Unit With the Young at Heart Teens With Mental Health Problems

By Helen Puttick

Spending six months in hospital would be a daunting prospect for anyone. It is hard to imagine how vulnerable teenagers must feel when they arrive with their hold-all at Gartnavel General’s adolescent mental health ward.

Converted from an adult unit 20 years ago, staff repeatedly use the same four understated words to describe the facility: "It is not ideal."

Yet the ward has been crucial in the context of inadequate provision for child and adolescent mental health across Scotland. Its 16 beds at one stage made up more than half of the available service nationwide.

Research indicates that an increasing number of young people suffer from mental health problems – a Scottish Executive commissioned report in 2003 revealed that 10-per cent of young people in Scotland – 125,000 – at any one time have problems substantial enough to interfere with their day-today lives. It was in that context that the Royal College of Psychiatrists described the shortage of in-patient beds for children as a national disgrace.

Now, however, NHS Greater Glasgow has designed a new centre from scratch, purpose-built for teenagers whose conditions vary but include such problems as anorexia and psychosis.

With an undulating glass facade, and a full-sized badminton court, the planned unit presages a new era in the treatment of adolescent mental health.

Yet it will manage this while also accommodating more patients. The number of beds for 12 to 18-year-olds with mental health disorders in the west of Scotland is to increase from 16 to 24 under the plans.

Mary Hattie, adolescent mental health services manager with NHS Greater Glasgow, says: "Sixteen beds is not a lot. The [current] unit does run at capacity. The expansion in community mental health services for young people has led to an increase in the identification of people with difficulties. There is always a small number who need more intensive work."

These teenagers can face a queue for a hospital bed, and even the prospect of being admitted to an adult ward, if they need urgent care.

The new "unit" will in fact be a mini campus of three buildings on the site of Stobhill Hospital, Glasgow, much less of an "institution" than the current arrangement and more like the outside world.

Dr Michael Smith, consultant psychiatrist in Argyll and Clyde – one of the six health board areas served by the Gartnavel beds, says: "It has been recognised for a long time that there are insufficient in-patient beds for young people in the west of Scotland, and it does mean that some young people are admitted to general adult wards."

Under the current design, which is expected to go before Glasgow City Council’s planning committee next month, the 24 beds will be divided between three interconnecting houses. All rooms are single and en suite. Hattie says: "Each unit has its own lounge and a supported dining facility for them, and the nursing team will be organised around the eight-bedded unit, so it just feels a bit more homely. They [the patients] will get to know the staff better."

Teenagers who have experienced the existing service cite another advantage. One 16-year-old girl, who has been admitted to a number of different hospitals, told The Herald Society: "I like the fact that it is split into three separate units. This will allow people who are recovering to be separate from more-unwell people."

It also gives staff the opportunity to group together those who can support each other, and distance those who mix less well.

In addition, the health board has decided to separate the living space from the other sections of the hospital. Treatment is delivered in a distinct building, so at the end of a difficult therapy session the patients can walk out the door and leave some of the stress behind them. There is also a separate block for a small on-site school with its own sport facilities, and to reach it the teenagers will have to cross a landscaped courtyard.

This is a different world from the current set-up where there are classrooms leading off from the dining room. Asked to describe it, Hattie uses that phrase again: "It is less than ideal." She continues: "It is all part of the ward. It still feels like a hospital."

At the moment the 16 bedrooms available have shared bathroom facilities. Clinical consultations take place in a nearby Portakabin- style temporary building. Visits are on an ad hoc basis according to staff, with no specific visiting area or overnight accommodation. Space for overnight visitors will be part of the new building.

Charlie McMillan, director of policy for the Scottish Association for Mental Health, welcomes the fresh approach. He describes the physical environment in which much mental health care currently takes place as very worrying, and says: "A pleasant environment is going to help recovery."

At the moment teenagers who are well enough use community sports facilities, but the plans for Stobhill should provide more opportunities for all patients to exercise. McMillan notes that hospital stays are often sedentary and this can compound depression. "There is increasing research to suggest that physical exercise also benefits mental health, " he adds.

Campbell and Arnott, a Scottish architecture firm that has specialised in mental health facilities for 15 years, is behind the plans for the site. Director Arnie Dunn describes NHS Greater Glasgow as an encouraging client. "It is a bit more architectural than a lot of other public sector buildings, " he says of the planned facility.

Natural light was apparently important to the teenagers consulted on the design. Glass panels, installed at an angle to each other, form the front of the school and the intention is to use stained glass on some sections. Natural lightwill fall into the main school corridor and thought has gone into giving the other buildings in the project an airy feel. Dunn says: "We will be putting in larger windows than you would expect in buildings with a degree of security about them. He also points to the shape of the treatment block, with a roof that overhangs the entrance, as another attractive feature.

"It is so much better than what it was 10 or 15 years ago, "he says. "You really had to work very hard to make something domestic in feel which had to be a 30-bedded ward with two bedrooms and bathrooms."

Perhaps surprisingly, Dunn also says having three separate buildings has some advantages for the public purse. Land would have had to be flattened to throw up one large block, he explains, and this is an expensive process. Three separate buildings can be constructed on different levels.

The total budget for the project is GBP7.6m, but it is an investment that Julie Metcalfe, clinical director of adolescent mental health services for NHS Greater Glasgow, believes will make a difference to patient recovery.

Assuming that planning permission is granted, the aim is to start building in early August and complete the project by early December 2007. While such delay is perhaps inevitable, it does mean the improvements will come too late for some teenagers.

The 16-year-old interviewed via e-mail by The Herald Society signs off with the cheerful words: "It sounds great, but I won’t have to be there. I’m going to be discharged soon."