Breaking Ice in The Zone

For some reason, our journey to Plymouth took on the qualities of an epic journey to the wild west for the three of us - and it felt a very long way away, as if to an alien land (even stranger than south London, see 18 January). So we all prepared for the major trek in different ways, to make sure we would be bright eyed and bushy-tailed for a 10am start on Union Street - just off the main drag (called 'Armada Way') between the station and the Hoe. Maybe it was unconscious thoughts of Sir Francis Drake and his rather more impressive journey to Plymouth that so elevated it in our minds.

Without giving away trade secrets (or our names), one of our number exhibited excessive safety behaviour; one made good for an altercation with a railwayman about a missed train (and excess fare) in Cambridge last week, and the other was frankly exhibiting reckless behaviour worthy of a formal risk assessment.

The safety behaviour was allowing many hours 'hanging around' time to be there almost a day before it was strictly necessary, and booking to stay in an unnecessarily dull and corporate hotel. However, it did mean that it was daylight for that spectacular part of the journey west of Exeter, between Dawlish Warren and Teignmouth - where the train seems to be flying along the beach, almost lapped by the waves amidst the dog-walkers, and periodically diving into holes in the bright red cliffs - for miles and miles. In fact the train arrived at Plymouth with so much time to spare that it required a brisk walk round the Hoe and the Barbican areas to stave off boredom. But the sight of bare-chested young men 'hanging out' on the Hoe, and the release of several dozen purple balloons at dusk, by young folk with mohican hair arrangements, soon prevented any likelihood of that. A good curry nearby, amidst all the monumental architecture of England's glorious naval heritage, also helped stave off torpor.

Possibly the most sensible preparation was by the one of our number who arrived in the evening and had arranged a place to stay in a friendly B&B. But this was in contrast to last week, where extraordinarily lucky train connections and arrival without missing much were later counterbalanced by the team's excessive need to talk - resulting in a missed advance-price-ticket train with a mean penalty. But at least things were better in Plymouth! It does mean that none of us has now escaped the new-found ferocity of the railways' Revenue Protection Officers. Once upon a time it would have looked quite unnecessarily transferring resources back from one bit of the national infrastructure (the NHS) to another (the railway) - but we now live in mean and lean times.

The final member of the team decided that it was the perfect opportunity to make use of the excellent facility provided by the Paddington to Penzance sleeper train - leave London after a day's work and an evening at home, then have a good rest and sleep to the gently rocking rhythm of an inter-city train. What was not taken into the initial calculation was that the seats were not as conducive to shut-eye as the cabins, and that not everybody on such trains quite understands the word 'sleeper'. An exorbitantly tall man with a German accent talked a great deal, then decided to lie under the table to go to sleep. It was rather mystifying, and quite possibly sinister, to become half-aware that he had disappeared somewhere west of Taunton - how could his considerable frame have slipped under the seat? Or should Miss Marple be called? The other consideration of hazard was that a train scheduled to arrive in Penzance at 0759 actually arrives in Plymouth at 0513: and there is not a great deal of entertainment to be had at Plymouth station at 0513, nor in the town nearby. In the dark. And in the pouring rain. And just who might one meet then?

Nevertheless, we successfully met about half an hour before the appointed time, and found a cafe near The Zone to gather ourselves. It did have black tablecloths and a quite unique ambience - but the staff there were very friendly as well as interestingly attired, and we felt all the more energised by the Bohemian vibes.

The local youth are quite cool and casual about attending The Zone, we were told, because it's where everybody goes to get the free condoms. Even though we were all at least double the age of their clients, we were warmly welcomed - didn't feel our age at all - and were led through the warren of municpal corridors and staircases to the Icebreak offices where we started the work of the day. Thankfully, caffeine was offered rather than condoms, and it was much appreciated.

The photos chosen reflect some of the conversations - but also capture some words which were felt to summarise something important about the place.

The Manzil Way to Cowley Road in Oxford

This was the second visit of the day - Reading in the morning and Oxford in the afternoon. The road between the two was about an hour's struggle through all the pretty Thames-side villages with synchronised speed cameras, and the train was 25 minutes non-stop. A no-brainer, as they say. The only snag was the rather intimidating car park at Reading station where you have to purchase an unusual-looking token without which it is presumably impossible to escape (see Tuesday - 'controlled access'), by car at least (see earlier today - lots of lovely places to go by train).

But after that slight anxiety, the first thing we noticed was what an easy journey it was - ticket to platform to train to helpful refreshments trolley person - to taxi - to Oxford Complex Needs Service. Even time for a breath of fresh air before we went in, which we did exactly at the appointed time. The refreshments trolley person on the train was particularly impressive - after missing her whizzing past first time round, she said not to worry as she'd be back. When we were ten minutes away from Oxford station we had given up, and resigned ourselves to a couple more biscuits and a hungry afternoon - but no! Nine minutes before arrival, she was there again, all smiles and selling us a quite tasty looking sandwich and bean salad. Bean salads are a bit difficult to eat with your fingers, but thank goodness for M&S foodstores on station concourses - free forks!

Negotiating the door entry buzzer and rampant cheese plant foliage in the entrance was quite easy (I remember a colleague used to say that the best way to instantly assess the overall health of a psychiatric unit was to look at the plants), and we were offered coffee, and everything else we might need. The building was NHS, but free of most of the signs of over-institutionalisation - and we had the  first hour in an office and the second hour in a large comfy room with several sofas. I often think the presence of sofas says something important about the prevailing attitude in a workplace - but it's hard to say exactly what it is, except that when I recently heard of the exact opposite (meetings without any seats at all - to keep everybody sharp and focussed, and maybe awake), it seemed obvious where it would be nicer to work.

Oxford seems to be one of those places where odd coincidences happen - maybe some ley-lines cross there. When we were walking out for our debrief, one of us in the visiting team met a long-time colleague and friend who lives in Surrey and was on his way to work in Hereford via a synchronous visit to an adjacent building in this colourful and lively part of Oxford. Such weird coincidences must mean something...

For our debriefing, one of us was keen to introduce the others to the delights of the 'Excelsior Cafe' over the road - which is possibly the most authentic 1950s 'greasy spoon' experience available in England today. Sadly the staff at the unit got wind of this and started to describe it in most unfair terms, such as 'an inch layer of grease on top of your tea' - and the visitors chose a much more respectable coffee bar close by. But by now it was after 6pm, and at least they served beer!

The request for a photo was a bit more complicated than usual, as three different groups of service users who had never met each other came together - with two of them from far-flung corners of Oxfordshire. So each of the three groups has been invited to send us a photo of their own TC, showing what they would like to convey about it, with a few notes. They will be put here as soon as they arrive...

Where is the Gnome of Winterbourne?

Those who don't know the ancient Royal County of Berkshire's capital often find the traffic system and ability to park rather baffling. The trains are so much easier - and one of the DH team has been know to say that the best thing about Reading is the station, where one can so easily get trains to fascinating places like Penzance, Carmarthen and even Scotland - and so escape from Reading. A town which was once, and probably still is, renowned for shopping, clubbing and fighting.  But if only those trains had all the personal comforts that every car now has as part of the standard kit. When the carriages come fitted with integral bluetooth connectivity, acceleration for 60-80 before you get to the next station, and double-fleece lined airbags, then public transport will start to claim the upper hand. But, as they say, one reaps what one sows. And today that included a horribly early start for members of the visiting team, and an anxious time hoping that the two hour parking zone would extend to three, as the discussions were too involved to get away exactly on time.

Another cars-in-Reading story very directly affected those at Winterbourne recently: a thief stole a car from just up the road and drove it off in something of a hurry. Unfortunately, he (or maybe she - but less likely) had rather a struggle to get the steering lock off. So s/he did not manage to deviate from the Newtonian principle of 'everything carries on in a straight line at the same speed unless acted upon by a force'. Unfortunately, the force that eventually stopped this runaway vehicle was the very solid hundred-year-old eight foot brick wall surrounding the centre's small garden. And that is where the car ended up, stationary at last. After many months of protracted contractual and insurance processes, the wall - and the garden within - were rebuilt. Hence the photos below, which the service users chose to have as their photo of something they wanted to be recognised.

Winterbourne's garden after rebuilding the wall

Unfortunately, there was a stronger but unfulfilled wish to have a photo of the Gnome of Winterbourne.

But this could not be found in the garden, and although there were rumours it was somewhere in the house - these could not be confirmed by the visitors.

Could this be who we are looking for?

If any members of Winterbourne would like to put the record straight - we promise to add the photo below, if you send it to us (we left our email details).

The quality of the biscuits ('decent shortbread') and coffee (freshly brewed) was noted favourably - especially as one member of the visiting team, with two very small children at home, was in great need of heavy caffeine doses.

The building caused some confusion - and although not exactly 'squashed olive controlled access' (see Cambridge, from Tuesday), it did have other more subtle ways of preventing visitors from leaving. One was to lead them from room to room in an effort to disorientate them, then to have strange twisting corridors leading nowhere when they tried to get away. The other (please forgive the indelicacy) was the loos. One was found hidden down a scary wood-panelled narrow staircase into the bowels of the building - where one could have well met a ghoul, or vampire or ork on the way; the other was up a strange curly staircase to another dead end corridor - with an oddly large loo at the top of it. Perhaps it is no surprise that accessibility requirements are demanding that the service moves to less haunted, or strange, premises.

The Complex Case of Cambridgeshire

The sun shone as we converged like the winds, from southeast, north and southwest, although the north wind had a little trouble with a cancelled train at Leeds - though still managed to arrive less than ten minutes late.

Greeted with warmth and hospitality, as well as coffee and tea, we arrived a few miles outside Cambridge on the site of the old Ida Darwin learning disability hospital - which is now a collection of similar looking low-slung brick buildings housing all sorts of different parts of what constitutes a modern mental health service. The once proud and renowned Fulbourn, a major epicentre of the 'unlocking the wards' movement of social psychiatry in the 1950s and 1960s, is now the trust headquarters about a mile away. It was explained to us how the locked wards are now not locked, but are described as having 'controlled access'.

Interestingly, this controlled access comes at a price: staff have small electronic gadgets (black plastic - about the size and shape of a squashed olive) on their key-rings, without which they can go nowhere. Indeed we had to have an official squashed olive carrier with us wherever we went. But we were told that the price of squashed olives is very high - at about £185 each. The squashed olives themselves only cost about £35, but it is the reprogramming of them that bumps the price up. So woe betide anybody who loses their squashed olive!

Interestingly, the whole-county foundation trust which runs it all is learning all it can from the experts of Arizona about 'recovery', and is doing everything it can and should to ensure that it is doing it properly.

We were reminded from time to time that the whole unit was in a state of temporary turmoil, while refurbishment work was being undertaken to construct a 12-bedded ward (controlled access) as an expansion of the service. Perhaps most curious was the fact that a monumentally extensive network of rabbit warrens lies underneath the building works. Apart from whimsical recollections of Chas and Dave, for when the rehoused service needs a team song, thoughts come to mind of the potential underground traffic in both directions. Fluffy bunnies appearing unexpectedly in the midst of art therapy, or gym sessions, or (heaven forbid) the group's cooking sessions - but in the other direction visions of the final scenes of the Sound of Music or even Colditz - overcoming the most controlled access of all!

Continuing the small furry animals theme, one of the rooms where we were offered space to meet people was called the 'hamster room' - though try as we might, we could find no sign nor trace of a single hamster. When we enquired further, we learned that one of the senior staff, on first entering the room, said 'this room smells of hamsters' - and the name stuck. Difficult to work out quite what the lesson is there, but I'm sure there is one!

However, a real animal that we did meet was a small pretty dog - which was sat on the group room sofa when we arrived. It seemed a rather lovely example of how therapeutic people find their relationships with animals, particularly when humans have often failed them. But we suspect that somebody thought it wasn't suitable for dogs to be present when 'the Men from the Ministry' were visiting, so we did not get the chance to make his or her acquaintance before he or she disappeared from the scene - which is rather a shame as the dear thing seemed to be an ideal subject for the 'what would you all like as a photo on the blog?' decision.

But it was not to be, and a picture of the Life Space room, plus a fairy with enormous wings, and the vibrant corridor mural were chosen instead. And the cakes we were offered (but sadly declined!)

IMPARTing innovation in NE London

South London is one thing (see 18 January), but the land beyond the East End – which merges imperceptibly into deepest Essex – is another world entirely. The trains are a funny shape, you have to fight through swarms of commuters coming the other way to get to them, and they go from a part of Liverpool Street station that is kept away from public view, and go through bleak lands with the enormous construction works for the 2012 Olympics. And the signs said ‘Shenfield’ is at the end of the line – just what sort of name for a town is that? ...and where on God’s earth is it? It sounds like a cross between Sellafield (see yesterday) and Highfields Happy Hens (greencare).

Goodmayes is one of those hospitals like they don’t make them any more, in true Victorian county asylum style. The front entrance is straddled by two foundation stones – one saying that the building was started in 1898, and one celebrating the opening in 1903 – by the mayor of West Ham. Apparently, it will not make it far into its second century, as it is likely to be demolished for development in the next few years.

Perhaps I was unwittingly wise to have arrived on my Brompton – as the car park can hold unpleasant terrors for those who choose to drive there – particularly the owners of swanky cars, and other petrol heads and Jeremy Clarkson fans. Some while ago, a 'hospital guest', who was detained at the pleasure of the Mental Health Act Commissioners, decided to make some sort of protest against all the cars in the car park – and kicked all their doors in. He did it quite calmly and methodically, and then went back to his ward to sleep off all the exertion. The local police made an impressively spirited response – turning up in a fleet of five vans, each full of suitably qualified officers – to mount an exhaustive investigation. Numerous photos were taken, measurements made and people interviewed. Sadly though, it does not seem that anybody gleaned much idea of just what the protest was about. But we can’t expect police officers to be psychologists, can we?

We were warmly welcomed with tea and cinnamon cakes, and shown the colour coded highlights of the premises: a purple room for one of the project leaders, and a yellow room for the other. One of whom was interestingly described as being like ‘a satnav with the voice turned off’. The yellow room had a fish tank, excellent for mindfulness we were told, with three inhabitants: ‘brownie’, ‘cup cake’ and ‘éclair’. The previous occupiers of the tank had the interesting names of ‘fish’, ‘chips’, ‘salt’ and ‘vinegar’. It doesn’t take much imagination to think what might have happened to them – though you’d need a few loaves to feed the five thousand, if you’re starting with four goldfish.

It was too difficult to choose a single photo to portray what the service users were proud of, so they chose four: a kettle to represent the ‘help-yourself’ way the kitchen is run; an owl for wisdom, a soft animal toy for comfort in times of stress, and a remarkably effective cross-stitch of a horse (in black and red – significant colours) made by a member of the group.

317 miles north

Our first impression of the Cumbrian Innovation Centre for PD was that it is a long way away. In fact Carlisle station (where we gathered) is just eight miles from the Scottish border. And that of course means more nowadays than it has done for several hundred years. In fact, on our journey out from Carlisle towards the Irish Sea, beyond the green acres of grazing sheep, we could see across the Solway Firth – at the end of which Hadrian built the western end of his enduring boundary between us and those people further north. 

Aspatria (pronounced eigh-spart-rya) was our destination, and we were whisked away, via Tesco’s car park next to the M6, for the 40 minute journey by car. To the town’s thriving rugby club. Once we arrived, our first observation was that the general idea that the north is colder than the south was not supported: it is quite clearly a great deal colder in Essex than in Cumbria. The first of several myths we were to explore…

Apparently, some people in these parts still worship the God Lug – from whom the ancient city of Carlisle took its Roman name, Lugovallium. Indeed the Romans, for all their faults, were quite tolerant in adapting to the tribal customs and beliefs of their northernmost outpost and in recognising the local importance of dear Lug. Myself, I am rather more suspicious of how Hoffman-Le Roche managed to bring a very similar word into everybody’s language in 1963.

After Roman times, the ancient kingdom of Rheged held sway in this corner of England: its boundaries are very similar to modern Cumbria. But before ‘Cumbria’ was invented in 1974, this area was largely Cumberland (in the North), Westmoreland (to the South) and parts of Lancashire (around Barrow-in-Furness). However, 1974 is quite long enough ago for most – and in the recent NHS Foundation Trust merger to cover mental health in the land of Rheged, few in the less populous south, who were happy with and used to their cultural practices and tribal rituals, saw it as a glorious return to the days of Rheged.

A more recent local tradition, dating from Victorian apprentices being paid at the end of every week, is ‘blackeye Friday’. This is the last Friday before Christmas, when all the vigorous young men of Carlisle had wages in their pockets, beer in their bellies and aggro on their minds. Hence there was a statistically significant increase (no reference available) in the number of black eyes in the homes and streets of Carlisle on the Saturday before Christmas. The visiting team understands that, to this day, one needs to proceed with caution down Botchersgate on that Friday before Christmas. But then, like many English towns and cities, many people choose not to proceed down pub-filled streets on any Friday or Saturday night, more than a century later.

We gathered one rather more compassionate story on our travels, albeit one with an unhappy ending. Farmers in these parts are said to be of a generous and kindly nature: after a new-born lamb was failing to feed, a visiting family were happy to be given the task of bottle feeding it to good health, which it soon regained. On planning to return, the farmer gave them the young lamb to bring up themselves. Unfortunately, their other responsibilities meant that this became impossible after a while, and the lamb was returned to the farmer. Although no certainty can be established, it is most likely that mint sauce and roast potatoes were its next companions.

And, without wanting to draw any inferences or conclusions from it, we were interested to hear that the largest stable employer on the coastal part of Cumbria is the Sellafield nuclear plant, where many sensible and professional people work, and live nearby. Unfortunately, we could not get the image of Homer Simpson and the family (and more widespread social) psychopathology our of our minds as we thought about Springfield-in-Cumbria.

As usual, we asked  our hosts to think of a photo that they would like to have included on this blog. The answer was clear, when we came to the end of our proceedings: "the view over the countryside which we can see when we do our art therapy". So here it is:

Now, to be fair, I'm not sure this is from the angle the group intended - and we had a discussion about sending us a photo that you've already got - so do ask if you want a different one here! (and make whatever comments you want, below, as well - please)

***UPDATE***

Today, a day later, we have received three photos that our Cumbrian colleagues wanted to be included. Here they are: