GB2617530A

GB2617530A - Inpatient child and adolescent mental health service (CAMHS) facility for the flexible and responsive provision of mental health care, therapies and services

Info

Publication number: GB2617530A
Application number: GB2111800.5A
Authority: GB
Inventors: Cyrus Beverly; Smith Lee; Derrick Cyrus Horace
Original assignee: Cove Care Holdings Ltd
Current assignee: Cove Care Holdings Ltd
Priority date: 2021-08-18
Filing date: 2021-08-18
Publication date: 2023-10-18
Also published as: GB202111800D0

Abstract

An inpatient care facility (100) has at least two sub-wards (108a, b, c, d), each comprising a plurality of bedrooms, a first communal area having a first lockable partition wall, and a secure entry / exit. The care facility has a first configuration in which the first lockable partition walls of each of the at least two sub wards are closed and locked such that the sub-wards are separate and access to each respective sub-ward is provided via the secure entry / exit and a second configuration in which the lockable partition walls of each of the at least two sub wards are opened such that the respective first communal areas of each sub-wards are in communication with each other to form a two-sub ward combined ward.

Description

Inpatient Child and Adolescent Mental Health Service (CAMHS) facility for the flexible and responsive provision of mental health care, therapies and services

Technical field

[0001] The present invention relates to a reconfigurable inpatient care facility for flexible provision of mental health therapies and services. More specifically, the present invention provides an inpatient CAMHS tier 4 environment which can be transitioned between at least two configurations to provide for the changing needs of the patients within.

Background art

[0002] Children and young people with mental health problems, their families and carers require access to high quality care, in the right setting. Such care is known as a Children and Adolescent Mental Health Service (CAMHS). Countries such as the UK approach mental health problems in children and young people in an inpatient setting.

[0003] There are four tiers of CAM HS provision in the UK, which are: 1. early intervention and prevention services and provided through schools and children's centres, health visitors, school nurses, GPs, Youth Connexions, helplines and websites; 2. early help and targeted services provided by specialists; 3. multidisciplinary teams supporting specialist CAMHS, including eating disorder services; and, 4. specialised day and inpatient units, where people with more severe mental health problems can be assessed and treated.

[0004] The term 'inpatient' is used herein to refer to patents admitted to a CAM HS tier 4 facility for medical treatment who reside in that facility. Inpatients will spend at least one night sleeping at the facility, and therefore will live there, albeit on a temporary basis. Therefore inpatient facilities can be distinguished by the provision of facilities which facilitate habitation -such as bedrooms.

[0005] CAM H disorders include patients presenting a high degree of risk to themselves or others, a variety of mental health difficulties and eating disorders.

[0006] Because of the age and specific disorders that children and young people exhibit, admission as inpatients into adult hospital beds is not desirable. Therefore, specific facilities, or clinics, (within or outside hospitals) are provided which cater to the specific needs of the CAM HS inpatient group.

[0007] Existing units are typically provided with individual bedrooms, and communal areas such as lounges, classrooms and kitchens. Various clinicians and other specialised staff will be present in such a unit, such as psychiatrists, clinical psychologists, nurses, occupational therapists, speech and language therapists, family therapists and teachers.

[0008] The typical inpatient CAM HS unit (e.g. in the UK) is a large, fairly open space, often of around 12 beds, with specific areas adjacent to, or usually indeed within, the main ward area to manage difficult or crisis situations reactively (i.e. seclusion, de-stimulation or de-escalation areas of the ward). These large group setting wards often see sub-optimal mixing of young people by way of age range, clinical presentations, risk factors and gender. There are frequently secondary psychiatric difficulties for the young people triggered by the admission itself, exacerbated by crowded, chaotic, disturbed and noisy environments. Behavioural cross-contamination between the young people is often seen (i.e. young people 'learning' maladaptive coping from each other, such as deliberate self-harm), prolonged admission times often due to these behavioural difficulties and poor long-term outcomes following protracted inpatient experience.

[0009] Clearly, this "one size fits all" approach is sub-optimal. The physical configuration of the prior art CAM HS units has drawbacks in terms of providing a suitable environment for the patients within it. It is an aim of the present invention to overcome, or at least mitigate, the aforementioned problems.

Summary of invention

[0010] According to a first aspect of the present invention, there is provided an inpatient care facility comprising: at least two residential sub-wards, each comprising: a plurality of rooms; a first communal area having a first lockable partition wall; and, a secure entry / exit; the care facility having: a first configuration in which the first lockable partition walls of each of the at least two sub wards are closed and locked such that the sub-wards are separate and access to each respective sub-ward is provided via the secure entry / exit; and, a second configuration in which the lockable partition walls of each of the at least two sub wards are opened such that the respective first communal areas of each sub-wards are in communication with each other to form a combined ward comprising the at least two sub-wards.

[0011] By "residential", we mean that the sub-wards have facilities making them suitable for overnight accommodation. This includes bedrooms, and bathroom facilities including e.g. a toilet, shower, bath etc. The bathrooms may be en-suite facilities, and may be provided for each of a plurality of bedrooms.

[0012] Advantageously the present invention provides a technical solution to the aforementioned problem. The facility can be used in the first configuration with the sub-wards fully and securely isolated (for example for psychiatric intensive care) or opened up into the second configuration where a single larger ward is provided allowing for more (controlled) interaction between the patients in a larger group.

[0013] Preferably a central access area is provided between the at least two sub-wards, the central access area having a secure entry / exit, and wherein in the second configuration the respective communal areas of each sub-wards are in communication with the central access area, and access to the combined ward is provided via the secure entry / exit of the central access area.

[0014] Preferably the facility comprises: i) at least four sub-wards provided in a 2 x 2 formation; H) in which the central access area is formed in a cross shape between the four sub-wards.

[0015] Preferably the central access area comprises two corridors crossing at a central station to provide four corridor portions, wherein the central station has at least one access control door to each of the four corridor portions.

[0016] Preferably each of the four sub-wards comprises a second communal area having a second lockable partition wall, and wherein each lockable partition wall of any one sub-ward faces a lockable partition wall of another sub-ward.

[0017] Preferably the facility has: i) a third configuration in which: ii) the first and second lockable partition walls one of a first sub ward are opened; iii) the lockable partition walls of the two adjacent sub-wards facing the first and second lockable partition walls of the first sub-ward are opened; and, iv) the lockable partition wall of a second sub-ward facing the first lockable partition wall of the first sub ward is opened; v) the lockable partition wall of a third sub-ward facing the second lockable partition wall of the first sub ward is opened; and, vi) the remaining lockable partition walls of the second and third sub-wards are closed and locked; vii) such that the first, second and third sub-wards form a three sub-ward combined ward. [0018] Preferably the facility has: i) a fourth configuration in which: H) the first and second lockable partition walls of all four sub wards are opened; Hi) such that the four sub-wards form a four sub-ward combined ward.

[0019] Preferably the secure entry / exit of each sub-ward comprises two spaced apart doors delimiting a secure lobby area, in which the two spaced apart doors are configured such that only one of them can be opened during normal operational use. In other words, the secure entry / exit is an airlock entry / exit.

[0020] Preferably the central access area comprises at least one secure entry / exit having two spaced apart doors delimiting a secure lobby area, in which the two spaced apart doors are configured such that only one of them can be opened during normal operational use.

[0021] Preferably the central access area comprises one secure entry / exit at each end of each corridor portion thereof.

[0022] Preferably the facility has an electronic access controller, the controller configured to control operation of each secure entry / exit.

[0023] Preferably the facility has an electronic access controller, the controller configured to control operation of each lockable partition wall.

Brief Description of Drawings

[0024] Example devices according to the present invention will now be described with reference to the Figures in which: [0025] Figure 1 is a plan view of an inpatient care facility in accordance with the present invention; [0026] Figure 2 is a plan view of a part of the facility of Figure 1; and, [0027] Figure 3 is a detail plan view of a part of the facility of Figure 1.

Description of Embodiments First embodiment

Configuration of the first embodiment [0028] Referring to Figure 1 there is shown an inpatient care facility 100 providing within a building 102. The care facility 100 comprises an outer perimeter wall 104 (which in this case is the outer wall 106 of the building 102).

[0029] The facility comprises a plurality of zones, specifically a central zone 108, a first peripheral zone 110, a second peripheral zone 112, a reception zone 114 and an annex 116. Corridors are provided connecting each zone. These are reception / central zone corridor 118, central zone / first peripheral zone corridor 120, central zone / second peripheral zone corridor 122 and central zone / annex corridor 124. The facility 100 is generally cruciform in plan, with the central zone 108 provided in the centre, and each of the four other zones 110, 112, 114, 116 provided on four sides (90 degrees apart) of the central zone 108. Therefore, all of the zones are connected to enable people to move between each.

Central zone 108 [0030] The central zone 108 is shown in more detail in Figures 2 and 3. Referring to Figure 2, the central zone 108 is generally square in shape, having four sub-wards 108a, 108b, 108c, 108d. The sub-wards 108a -d are positioned in a 2 x 2 grid pattern with a "+" shaped central access area 126. [0031] The central access area 126 is comprised of two perpendicular corridors 126a, 126b that cross in the middle. The central access area 126 comprises a central secure section 162 which includes the intersection of the corridors 126a, 126b and is enclosed by a door 163a, 163b, 163c, 163d in each of the corridors extending away from it. The central secure section 162 is configured to be 'airlocked' as will be described below. At the centre, within the central secure section 162 where the corridors 126a, 126b cross, there is provided a nursing station 160.

[0032] At the distal ends of each corridor 126a, 126b, there are provided peripheral secure sections 164, 166, 168, 170 having lockable doors at either end, the sections configured to be 'airlocked' as will be described below.

[0033] The sub-wards 108a -d are mirrored in two planes of symmetry P1, P2 which run along the respective corridors 126a, 126b. Sub-wards 108a, 108b are mirror images about plane P1. Sub-wards 108c, 108d are mirror images about plane P1. Sub-wards 108a, 108c are mirror images about plane P2. Sub-wards 108b, 108d are mirror images about plane P2.

[0034] Sub-ward 108a will be described in detail with reference to Figure 3. It will be understood that sub-wards 108b -d are identical (albeit mirror images of sub-ward 108a).

[0035] The sub-ward 108a comprises three en-suite bedrooms 128a, 128b, 128c each opening into a hallway 130. A school room 132, a nurses' station 134 a clinic 136 and a kitchen 138 are also provided, all of which open into the hallway 130. The sub-ward 108a further comprises a lounge 140.

[0036] The school room 132 has a door 156 connecting it to the hallway 130 and a reconfigurable partition wall 154. The partition wall 154 has a closed configuration in which it seals school room 132 from the adjacent part of the central access are 126 (corridor 126a), and an open configuration in which the corridor 126a is in communication / open with the school room 132. In the Figures the wall 154 is shown in a closed configuration with a partially open configuration in dashed lines. In this embodiment, the wall 154 is shown as a multi-leaf folding partition. It will be noted that in the closed configuration the wall 154 is locked in place to form a secure barrier to passage between the corridor 126a and the sub-ward 108a.

[0037] The lounge 140 has a door 142 connecting it to the hallway 130, an external door 144 and a reconfigurable partition wall 146.

[0038] The partition wall 146 has a closed configuration in which it seals the lounge 140 from the adjacent part of the central access are 126 (corridor 126b), and an open configuration in which the corridor 126b is in communication / open with the lounge 140. In the Figures the wall 146 is shown in a closed configuration with a partially open configuration in dashed lines. In this embodiment, the wall 146 is shown as a multi-leaf folding partition. It will be noted that in the closed configuration the wall 146 is locked in place to form a secure barrier to passage between the corridor 126b and the sub-ward 108a.

[0039] Referring to Figure 3, the reconfigurable partition walls 146, 154 are provided on two perpendicular sides of the sub-ward 108a and thus face in directions 90 degrees to each other. [0040] The sub-ward 108a comprises a secure entry / exit lobby 148 having a first door 150a, second door 150b separated by a lobby area 152. The doors 150a, 150b are configured to form an 'airlock' as will be described below.

[0041] Various door configurations above have been described as configurable to provide an 'airlock'.

This means that there are two controlled interlocking doors (or two sets of controlled interlocking doors). One set of doors will open and close before the second set opens. In other words, only one door or set of doors may be in the open condition at any one time, thus creating (metaphorically speaking) an 'airlock' providing a high degree of access control. The airlock functionality may be provided by mechanical or electric / electronic means.

[0042] The required level of access control is mandated by guidelines / standards. Firstly, for general adolescent services the NHS standards' provide that tier 4 inpatient CAM HS services have four levels -medium secure services, low secure services, psychiatric intensive care units (PICU) and general adolescent services. PICU standards' require that access to the clinical area for staff, patients and visitors is through an airlock.

[0043] Referring to Figure 2, it can be seen that the reconfigurable partition walls 146 of the sub-ward 108a and 108c are directly opposite and facing (across the corridor 126b). The reconfigurable partition walls 154 of the sub-ward 108a and 108b are directly opposite and facing (across the corridor 126a).

First peripheral zone 110 [0044] The first peripheral zone 110 comprises two 3-bed peripheral sub-wards 158a, 158b.

1 NHS England (2018): Service Specification: Child and Adolescent Mental Health Services (CAMHS) Tier 4: General adolescent services including specialist eating disorder services NHS England (2018): Service Specification: Child and Adolescent Mental Health Services (CAMHS): Psychiatric intensive care units Second peripheral zone 112 [0045] The second peripheral zone 112 is a mirror image of the first and extends from the opposite end of the corridor 126b.

Reception zone 114 [0046] The reception zone 114 comprises the main entry / exit into the facility.

Annex 116 [0047] The annex 116 comprises communal facilities such as clinical facilities, further lounge and fitness facilities.

Operation of the first embodiment [0048] The invention is primarily embodied in the central zone 108. The central zone 108 can be reconfigured into various different configurations to suit the clinical needs of the patients. Fundamentally, the different configurations as described below provide a technical solution to the problem of having a facility that attempts to provide a 'one size fits all' approach.

Configuration A: 4 x 3 bed wards [0049] In this configuration, each of the sub-wards 108a, 108b, 108c, 108d is fully isolated from the others. The partitions 154 are closed and locked, isolating the sub-wards from the adjacent central corridors 126a. The partitions 146 are closed and locked, isolating the sub-wards from the adjacent central corridors 126b. Access to each sub-ward is only possible via the airlocked access doors 150a, 150b.

[0050] In this configuration, each individual sub-ward can be used to treat up to three individuals in a secure setting, and mixing of inpatients from other sub-wards may be controlled, and prevented if desired.

Configuration B: 1 x 6 bed ward, 2 x 3 bed wards (i) [0051] In some circumstances, it is useful to be able to combine two sub wards to form a single 6 bed ward. In configuration B, this is achieved by opening the partitions 154 of either (i) sub-wards 108a, 108b or (ii) sub-wards 108c, 108d. This essentially creates a new communal area from the two school rooms 132 and part of the corridor 126a (between the central secure section 162 and the outer secure sections 164 or 168. Because of the secure sections, the newly formed 6 bed ward is secure and access can be controlled via airlocked door systems. In this configuration, the other two sub-wards remain individually secured.

Configuration D: 1x 6 bed ward, 2 x 3 bed wards (ii) [0052] As an alternative to configuration B, wards 108a & 108c or 108b & 108d may be combined by opening the partitions 146 (whilst partitions 154 remain closed). This essentially creates a new communal area from the two lounges 140 and part of the corridor 126b (between the central secure section 162 and the outer secure sections 166 or 170. Because of the secure sections, the newly formed 6 bed ward is secure and access can be controlled via airlocked door systems. In this configuration, the other two sub-wards remain individually secured.

Configuration D: 2 x 6 bed wards (1) [0053] This configuration can be achieved through combining the sub-wards 108a & 108b and 108c & 108d into two separate 6 bed wards. The wards are then separated by the central corridor 126b and access is controlled via the central secure section 162.

Configuration D: 2 x 6 bed wards (ii) [0054] This configuration can be achieved through combining the sub-wards 108a & 108c and 108b & 108d into two separate 6 bed wards. The wards are then separated by the central corridor 126a and access is controlled via the central secure section 162.

Configuration E: 1 x 9 bed ward, 1 x 3 bed ward [0055] This configuration can be achieved through combining three sub-wards. For example, 108a has partitions 154 and 146 open. 108b has 154 open. 108c has 146 open. This creates an "L" shaped 9 bed ward with 108d remaining isolated.

Configuration F: 1 x 12 bed ward [0056] If all partitions are opened, a full 12 bed ward can be formed with free access throughout.

Access into and out of the ward is controlled by the secure sections 164, 166, 168, 170. This is more akin to the prior art wards.

[0057] The purpose of this unique design is to allow operational adaptation and flexibility, providing either individual, 3 bedded wards detached from each other (in 'Partitioned' mode), or easily adapted to provide larger, joined-up sections of up to a single ward of 12 beds (in 'Opened' mode), and the various configurations available described above.

Variations on the first embodiment [0058] Instead of a standalone building 100, the present invention may be provided within another building-for example a general clinic or hospital.

[0059] The lockable partition walls are provided as the folding-leaf type in the above embodiment. It will be understood that other types of lockable partition walls may be provided-for example large single leaf rotating panels, sliding doors etc.

Claims

Claims 1. An inpatient care facility comprising: at least two sub-wards, each comprising: a plurality of bedrooms; a first communal area having a first lockable partition wall; and, a secure entry / exit; the care facility having: a first configuration in which the first lockable partition walls of each of the at least two sub wards are closed and locked such that the sub-wards are separate and access to each respective sub-ward is provided via the secure entry / exit; and, a second configuration in which the lockable partition walls of each of the at least two sub wards are opened such that the respective first communal areas of each sub-wards are in communication with each other to form a combined ward comprising the at least two sub-wards.
2. An inpatient care facility according to claim 1, wherein a central access area is provided between the at least two sub-wards, the central access area having a secure entry / exit, and wherein in the second configuration the respective communal areas of each sub-wards are in communication with the central access area, and access to the combined ward is provided via the secure entry / exit of the central access area.
3. An inpatient care facility according to claim 2, comprising: at least four sub-wards provided in a 2 x 2 formation; in which the central access area is formed in a cross shape between the four sub-wards.
4. An inpatient care facility according to claim 3, in which the central access area comprises two corridors crossing at a central station to provide four corridor portions, wherein the central station has at least one access control door to each of the four corridor portions.
5. An inpatient care facility according to claim 3 or 4, wherein each of the four sub-wards comprises a second communal area having a second lockable partition wall, and wherein each lockable partition wall of any one sub-ward faces a lockable partition wall of another sub-ward.
6. An inpatient care facility according to claim 5, having: a third configuration in which: the first and second lockable partition walls one of a first sub ward are opened; the lockable partition walls of the two adjacent sub-wards facing the first and second lockable partition walls of the first sub-ward are opened; and, the lockable partition wall of a second sub-ward facing the first lockable partition wall of the first sub ward is opened; the lockable partition wall of a third sub-ward facing the second lockable partition wall of the first sub ward is opened; and, the remaining lockable partition walls of the second and third sub-wards are closed and locked; such that the first, second and third sub-wards form a three sub-ward combined ward.
7. An inpatient care facility according to claim 5 or 6, having: a fourth configuration in which: the first and second lockable partition walls of all four sub wards are opened; such that the four sub-wards form a four sub-ward combined ward.
8. An inpatient care facility according to any preceding claim, wherein: the secure entry / exit of each sub-ward comprises two spaced apart doors delimiting a secure lobby area, in which the two spaced apart doors are configured such that only one of them can be opened during normal operational use.
9. An inpatient care facility according to any preceding claim, wherein: the central access area comprises at least one secure entry / exit having two spaced apart doors delimiting a secure lobby area, in which the two spaced apart doors are configured such that only one of them can be opened during normal operational use.
10. An inpatient care facility according to claim 9, wherein the central access area comprises one secure entry / exit at each end of each corridor portion thereof.
11. An inpatient care facility according to any preceding claim, comprising an electronic access controller, the controller configured to control operation of each secure entry / exit.
12. An inpatient care facility according to any preceding claim, comprising an electronic access controller, the controller configured to control operation of each lockable partition wall.