Do we need a new mental hospital in York?

BOOTHAM Park was purpose-built in the 1770s as a psychiatric hospital and is now the oldest in the country still being used for its original purpose.

With its high ceilings, wood-panelled walls and large windows, it seems more like a country mansion than a hospital. But because it is so old, and because it is near the railway line, rats were always going to be a risk. There are also problems with the drains.

The building is Grade 1 listed, which makes it difficult to adapt to the needs of modern health care. Replacing a door can cost £400, says Mr Millard. "You have to have a pattern made, which must be approved by English Heritage."

Finding a site for a new hospital might be a problem, however.

Residents in the Bootham area of York are already concerned about plans to replace the 83-bed hospital with a new building in the grounds.

"There is no way a modern building should be built in front of the hall," said campaigner Dave Nicholson. "It is a listed building and the view of it should be protected."

AS we stand looking through the conservatory windows, one of Julie Oxer's patients comes up and slips his hand trustingly into hers. She gives him a reassuring smile.

We are in the conservatory lounge at the Elderly Assessment Unit at Bootham Park Hospital where Julie, the unit's clinical services manager, has been explaining the relaxed regime.

The mainly elderly patients suffer a range of conditions, from depression and psychosis to neurosis and dementia.

There are 20 bedrooms, mainly single, lining a corridor around a central courtyard. Surprisingly, many of the bedroom doors are still closed even though it is mid morning. Julie says this is because it is important to make the patients feel at home - so breakfast is a relaxed affair, and there are no rules about when patients have to get up. "If people are used to lying in bed until 11am, and having someone bring them tea in bed, we do that here," she says.

I have been invited to look around after an Evening Press report highlighted environmental health officers' concerns about rats, dirty kitchens and "appalling" odours at the Georgian hospital.

The problems were identified months ago and were promptly put right, says Gary Millard, director of mental health and social inclusion at the Selby and York Primary Care Trust which runs the hospital.

Nevertheless, the incident seems to have brought to a head health bosses' concerns about the suitability of the Georgian building to provide modern mental health care.

Regional health bosses have already approved in principle a new in-patient mental hospital for York, to be built using private finance. A business case is now being put together for consultation. No site has yet been earmarked, but mental health bosses are believed to be considering the 12 acres of land in the grounds of Bootham Park itself, or land on the former Clifton Hospital site.

"We need to provide health care in modern facilities," says Mr Millard. "The big question is whether Bootham Park provides the right sort of environment to provide modern mental health care."

Any new hospital could be five years down the line. So how can we be sure that in the meantime, mental health patients in York will continue to get the care they deserve?

That is the reason for my visit today - to see for myself.

My first stop has been the Elderly Assessment Unit, where the relaxed regime and sight of Julie patiently holding the hand of her elderly patient - who is acting as a kind of self-appointed guide as we walk around - speaks volumes.

It is also clear that while Bootham Park may be old, it has some advantages no modern-built hospital could enjoy.

Some corridors in the unit are dark and gloomy, but the bedrooms all have their own windows and the unit, in a wing of the Georgian hospital, has a style and charm that would be lacking in a modern hospital.

The conservatory lounge is one of two high-ceilinged, comfortably furnished patient sitting rooms here. There are also two secure, fenced gardens attached to the unit, a central, enclosed courtyard, and two dining rooms - one with an attached mini-kitchen with toaster and microwave so patients can make snacks and hot drinks.

Consultant psychiatrist Linda Brown admits that there are things that would be missed about Bootham Park.

"It is cool and the ceilings are high," she says. "If you go to the district hospital on a day like this, it is hot and oppressive."

What health chiefs are keen to stress, however, is the quality of the modern psychiatric care offered within these ageing walls.

That is apparent from my tour of the rest of the hospital.

In addition to the Elderly Assessment Unit, the hospital has three general admission wards and a psychiatric intensive care unit. Unusually, on one ward there is also a mother and baby unit. Here, mothers battling severe post-natal depression are helped to form a bond with their babies, in conditions where there is no risk to mother or child.

The trust also has a crisis resolution team, which offers home care for people who would otherwise have been admitted to hospital, and a Recovery After Psychosis Team (see panel above) which helps younger patients recovering from a psychotic episode begin the difficult job of readjusting to life back in society.

It is also ahead of the game in employing nurse consultants. Barry Ford, an expert in psychosocial interventions, and Nick Jones, who specialises in child and adolescent care, are two of just 140 nurse consultants across the country working in mental health.

"I would not want people to look at an old-fashioned building and think we have an old-fashioned service," says Gary Millard. "We provide some of the most modern, up to date services in mental health."

But how can relatives - and patients themselves - be confident there won't be a recurrence of the hygiene problems of earlier in the year?

Staff have always been concerned about cleanliness, Mr Millard insists. After the shock of the environmental health inspectors' report experts were brought in to check the hospital over, even to the extent of sending CCTV cameras down the drains.

The main guarantee, however, remains that the hospital operates a virtual open-door policy on visits. This may be a Georgian hospital, Mr Millard says, but it is far from a locked-up Victorian asylum.

"We do close wards down at therapy times," he said. "But otherwise we're totally open. Relatives can come and see for themselves."

BOOTHAM Hospital's specialist Recovery After Psychosis (RAP) team helps young people who have suffered a psychotic attack recover and find their feet in society again. That involves home visits, psychosocial intervention therapy, help and advice on training and accommodation, and even support for families.

John, who doesn't want his full name using, cannot speak highly enough of the team's work.

His 24-year-old son suffered a psychotic episode which left him needing hospital treatment.

"He was living in London near Brixton and had been using cannabis quite heavily for a while," says John. "We had been worried about him for some time because of his eccentric behaviour. Then one day I got a telephone call from his flatmates saying you had better pick him up."

John drove down to London. His son was extremely confused, he said. He had been writing on the walls, wasn't sleeping, was talking to himself and believed he was descended from an ancient Chinese dynasty and from the Egyptian pharaohs. He was also convinced messages were being sent to him from power tools being used by builders working across the road.

John brought his son back to York. At first, they were reluctant to seek help, viewing Bootham Park as a 'Victorian institution'. "He said he didn't want to go into Bootham," says John.

Eventually, John had no choice. His son was admitted to The Retreat because Bootham was full, and stayed in hospital for six weeks as a voluntary patient.

He later suffered a second episode but now, with the RAP team's support, he is doing much better, John says.

"They gave him strategies for coping, they gave him support with benefits, they looked at training programmes, work options, got him a flat. They were fantastic."

The team also supported the whole family.

John admits seeing his son's descent into illness was shocking. "I couldn't work, I physically couldn't do anything," he says. "Mentally, it was as though part of my brain had shut down."

The RAP team were incredible, he says. "They gave us information and support and came to see the family regularly and frequently. They were there for us right from the word go."

How to tackle irrational fears...

ONE of the main tools used in psychosocial intervention is cognitive behaviour therapy, says nurse consultant Barry Ford, above. If a patient is convinced they are being followed by MI5, for example, the aim is to talk to them and help them realise their fears are irrational.

An irrational belief may be strongly held, and perfectly plausible from the patient's point of view. So it is no use simply telling them they are wrong, Mr Ford says. "They might say 'of course I'm being persecuted. See that car that pulled up outside? They are looking at me'." Instead, the idea is to appeal to their rationality. "You can help them to weigh up the evidence," Mr Ford says, "maybe jot down on a piece of paper the evidence for and the evidence against."

Updated: 10:48 Wednesday, September 28, 2005