What I do: Shirley McNicholas

Supporting women in acute mental health crisis in Camden and Islington, London

Drayton Park Women’s Crisis House celebrates its 21st anniversary this year marking its well established reputation of a true alternative to hospital for women in acute mental health crisis. The evidence for its ‘success’ comes in academic research, focusing on the demographics and symptoms that women present with and matching that to those women admitted to hospital. Equally compelling however is the overwhelming positive and very moving feedback from women about their experience of the service and the impact on their lives. Some of these comments include:

Some of the comments we’ve received include

Feeling safe and protected, knowing how much Drayton Park really care about you

I have a lot more trust, happy knowing the people you need in a crisis have been there for me.

I loved the 2 workers allocated to myself. I felt heard and encouraged… able to take those skills, knowledge and healing with me.

The staff gave me solace at a time when I was in great need.

I felt ‘protected’ in some way, with many woman and a place to stay every night.

The diverse voice of women is central to everything in the service and this included its initial development. A group of women who had used services were on the advisory group and they worked tirelessly to help create the policies and job descriptions about how the house would actually work. Many of those women continue to be the backbone of the service and hold the Trust and the team to account. As the manager, I am responsible for leading the team and my expectations are extremely high at all times. A core feature of the Drayton Park model is the staffing structure. We wrote job descriptions that focused on skills, experiences and, crucially, attitudes that were needed to work in a women-only crisis house. This is not a traditional multi-disciplinary team.

The expectation of the women-only staff team is that they are committed to empowering women and that they have an understanding of the political and social context in which we work.

At the beginning the service was based on a systemic model including an understanding of the power of language and this was embedded in the policy and practise. We constantly reflect on the language we use and challenge each other if we slip into the dominant discourse of the psychiatric system. The Drayton Park Model is now based within a trauma understanding. This means to understand and hold the likelihood that most people who come to mental health services are likely to have experienced childhood sexual, physical or emotional abuse. Research clearly evidences this belief and most mainstream service provision does not routinely acknowledge the level of trauma and therefore has the potential to re-traumatise by the denial and our consequent behaviour. At Drayton Park it is built into every aspect of the service. Routine inquiry i.e. asking at every referral and assessment very clearly if there a history or current experience of abuse, ‘has anyone every frightened you?’ and giving women the chance to tell. It is very humbling as the majority of women do disclose and for many of them, no one asked before.

As a statutory service we have a duty of care to working with the safeguarding structures if there is a disclosure that is about current abuse. This is daily work for the team at Drayton Park and has to be held in the context of providing an acute alternative to women in crisis who would otherwise be admitted to hospital. The referral and assessment framework is designed to assist staff to work with a narrative approach whilst at the same time, getting the ‘task’ done i.e. is the outcome of the assessment that this women is at risk of being admitted, if not, we cannot offer a place. Once we do offer a place the majority of the work is supporting women who are usually a high risk to themselves and we have created a Managing Risk Framework that is based on collaboration and mutual trust. We create an Agreement Plan (Drayton Park model), not a care plan.

Find out more about Drayton Park’s Women’s Crisis Centre here.