake daily exercise sessions aimed to increase
motivation and provide a fun start to the day.
The session is suitable for all ages and abilities
and tailored to meet individual physical needs.
Using music and movement, the session is an
effective way to energise the body and mind and
get everyone (staff are always welcome too!)
motivated for the day.
Activity Co-ordinators.
Each ward in the hospital has a nominated activity
co-ordinator or member of staff each shift to
support the delivery of activity, ensuring patients
Who are we?
Wotton Lawn hospital is an 84 bedded acute
mental health unit for adults of working age,
situated in the centre of Gloucester. The hospital
provides inpatient services for the whole county
of Gloucestershire. The hospital has 4 acute
admission wards, a nurse led psychiatric intensive
care unit (PICU) and a Low Secure Unit.
Why Star Wards?
Through NHS service re-design, in late 2006
inpatient services in Gloucestershire were subject
to signifcant change resulting in all inpatient
services being provided from one site, Wotton
Lawn. As the process of change was already
underway, it was an ideal time to introduce a
framework by which to improve the patient
experience. Star Wards was deemed to be a
practical, cost effective, achievable initiative which
would draw together all the disciplines working
within the hospital to strive to achieve a common
goal high quality treatment outcomes.
Making it happen.
Star Wards Champions.
Given the theory that enthusiasm is contagious,
several people of differing professions, including
activity co-ordinators, occupational therapists,
nurses, ward managers and the modern matron
took on the role of Star Wards Champion.
This ensured that a core group within the
hospital were responsible for promoting and
developing new ideas to ft with the Star Wards
suggestions and had the pleasure of presenting
at the momentum meeting and various events
throughout the trust to promote the good things
coming from the Star Wards project.
Rate yourselves.
Once Star Wards had been taken on in the
hospital, Alan, the modern matron, devised a way
of rating what was already offered in the hospital
and subsequently what areas needed to be
worked on to achieve all the relevant suggestions.
This proved to be a really positive exercise
highlighting how much good practice already
existed within the hospital. On commencing the
Star Wards project, 38% of the suggestions had
already been achieved, 21% partially achieved and
41% were yet to be addressed.
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have access to a wide range of activities 7 days a
week. This activity program may vary hugely from
week to week dependant upon the interests and
needs of the patients.
Activity on a Psychiatric Intensive
Care Unit,
Inge Jones Activity co-ordinator Greyfriars PICU:
On a PICU patients dont stay for long so
fnding what interests they have early on is vital
to expect any participation. The weekly activity
timetable is written on a big white board and
changes weekly, refecting what is happening on
the ward and in the hospital.
On a Saturday, the ward has a Karaoke night
with an oldies theme. One night none of the
patients wished to participate but regardless,
a member of staff began to sing, (she was
no Whitney Houston!) A neighbouring wards
patients heard this rendition and came across
to have a go. Singing and dancing flled the
hospital and although the PICU patients didnt
actively take part they were sitting in the
corridors, swinging their legs and humming
along. So, the motto to all is please start the
activity even if no one is interested, activity tends
to be contagious!
Full Day Therapy Program.
A team of occupational therapists, sports
therapists and physiotherapists provide
therapeutic interventions 7 days a week
(including evenings) providing patients with
opportunities to engage in activities outside of
traditional hours. This has increased access to
therapy for many patients who struggle with early
parts of the day and ensured that therapeutic
intervention continues to support the recovery
process more than just Monday to Friday.
Having a larger therapy team and working
to cover increased hours has allowed the
development of new and innovative intervention
sessions.
Therapeutic Trampolining
Providing patients with the opportunity to learn
a new sport, taught by staff with a qualifcation in
trampolining and experience physical and sensory
benefts.
Explore Leisure
An education-based session enabling patients to
understand the benefts of leisure in maintaining
mental wellbeing and explore new leisure
pursuits for the future.
Work Matters
A practical and education based session enabling
people to validate and explore their experiences
and aspirations for work roles.
Total Well-Being
The session allows patients to engage in a
programme of activities and education to increase
positive self-worth and explore ways to maintain
physical health and ensure Total Wellbeing.
Music is Therapeutic:
In addition to Star Wards suggestions, the
provision of music has been taken on in the
hospital with signifcant benefts. Thanks to a
Department of Health research project, every
2 weeks musicians have been entertaining the
hospital with very positive outcomes. Therapeutic
Drumming has also been established and proves
very popular with our younger population.
Individual Psychotherapy
A psychology service is now available, offering
both individual and group psychotherapy.
Recovery Groups
Enabling people to share personal experiences of
recovering from mental illness and to hear how
others have coped.
Emotional Skills and Mindfulness
Enables people to fnd ways of managing intense
feelings in a safe and supportive environment.
Cognitive Behaviour Therapy
Enables people to work as a group to understand
the links between thoughts, feelings and actions.
Benefts of Star Wards at Wotton
Lawn.
As well as all the innovative new activities and
changes to the environment directly benefting
patients, Star Wards has provided several benefts
for the staff group. Since taking on the project,
there has been a signifcant increase in multi-
professional working, a greater understanding
of the impact of the hospital environment and
activity on the process of recovery and of great
importance is the increase in staff morale.
Rebecca Shute
Senior Occupational Therapist
rebecca.shute@glos.nhs.uk
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The Acute Care Collaborative
The 5 Boroughs Partnership
implement it. The collaborative approach is about
a continual process rather than a project with
a beginning and an end. It is about sharing your
problems and seeking solutions and innovations
for maximum spread and reach.
We hold regular events and meetings where all
three Trusts in the Collaborative meet to discuss
and share progress. Local Trust Collaborative
days are also held, when attendees learn about
the concept of a collaborative and how to use
PDSAs (Plan, Do, Study, Act). PDSAs are a
template to assist in the planning, monitoring
and evaluation of the progress of small service
improvement ideas. Completed PDSAs can then
be shared both internally and externally of the
organisation and are now available to download
from the Trust intranet website as a library of
improvements for sharing ideas and experiences.
Benefts for staff
It empowers staff at all levels
Teams can try out new ideas and take
positive risks
Project leads get training in use of service
improvement tools
It focuses on an often neglected part of the
service
Staff have the opportunity to learn new skills
Staff are part of something special!
As the Collaborative has progressed, many
important issues have been raised, such as
how we meaningfully include service users and
carers and if the project should be extended
to include community teams. This has resulted
in, for example, service users and carers now
being invited to the events to involve them in the
protected planning time with the Borough teams
as well as seeking their perspective, suggestions
and participation in the ongoing work.
It was agreed that we should try and develop a
Knowledge Community on the CSIP website.
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The 5 Boroughs Partnership are the Host
Trust for the Acute Care Collaborative; an
initiative, organised and funded by CSIP (Care
Services Improvement Partnership). Three Trusts
participate in the Collaborative, the other two
being Cheshire and Wirral Partnership and
Pennine Care.
This approach has been successfully used
nationally to make positive changes in health
services (cancer, orthopaedics and mental health
and older persons mental health). A ffteen-
month mental health collaborative run by the
Northern Centre for Mental Health achieved
signifcant improvements; more recently the CSIP
London Development Centre Collaborative
helped deliver small, realistic changes in practice,
which enhanced the experience of service users
and staff in acute mental health inpatient services
in London.
These improvements included protected
engagement time, dual diagnosis training and an
improvement in the provision of activities. The
Collaborative worked because of the positive
attitude of the project leads, and other staff, and
their willingness to devote time and energy to
collaborative work.
The Acute Care Collaborative project here in the
North West has been just as successful and has
worked within its scope: trying out small changes
to improve services for people who use them.
What is a collaborative?
Takes the service user perspective
Evidence based
Focused on action
Takes bottom-up approach
Challenges local systems and accepted
practice
Incorporates measurable achievements
Tries out improvements rather than having
to deliver prescribed targets
Why collaborate?
As long as service improvements are being
carried out there is no such thing as failure. It is
a way of trying out ideas and if they dont work,
modifying it and looking at how you tried to
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Some examples of completed and
ongoing improvement work:
Increased capacity/less occupancy on
inpatient wards
Decreased length of stay on inpatient
wards
Increased therapeutic time
Revised shift system to suit ward activity
Increased focus, assessment and
awareness of physical health needs and
well-being for service users
Psychosis education for colleges and
schools (PECS) website and interactive
CD ROM agreed, funded and planned
for 2008
8 service users and carers are now fully
trained to carry out serious untoward
incident reviews with staff and make
recommendations for inclusion in action
plans
Two service users now deliver training to
staff on good customer care
Universal Trust leafets now designed
with specifc information in relation to
what minimum expectations service
users should have on admission to an
inpatient unit
Stronger, more robust inpatient care
pathways
Cheshire and Wirral have been successful
in achieving AIMS Accreditation for
Acute Inpatient Mental Health Services
HONOS (Health of the Nation
Outcome scales) have been rolled
out across all inpatient units and went
electronic for comparison of scores
across services from January.
This is just a small selection of the work and much
more has resulted as a direct outcome of the
ACC work.
Joanne McDonnell
Joanne.Mcdonnell@5bp.nhs.uk

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Talking Therapy Group
Sussex Partnership Trust Acute Admission Wards
cherished, etc.) But we try to avoid clichd
interpretations or fowery therapist language. We
usually progress beyond discussion at this level, as
members of the group collectively fnd their feet
within the session. We are often amazed at how
the group quickly achieves a sense of safety. This
allows profound discussion to develop around
issues such as why people attempt suicide and
how they feel about having survived.
Providing basic boundaries, and working gently to
ensure a narrative connection is made between as
many participants as possible, creates a surprisingly
powerful forum. Relatively strong leadership
can be required for the session to open up into
meaningful territory. If the group facilitators
demonstrate through active encouragement and
supportive listening that they themselves can cope
with the pain of someones story (e.g. a tearful
recounting of an overdose taken the weekend
before), then genuine engagement can follow.
Naturally, facilitators must be constantly aware
of the level of risk represented by patients in the
group. A strong lead in managing the ending of the
session is crucial, perhaps with a little summary in
which the strengths of the group are highlighted
and participants are thanked.
Comments from participants include this is
somewhere I have really felt able to talk, I have
been really listened to, and its so helpful to
have a safe place to bring up personal issues.
Sometimes patients ask to leave part way through
because they are not following the discussion or
the content is not helping their symptoms, but
such occurrences are so common, and accepted
in the acute setting that it is much less disruptive
than in other contexts. We have not yet had a
specifcally negative comment about the group,
nor any hostility between patients that has not
been able to be worked with in some way.
A group like this can be very healing. It can also
encourage peer support, provide a context
for learning about others reactions to ones
behaviour, and help foster an attitude of open
communication and acceptance on the unit.
Tom Smiley Vijay Kaleechurn
Clinical psychologist Ward manager
Tom.Smiley@sussexpartnership.nhs.uk
The simple human activity of talking, and listening
to one another can be remarkably therapeutic.
Anyone can do it; you dont need to be well; and
the outcome can be such that someone who is
feeling lost and fragile can be made to feel more
valued and empowered.
We have run a weekly 45 minute talking therapy
group for about a year now and it has been a
real success. Once-a-week talking therapy groups
have not historically been thought of as a very
proftable idea the ideal being a daily meeting
to ensure continuity of participants and content.
But a number of weekly groups are springing up
in Acute Care settings across the country, and the
feedback from them has been largely positive.
The style of our group is undergirded by principles
of Group Analysis and Irvin Yaloms tried and
tested approach to inpatient group psychotherapy.
In practice it looks more like a drop-in group
for a diverse mixture of people to come and
talk about whatever is on their mind. There are
often considerable differences in the diagnoses
and struggles of participants, and interruptions
as patients are called away for review meetings.
Once, we started with one participant, quickly
went up to six, fnished with four, and still
managed to have a very meaningful meeting. It
may not ft the models in the textbooks, but with
limited resources and a high patient turnover we
had to be creative. It seems to be working.
The group is open to any patient from the two
admission wards who wants to talk in a group
setting about what currently concerns them.
Named nurses often encourage their patients
to participate (although sometimes a decision is
taken that someone would not be suitable). The
group is facilitated by a clinical psychologist and
one of the ward managers, and we are training up
two enthusiastic staff nurses to become facilitators.
We provide ground rules and boundaries and
guide the discussion when necessary, but we try
not to overly infuence the content. We tolerate
short periods of silence when appropriate,
while careful not to allow silences to become
uncomfortable and counter-productive.
Themes that emerge are wide-ranging to say the
least. Ward cleanliness and quality of food are
regular starter topics (perhaps hinting at deeper,
unspoken, feelings of not feeling nourished,
When I met Patrick Cullen Lead Nurse and also manager of inpatient services in the North Directorate of
Birmingham and Solihull Mental Trust he was dressed in rather sombre, formal Victorian clothes. It isnt that he
has terrible clothes sense, or that his gear refects an alarmingly outdated approach to managing services on the
contrary, it was Christmas and hed kindly invited me to Highcrofts Christmas Victorian Extravaganza. The energy,
creativity, inclusivity and sheer fun exemplifed the fabulous work of Star Wards members. Ill remember forever the
ward choirs, variously dressed as reindeers, snowmen and Victorian parlour maids!
Star Wards 2 is full of examples of best practice that most wards could replicate fairly easily. But there are some
issues, like ward rounds, which feel, and indeed are, encased in hierarchy, entrenched procedures and tricky inter-
professional dynamics. (Not to mention hospital or Trust politics!) So it was exciting to learn from Patrick about how
his service has accomplished what could be daunting or seemingly impossible changes to beneft patients and staff.
From: Cullen Patrick [Patrick.Cullen@bsmht.nhs.uk]
Hi Marion
I would be happy to write a piece about the acute wards I manage for your publication. In particular
Protected environments not just at mealtimes or short periods for therapeutic engagement but all the time!!
Our redesign of the inpatient workforce to improve quality and experience some of the roles including
Our Medicines Management Team of registered nurses and the fantastic work they have done to engage
and educate
Our Admissions and Discharges Liaison staff
Our Practice Development Nurse
Our Inpatient Administrator
Entertainment staff (to provide fun and recreational activity which also allows OT to focus on specialist
aspects of their work)
How we have implemented appointments system for reviews, and how these have been shaped by ongoing
service user evaluation
How we have taken all non-direct care work off our ward staff to allow maximum clinical capacity to be with
the service users
Family friendly visiting designated kids time to coincide with school runs
All of this underpinned by an excellent building design gender specifc wards with a central admin block for
meetings and reviews two wards, one service.
Zoning approach to shift management, which ensures meaningful interaction and activities
There is enormous amount of evidence and positive feedback from service users to demonstrate the
effectiveness of what we do so please let me know if this would be of interest.
Regards
Patrick Cullen

From: Marion Janner [mailto:Marion@brightplace.org.uk]

Hi Patrick
Yes, yes yes!! Thank you so much. These examples of excellence, imagination and, frankly, courage, are exactly what
wed love to showcase. Please can I ask a few questions? (And add a few comments!)
Are protected environments the same as protected time? Are there particular ward areas which are protected?
What impact has it made to the patients experience with medication having a Medicines Management Team? It
would also be fascinating to know what effect its had on staff satisfaction and performance even things like
sickness and retention rates.
Entertainment staff! Wow!! I havent come across this in acute wards. What is their role? What sorts of backgrounds
do they have? How have other staff (including consultants!) responded to the concept? Taking all non-direct care
tasks from ward staff is so impressive! Was it hard to introduce and implement? And how have you managed it?
Were there any surprises with the process? It must totally transform a ward. Fitting in with school runs is a fantastic
idea a great example of thinking not just outside the box but outside the hospital. Im not familiar with zoning
shift management. What does it entail?
Thanks again
Marion
Dear Patrick...
Birmingham and Solihull
Mental Health Trust
Star WardS
10+
From: Cullen Patrick [Patrick.Cullen@bsmht.nhs.uk]
To: Marion Janner
Thank you for your wonderful response Marion. I will get writing straight away!!!
The living areas of each of the wards - the male and the female - that is to say the lounges, the
dining areas and the bedroom areas are classed by us as totally protected and the only staff
allowed are nursing and occupational therapy (i.e people who all of the service users would
know.)
All visits from all professionals take place in a central corridor which has rooms available for this.
The visiting rooms are also immediately off the reception so visitors do not need to go onto the
day areas of the ward.
The Medicines Management has proved hugely engaging for our service users - one example
being that it means that staff are no longer rushing to get meds done in a half hour after
mealtimes - and we have found that we are now administering meds at times when people would
take it in their everyday lives.
The Entertainment staff came out of service user feedback - they told us that therapy was fne
but they wanted to have a bit of fun too - so we created a new role - which required no mental
health training or background - and went for a Redcoat style approach. She not only provides fun
activities but also organises things like our open days for our local community to come in (the last
one had a theme of 1950s Holiday Camp and raised nearly over 800 as well as informing the
local community.)She also organises our parties and service user birthdays.
In terms of taking non-direct care off the ward staff, we didnt fnd it diffcult as it was our vision
from the start. The only tricky thing has been getting those ward staff to realise that everything
we are doing is to allow them more time with the customers and that that is the single most
important role on the unit (and not the new roles and ways of working.) Interestingly, we are also
getting a little bit of kick back from some community colleagues who I think are a little jealous
and dont feel comfortable that the downtrodden inpatient service is leading the way on some of
these things when they are supposed to be the sexy, glamorous services.
Thanks again for your interest
Patrick
From: Marion Janner [mailto:Marion@brightplace.org.uk]
Hi Patrick
THANKS!! This is exactly the detail I need to really understand, appreciate and be able to
share what a brilliant staffng and management structure youve created in order to provide
an excellent service to patients. This is so so much what Star Wards is about. Discovering
excellence in acute care, letting it be widely known that there absolutely IS excellence in acute
care (countering the myth that its all crap) and sharing the details so that other wards can be
informed and inspired by it.
All the best
Marion
From: Cullen Patrick [Patrick.Cullen@bsmht.nhs.uk]
Dear Marion
Like you we are passionate about inpatient care. To explain - when I frst took over as Service Manager, I walked
onto the wards and watched what was happening a bit more objectively than I had when I was a ward manager
myself. In a nutshell, I witnessed well-meaning staff trying to:
Deal with often challenging situations
Deal with usual customer queries
Manage an incessantly ringing telephone and requests from elsewhere
Trying to give meaningful time to the customers
Deal with relatives queries
Manage the environment
Organise mealtimes/drinks
Deal with students
Deal with medical staff and other visiting professionals
Deal with new admissions / discharges
Provide activities
And all the other 101 things that staff are traditionally called upon to do. Like so many areas, the staff were
working hard but not achieving that much in any of the areas and getting frazzled in the process. The frst thing
we did was to use the design of the building - which I have mentioned before - and decided that only nursing
and OT staff would be on the living areas. This reduced the 'traffc' and made the environment feel less frenetic.
We then have all calls to the ward managed by our central receptionist, rather than immediately going through
to the ward, which dramatically curtailed the phone ringing and 'could you just do this or that' type of enquiries
which disrupt plans for the day.
We have created an Inpatient Administrator role - which does all the paperwork, data inputting, organising
reports, dealing with complaints, preparing rotas, annual leave and liaison with our partner organisations re:
environmental issues. This has enabled us to have one Manager for the two wards - to promote consistency and
fexibility. This gives our manager a lot of clinical capacity to be on the ward supporting and being highly visible.
All reviews are managed by our Admissions and Discharges Liaison Nurse - who organises the info, educates
the service user, distributes the agreed plan and debriefs the service user (this includes some evaluation of their
experience at their review). We have just created an assistant role to the ADLN - who carries out planned
escorts (having been trained in assessment and support for escorts) She will take people to sort their money
out, to check their property, to prepare for discharge anything the customer requires really.
Our Matron manages the Ward Housekeeper who attends to all the hospitality issues - and our aim is hotel
standard welcome. We have a Practice Development Nurse who organises the learning environment and deals
with students on placement and the needs of our more junior staff. And the three Medicines Management
Nurses organise all of the issues relating to storage and administration.
Our Entertainment Offcer provides fun and recreational activities on our dedicated activity centre and this
allows the OTs to focus on more specialist intervention.
On the ward itself, the shift lead allocates service users to a designated nurse for the shift - and a minimum
standard of one meaningful 1:1 per day. Without having to worry about all the things they would have to in the
traditional model, they have huge amounts of time to spend with the customers with very little interruption.
In essence therefore I think we have created a management team for the service - all of whom have a
requirement to monitor quality and service user satisfaction. All have or are producing operating procedure for
what they do, so that anyone can step into their shoes and follow the processes. It is quality driven.
It has led to a much more predictable service and ensures that the interventions and approaches don't stop if
one or two key people are away or dip if the clinical picture becomes challenging.
Regards
Patrick

You can see why I was excited, and why I love Star Wards members! From complex,
interdisciplinary transformation to tweaking arrangements so that they thoughtfully ft in with
carers and friends needs. And Patrick makes it sound like it wasnt a particularly big deal!
For more information contact: Patrick.Cullen@bsmht.nhs.uk
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Well, I couldnt think what else to call this bit. There are some useful addresses, a bit
about NAPICUU and space for your notes.
Useful Contacts ....................................................................... 108
National Association of
Psychiatric Intensive Care Units (NAPICU) ....................... 109
Notes and Ideas Pages ................................................. 110114
Thanks..................................................................................... 115
Section 5. Extra bits
Star WardS
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Accreditation for Acute Inpatient Mental Health
Services (AIMS)
Royal College of Psychiatrists Centre for Quality
Improvement
4th Floor, Standon House
21 Mansell St
London E1 8AA
020 7977 6694
AIMS@cru.rcpsych.ac.uk
http://tinyurl.com/32nncg
Citizens Advice Bureaux
Myddelton House,
115-123 Pentonville Road,
London, N1 9LZ
020 7833 2181
www.citizensadvice.org.uk
Mind
1519 Broadway
London E15 4BQ
020 8519 2122
contact@mind.org.uk
www.mind.org.uk
Music in Hospitals
74 Queens Road
Hersham
Surrey KT12 5LW
01932 252809
info@music-in-hospitals.org.uk
www.music-in-hospitals.org.uk
Music Spaces
The Vivien Duffeld Centre
St Matthias Campus (UWE)
Oldbury Court Road
Fishponds
Bristol BS16 2JP
Tel. 0117 328 4541
national@musicspace.org
www.musicspace.org
Useful contacts
NAPICU
01355 244585
info@napicu.org.uk
www.napicu.org.uk
Pets as Therapy
3 Grange Farm Cottages
Wycombe Road
Saunderton
Princes Risborough
Bucks HP27 9NS
0870 977 0003
reception@petsastherapy.org
www.petsastherapy.org
Rethink
Rethink Head Offce
5th Floor
Royal London House
22-25 Finsbury Square
London
EC2A 1DX
Telephone: 0845 456 0455
info@rethink.org
www.rethink.org
Thrive
The Geoffrey Udall Centre
Beech Hill
Reading
Berkshire
RG7 2AT
0118 988 5688
www.thrive.org.uk
Visit the Virtual Ward website
The Virtual Ward is a place to share good practice
between staff and people who use mental health
services. The site is designed for all to access
information about positive and innovative practice,
to read supporting policy and to utilise the
examples of training underpinning those examples.
www.virtualward.org.uk
Star WardS
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What do we do?
The National Association of Psychiatric Intensive
Care Units (NAPICU) has a ten year history
of achievements in developing and improving
the care and treatment for those who require
psychiatric intensive care / low secure care (PICUs
/ LSUs). The organisation is run by a team of
clinical practitioners from varying disciplines.
NAPICU achievements include:
Providing evidence to the DOH on the
quality of the estate of PICUs/LSUs that
identifed need for capital investment. This
supported the Departments decision to
invest signifcantly in capital projects.
Thus the environments have got better!
NAPICU was instrumental in development
of the policy implementation guidance for
PICUs / LSUs that was published in 2002.
Thus the standard of care has got better!
In collaboration with the Royal College
of Psychiatrys Centre for Quality
Improvement, NAPICU has launched a PICU
/ LSU advisory service (PICAS) that aids
organisations and unit teams with service
delivery and improvement.
Thus improvements have got better!
Successfully running a Practice Governance
Network that has led to improvements in
patient care in a number of participating
units.
Thus sharing of best practice has got better!
The Journal of Psychiatric Intensive Care
was launched in 2005 and is NAPICUs
offcial journal. It is the only peer-reviewed
publication dedicated to the subject of
Psychiatric Intensive / Low Secure care.
Thus our knowledge has got better!
The award winning textbook, Psychiatric
Intensive Care was edited by Executive
Members of NAPICU and a second edition
will be published in 2008.
Thus we can all have a shiny new book!
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Benefts of membership include:
Subscription to the Psychiatric Intensive
Care Journal
Monthly electronic newsletters that provide
information on the latest developments and
forthcoming events that are of interest to
PICU / LSU services.
Free access for staff to attend quarterly
educational meetings.
Discounted rates to attend NAPICUs annual
educational conference. Both the quarterly
meetings and annual conference provide
useful education and debate as well as
sharing of good practice.
Discounted rates for staff to participate in
a (soon to be) on-line course that is run
in conjunction with Kingston University
(starting September 2008)
Access to the Associations web site which
includes a discussion forum and a members
area for sharing documents, policy and
educational information.
Ability to apply for the Team of the Year
which raises the profle the unit and the
services that it provides.
Future developments for NAPICU
include:
Development and implementation of an
National Accreditation Scheme for PICU/
LSU
Update the National Minimum Standards in
line with current policy framework.
CPD specifcally aimed at medical staff
Special interest groups for other professional
and service users (eg OTs Matrons and
Managers)
Development of a proposed board to supply
information and knowledge to patients and
carers and promote discussion.
For further information, please visit our website:
www.napicu.org.uk or contact Elaine on 01355
244585 / info@napicu.org.uk
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National Association of Psychiatric
Intensive Care Units (NAPICU)
Promoting recovery through intensive care
Notes and Ideas
Notes and Ideas
Notes and Ideas
Notes and Ideas
Star WardS
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Notes and Ideas
Notes and Ideas
Notes and Ideas
Notes and Ideas
Star WardS
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Notes and Ideas
Notes and Ideas
Notes and Ideas
Notes and Ideas
Star WardS
112
Notes and Ideas
Notes and Ideas
Notes and Ideas
Notes and Ideas
Star WardS
113
Notes and Ideas
Star WardS
11+
Thanks for your support...
Top dogs:
Star Wards 2 contributors
NIMHE/CSIP for funding Star Wards 2
Superstars
Anthony Bateman
Ian Hulatt
Malcolm Rae
Ian Trodden
Funders:
Allen Metherall and team at Wotton Lawn
Hospital
Allen Lane Foundation
Comic Relief
Department of Health
Department of Health Section 64
Esme Fairbairn Foundation

Goldsmiths Charity
John Ellerman Foundation
LankellyChase Foundation
London Development Centre
NIMHE/CSIP
And lots of thanks to:
Louis Appleby
Sylvia Barry
Lisa Bersabel
Rory Bolton
Louise Helsdown
Yvonne Stoddart
Bright trustees
Advance Tuso
Sarah Wilson

Star Wards 2 was brought to

you by the Star Wards Team
Sarah Cable
Jude Hackett
Marion Janner
Alan Simpson
Nick Page
All the team would like to
thank each other. Wed also like
to thank our agents, masseurs,
personal trainers, stylists,
chaffeurs and helicopter pilots.
But we havent got any yet.
Talking of which, although you
might count fve names above,
the fact is that Star Wards is
delivered on the equivalent of
two full-time posts. So if you
want to consider supporting
us in any way (well, fnancially,
if were honest although
chocolate is always welcome)
then please get in touch. And
you, too, could appear on the
inside back cover of Star Wards
3. Above the dog.
Star Wards 2 was designed by
Nick Page. Thanks to everyone
for the use of their photos and
artwork.

Another Bright idea

Bright
16 Springfeld Avenue
London N10 3SU
07932 696083
marion.janner@brightplace.org.uk
www.brightplace.org.uk
Star Wards website:
www.starwards.org.uk