Camden and Islington NHS Foundation Trust Drayton Park Women's Crisis House and Resource Centre

1. Camden and Islington NHS Foundation TrustDrayton Park Women's Crisis House and Resource Centre Established 1995

2. 32 Drayton Park N5 1PB • Artist Tanya Raabe – collaboration between artist, Islington Disability Arts Forum, and Drayton Park

3. ‘founders of alternatives to hospital for women. • Drayton Park is an alternative to hospital admission for women in mental health crisis. • The service was created by women service users and a group of dedicated professionals who were committed to developing a gender sensitive service for women. • It was inspired and supported nationally by government recommendations and work such as the ‘stress on Women’ campaign (National Mind) 1994 and it became a beacon service in 1999 as part of the the NHS learning network.

4. Management Advisory Group • This group consisted of women who have used services and women who work in mental health organisations within Camden and Islington. They guided the service in its first few years, maintaining an alternative focus and supported the project in its development. • 1n 1999 this became a Drayton Park Women’s User Forum and then in 2000 became a Trust Wide Women’s Strategy Group. The group supports and develops increased sensitivity and service delivery towards women in single sex and mixed sex services. In 2008 the manager of the service became the Trust wide Women’s Lead. • The trust and this service was involved in the initial stages of the National Women’s Strategy which was launched in 2001 and the project was cited as ‘ a positive practise example of a service. in the Implementation Guidance in 2003. • Nationally there was a drive for single sex services and alternatives for women.

5. How does the service function • Drayton Park is staffed by a women only team who come from a variety of backgrounds and work experiences. The roles are not traditional nursing or social work. Team members are recruited for the right experience , attitude and understanding of the stress and context of women’s lives and how this impacts on their mental health. • The service is based on a Systemic Model. This is included in how referrals are taken, assessments are facilitated and how the team understand the context of the women’s lives and the social and political climate the service operates within. In this model , language and how it is used in imperative , framing and understanding what is happening for the women with the widest possible lenses.

6. Environment • 12 bedrooms with bathrooms ensuite • Two sitting rooms • Healing room – massage takes place and offers a safe quiet space for women to use to meet spiritual needs • Crèche • Art space • One to one space • Large garden – access to fresh air and light 24 hrs a day • Knocking door policy • Signing in and out board • Bedroom and lift to support women with physical disabilities

7. Access • Referrals are made 24hrs a day and can be made by anyone. Crucially in a model of service to empower women, self referral option has been maintained for the fifteen years of service. ‘valuable/empowering to have this facility and builds further on the trusting relationship that DP and women have in the mutual trust of the work/treatment-relationships’ • Source of referrals. (self, crt, gp, inpatient ,voluntary sector) • Relationship with CRT’s.

8. Assessment • Women attend the project for assessment and meet with two staff members to explore the crisis , what previous experiences may be impacting now and crucially what is the current risk. • Staff have to remember the key function is to provide an alternative to hospital for women who would otherwise be admitted

9. Trauma and Abuse • The service promotes itself as having a specialist function in the way it works with trauma in the context of crisis. • Led for the Trust on the pilot programme ‘DOH Violence and Abuse Programme’ • Domestic violence. Manager of the service is MARAC lead for the Trust and the service works closely with DV colleagues.

10. Outcome of clinical audit 2009 Camden and Islington • Of the 210 assessments audited, 28% included the question (59) • 31% were asked the question (65) • 76% of those asked disclosed abuse (50) • In addition a further 10.9% (22), of case notes showed evidence of abuse. • As Drayton Park was in the pilot , and one of the leads manages this service, it is expected that the question being asked is a high ratio. • The audit clearly shows that were the question is in documentation the question is asked more frequently. • The data was taken from reports compiled by Andrew Greenhill , Natalie Rodriquez and Jason Chan, supervised by Shirley McNicholas. • Drayton Park are currently working on a proposal to collate the data collected and use this to evidence the link between trauma and mental health problems.

11. Children • A unique function of the service is providing residential care for a women and her children. • The service can have four children stay at any one time , ranging from six months to 12 yrs for boys and 15 for girls. • In any given year approximately twenty children stay. The service works closely with Children and Families whether a child comes to stay or not to ensure their emotional needs are being assessed as well as any other needs. • Offering a place to children is also challenging and demonstrating that women with mental health problems, even in crisis , can with support, take care of their children . Women with children make self referrals and access the service when they detect early signs of crisis and therefore recover more quickly and maintain their parenting.

12. Staff • Certain roles in the team have lead areas. The manager and one deputy leads on trauma relating to child hood experiences and current trauma. They support teams members to offer interventions that are useful to women with traumatic pasts, who are in crisis. • One deputy manager specialises in perinatal mental health and is similarly able to guide the team in issues relating to pregnancy and early parenting. • Many of the team are trained and skilled in grounding techniques, mindfulness, CBT . They understand and are able to support women who dissociate or have similar anxiety states. These techniques are also very useful for those suffering with psychosis , helping to distract from voices etc. • One senior member of staff leads the Black Women’s Forum and helps to hold our attention to the needs of BME women • One senior member of staff leads on the needs of LGBT women . Women have fed back that they had the space to ‘come out’ and get further support.

13. Self Harm • Due to the high level of self injury that the service encountered, we worked alongside a group of women who self injure and created the ‘ Drayton Park Self Harm Policy’ • This ensures we work respectfully with women who self injure , introduce alternatives and raise awareness of triggers etc. the service also provides clean self harm packs if this is required. The service provides training to the trust and other local services in positive ways to work with self injury.

14. Stay at the service • If women take up a place, they are offered one to one sessions twice daily and will have two works closely assigned to them to coordinate their stay. An agreement plan will be completed at the beginning of the stay which will detail what the issues are and what support can be offered. This is usually done mutually and empowers women to recognise their own abilities and maintain control and responsibility , raising awareness of their problems and transparency about what staff should and can offer. • Women are offered a week initially and this can be extended up to four weeks. • Part of the work is assertive liaison with all those involved in the women's care and thinking creatively about what else might help her to move forward and return home. • The service has a weekly group which women can attend once they leave and two massage therapists offer three session of body work a week. This is very positively received and these therapists are experienced in working in mental health and often are re introducing touch to those who are afraid of touch due to abusive experiences.

15. Snapshot • May 2011 • 12 women staying • Ethnic breakdown • Somalia, African , Asian, Danish, Scottish, Turkish, 5 white British and Bangladesh. • 10 women had previous hospital admissions with 3 women transferred from acute wards. All three were on section prior to transfer here. • Mental health issues included • Eight women with primary diagnosis of psychotic illness. All on CPA. One under EIS. Seven women have care coordinators. • Four women with dual diagnosis. • Trauma issues relevant to crisis included FGM, sexual abuse histories contributing to current flashbacks, termination of pregnancy, recent sexual assault. • Two women were admitted via A&E having taken substantial overdoses. • None of these women had young children but three had adult children in their lives. • All twelve women were taking medication.

16. Resource Centre • Drayton Park is open 24hrs a day and so a telephone help line is available all the time. This may be ex residents calling for support or new callers trying to access help for themselves or someone else. • The team are also contacted on a daily basis for support , advice or consultation about issues related to women. this is most often about trauma issues. • The weekly support group is open ended and provides an ongoing contact for women. many women feel attached to the service and this allows contact in a boundaries and useful way. • One day a week a counsellor is available and takes referrals from the staff within Drayton park of current residents. Women can be seen for up to 12 – 16 weeks. This is usually held for women who have not had any form of counselling before and how may have disclosed abusive histories for the first time. • Black women's Forum. This is a mostly forum facilities by one of the senior staff which offers black women a place to come and be involved in improving access to services for black women , to gain support and to learn about new issues from speakers invited. This forum is supported by the trust wide women's forum network, which was created and supported bit eh Trust wide women's strategy group and women's lead. • The service has open events on international women's day, black history month , annual anniversary and has also hosted days to celebrate Gay, lesbian and Transgender.

17. Research and Evaluation • There are very few women’s crisis houses but they have been included in wider studies as well as those mentioned below. • Sonia Johnson, C.bingham, j.billings, S. Pilling, N.morant, p.Bebbington, S. McNicholas and J. Dalton (2004)Women’s Experiences of Admission to a Crisis House and to Acute Hospital Wards; qualitative Study. Journal of Mental health 13.247-262 • Drayton Park, an Alternative to Admission for Women in Mental Health Crisis. Helen Killaspy, joy Dalton, Shirley McNicholas. Psychiatric Bulletin 20 . 101- 104 • Women and Psychiatric Treatment. A comprehensive Text and Practical Guide. Edited by Claire Henderson, Catherine Smith , shubulade smith and Angela Stevens. Routledge 2006. Drayton Park , a residential crisis project for Women (chapter by shirley McNicholas pages 54-63)

18. Effectiveness and cost effectiveness of admission to women crisis houses compared with traditional psychiatric wards: pilot patient-preference randomised controlled trial. • ‘results suggest that when services are able to provide interventions preferred by patients, those patients are more likely to be satisfied with treatment. The pilot study provides some evidence than women's crisis houses are as effective as traditional psychiatric wards and may be more cost effective. • L.howard, C.Flach, M. Leese, S.byford, H,Killaspy, L.cole, j.Betts , J. sharac, P.cutting, S. Mcnicholas and S. Johnson • The British Journal of Psychiatry 2010 197 s32- s40

19. Study • ‘Clinical factors , including history of service contacts, number of hospital admission , diagnosis and a low level of employment were not associated with admission to either a crisis house or a ward, which suggests that WCH are admitting patients with complex and sever mental health problems. This study therefore suggests that WCH’s are a viable alternative to psychiatric wards for women who need admission to a psychiatric facility but who do no need intensive observation or detoxification and are not violent.’ • Psychiatric Services’ ps.psychiatryonline.org December 2008 Volume 59 NO 12

20. Study • ‘Little is known about the effectiveness of women’s crisis houses but this study found few clinical or sociodemographic differences between women admitted voluntarily to traditional psychiatric facilities and women admitted to women’s crisis houses. The findings suggest the WCH are a viable alternative to traditional psychiatric hospitals for women with severe mental illness who did not require intensive observation or supervision’ • Admission to women’s Crisis House or Psychiatric Wards; Women’s Pathways to Admission. • Louise m. Howard; PHD, M.R.C. Psych. Elena Rigon, M.D; Laura Cole, BSc, M.S.c. Caroline Lawler, B.Sc, M.Sc. Sonia Johnson, PH.D, M.R.C Psych

21. Contact • Shirley McNicholas 0207 607 2777 • Email shirley.mcnicholas@candi.nhs.uk • Camden and Islington NHS Foundation Trust.