Orchid Ward: Women's Locked Challenging Behaviour

Care Pathway

Orchid Ward is a ward for women with complex and persistent mental health needs requiring intensive long or short term therapeutic approaches in an enhanced safe environment. It is part of our integrated women's care pathway which includes our medium secure unit Pattison Ward and low secure unit Tiffany Ward within one site at Cygnet Hospital Stevenage.

We also work closely with our sister Cygnet hospitals in joint assessments and collaborative treatment plans aimed at progressing service users along the whole care pathway towards recovery. In addition to this Orchid Ward is well positioned to channel service users to appropriate after care programmes, such as Cygnet Supported Living programmes and open rehabilitation.

Furthermore, Orchid Ward accepts referrals from specialist services i.e. Personality Disorder Units, Eating disorder Units, where behavioural pattern driven by personality traits is extremely challenging and difficult to manage on such units.

Orchid also welcomes referrals of service users with persistent, repeated treatment resistant behaviours where intensive psychotherapeutic approach in a safe environment is required.

Therapy

The underpinning established therapy principles used on Orchid Ward are derived from well recognised therapy models namely Dialectical Behavioural Therapy (DBT) and individual and group Schema-focused therapy. They are used as points of constant reference in this environment as service users have their care imparted in a non-judgemental manner.

Although attendance and participation in therapy is an expectation. We strongly believe that exposure to therapeutic atmosphere, based on DBT approach adopted with all members of the team and examples from other service users can be a good motivating factor for newcomers to participate in therapeutic programme provided. It is therefore not an exclusion criterion if potential service user exhibit resistance to engage in therapy in the first instance.

This is complemented by the use of Behavioural Incentive Planning focused on helping service users individually identify their goals and agree a plan on how to achieve them in joint and collaborative ways with the MDT. Furthermore there are a variety of occupational and psychology based therapies (including offence related work) tailored to individual service users needs.

Core Values & Philosophy of Care

The MDT believes in a non-restrictive; positive risk-taking approach, as this challenges the service users to put into practice and refine the many coping skills they have learnt over time whilst in our care, to their utmost benefit. This is achieved through the use of My Shared Pathway and Recovery principles as well as application of Relational Security.

Our focus of care is ultimately to see our service users live fuller, more independent, reintegrated lives in the community. Whilst at the same time ensuring that their experience whilst in this unit is a meaningful and memorable one.

Admission Criteria

Admissions to the service are based on the level of risk, level of security required to manage that risk, risk in relation to mental disorder and failure to respond to previous interventions. The service will accept admissions whose movements are restricted by the Courts or Home Office i.e. those who are detained under Part III of the Mental Health Act 1983.

• Female
• Age 18+
• Will be detained under the Mental Health Act 1983
• Displaying one or more of the stated behavioural characteristics:
  • I. Self-harming, suicidal behaviour and parasuicidal behaviour
  • II. Aggression and violence towards people and property
  • III. Absconding: usually periodic or persistent, the consequences of the absconding are may be serious
  • IV. Sexually problematic behaviour (not related to particular offence category)
  • V. Dual Diagnoses
  • VI. Personality disorders comorbid with eating disorders, schizophrenia, substance misuse, affective disorders
• Presenting with behaviour that cannot be managed safely in an open environment
• They do not present a grave or immediate risk to others, but can present with immediate risk to self, i.e. risk of self-harm/suicide. There are significant risks in relation to mental disorder or short-term risk/symptoms requiring stabilisation
• They have had multiple attempts at treatment or are assessed as not being able to respond to transitional services but are able to move along the rehabilitation care pathway

Exclusion Criteria

• Patients with severe and chronic cognitive deficit
• Moderate and severe learning disabilities
• Substance misuse as a primarily diagnosis
• Acute episode or relapse of schizophrenic and affective disorder

For more information, or to make a referral, please call the hospital on 01438 342 942.