The Blackthorn Garden Project - Centre for Mental Health

Embed Size (px)

DESCRIPTION

The Blackthorn Garden Project - Centre for Mental Health

Text of The Blackthorn Garden Project - Centre for Mental Health

  • 1.The BlackthornGarden Project Community Care in the context of Primary Care 1995Julia Nehring and Robert Gareth Hill The Sainsbury Centre for Mental Health, 1995The Sainsbury Centre for Mental Health 134-138 Borough High Street London SE1 1LBTel: 020 7827 8300Fax: 020 7403 9482

2. The Blackthorn Garden Project2 The Sainsbury Centre for Mental Health, 1995The Blackthorn Garden ProjectCommunity Care in the Context of Primary CareBy Julia Nehring and Robert Gareth Hill The Sainsbury Centre for Mental Health 1995All rights reserved. No part of this publication may be reproduced, stored in aretrieval system, or transmitted in any form or by any means, electronic, mechanical,photo-copying, recording or otherwise without the prior permission of thepublisher.ISBN: 1 870480 20 1Published byThe Sainsbury Centre for Mental Health134 -138 Borough High StreetLondonSE11LB0171 403 8790 3. The Blackthorn Garden Project3 The Sainsbury Centre for Mental Health, 1995Table of Contents 1. The Blackthorn Garden Project ................................... 5 2. The Co-workers .......................................................... 19 3. The Co-workers Views................................................. 30 4. Integrating Community and Primary Care ................. 41 5. Conclusions....................................................................... 51 6. Appendix 1........................................................................ 54 7. Appendix 2........................................................................ 59 8. References......................................................................... 64 4. The Blackthorn Garden Project4 The Sainsbury Centre for Mental Health, 1995AcknowledgementsThe researchers wish to thank the co-workers, volunteers and staff ofBlackthorn Garden and the general practitioners and therapists working in theBlackthorn Medical Centre and Trust. We also wish to thank Orly Klein,researcher at The Sainsbury Centre for Mental Health for interviewingagencies referring people to the Garden Project.The study was funded by grants from the Gatsby Trust Charitable Foundationand from the South-East Thames Primary Care Development Fund. 5. The Blackthorn Garden Project5 The Sainsbury Centre for Mental Health, 1995Blackthorn Garden A GPsperspectiveAs students one took up medicine in part at least to fulfill ideals of helpingones fellow man. A few years as a GP however confirm that some patientsproblems are too complex and ingrained to be altered much by ones limitedtraining, best efforts and the number of hours in the day. Indeed these patients,many of whom have long-term mental health problems, seem to remind one ofones inadequacy. The numbers now in the community for whom the GP hasclinical responsibility and their frequent attendance can have significant impacton the morale of doctors and the practice team. Their demands can encouragenegative and unloving behaviour (impatience, irritation, cant be bothered; ofwhich one is duly ashamed), simply because the problems they bring are toogreat and one knows from experience that ones concerted effort even overlong periods brings little return.Modern medicine lays heavy emphasis on treating disease while unwittinglyleaving the patient himself on the sidelines. For long-term mental healthproblems this will simply not do. Promises of a cure are not forthcoming andthese illnesses are on the increase.A co-ordinated service is called for which addresses the needs of eachindividual and draws on his aspirations, talents and effort. This can be achievedby a working community like Blackthorn which also strives to understand andimprove the human condition in illness.Working at Blackthorn is an uplifting experience. The sense of communitycreated by staff and co-workers alike lightens ones load. The burdens of theday can be shared be it with an illness like schizophrenia or the apparentlytedious refrain of ones usual workload. One can bear to look at such icebergsonly when the means to tackle them is close at hand.Morale runs high in the Garden because things seem possible which didntbefore. Warmth, understanding and a sense of belonging for individuals whohad previously felt out in the cold allow them to begin to free up and move.The wide variety of tasks there and coaching available to master them,restores a sense of purpose through being gainfully employed. The high quality 6. The Blackthorn Garden Project6 The Sainsbury Centre for Mental Health, 1995of services and produce available to the general public who frequent theGarden leads to much genuine appreciation and gratitude raising confidenceand self-respect amongst co-workers. One is freer to concentrate on medicalaspects while others in the circle can make better use than before of onescontribution. In between times, the social life that fills the Cafe and surroundsthe washing up bowl enlivens the days routine with laughter and camaraderie.Contact with patients, co-workers, families, colleagues and health professionalsboth in and relating to the practice is positive because one is in a position tooffer help. Doors that used to feel closed feel more open, at least in that nowone has the means to try.Everyone understands that numbers have to be limited, that this primary careproject is an experimental model. We are now privileged to be working withThe Kings Fund, London, and four other practices in Bristol, ParkwoodMaidstone, Shrewsbury and Stroud, to demonstrate over the next 3 years thatBlackthorn Medical Centre and Garden is indeed a replicable model. Thiswould not have been possible without the substantial help we have receivedfrom The Primary Care Development Fund and The Sainsbury Centre forMental Health.David McGavin26.11.94 7. The Blackthorn Garden Project7 The Sainsbury Centre for Mental Health, 19951. The Blackthorn Garden ProjectIntroductionBlackthorn Garden is a community care project for people with long-termmental health problems and other chronic or disabling illnesses. Unlike mostcommunity care projects, it is based in a primary care setting. It developedfrom an initiative the Blackthorn Trusf, pioneered by an NHS general practicein Maidstone. The Trust was set up to work in conjunction with the generalpractice to provide anthroposophical creative therapies (art therapy, musictherapy and eurythmy therapy), counselling and support groups to patientsreferred from the practice who had not responded to conventional treatment.Individuals referred to the Trust have had problems such as multiple sclerosis,chronic fatigue syndrome, cancer and depression. They receive the creativetherapies together with mainstream medical treatments and anthroposophicalremedies prescribed by the general practitioners. The work of the BlackthornTrust and the theoretical basis underlying it (anthroposophy) are described inAppendix 1.The Blackthorn Trust and General Practice embarked on a new project - theBlackthorn Garden - in September 1991, following approaches from Healthand Social Services who were looking for opportunities to develop care in thecommunity. The aim was to create a supportive work environment in thecommunity for people with long-term mental health problems. The capitalfunding for the new project was provided by Health and Social Services,charitable foundations and local companies. Researchers from RDP (now TheSainsbury Centre for Mental Health) were invited to evaluate the first twoyears of the project as part of a larger study of work projects for people withlong-term mental health problems. The study was supported by funding fromthe Gatsby Trust Charitable Foundation and from the South-East ThamesPrimary Care Development Fund.This report and a previous publication Work, Empowerment and Community(Nehring et al., 1993) describe the development of the Blackthorn GardenProject during its first two years (January 1992 - December 1993). Althoughthe project has a number of unique features, we describe it mainly as a modelwhich illustrates how the community care of people with mental health 8. The Blackthorn Garden Project8 The Sainsbury Centre for Mental Health, 1995problems can be integrated with primary care. The evaluation has ended, butof course the Blackthorn Garden Project continues to evolve. Nevertheless,we write about the project as it appeared to us during the first two years -1992 and 1993.Blackthorn GardenThe Blackthorn Garden Project was set up at the end of 1991 on land adjacentto a new medical centre which had been built for the Blackthorn Trust andGeneral Practice. Its aim is to provide work rehabilitation and communitysupport for people with mental health problems, particularly those who aredisabled by their illnesses and who have not responded to other treatments.Such individuals, referred from the Blackthorn Medical Centre, by other GPsand by psychiatrists, are taken into the project as co-workers. They workalongside the project staff and volunteers drawn from the local community,many of whom are or have been patients of the Trust.Co-workers were referred to the project gradually during the first year and bythe end of the year, 31 had joined and 25 were still involved. By Autumn 1993the project had taken on 55 co-workers, 38 of whom were attending regularly,with four coming occasionally. At the end of the second year, between 40 and50 co-workers were working in the project each week. There were fourmembers of staff: the Director, the Garden Project Leader, the Bakery ProjectLeader and a part-time Cafe Co-ordinator as well as eight volunteers.The aims of the Blackthorn Garden Project are: 1. To establish a place of rehabilitation through work for thementally ill in the community.The project aims to engage co-workers in valued and fulfilling workwhich will help them to develop confidence and general work skills. 2. To create a place of social integration and cultural activity inthe Barming District of Maidstone.The aim is to foster an environment in which individu