‘I’d Rather Die Than Go Back to Hospital’: Why We Need a Non-medical Crisis House in Every Town

Anne Cooke
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Drayton Park women’s crisis house in North London offers an alternative to hospital admission for women experiencing mental health crises. It was Shirley McNicholas’ vision that brought it into existence and she has been leading the service since it opened.  As it approaches its twentieth anniversary in December, she talks to Anne Cooke.

It was exciting going back to my old stamping ground.  Years ago I’d worked in one of the local community mental health teams and had referred many women to the Drayton Park Crisis House.  Walking up the steps of the house to meet Shirley brought back memories of standing there with desperate and suicidal clients, some of whom had told me that they would rather die than go back into hospital.  As you can imagine, to say I had been glad that there was an alternative would have been an understatement.

The house is a large Victorian villa which looks much like its neighbours in a typical North London street.  Shirley showed me round.   The house was as I remembered it: furnished in a homely, ‘Ikea’ type style, with a lovely, airy living and dining space at the back overlooking the garden.  Each resident has her own en-suite room, with a key, and there are cosy rooms for individual conversations and even massage. Residents’ children are also welcome.  If I have a mental health crisis, take me there or somewhere like it.  Unfortunately that’s unlikely to be possible – despite their overwhelming popularity there are still only a handful of crisis houses in the UK.  I was keen to find out from Shirley how and why Drayton Park happened, and what has sustained it for twenty years.  So on to my first question.

Anne: How and why did Drayton Park come into being?

Shirley: In 1994 I became co-ordinator of Camden and Islington NHS Trust’s project – instigated after extensive lobbying by local women – to create a crisis house as an alternative to hospital admission.   The steering group shared a basic philosophy:  a holistic, psychosocial approach to mental health, drawing on social constructionist and feminist ideas, on work highlighting the links between trauma and mental health, and on the service user/survivor movement.    I was also personally influenced by systemic theory, having studied it at the Tavistock Institute.   We wanted to create something new that would be robust enough to provide an alternative to hospital for women in acute crisis, but with a very different philosophy and therapeutic approach.  Women were telling us that such a service was desperately needed.  For my part, having trained as a psychiatric nurse and worked as a ward manager for many years, I was determined to create something very different to what I had experienced working in hospital.

Anne: Different in what way?

Shirley: The illness model – the idea that psychological problems arise primarily from problems in the brain and so need medical treatment – still dominates most of our thinking within services and is enshrined in law in the shape of the Mental Health Act.   By contrast, social constructionists emphasise the power of ideas and language to shape our experience of the world (Gergen, 1985).  This is nowhere more relevant than in the field of mental health, where diagnoses powerfully determine how people are treated, both within services and also in the wider world.   It is not that diagnoses can’t be helpful, but they have immense power, leading us to view someone’s problems in a certain way and often to overlook other ways of understanding what might be going on.  For example, they can distract our attention from ways in which the person’s problems might be related to their prior experience of the world.  By contrast, a systemic way of thinking sees each person within the context not only of their family and their immediate social setting but also their social roles as, say, a woman or someone from a devalued group. It recognises that different people have different ‘stories’ about a particular situation or problem.  None of these have a unique claim to truth, including those advocated by the ‘experts,’ but all impact powerfully on decisions about what might help.

Anne: So what does that mean in practice for how you do things at Drayton Park? 

Shirley: One example might be the referral process.  Professionals can refer in the usual way, but women, their families and friends can also self-refer.  This obviously gives women more control, but it also makes an important statement about power and ownership.  Over the years we’ve often had to resist pressure to limit or stop self-referrals, and go back to the old system where clinicians decide. People worry that the service might be abused or overwhelmed, that women who are not in acute crisis might get in. I think it’s interesting those questions are not raised when it’s clinicians who refer.  We’ve fought hard to stick to the principle of ‘no decision about me, without me.’

Anne: What about mothers who are in crisis but have young children?

Shirley:   Drayton Park is relatively unique in that children can stay here with their mothers.  This can be a challenge, of course, but many mothers have the main or sole responsibility for their children,  and even when they really need help they will often wait until they are sectioned rather than leave their children.

Anne: You are a women-only team.  Tell me about that?

Shirley: Interestingly in 1994 this was not questioned and nor was the makeup of the team: the Trust and the local authority were open to trying a new way.   We created a team based not on professional qualifications but on skills, experience and attitude.  Compiling job descriptions was exciting: our ‘person specifications’ included an expectation that staff had an understanding of the relevant political debates, for example.  Within boundaries, women are expected to draw on their own life experiences in their work. Staff come from a wide range of backgrounds including the voluntary sector and social care settings as well as psychology graduates.

Anne: So you were quite different to most services.  How did people react?

Shirley:  Really well, mostly.  The service was hugely popular both with the women who used it and with local colleagues from all professions. We knew we were getting it right when audits showed that whilst the demographics and reasons for admission were similar to the inpatient wards, the feedback was much more positive.  Women who stay here are choosing to do so, so the basis of the relationship was often different.  Nevertheless, there is no doubt that the experience was very different too. Women told us that they appreciated the authenticity of the team, and that they particularly valued our willingness to hear and bear traumatic accounts, and to work jointly with women to contain suicidal feelings and self-harming behaviours.

Anne: You mention self-harm, which is often something services struggle to know how best to respond to.  What is Drayton Park’s policy?

Shirley: This was something we gave a lot of thought to.  We had learnt from specialist services, but we were also learning from each woman who came to stay. Women were often skilled in using alternatives to self-harming, and keen to participate groups and to try to understand why they harmed themselves.  We agreed a policy that included staff keeping clean blades that women could use when nothing else was working. Although this seems dramatic and risky, it had a paradoxical effect, as the women knew it would:  the knowledge that they could come for a blade meant that self-harming behaviour reduced. Women were also learning to trust others with their injuries.  Our non-judgmental approach enabled many women to show their scars and wounds to someone else for the first time.  We also had to work with women who harmed internally, inserting blades inside themselves. Again, although it felt counter-intuitive to those staff more used to working in settings which intervene by force if necessary to keep someone safe, we found a way of working that didn’t involve taking control away from the woman.  We worked with each woman to be as safe as she could be, trusting her judgement but also being aware of our limits and being honest about this. It has been a very rare occasion where working with someone in this way has not been possible.

Anne: Tell me more about your risk management policy?

Shirley: Our policy has to be consistent with the Trust-wide one, but the basis is collaboration and psychological ‘containment’. It was a woman staying who first used those words, and I immediately recognised that this was a very useful way of describing how risk is held within the service.  Rather than the ‘observations’ made in hospitals, we make contacts.  The team follow a structured 24-hour timetable: at particular intervals each worker finds and connects with each woman she is allocated.  We know that the woman is safe, and the woman knows that she is held in mind. The feedback about this has been very moving.  People really appreciate not being left alone for hours in a bedroom, and knowing someone will come and find them.  However withdrawn, irritable, or unwilling you are, your worker will come and find you. Each worker on every day shift offers a one-to-one session to each woman she is looking after, so everyone gets regular private time to talk.

Anne: What are the talking sessions used for? 

Shirley:  Often they are used to address practical issues or simply for support and reassurance.   However, sometimes we listen and bear witness as women describe past and present traumas that are that are overwhelming and painful. We know that the majority of the women who use our service – and indeed other acute mental health services – have experienced trauma. It still amazes me how little attention is paid to this. In the two to three weeks that women generally stay with us, we offer counselling, grounding techniques, mindfulness, and help people develop coping strategies. We are also supported by a massage therapist whose input is highly valued by the women.

Anne: Do you think the physical surroundings are important?

Shirley: They are hugely important.  We were fortunate enough to be offered a large Victorian house to house the service. This allows for a homely atmosphere with space for art and information.  We’ve tried to create a space that is comfortable for a diverse range of women, and people certainly tell us that they find it a comforting and soothing environment. Our policy, which is on the notice board in every bedroom, is that staff will knock three times before using a key. This small practice has huge ramifications. It symbolises respect and privacy but also communicates recognition of the trauma that so many women have experienced, often in bedrooms. The simple act of giving people time to open the door powerfully communicates symbolically that ‘you are in control here’.  The spirit of the Drayton Park model is reflected and perpetuated in the details.

* * * * *

References:

Gergen, K. (1985) The Social Constructionist Movement in Modern Psychology. American Psychologist, 40, 3, pp 266 – 275

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21 COMMENTS

  1. Hi,

    I think its more or less recognised now in the UK, that the system will have to change.

    The last time I was in hospital, 30 + years ago, I left with an extreme diagnosis and a poor expected outcome. After that I got better through not taking my medication (slowly), (and moving to psychology).

    http://www.bbc.co.uk/news/uk-politics-34613957

    I believe the UK ‘Mental Health Crisis’ has been caused by the Psychiatric System itself, and more ”Psychiatry” is not the solution.

  2. Again, I must contribute, that a necessary, vital element in healing and recovery, is Justice – specifically, Restorative Justice. https://en.wikipedia.org/wiki/Restorative_justice

    Humanity is degraded so terribly that we have normalized and made socially acceptable the commonality of abuse. The lie of “mental illness” has allowed some people to not have to be responsible and accountable to do the work it takes to restore ourselves to rightness. The victim becomes the scapegoat – the identified patient – and under the banner of mental illness, offenders have been absolved of responsibility. The result is that, in the worst of it, we waste our lives in treatment, only to step outside those doors of privacy, back into a disharmonious and suffering society.

    I also would rather die than go back to any hospital, medical or mental, that endangers me, rather than genuinely care for me, understand me, and treat me right.

  3. Nice to see a place still operating where people are thinking straight about how to compassionately approach severe life problems.

    It’s ridiculous on the face of it that mental “hospitals” are even called that, since the problems that bring people there are primarily an accumulation of life and relationship stresses, rather than medical issues.

    The mental hospital system is like a giant network of voracious weeds that sucks the life and money out of the undernourished flowers (people) that enter them. The “treatment” is being labeled with a lifelong hopeless disease (e.g. schizophrenia) and then being given drugs which more often than not cause cognitive impairment. How does that help the flower grow?

    When I went to mental hospital many years ago I said the exact same thing to myself, that I’d sooner shoot myself than return to the grim cauldron of hopelessness, dehumanization, power inequity, awkwardness, and deadness that is a mental hospital. Thank goodness I got better and achieved my goal of avoiding a return to that nightmare.

  4. I hear this regularly from young adults traumatized by our *state of the art* psychiatric treatment model– and again, I wonder, how the majority of MH professionals continue to serve up this recipe for *lifelong dependency on the MH system”– . Hey, maybe I just answered my own question?

    In a civilized society, where professionals are highly educated, one should reasonably expect leaders to emerge and direct their profession towards *better outcomes*. Yet, here we have professionals who will complain about what *society* has not provided for the group of people they “have to” lock up and drug.– In order to keep their jobs and potentially help *some* of the poor unfortunate people who get caught in the TMAP net. Right.

    So much for the *experts* with the degrees, credentials and lifestyles they will not compromise to perform the job they will have until *society* becomes educated …

    Regardless of the evidence that first line treatment for first episode psychosis is traumatic — at best, it remains carved in stone. So the promises made by prominent academic psychiatrists to J&J, GSK, etc. are fulfilled… a long winding conveyor belt to lifelong consumers of drugs and psych treatment is the best our MH professionals can do.

    • Katie

      I think that one of the big assumptions is that psychiatrists are well and broadly educated. In fact, their education is very narrow, lacking any background in the Humanities, the Arts, Philosophy, History, you name it. They get a very narrow education based on science. This is pretty much the case with all medical professions. And where psychiatry is concerned, they don’t even learn how to do any kind of talk therapy. If they do learn how to do therapy they have to do it on their own and it’s the very rare individual that does this these days.

      They understand nothing about symbolic language that flows out of mythology and things like fairy tales. They are sorely lacking in the knowledge of interpretations of ideas. Most of them can’t fight their way out of a wet paper bag when it comes to philosophical discussions and debates. And one of the greatest things that they seem to lack is the ability to put themselves into the shoes of the people that they are supposedly “treating”. Most lack empathy on a grand scale and too many are arrogant beyond belief. On the whole the so-called “experts” know very little about most everything, except how to drug people to the gills in order to make them compliant and quiet and docile. They are pretty good at keeping track of their money and property and investments though.

      • I completely agree, Stephen, the psychiatrists “understand nothing about symbolic language that flows out of mythology and things like fairy tales. They are sorely lacking in the knowledge of interpretations of ideas. Most of them can’t fight their way out of a wet paper bag when it comes to philosophical discussions and debates. And one of the greatest things that they seem to lack is the ability to put themselves into the shoes of the people that they are supposedly ‘treating.’ Most lack empathy on a grand scale and too many are arrogant beyond belief. On the whole the so-called ‘experts’ know very little about most everything, except how to drug people to the gills in order to make them compliant and quiet and docile.”

        So true, and the psychiatrists know next to nothing about religion, too. My psychiatrist’s medical records state he believed an analogy about betrayal of Jesus by Judas Iscariot, was an analogy related to Judas Priest. My psychiatrist’s medical records indicate he also thinks ‘interior design’ is the same thing as “graphic design.” He thought ‘Chappaqua, NY’ was “Chipawa, NY.” He thinks Miami University is a “fictional” university. He called “driving to Chicago,” to get a haircut by a hairstylist I’d been going to for 15 years, a “sign of mania.” He also claimed regular moderate exercise to be a “sign of mania.” He thought a dream query was “psychosis.” He believes “voices of God talk through her to other people.” I could go on and on, he was completely delusional.

        In the end, after some decent nurses had handed over his medical records, with all his odd delusions written in them, and I read it. I confronted this psychiatrist regarding all his delusions. His terrified response, he claimed my entire life was a “credible fictional story.” Then had his receptionists try to get me to sign a sheet full of stickers that stated “I declare this is true” on them. What a sick loon!

        My experience with the psychiatric industry has proven to me that the psychiatrists are among the dumbest, most delusional, disingenuous, disrespectful, insane, and ignorant of all humans. But they do know how to defame people with scientifically invalid and unreliable “mental illnesses,” then create the symptoms of their “mental illnesses” with their drug cocktails for profit. But this type behavior is nothing more than gas lighting people. And all people should know gas lighting people is mental abuse, not medical care, thus inappropriate human behavior.

      • All true, Stephen, but as I am sure you realize, psychiatrists are well supported by a myriad of MH professionals. In fact, they could hardly keep this farce running on their own. How many social workers/therapists are sustaining the psychiatry industry- just as it is? Takes a big village to keep a good scam rolling…

        On the other hand, we should be asking why so many *better educated* MH professionals aren’t pushing back, refusing to engage in unethical and illegal practices at the behest of psychiatry? Why aren’t the *alternatives* coming directly from the *insiders* professional critics? —

        Psychiatry cannot exist without its groupies– Psychiatrists spend the least amount of time with patients and those who have the most influential leadership positions often have the least experience practicing psychiatry, seeing actual patients. Insiders know this– and yet they keep on following these frauds.

        Remember the story, “The Little Red Hen” ? She kept asking for help with the work of planting, cultivating and harvesting and thrashing wheat. All of the other farm animals were just too busy, or too lazy to help, but they showed up when they smelled bread baking. Well, she did not break her bread with them, did she?

        Some of us realize that the horrifically abusive MH system is hurting and destroying actual people, many of them children. Some of us are fully aware of every fallacy this system is based on and though we can engage in rigorous debate with proponents of this system, it is us, not *them* who are pressed for the *alternatives* to fraud and harm for profit MH care! This is outrageous.

        And then there are some critics who are proposing the role they can play when the system has been dismantled, or at least drastically changed. By whom? Not them.

        It is refreshing to read about the human endeavors that a group of like minded professionals can pull off– just because, they saw a NEED for an alternative to psychiatric treatment. Well, also because their work ethic is solidly grounded in the work required. Anne Cooke has shared what is possible— here and now.

        Still waiting to read comments from the MH professionals who regularly write blogs and comment on this site– wonder what stops them from organizing alternatives to the subpar system and practices they claim to be *stuck in*…

      • Humanities aside – most doctors and that included (first and foremost) psychiatrists are not very well educated in …biology. It seems counter-intuitive to a lot of people but the biological education in medical school is very narrow and little attention is paid to making students understand even such basic concepts as theory of evolution.

        I’ve had first-hand experience as part of my studies was done at the medical university where my faculty shared some of the courses with medicine. They were very good at some things (like anatomy) but lacked in other respects and even well-prepared biological courses were treated as “unimportant”. Later on I had to work in a collaborative environment between doctors and life scientists and such issues were showing – things that were obvious for us (like that using drugs cocktails to treat cancer or HIV should work better long-term to prevent drug resistance) were coming as a surprise and hard to understand concepts for doctors. So I’m not very surprised when members of this profession show sometimes stunning ignorance even on issues they should be educated about and psychiatrists are probably the worst offenders.

    • “”I’d Rather Die Than Go Back to Hospital’: Why We Need a Non-medical Crisis House in Every Town,” I agree. Sounds like yours is a wonderful program, much better than the US mainstream medical industry’s way of dealing with, no doubt, a common problem. Adverse reactions to their drugs, especially the antidepressants, which 25% of American women are on today.

      Since this is what is recommended to treat the common symptoms of antidepressant discontinuation syndrome, or antidepressant induced mania, which the US DSM5 now claims should be diagnosed as “bipolar.”

      According to the Mayo Clinic, these are the drug combinations recommended for this completely iatrogenic “bipolar” diagnosis today:

      “Medications may include:

      “Mood stabilizers. Whether you have bipolar I or II disorder, you’ll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).

      “Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic medication such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.

      “Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it’s usually prescribed along with a mood stabilizer or antipsychotic.

      “Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the Food and Drug Administration specifically for the treatment of depressive episodes associated with bipolar I disorder.

      “Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep. Benzodiazepines are generally used for relieving anxiety only on a short-term basis.”

      I’m quite certain this is medical advise meant to harm patients for profit, especially given the medical fact that combining these drug classes is known to cause anticholinergic intoxication syndrome, a syndrome whose central symptoms are almost identical to that of the positive symptoms of “schizophrenia.”

      “Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may have additive effects when used in combination. Excessive parasympatholytic effects may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

      “Substances that may cause [anticholinergic] toxidrome include the four “anti”s of antihistamines, antipsychotics, antidepressants, and antiparkinsonian drugs[3] as well as atropine, benztropine, datura, and scopolamine.” Exactly the drug classes recommended to “cure” “bipolar” by the well respected hospital’s today.

      What is being recommended as the proper treatment for antidepressant induced “bipolar” today will result in an illness that looks like the theorized “schizophrenia” to the doctors, but is actually the medically known, completely iatrogenic illness of anticholinergic toxidrome / anticholinergic intoxication syndrome.

      I’m quite certain weaning people off these drugs or patience within a caring environment, in other words, non-medical approaches to dealing with the common symptoms of antidepressant discontinuation syndrome or antidepressant induced mania would be much better than what the most prestigious US hospitals are recommending as appropriate treatment today. Especially given the reality, “In most cases symptoms [of antidepressant discontinuation syndrome] are mild, short-lived, and resolve without treatment.”

      “So much for the *experts* with the degrees, credentials and lifestyles they will not compromise to perform the job they will have until *society* becomes educated …” The “first line treatment” for “psychosis” (belief you’re suffering from adverse effects from one of the many psychiatric “wonder drugs” / “safe smoking cessation meds” / dangerous mind altering antidepressants) today can actually cause “psychosis” via today’s hospitals’ anticholinergic intoxication syndrome “cure.”

      Monopolization of treatment options, a form of absolute power, results in absolute corruption. I hope the US will catch up to the UK in funding alternatives to the now completely corrupted psychiatric ruled “mental health industry.” An industry which is actually creating the serious “mental illnesses” in their patients, with their drugs, for profit. Psychiatry has always been, and still is, complete medical fraud. But now we all have the medical proof.

      What a shame that a percentage of our population seemingly has odd delusions that if you chose to study a subject other than medicine in college, you did so because you’re incapable of researching medicine. Thus, you deserve to be made sick via this “dirty little secret of the two original educated professions.” Thankfully these delusions of grandeur filled psychiatrists are wrong, and we may all research medicine for free online now, and point out this deplorable medical / psychiatric “dirty little secret.”

      Non-medical solutions to aid people, especially women and children, suffering from distress are absolutely needed. Since only fools would believe distress is caused by a “chemical imbalance” in one’s brain, rather than real life concerns.

  5. Most suicides after hospital…

    http://www.google.com/search?q=most+suicides+after+hospital

    You are suicidal but don’t worry we are going to get you “help”.

    Help – Lockup, strip search, dehumanization, no smoking (nicotine withdrawal hell added) , drug coercion using threats (needle assaults and the state hospital) and forced drugging.

    ‘I’d Rather Die Than Go Back to Hospital’ , the cemetery is full of people that said that.

    Meanwhile if you click on the search you see the industry has 1001 excuses to explain why people who fall into suicidal despair after getting “help” instead of the obvious truth that “help” was the nightmare that drove them over the edge.

  6. Has anyone heard of this in Australia – home of the so-called `enlightened’ programs for schizophrenia? I keep hearing these stories but never the `enlightened’ ones. When I try to find somewhere to send people, there are no `enlightened’ programs on offer. The government has cut funding to psychologists to 10 sessions a year, but you can go to a psychiatrist as many times as you like, and the government pays. No wonder they are such a powerful lobby that they can get legislation changed to suit themselves and their pockets.