Small-scale answer to ward trauma

By MARTIN JOHNSTON health reporter

When Jim Burdett felt his mental state starting to deteriorate, he became terrified that he would be sent to a psychiatric hospital.

He says he was so frightened that he deceived his psychiatrist about how bad his mood disorder had become during the bout of acute unwellness.

Mr Burdett is a consultant for Mind and Body, a company which advises mental health services from a "consumer" perspective.

He said admission to an acute ward was traumatic for most patients.

"For a small group who are man-handled and put into seclusion, the experience remains the single most traumatic event of their life."

Auckland University clinical psychologist Dr John Read said putting someone suffering from psychosis into hospital could make the problem worse because he or she was surrounded by people who acted in distressing ways.

Mind and Body, the university and the Auckland District Health Board are sponsoring a speaking tour by Dr Loren Mosher, an American psychiatrist who advocates a small-scale alternative to psychiatric hospital wards.

Dr Mosher, who has been medical director of large mental health services and headed the study of schizophrenia for the US National Institute of Mental Health, said the so-called Soteria House concept would not replace hospitals.

But it could help keep some patients off anti-psychotic drugs and could be much cheaper than hospital care.

Trials comparing it with traditional treatment had found it was at least as effective as hospital care.

In 1971, he set up the first Soteria House, a form of mental health crisis care that has generated spin-offs in Switzerland, Sweden and Germany.

The concept involves residential-style homes containing no more than 10 patients and staff.

The emphasis is on development of empathic relationships with patients and recovery from crisis.

In one trial, involving newly diagnosed schizophrenia patients, most in the Soteria group went without anti-psychotic medication for six weeks. Their mental wellbeing was similar to a hospital-treated group.

After two years, the Soteria group was significantly better on a range of mental and social scores, and 43 per cent had avoided anti-psychotic drugs.

A later trial, involving people with serious mental illness who took anti-psychotics, produced equal patient-wellness results in each group. But it cost 45 per cent less to care for Soteria patients.

The Auckland health board spends $375 a day - about $136,000 a year - to keep one patient in an open ward at its Conolly Unit.

Dr Mosher said there were great benefits in avoiding anti-psychotic drugs, which were associated with side effects such as tremors and weight gain. Newer versions caused fewer problems, but one drug had been associated with diabetes.

He said psychosis was often triggered by troubled relationships.

"The medication can't teach you how to become social. That takes skill building, relationship building."

Dr Wayne Miles, president of the Royal Australian and New Zealand College of Psychiatrists, said that in New Zealand's overcrowded and understaffed mental health system building good relationships with patients was usually impossible.

The Auckland board's acute mental health services manager, Karla Bergquist, did not know of any Soteria-type facilities in New Zealand.

"It's another option that would be fantastic to have."

nzherald.co.nz/health