Challenges to specification in mental health

By Jo Makosinski 28-Sep-2016

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The design and construction of mental health service facilities present particular challenges - and some facilities are a long way from ideal.

Quickly adapted, or pressed into service from a totally-different purpose, they contribute little to the therapeutic environment. More worryingly, they can even be dangerous for those at risk of self-harm. Between these two extremes are the examples that try, but miss, the mark.

Sadly, some thought or foresight is often all that is needed to make significant improvements – improvements that could save money, reduce staff workloads and improve patient safety.

A lack of understanding

When there is a lack of understanding, a simple error can have life-threatening consequences, or can leave a facility dangerous or impractical for staff and service users. It is important to recognise that this lack of understanding can occur at any stage – from the outset where a construction project is discussed, to the day-to-day operation when a facility is operational.

Estates managers are often under extreme pressure, facing both tough spending constraints and diverse workloads, so short-term solutions are often put in place and economies made, all for good reasons, but in the longer term these decisions can result in wasted money and wasted opportunities.

Imagine the situation where a trust decides to consolidate provision of inpatient care for dementia sufferers onto one site. Locks, door and window handles are chosen specially for those with reduced manual dexterity. However, it is later decided to move patients to a different building.

Before the site is even opened, it is not fit for purpose and has to be adapted, with the cost now coming out of the estates department’s budget and not capital costs.

Without the luxury of unlimited budgets, and in an adaptive healthcare system, it is important to make spending decisions that will cope with such changes in use.

Flexible systems

Although there are Department of Health guidelines on the standards of high, medium and low-secure mental health units; there remains a considerable difference between how trusts provide these facilities.

In truth, though, patients don’t fit into neat high, medium and low boxes. Their conditions change over time, sometimes day to day or hour to hour.

What is needed, therefore, is not a rigid system, but an adaptable one – a system that can be altered to suit an individual.

Of course, it also has to offer all the safety and security that is necessary. This is no place for a bodge job or ‘make do and mend’ approach. Rather, it is a place for smart ideas.

The old adage about spoiling the ship for a ha'porth of tar contains a lot of truth. Huge amounts of time are invested in new-build projects or major refurbishments, so things ought to be perfect. But sometimes the smallest parts of the project, if incorrectly managed, can have serious consequences.

If hardware, for example, is incorrectly installed it can compromise patient safety and if a tragedy occurs within the NHS, systems, procedures, and infrastructure come under intense scrutiny.

If hardware is incorrectly installed it can compromise patient safety

If hardware is incorrectly installed it can compromise patient safety

Safe and secure

Patient environments must be safe and must eliminate the risk of self harm, and products must be specified to ensure they are fit for purpose, not just because they are the cheapest.

Previously, the function of a building was the only thing that mattered, leading to environments that were institutionalised and custodial. Now the NHS demands an environment to be homely in appearance without compromising safety and security.

Following on from Professor Louis Appleby’s report addressing anti-ligature measures, hardware was adapted so that handles sloped downwards. Now there are dedicated products proven to resist the attachment of ligatures - things that were unheard of only a relatively short time ago.

The Disability Discrimination Act and the later Equality Act have also changed the specification process.

And there is a drive for style and colour and more user input in the design and specification of a good therapeutic environment. As a result, projects have slowed and become more considered, and that shows positive results.

The process of specification is changing, but not everyone is up to speed.

The necessary measures to prevent problems could be implemented on every single project without major complications. It just takes a little more thought, education and understanding.

Challenges to specification in mental health