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The house that users built

March 9, 2001

Adam James tells how Leeds psychiatric patients overcame hurdles to create one of the UK's first user-led crisis services.

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During the eighties a groups of Leeds psychiatric patients shared a dream - that they themselves would one day run a mental health crisis service.

Members of the local branch of Survivors Speak Out used to meet at a community centre and discuss their disillusionment with psychiatry.They criticised the profession for at best being over reliant on medication, and at worst abusing patients' civil liberties. They longed for an alternative philosophy of caring for the city's mentally ill - somewhere patients could receive empathy and social support when in distress, rather than medication and electric-convulsive therapy.

Moreover, they argued, with their own personal experiences they were best skilled to provide this care - particularly human empathy and understanding so often lacking in overcrowded psychiatric wards.

It may be a decade later, but this dream was realised in December, 1999, when a three-storey listed Georgian building in Halton, Leeds, became the premises of Dial House, one of the UK's first user-led crisis services.

Working in partnership with Leeds Social Services, Dial House offers an innovative approach towards mental health care.
Its "guests", while experiencing a mental health crisis, will be offered time and space in a non-medical, domestic setting.

And the expertise of Dial House's one full-time and four part-time support workers lies not in medicine, psychology or nursing, but their own "personal experience of crisis."

"Dial House does not operate on a medical model approach to mental health," explains committee member Terry Simpson, one of the original Survivor Speaks Out campaigners.

"Instead people will receive the social support to help see them through their period of crisis. And users, because of their own experiece, are often best capable of providing this support "
Dial House works on a self-referral system. It is up to an individual to first contact the service by telephone

Staff will then talk through the person's problems to decide whether they should visit Dial House.

"Often we have found that a talk over the phone is all someone has wanted," explains Dial House co-ordinator Phillipa Croner.
"But if they decide to actually come here we will first offer them a coffee and find out how they want to us our service. Some have just had a talk and then gone away. Others have wanted to stay longer. "But essentially we offer somewhere people can off load their problems by talking them through. We do not address a diagnosis but the person's needs, worries and personal troubles."

Croner, who previously ran a mental health day centre, hopes Dial House will ultimately prevent individuals ending up in psychiatric hospital. "Our aim is to reach people before they end up in the psychiatric system. We hope ultimately that a GP will be able to suggest people come here rather than hospital."

Dial House's relaxed, informal and homely environment means it can also cater for families. Staff have already supported a couple suffering "massive stress" while their relationship was falling apart, plus their four young children. "The support we were able to offer was fantastic," enthuses Croner. "Both parents had mental health needs but were scared to approach social services because of previous problems. "But we paid for a child-care worker and while the children were fed fish fingers and beans we worked with the parents! "After they left I spoke to the mother who said how marvellous it was to have been treated nicely. She also mentioned how her kids had had such a good time."

Although Croner believes Dial House is meeting a need, she recognises Dial House can not cater for the most seriously ill.

"People have to be able to stay responsible for themselves. They can not hand themselves over to us to shield them from the real world. However this does not mean people can not come here being very distressed, perhaps hearing voices, or are at risk from self-harm."

Nevertheless, workers at Dial House insist they will never initiate a sectioning of one of their guests. "If it ever came to the situation that we felt someone was dangerous and we wanted them to leave then we would tell them if they did not leave the police would be called. However when people come here and see how nice the place is, and how welcome they are, there should not be the need to get angry with us," says Croner.

Those involved with Dial House hope it will set an example of how users can have genuine power in running mental heath services, turning the buzz words of user/professional partnership into a working reality.

Political battles have, however, had to be won to get this far.
"We survivors did have to struggle for the idea of the service being genuinely user-led," recalls Simpson.

"Most on the crisis-service planning group wanted to extend a social services counselling service which was already in existence. It was mainly users and representatives from the voluntary sector who pushed for a service intrinsically different."

But users' crucial ally within Leeds Social Services was Jeremy Pritlove, a user development worker credited for swinging the planning group to accept a separate user-led service working alongside mental health services already available. "It always seemed quite clear to me that the aim was to create a unique service which complemented those already on offer," reflects Pritlove.

Since Dial House became up and running Leeds' mental health service's main role is to provide Dial House with its own array of skills and experience. This includes day-to-day administration and training. "Social services takes care of pay-roll issues, tax and all the bureacracy. This means I am not having to do it all and can concentrate more on working with guests," says Croner.

In the future mental health providers will be eager to assess whether Dial House offers a creditable complement, if not an alternative, to hospital care. "We have no doubts that we will be able to prove our worth," asserts Croner. "Everybody knows that at the moment the psychiatric system is untenable because of too few psychiatric beds. Anywhere that offers additional support is valuable."

Project profile:

* Project: A crisis service in Leeds managed and run by present or past users of the mental health service.
* History: Dial House is the result of Leeds Social Services's on-going consultation with user groups. It took five years after funding was ear-marked to set up Dial House A planning application was submitted three years ago for a suitable premise but it was turned down. Users say they were the victim of Nimbyism from residents not wanting to share their street with "mental patients".
Dial House's management committee is made up of 12 representatives. The committe's chair, secretary and treasurer must all be a past or present user. More than 50 per cent of the committee must also be users. Professionals serving on the committee include social services's principle unit manager, the health authority's mental health commissioning manager and the chief executive of Community Links, a voluntary mental health housing organisation.
* Funding: Leeds Social Services and Leeds Health Authority made available £350,000 joint finance for a user-led crisis service. The project was put out to tender. Leeds Social Services and local users formed a partnership and were awarded the contract. The Mental Health Foundation has given £20,000 every year for three years to cover Dial House's staff salaries.
* Staff: As well as experience of working in mental health, one of the requirments of the five workers is that they "have a personal experience of crisis". This includes experience of caring for a relative or friend in crisis.
* Clients: People experiencing a mental health crisis. Most guests who self-refer to Dial House have a mental health diagnosis such as schizophrenia or manic depression and have previously been admitted to psychiatric hospital. Many come to Dial House after a relationship breakdown, or are suffering from panic, anxiety, and bereavement. Many are abuse survivors.
* Contact: Phillipa Croner, Dial House, 12 Chapel Street, Halton, Leeds. LS15 7RW. Tel: 0113 260 9328

Practice Points:

* Dial House distributes leaflets and presents talks to other agencies so they can recommend Dial House to clients.
* Dial House operates a self-referral system. Inital contact is by telephone when workers will discuss whether an individual needs to visit Dial House.
* Guests will either be offered someone to talk through the problems or be allowed the space to be alone. Presently Dial House is only open on Friday evenings and weekends. Since it opened 23 people have used the service. The number of guests aceepted in to Dial House at any one time is dependent on their needs. Overnight accommodation is to be available within the next two months, with plans to extend opening hours.
* Staff keep anonymous records of telephone calls and the guests they receive. Instead of conducting a traditional clinical assessment during a face-to-face meeting, staff will record details of an individual's needs. Staff suggest guests consult their GP or psychiatrist about medication concerns. Aggressive or violent guests or those suffering the effects of alcohol or drugs will be asked to leave. This does not mean they can not return later.
* Leeds Social services offers training and support to Dial House staff.

© Copyright Psychminded, March 2001