In the classroom beyond the wire

23rd May 2003 at 01:00
A multi-curricular, multi-agency spirit of lifelong learning at the high security State Hospital at Carstairs aims to open up new avenues for the patients, writes Eleanor Caldwell

As you drive past, Scotland's State Hospital at Carstairs presents a daunting sight with its high fences topped with rolls of spiked wire. Yet, contrary to popular belief, this is not a penal establishment.

The 240 patients - 90 per cent of whom are men - are, like any other psychiatric patients, there to get better, though they require high security.

In official terms, the hospital provides "treatment and care in conditions of special security for individuals with mental disorder who, because of their dangerous, violent or criminal propensities, cannot be cared for in any other setting". The roll includes sex offenders and murderers.

At reception, visitors undergo the brisk and undaunting airport-style procedures of a bag search and electronic body scan and body frisk before walking out into the grassy grounds. The campus is dotted with a variety of buildings. Head of corporate services Paul Cannon points out the education and community centres, activity and recreation facilities and buildings that contain the hospital's 11 wards.

Visitors are accompanied at all times by a member of staff who carries a two-way radio: the protection and care of both visitors and patients is of paramount importance, says Mr Cannon. The campus is under 24-hour surveillance but the closed-circuit televison cameras are unobtrusive.

Groups of patients and staff are enjoying a sunny day while walking between buildings.

The average age of the patients is 36 and they may stay at the hospital for anything from 10 weeks to 30 years, though the average is four and a half years. To open up possibilities for them, the hospital is adopting a fresh approach to the inclusion of education, says Ian Jones, the new learning and development director.

"We are aiming to expand the role of education and make it more part and parcel of the daily activity of all patients. It will become an integral part of each patient's personal care plan," he explains.

A more structured approach to continuing personal and professional development for staff is also part of the new strategy. For example, staff may also enrol on the European Computer Driving Licence course being taken by some of the patients.

In the two brightly decorated classrooms in the education centre, small groups of patients are working on maths, reading and computing.

Rehabilitation instructor Jamie Morrison says patients have the opportunity to be assessed before choosing their subject areas. The three instructors use a combination of the Suffolk Reading scale, the National Foundation for Education Research profile of mathematical skills and the hospital's own assessment papers.

The patients are also interviewed. "It is important that we know what individuals think is important to them, so that we can then point them in a positive direction," says Mr Morrison.

The range of educational ability is wide. Many patients initially express an interest in the Open University, which they have heard of, but the main focus of learning in the hospital is 13-week, 39-hour open learning courses with Telford College.

Communications, maths and, increasingly, computing courses are available at four levels for three hours of study per week. Mr Morrison hopes to introduce a desktop publishing course run by Stevenson College as a new element to the computing courses. He sees this as a chance to develop more creative opportunities.

Work is sent by post to and from Telford College. Contact with their tutor is very important to the patients, says Mr Morrison. "They are excited to get an assessment back and regard it as correspondence from someone who cares, a bit like a penpal."

Each classroom is equipped with six computers. Patients have no access to the Internet but the education centre makes use of software such as BBC Webwise, which teaches the basic techniques of Internet and e-mail usage.

Game-based learning packages such as the sport-based Play 2 Win are also used.

The patients are encouraged to have an active say in the purchase of new materials, such as books, software or electronic games.

"It's not our place to tell patients what they should be reading or working with," says librarian Gerry Maclean. "Those judgements are made by clinical staff. The library committee make suggestions and requests and, if necessary, we have to justify why material might not be suitable."

A recent award of pound;1,000 from the UK Libraries Change Lives scheme was a big boost.

Classes, with normally a maximum of four or five patients, are run on a very informal basis. Each patient's key clinical worker is encouraged to come along too. The instructors have no access to medical records but liaise with the clinical staff to work within patients' personal care plans.

The hospital hopes to improve support for patients with learning difficulties and is developing a learning package for them.

Sessions on anger management are also organised.

Work with the campus population of small animals - rabbits, guinea pigs and ducks - combines the teaching of care skills with an effective therapeutic approach to treatment.

Patients can also study for Scottish Vocational Qualifications in gardening in the hospital grounds.

Ms Maclean, a former college lecturer, runs a regular book group in the community centre, which includes the hospital library. Patients of all reading abilities attend and she adopts a variety of inclusive teaching techniques to avoid any sense of inadequacy or boredom.

The community centre also has a hairdresser's, a bank run by hospital staff and a shop, where patients can buy a variety of small items, including greetings cards. It also serves as a learning resource for those who have difficulty in working with money.

"A patient can take a certain sum of money, make his or her selection and then be asked to work out the amount of change. It's a small but realistic way of teaching that can only benefit patients when they leave," says Ms Maclean.

The hospital has recently been recognised as a learning centre by the Scottish University for Industry and awarded a pound;20,000 grant, which has been used to buy six computers and six laptops for use by the patients and staff. Ms Maclean sees this as an important milestone for the hospital.

She now hopes to receive funding from the Scottish Arts Council for a visiting writer who will work regularly in the hospital. Scottish writer Ian Brotherhood has already worked with patients through the Scottish Book Trust's Writers in Scotland scheme and his readings and talks about creative writing were popular.

"My aim is to engage people to take one step at a time in whatever direction they want," says Ms Maclean. "The steps are small and incremental but are all contributing to the quality of life."

Keeping fit is important too. The patients and staff are encouraged to participate in fitness programmes in the hospital gym.

There is a tangible sense of care for all among the 550 members of staff.

In a recent audit conducted by human rights expert Professor Alan Miller, under the auspices of the 1998 Human Rights Act, the hospital reviewed all its practices and policies. "As a result, many of our staff have a very high understanding of human rights and we want to build on the audit," says Mr Cannon.

Mutual understanding and respect for everyone in the community is the quintessential ethos, he says.

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