Through the keyhole: On a decision unit

This is one service user’s account of their time on a decision unit – what it meant to them and what they would like to see going forward.

I am a patient with a long history of mental health issues dating back to my teens, I have had almost 20 years free of admissions until a few years ago. Since then I have spent around half of that time in acute ward settings or on the decision unit. I am also high functioning, with a senior position for a high profile employer…in my spare time.

Initially when the decision unit was suggested to me, I could not comprehend the concept. A ward that is not a ward, with no bed, a mental health assessment centre that wasn’t A&E? However I quickly learned that the decision unit is unique and rather special.

The decision unit is a mixed gender nurse-led assessment unit. As it is not technically a ward there are no beds instead there are reclining chairs, I find them comfy but I have the advantage of my size. It’s a little like flying business class without the champagne and the holiday at the end.

The unit has a supply of cold and hot food accessible 24/7, snacks and fruit, hot and cold drinks. There is a small outside area with table tennis, outdoor chess and draughts and a raised flower bed. The space is open plan and visible from the nursing station. There are also interview rooms, and board games, art materials and information signposting people to relevant services.

People are admitted to the unit for up to 48 hours of intensive assessment, although this can be extended to 72 hours. Patients are voluntary, coming from A&E, Home Treatment Team, or from the section 136 suite, following an assessment which has lifted the section. The issues that bring patients to wards are obviously a mental health crisis or a worsening of an ongoing condition. What is special about the decision unit is that the reasons for the crisis are often addressed there and then, for example, people may begin their journey of detox and are referred on to community drug and alcohol services, and patients whose homelessness or inadequate housing have exacerbated or caused a crisis are supported to attend their local council offices with letters of support confirming their vulnerability. Other patients may benefit from the time on the unit and be discharged back to the community, possibly with the support of the Home Treatment Team, or are admitted to wards.

As you can imagine the decision unit has a rapid turn over, with the patient group dynamics constantly shifting. People are also presenting with a huge variety of issues and circumstances that require the staff to think on their feet and to treat people as individuals, not merely their label or their presentation but the whole of the person. It is my experience that the decision unit considers individuals’ holistic needs, with the individual at the centre. Patients are admitted and have a gateway assessment where the reasons for their admission, presentation, history and needs are considered and this is the start of making a plan of how to best help the patient. An outcome may not be immediately obvious and that is why the extra time, compared to an A&E 4 hour assessment, is so valuable, as it gives staff and the patient to settle, send time together, having regular one-to-ones, time to observe and to find the best possible solution for the patient.

I have a friend who is my next of kin, my person. She is not my carer, although we support each other, and she is not my partner, but she plays a significant role in my life and in my care. Because she doesn’t have a defined role, like a relative or carer, her role is often invisible. Decision unit staff have acknowledged her role involving her in discussions and discussing with her how she is managing and signposting her to relevant groups. They keep her in touch with care plan changes. This is extremely useful as it makes her feel supported, seen and gives her a chance to discuss her feelings about my ongoing and increasing crisis.

For me the decision unit has been life saving, risk reducing and has also been empowering. While I am on the decision unit if there are items on the unit that are triggering urges to self harm these are not necessarily removed. Instead I am given the control in managing them, with the invitation to use the staff when the urge becomes unbearable. This enables me to learn to tolerate an urge and empowers me to work to avoid self injury in the presence of the item. This is essential when you consider that our lives at home are full of items which could be used to harm ourselves, so the decision unit is helping me to develop internal tools to take home and simultaneously to maintain my independence.

If there were things I would want the decision unit to make changes to, I would wish for:

  • Less use of agency staff who do not know the ways of the unit. It’s a lot of pressure for the regular staff if they are the only regular staff member on to manage the admission of distressed patients at night, for example.
  • For agency staff to remember that they are essentially sitting in patients’ bed areas and need to to be quiet enough to enable sleep.
  • More interesting and varied sandwiches and meal options and some yogurts.
  • Duvets (I bring a set of throws as I’m always cold).
  • Alive plants in the flowerbed.

You can be assured that I know how to advocate for myself and others. I am passionate about ensuring people are treated well, that people have their needs met. If I had serious concerns about the decision unit you can be certain I would be raising them; I don’t and I hope I have conveyed why this service is important to me and many others.

I would like to thank the decision unit for their hard work with me and with others who pass through their door. I hope the Trust continues to support the unit to enable its ongoing provision.

*All identifying details have been changed.