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Community rehab

Using art to help manage the life long effects of a brain injury

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Natalie Mackenzie, of BIS Services, has worked with ‘James’ since 2002. In fact, he was one of her earlier clients in her career. She is immensely proud of the challenges he has overcome; not all of the effects of the accident have been surmounted, but none the less he has exceeded many expectations of medical professionals, with a will of iron and an exceptional talent that is finally being acknowledged. Here she shares the experience.

James is not defined by his brain injury, but his experiences and the challenges of his TBI have moulded his work and the individual we now see. As we are all aware, living with a severe TBI is a lifelong journey, and I still support Jim in the community, and have continued to do so whilst he has travelled around the world, through the now ‘normal’ virtual rehabilitation.

I have watched his art bring meaning and focus to his daily life, encouraging a motivation and structure that is always needed for individuals like James managing their cognition. Although there remain issues with some areas of function, James has learnt, consolidated and implemented a toolbox of strategies that support him to pursue his passion and bring joy to others.

It has been a pleasure to work with someone as driven as James, and I have seen him take a turbulent journey through his recovery, which I am sure many professionals in the field can relate with.

His need for increased rehabilitation through life challenges is always available and those of us that work with him remain committed to supporting him as he continues to develop his artwork further, wherever that may take him. There may even be a few of you reading this today who have been part of his journey.

Some of his artwork now hangs proudly in the BIS Services office with room for more to come.

Here in his own words, is his story.

James Cyril Gardiner was born in Woking, Surrey in 1967. Parents Margaret, a cleaner, and ‘Jock’, a hospital porter, subsequently brought him up in the village of Englefield Green, Surrey.

Despite a troubled and turbulent early life James did well in most subjects at school, excelling at Art and English. His O-level mark in Art which gave him grade A was, according to his teacher at the time, ‘the highest recorded in the borough for over 10 years’.

After gaining an A-level grade B at the local sixth form college and being offered a place at Chelsea School of Art, he was faced with a difficult choice. Either go away to London to develop his Art education, or stay and work in order to look after his older, autistic brother, following his parents’ divorce and subsequent loss of the family home.

He chose the latter, and so began the next 17 years of warehouse, stock control, purchasing and accounting roles. Beginning at a fledgling Thorpe Park, and ending at China House on Piccadilly (now ‘The Wolseley’) via 7 years at the uber-trendy Halkin Hotel in Belgravia – his aptitude for detail, mathematical exactitude and forecasting meant he had developed a successful career, although a world away from anything exploiting his early artistic talent.

Maybe this was shown in other ways, however, as he was also developing a sideline career as a talented songwriter and guitarist in indie pop, with a modicum of success, but with great hopes for the future.

Life was good, and was only going to get better. Now living in London’s Olympia, with a steady, reasonable income, an active social life, and daily gym sessions meaning any excesses from the weekend were negated, all meant life was pretty much as good as it gets for an early thirty something man in the capital…

Then, one night in early September 2001, everything changed.

That evening he visited a friends’ nightclub- the infamous ‘Uncle Bob’s Wedding Reception’- to witness the first London performance of a mutual friend’s band, The Darkness.

Earlier that day, England had beaten Germany 5-1 during the qualifying stages of the 2002 World Cup, and it was a hot, heady, boozy and celebratory evening, which spilled over into the early hours of the following morning.

Eventually, he and a friend were driving home (the pal being the sober driver) when, at about 4.30 am, ‘joyriders’ were ironically the reason for James eventually being painfully aware of the word ‘Anhedonia’.

Teenage car thieves, being pursued by the Police, were travelling on the wrong side of the road with lights off at a speed of over 80mph. The head-on collision saw James’ car being bounced off some railings and then into a traffic light, therefore involving three collisions with devastating results.

The crushed pelvis, broken arm bones, eye damage and two collapsed lungs were the immediate, obvious results, a GCS of 3 on admission to hospital meaning the medical team were less than optimistic as regards the chances of survival.

Any Traumatic Brain Injury was not obvious, even after being eventually roused from the 12 day induced coma, and the long, slow process of rehabilitation commencing.

After over a year of appointments, hard physical work and bewilderment, other professionals ‘in the trade’ suggested that there was possibly another subtle, yet massively important result of the accident which would have a permanent effect on his cognition, mood and subsequent PTSD.

After eventually accepting that the previous working life was now gone forever, James was happy to see that although his hemiparesis meant his guitar playing was also a thing of the past, he could still draw – a long dormant avenue of expression was gleefully available to be explored again.

Although fatigue, scar tissue, recurring eye issues (a lens replacement and detached retina being just two) all hampered progress, the relief from the Anhedonia -with which he was now all-too familiar – was only felt when successfully completing a drawing.

The next five years were spent exploring differing media, instruction, approaches, ideas and styles, and probably meant the Foundation Course and Degree missed in the Eighties was now complete. A particular favourite was the drawing of cities around the world,

Though London was a readily available source of material. The idea of just replicating what was there in front of the artist always seemed unsatisfying, however, ‘I had done many still life works during my teens. I knew the ability to reproduce things I see accurately was still intact… but there had to be something more to be explored…’

Eventually a theme was developing in the artworks – one of recording the space occupied by people, questioning when a person REALLY exists.

‘ I think this came about as a result of thinking about my friends and family coming to visit me in hospital, when I was comatose.I was there, lying in that bed, alive. But I wasn’t there. I was occupying the space. We had an experience there, together. In that space, at the same time.

‘But, although my body was there, my personality wasn’t. And I have no memory of that time.’ This idea soon started seeping through into the artworks. Thin, black outlines of people were drawn ‘over’ a background of monochrome cityscapes, sometimes with a minimum of primary colour to provide relief.

‘I would often sit in a place, drawing the background of the city structures. And, during this time, I would take many, many pictures with my iPhone of the passers-by in my view. I would therefore record the people that had also been in that space with me, during that time.

‘Later, I would choose the stances and shapes that appealed to me from the photos, and make a composition that I felt recorded that time I was there. But all I recorded were the outside shapes of the people. Not really them, themselves , with their personalities, and thoughts and feelings…’.

The U.K. lockdown during 2020 meant the artworks suddenly had an increased level of pertinence, and this prompted a series of new works entitled ‘The City Missing The People’, showing London landmarks – this time drawn in colour – empty but with the now familiar trademark ‘Outline people’ drawn with white lines, suggesting an almost ghostly feel…

‘I wanted to show the city with a personality, but mourning the sudden absence of the multitudes of people that normally give the city it’s life, it’s feeling… it’s personality… as if it was therefore missing that part of itself’.

These drawings were included within BBC Radio London’s ‘Make A Difference’ feature, the proceeds from selling online and original purchases being donated to ‘The Big Issue’.

This work has prompted further developments – ‘ I liked the idea of looking further back – other people have also been in the same space, perhaps themselves looking back – perhaps looking forward, imagining us – a future they could not comprehend. But they WERE there then. They DID occupy that space…’

So another series of drawings has been made, redoing the ‘The City Missing The People’ works, but with the addition of Edwardian and Victorian characters posing, as if for the camera, in those same spaces, the juxtaposition of the white outline contemporary figures with the more solid, yet partially drawn grey antique poses raising all kinds of questions…

‘I look forward to continuing to develop this – and other -styles. I think I am a person with a chequered history first – and an artist second. Maybe the injury to my brain has enabled me to see things in a different way. Maybe I would never have thrown myself into Art again – there’s just no way of knowing. I hope there is still enough of the pre-accident ‘me’ to inform my Art accordingly, as the last thing I want to create is needy, ‘damaged’ pieces asking for sympathy. I hope I am now exploiting the unique approach my experience has given me…’

James’ work can be viewed and purchased on www.jamescyrilgardiner.com

Community rehab

Mental health NHS Trust extends roll out of Perfect Ward

Barnet, Enfield and Haringey mental health NHS Trust (BEH) plan to extend the Perfect Ward system to 12 community teams

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Three members of NHS staff walking down a corridoor in uniform using the Perfect Ward system

Barnet, Enfield and Haringey mental health NHS Trust (BEH) is extending the rollout of Perfect Ward to 12 community teams.

This will include the organisation’s health services in Enfield where the majority of the Trust’s 128,000 patients receive care at home or at local clinics.

BEH is a provider of integrated mental health services to a population of 1.2 million. They introduced Perfect Ward’s quality improvement digital technology to transform the way quality and is measured across the large organisation. Since it was introduced, over 300 staff in 45 teams rely on the system to conduct 13 quality audits on mobile devices.

The latest implementation took four months with 12 of the 20 community teams going live with Perfect Ward in November 2020.

Read more: Alzheimer’s Research UK receives diagnostics funding boost

To assist the rollout to the community teams, the Trust enlisted the support of the IT department to install Perfect Ward on mobile devices and introduced training before the launch date. Staff were shown how the technology could simplify their life and encouraged to get involved in the design process. Any initial reluctance to engage was quickly dissipated and inspection rates are at 100 per cent.

Using the system, BEH’s community team can conduct their own audits and reconfigure the content and questions to match their own requirements. They can also receive instant feedback allowing them to react immediately to the results and track their performance in real-time. The efficiency of the Perfect Ward app vastly reduces the number of hours spent auditing staff giving them more time to spend with patients.

The exterior of BEH hospitals where the Perfect Ward system is being extended

Caroline Sweeney, deputy director of nursing and quality governance at BEH Mental Health NHS Trust, commented: “This latest development is part of our overall plan to integrate mental and physical health services to provide a better, more holistic level of care.  An ambitious goal like this requires an equally sophisticated tool to bring together our patient safety incident, auditing and patient experience survey results all in one place.

“Perfect Ward has already proved its worth in supporting Good Governance, combining consistent processes with a cohesive view of all quality activities in a single solution, the basis of a robust QI framework that guarantees continuous improvements in patient care.”

Alan Birch, chief commercial officer at Perfect Ward, added: “Our highly customisable technology combines intuitiveness with flexible configurability to transform the way organisations like BEH effectively measure quality across their large, complex and diverse organisations.

“At a glance, both clinical and non-clinical staff in all kinds of healthcare settings are able to flag up issues and monitor performance to boost staff morale and drive meaningful quality improvements simply using their smartphones or mobile devices.

“What is more, our technology is widely recognised as a valuable strategic tool.  With access to dynamic data, NHS Trusts such as BEH are empowered to contribute to national programmes including the Mental Health Act or meet the unique challenges of a global pandemic amid a rapidly changing healthcare landscape.”

Read more: Osteoarthritis: breaking the cycle

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Brain injury

Community rehab programme saved by brain injury charity

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A vocational rehabilitation programme in the North East aimed at getting those living with a brain injury back into working life has been resurrected by a community charity.

Headway Tyneside worked closely with the NHS and fellow charities, Headway County Durham and Headway Darlington & District, to ensure the programme could continue following last year’s closure of Newcastle-based providers, Momentum Skills.

‘Headway to Work’ is the newly-branded service which will support around 14 people per year living in Durham and Darlington. Each participant will be individually assessed by therapists to gain an understanding of their difficulties, enabling the team to offer personalised support throughout the programme.

The training focuses on improving self-management skills such as self-care, goal setting, productivity, sleep and fatigue management, as well as technical skills such as IT and literacy. The final phase of the programme will involve voluntary placements for participants to ensure they feel comfortable, confident and have the relevant vocational skills before seeking paid employment.

In the future, the group hopes to deliver the ‘Headway to Work’ programme across more parts of the North East, within Gateshead, Newcastle, South and North Tyneside.

Alistair McDonald, chairman at Headway Tyneside, explains: “We all know how incredibly difficult the past 18 months have been. Those with disabilities or long-term health conditions have been especially vulnerable. The Momentum programme was well received and helped lots of individuals with a brain injury plan a route into employment, education or training and it’s fantastic that we can continue to deliver this type of service.

“The service will now be delivered closer to where participants live rather than having to travel to Tyneside. Less travel and being in a more familiar place should help people feel less fatigued and provide an opportunity to socialise and development friendships with other learners local to them.

“Currently, we have around 10 staff, including Julie Meighan our clinical service development manager, who will oversee training sessions run by a neuropsychologist and job coach. Julie worked as a specialist brain injury occupational therapist for many years so has the clinical knowledge and experience this programme needs.

“Our fantastic team of committed volunteers will support the delivery of this vital work to those who want to prepare for a return to work or plan a route into employment, training or education.”

Headway Tyneside is an independent charity providing support services to brain injury survivors and their families. In recent years, the board of trustees has developed a strategy to grow the scale and scope of services to provide more diverse and specialist services to their members.

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Brain injury

Supporting professionals to understand suicidal risk

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Understanding suicidal risk and supporting professionals to deal with such a hugely difficult topic is to be tackled in an event being held next week. 

Life-changing brain, spinal cord and complex injuries can be significant factors in increasing this risk, as a result of the huge spectrum of difficult emotions a person faces in dealing with their new reality. 

And for the professionals dealing with clients going through such trauma, suicidal thoughts and acts can cause great distress to them and it can be difficult to know how to react and what action to take. 

Through the ‘Understanding Suicidal Risk – A Guide for Professionals’ event, held by Sphere Memory and Rehabilitation Team, advice and guidance will be offered to empower those working in complex injury to deal with such situations. 

The webinar, held on Thursday, July 1 from 10.30am to 11.30am, will be delivered by consultant psychologist Dr Clare West, and is raising money for SameYou – the charity founded by Game of Thrones actor Emilia Clarke after surviving two brain haemorrhages, to give a voice to fellow brain injury survivors and to deliver better holistic rehabilitation care. 

Dr Katherine Dawson, director and consultant clinical neuropsychologist at Sphere, says that while the issue of suicidal risk has gained more prominence during the pandemic, for professionals working with brain and spinal cord injury patients and those individuals who have experienced trauma, the issue is ever-present. 

“It is a timeless issue, which can cause anxiety for those around the individuals regarding management and intervention. Furthermore, often individuals really struggle to even voice how they feel and the enormity of suicidality can often silence individuals which then worsens hopelessness,” says Dr Dawson. 

“If someone does share their suicidal thoughts and feelings, in response people often don’t know how to move forward with that.

“During the pandemic, the loneliness and isolation has increased, and very early into lockdown quite a lot of my clients went into crisis as their support network, which provides a lot containment, wasn’t there anymore – while Zoom serves a purpose, it’s not the same as in real life. 

“People hear ‘suicide’ and can panic. There is understandable fear associated with it, and often those around the individual may inadvertently respond in quite a reactive way, wanting to try and fix the issue. We recognise that this can cause significant distress and anxiety and it can be hard to know what to do in the face of suicidal risk.

“Hopelessness is the most immediate risk factor for suicide so instilling hope is essential. The assessments we will consider in the webinar outline how to assess the different levels of risk including looking out for red flags, primary drivers and secondary drivers. 

“We focus on how to complete a suicide interview collaboratively, leading to a clear plan of risk escalation and services to involve at specific times. 

“Through putting the spotlight on a suicide intervention management plan, we can look at this in a thoughtful and containing way, reducing the risk of reactivity and decreasing anxiety. 

“We’ve heard directly from a lot of case managers that risk and managing risk is something they are concerned about, so we hope this event will help them with what is a very difficult topic.”  

Sphere are asking for a suggested £20 donation to SameYou to attend the event. To register, visit here

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