The average patient and length of stay within a rehabilitation and recovery (R&R) setting at a Priory Healthcare unit can vary enormously. But Vicky Sykes, director of clinical services at Priory Dewsbury hospital, says her team’s focus is on helping people move back into the community, however long it takes. “From the minute somebody arrives, we’re planning their discharge,” she says. It’s a turning point for many that she feels privileged to see. “The goals people have aren’t massive aspirations, they’re things most people take for granted – having a job, having a family, having a home.”
The Priory’s R&R team specialises in severe and enduring mental ill health, dementia, neuro-disability (brain injury or brain damage), and neurodevelopmental delays including autism and learning disability. Many patients will have a range of needs and presentations, will be moving into R&R from another service (such as secure provision or an acute mental health ward), and will typically be referred by the NHS. For those for whom full recovery is not an option – such as in the case of dementia – there are community homes and supported living schemes.
“Recovery is an ongoing, lifelong process,” says Dr Steve Ramplin, the consultant forensic psychiatrist at a male high-dependency ward at the Priory Middleton St George hospital in Durham. Patients here will typically have a personality disorder or severe mental illness and will have been in psychiatric care for some time. But by working as part of a well-resourced team – there’s also a full-time psychologist and occupational therapist on the ward, plus an experienced nursing team – Ramplin says he’s seen many patients “make that full journey” to recovery.
He spent five years in the NHS and admits to having some anxiety about moving across to the independent sector a year ago. “But it’s been, without exception, a positive move for me. I feel like I’ve got much more clinical autonomy in my new role – we can be innovative and that’s supported within the hospital. There seems to be less bureaucratic interference than I experienced in the NHS.”
As well as engaging in one-to-one therapy, patients on Ramplin’s ward are encouraged to challenge themselves by preparing a meal for other residents once a week, volunteering at a local dog shelter, and participating in roundtable meetings with staff to provide feedback on their care. “It shows we take their concerns seriously and we’re listening to them,” he adds. “And it breaks down some of the barriers that can exist between staff and patients.”
In Birmingham, occupational therapist (OT) Hannah Paton works at the Priory Woodbourne hospital, in the psychiatric intensive care unit (PICU). As an OT in this setting, she has to be ready to adapt at a moment’s notice. “So if someone has been a very keen gardener but doesn’t have leave to go out to a garden centre, we’ll take pots on to the ward and do it that way,” she says. “Things might not go as planned, but that’s what makes the days enjoyable. It’s not static. It’s not routine. [Although] that in itself can be a challenge.”
Paton initially joined the Priory as part of the children and adolescent mental health services (CAMHS) but transferred to the PICU when the new unit opened. She had previously worked in forensic mental health and felt it complemented her experience. “There’s always the opportunity for people to see where their skills are best utilised on site,” she says about the move.
There are also ongoing opportunities for professional development. Paton is about to participate in sensory integration training to expand the service’s offering to patients with autism spectrum disorders.
In Nottingham, Tammazine Adcock, regional lead psychologist for the Priory East Midlands hospital, has just completed a course in cognitive analytic therapy (CAT) – a psychological therapy exploring past events to help understand present emotions, in order to problem-solve and formulate coping mechanisms – which is particularly useful when treating those with personality disorders. Adcock used to work in the prison service, but has found a real difference in the Priory’s approach to training and therapy.
“There’s more opportunity to be able to hone your skills specifically,” she says. “And from a psychologist’s point of view, we’ve got more scope to focus on the individual holistically with our treatment.”
She oversees a team of 12 psychologists who work across five sites, and more than 100 beds, a number of which are specifically for patients with learning disabilities. In these cases, the care is adapted so that patients can benefit as much as possible, such as using the “I can feel good” approach, for example, which is adapted from traditional dialectical behaviour therapy (a talking therapy based on self-acceptance and positive change). The aim is to help patients recognise their emotions, self-soothe, and reduce unwanted impulsive behaviours. Staff also use the RAID approach, which focuses on reinforcing appropriate behaviours and imploding destructive behaviours.
“It’s also about managing the jargon you might use, making accommodations around the length of session time to allow for concentration levels,” Adcock says about adapting therapy for these patients. “It may be that we go down a very practical, skills-based approach, as opposed to more concept-driven approaches. We can also incorporate more mindfulness or sensory activities – such as blowing bubbles.”
The biggest challenge, she adds, is having a team with the right mix of skills for the patients’ needs. That’s partly why she opted to do CAT training, to coincide with the opening of a new PICU and unit for women with personality disorders.
Sykes agrees that finding the right staff is the main priority. She has a very particular type of nurse that she looks for in R&R. “A really good nurse for me is more about attitude than skill … nurses that are positive, motivated, forward thinking, and future focused,” she says. And although there are always be risks and challenges associated with supporting patients in R&R, it is about a proactive, flexible approach: “Rather than looking at what we can’t do, it’s about looking at what we can do,” she adds.
