The vast grounds of St Andrew’s Healthcare have elements of an idyllic, English village. There’s a grand old church, tree-lined lanes and, on a fair day, games of croquet playing out on the lawn. But this is no rural backwater.
The 140-acre campus just outside Northampton town centre, is home to the largest mental health facility in the country and a national epicentre for neuropsychiatric care.
St Andrew’s offers specialist neuropsychiatric services for patients with acquired brain injury, stroke, complex dementia and Huntington’s disease, alongside their multiple physical morbidities.
Care is available for men and women in medium secure through to community-facing living environments.
Hospital director Helen Stokes says: “Amongst others, we manage those cases that are the most complex in terms of risk, challenging behaviour and multimorbidity. If patients are displaying a high level of behavioural disturbance, they need a specialist team to support them, plus the environment to manage risk, especially if they are showing extreme physical aggression. St Andrew’s is one of the few places in the country that can provide these things.
“We are constantly adapting and tailoring treatments to help patients live a full life with the least restriction and will move people through our pathway as smoothly and quickly as possible.”
St Andrew’s offers level one and two specialist rehabilitation treatment typically not available to patients in their local areas. The neuropsychiatry service (NPS) is a vital part of that.
There are over 200 beds available within the NPS pathway, ranging from admission units to bespoke individual placements, and a range of therapeutic options to help patients build towards independence and community re-integration where possible, or to offer the greatest quality of life for people requiring palliative care.
A rapid response service for people in crisis also brings patients to Northampton from across the country, when their highly agitated presentation may have proved too demanding at their existing acute or community setting.
Patients arriving at St Andrew’s will often have been detained under the Mental Health Act or on a Deprivation of Liberty Safeguard Order (DoLS), although NPS also accepts informal patients.
Clinical director Dr Vishelle Kamath says: “The first thing we do when clients come to us is rationalise their medication. By the time the patient reaches us they might have been in the hands of many different professionals, so it is important to establish an accurate baseline of each patient’s current needs, and develop a tailored care plan to promote their recovery.
“It’s about making sure the right treatment is delivered at the right time by the right people. We strive to build on the patient’s recovery day by day, continually improving their quality of life, levels of engagement and rehabilitation outcomes.”
Last year, 204 patients were cared for in the St Andrew’s NPS pathway, with 69% of discharged patients moving to less restriction within a locked environment, or on to a community setting closer to home. In addition, over 65 patients transitioned through the pathway within NPS to lower levels of security.
Continual investment in staff training is a significant factor in these positive outcomes. Almost 200 NPS staff are qualified across the principles of RAID (Reinforce, Appropriate, Implode, Disruptive), a relentlessly positive philosophy for working with extreme behaviour.
St Andrew’s also developed the globally recognised neuro-behavioural assessment tools SASBA, SASNOS and OAS-MNR, which are used alongside core measurements of cognitive function and physical health, and incorporated into Positive Behaviour Plans (PBS) for each patient.
Behavioural, cognitive and functional therapeutic streams are combined by the extensive multidisciplinary teams, including a psychology department of 14 and nine psychiatrists, with four specialist neuropsychiatrists.
Each neuropsychiatry ward also has dedicated physiotherapists, occupational therapists, advanced nurse practitioners and assistant practitioners, technical instructors, speech and language therapists and dieticians.
There is even a dedicated dysphagia kitchen, offering a wide choice of graded foods for patients who have difficulty in swallowing, and helping St Andrew’s to win the 2016 Healthcare Caterer of the Year award.
There is also a strong emphasis on vocational, social and spiritual wellbeing, with 350 patients from St Andrew’s, local charities and other providers accessing Workbridge services last year.
Recreational opportunities are abundant too, thanks to a wide selection of available activities, supported by two swimming pools and a gym, and the expansive landscaped grounds. Chaplaincy and spirituality services are also offered.
“All of these different elements enable us to manage behaviour and address both the physical and psychiatric difficulties being experienced,” says Dr Kamath.
“There is a real emphasis on people not staying in hospital for any longer than they possibly need to. ”But equally, some patients will always present with a high level of disturbance which requires a bespoke wraparound package that we can provide,” she adds.
A crucial strand of the NPS pathway is a support group for relatives run by clinicians and backed up by on-site family accommodation. Last year St Andrew’s was named Mental Health Hospital of the Year at the Laing Buisson awards.