The art of staying out

July 21, 2006

A mental health service user peer-support project in Dewsbury claims to have led to its members spending 89 per cent less time as hospital inpatients. How does it do it? Adam James finds out.

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In a farmer?s field in the Yorkshire Dales there is one caravan not used by holidaymakers but by people 50 miles away in Dewsbury who have severe mental health problems. The caravan is their refuge, a place to seek sanctuary.

While the £2,000 respite caravan is modest, it?s the only service of its kind in Britain, and exemplifies the inventiveness of a Dewsbury project which claims remarkable success in preventing ?revolving door patients? from being re-admitted to psychiatric hospital.

The Staying Out project, run by North Kirklees Mind, says it has led to an 89 per cent reduction in the average number of days its ?members? spend as hospital inpatients. It?s a statistic that impressed the National Institute of Mental Health in England which last year awarded Staying Out an award for ?promoting independence for people with severe and enduring mental health problems?. And last month Staying Out hosted its first conference, in Dewsbury, to disseminate its working model.

Set up in 1999, Staying Out runs three groups of eight members. The groups, which meet for two hours every week and are facilitated by one staff member, blend social informality with intensive self-help. Every member must sign a contract detailing what achievements they feel they must reach to help prevent hospital re-admission and, most importantly, committing them to attend every meeting, even if feeling mentally unwell. A big ask for vulnerable people, perhaps. But, group facilitator Peter Brown emphasises: ?The groups are for those people who are ready to make that commitment to [support each other] stay out of hospital. If someone does not attend it?s up to the group to decide what to do. It might be a matter of ringing them or writing them a letter.? Moreover, while Staying Out takes referrals from agencies, group members themselves decide whether or not to accept new members.

In January a Mental Health Act Commission report stated that more than half of psychiatric inpatient wards were understaffed with unpleasant, untherapeutic, environments. No surprise, then, that patients are keen to avoid admittance. Indeed, ?staying out? is a mantra for the three groups, simply called the Monday, Tuesday and Wednesday groups, reflecting the days on which they run. And,with the oldest group having run for seven years, each has drawn up its own rules to achieve this goal.

One group, for example, has published a booklet specifying what each member asks from other members should they feel suicidal, have urges to self harm or are acutely paranoid or deluded. This could be anything from a daily supportive visit or telephone call from another member, to ringing a social worker or GP, to just sitting with them quietly listening. And, as group members have long histories of psychiatric admissions, crises are frequent. Supporting members through such periods can be taxing, but the groups take this role on. Importantly, no-one has any duty to contact healthcare authorities when a fellow member is in crisis. ?We do not have statutory responsibility. We are working to a model of self-responsibility,? says Brown. Such is the commitment to providing a genuine alternative to hospital that members all share each others telephone numbers. Many clinicians would shudder at such a thing.

But the group sessions are not all gruelling. ?We might get a run of eight or ten weeks when it is really hard and intensive,? says project manager Cheryl Cook. ?But after that it might be more about the group doing something social ? going out for a movie or a meal.?

Each group also has a £2,000 pot of ?creative resourcing? funds. If a member believes an activity ? from driving lessons, hair-dresser training or private psychotherapy ? will help them stay out of hospital and improve their quality of life, then they have to persuade other members this is the case. This was how the idea of a respite caravan originated.

No independent research has been carried out on Staying Out. But its own research completed in 2003 is eye-catching. The year before joining Staying Out, 17 members spent a total of 604 days as inpatients; the year after joining it dropped by 89 per cent to 57 days. Staying Out boasts that it provides its service at £2 per member per day (equivalent to £730 per year), while just one overnight stay at Dewsbury District Hospital?s psychiatric unit is £325, says Staying Out. The project puts its success down to non-judgmental and committed social support. ?Their power lies in the fact that that the groups are simply about witnessing,? is how Brown puts it. ?The most powerful thing is to be there and sit with it [people?s distress] without turning away or necessarily trying to make it better.?

Mother-of-two Samantha Drain, who has been diagnosed with schizophrenia, first joined a Staying Out group in 1999. While she has been re-admitted twice since (in 2002 and 2003) she is adamant the group has prevented not only further admissions but also stemmed strong suicidal impulses. ?The support and listening from people who have the same illness makes so much difference,? she says. ?It?s kept me out of hospital. It?s kept me alive.?

Staying Out: .

* A shortened version of this article appeared at guardian.co.uk

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