The Pharmaceutical Journal Vol 263 No 7070 p743-745
November 6, 1999 The Society

Birdsgrove House: a progress report

 

It is now 12 months since Birdsgrove House was reopened as a treatment centre for pharmacists and other health professionals addicted to alcohol or drugs as well as for its traditional convalescence use (PJ, November 7, 1998, p741). How is the combined operation getting on? The editor of The Journal (Mr Douglas Simpson) went to the house, which is in Mayfield, near Ashbourne, Derbyshire, to find out

Rory O'Connor (director of Birdsgrove House) has a success story to report. The new treatment unit is filling a latent need - so much so that he is talking about opening another - while guests have been using the convalescent facilities in numbers that match anything that has gone before. The house, he says, has been given a new lease of life. There was a lot of activity and the overall response from patients and guests had been positive.

Treatment unit We spoke first about the treatment unit, which has been created within the former gardener's cottage in the grounds and which has been named Hope House. Mr O'Connor said that there had, to date, been 40 admissions to the unit. He had expected, when plans for the unit were being made, that the first year would see an average of three patients undergoing treatment at any one time. In fact the unit, which can take seven, had had an average occupancy of 4.4. Looking at recent months, occupancy for June had been five patients. This had increased to six in July and increased again to seven in August, a figure that had been maintained in September and October. The projections showed that the unit would be full until Christmas. Most of the patients are referred under the National Health Service, and health authorities pay their fees. So, in light of the good usage level, was the unit self sufficient financially? It certainly was now, Mr O'Connor said. And that took into account some of the costs that had been incurred in the refurbishment that had been needed to prepare the house for the new service. This had included converting domestic accommodation on the top floor of the main house into living accommodation for patients attending the treatment unit. Each patient generally undergoes treatment in the unit for five weeks. Were they all pharmacists? The unit was being used, Mr O'Connor said, by a mixture of doctors, dentists, pharmacists, nurses and veterinary surgeons. Pharmacists were well represented. Pharmacists wanted to go there, rather than another unit that existed for health professionals at Foxleigh Grove, near Maidenhead in Berkshire. The ratio of men to women in the treatment unit was about 2:1. Having health professionals being treated together helped the process. It broadened discussion and took people out of their own professional environments. However, there was little or no discussion about a particular person's profession. Patients were much more focused on the condition that they had and the treatment of it. Patients spent up to seven hours a day in the treatment centre. This was followed by two hours a day outside the centre, going to meetings of self-help groups such as Alcoholics Anonymous. The quality of the meetings locally was excellent. Going out to meetings gave patients a sense that they were in touch with the real world. Were patients still able to conduct their businesses or practices in any way? Mr O'Connor said that they were discouraged from doing so, but the unit was not rigid over this. It was sensible to allow, say, a community pharmacist to deal with urgent matters which, if they were not dealt with, might prejudice his business. And a person booked in for minor surgery would probably be allowed to go ahead with it. Each situation would be treated on its merits.	Rory O'Connor (left) in conversation with David Sunter, one of the treatment unit's four counsellors
	New accommodation is not only provided through the treatment unit: gardener Paul Greatorex has been building nest boxes
	Susan Smith, administrator of Birdsgrove House
	Three of the treatment unit's counsellors, Dennis Lynch, Grant Sharp and David Sunter, in discussion in the patients' lounge

Success rate

So far as the outcome of treatment was concerned, Mr O'Connor said that they were achieving around an 80 per cent success rate, where success was total abstinence from the use of mood altering substances after treatment. This was equivalent to success rates seen elsewhere in Britain and the United States. Statistics were being collected and would be validated and published after a suitable period, probably five years.
Did abstinence include tobacco? Some people continued to smoke, Mr O'Connor said. One of the dangers of trying to tackle tobacco at the same time as the principal mood altering substances was that treatment could go out of focus. It was better to have a single target.
His advice to patients, however, was that it was better to abstain from everything, including tobacco, eventually. If people really wanted to tackle tobacco while in the unit, the unit would try to help. Occasionally, a patient would present who was using tobacco in a mood altering way and needed help because of that.

No major problems

Had there been any major problems with the patients admitted to the unit? Mr O'Connor said that there had not. There had been no early discharges. Two patients had needed intensive support from nursing staff on admission because of gross intoxication, but they had quickly settled down.
If a patient relapsed after discharge, would he or she be taken back? Mostly, relapses lasted only 24 hours, and all that was needed was outpatient admission and a re-examination of after-care arrangements. One person had come back for a second session of treatment as an inpatient.
The people whom the unit was dealing with valued their professional occupation, Mr O'Connor said. They tended to be highly motivated. Furthermore, the treatment team at the centre were also highly motivated and knew what they were doing. They made it clear that there was no other option but total abstinence.
The treatment team was, Mr O'Connor added, as originally constituted except that he had added one counsellor, making four. The rest of the team comprised five nurses, one physiotherapist, a visiting physician and a visiting consultant psychiatrist.

Follow-up

There was a minimum of 12 months' follow-up after inpatient treatment. Sometimes this included daily telephone contact by a counsellor or a nurse, certainly in the early weeks after discharge. Patients would return once a week or once a fortnight for two or three months after treatment. This depended somewhat on distance. Patients came from throughout the United Kingdom.
Mr O'Connor said that he was pleased with the way that things had gone. Patients liked the set-up, where they lived in the house and went to the cottage for the day programmes. They enjoyed the surroundings and the grounds. They had fitted in well with what Birdsgrove House was about.

Guests' reactions

There had been no complaints so far as the treatment patients were concerned. There had, however, been four adverse comments about the treatment unit from convalescent guests. Considering the number of guests who had been to the house during the year (220) that was a small number. Two of the complaints had concerned noise from the top floor of the house where the treatment patients were accommodated. This would be dealt with by improved carpeting in corridors. Two other guests had expressed non-specific misgivings about the mixed use of the house, one of whom had pronounced that "the jury was still out".
In contrast, there had, according to Mr O'Connor, been many positive comments from convalescent guests about the existence of the treatment unit. Every Sunday morning, one of the counsellors invited convalescence guests across to the treatment unit and showed them round and explained the treatment that was given. Most convalescence guests accepted the invitation. This had eased concerns considerably.
Furthermore, there had been many positive letters from pharmacists expressing support for the unit.
Did the two types of guest, treatment and convalescent, mix? Hardly ever, Mr O'Connor said. They might meet in the grounds or occasionally in the snooker room. Treatment patients had little leisure time. There was not much opportunity for contact.
The existence of the treatment unit does not seem to have had an adverse effect on the popularity of the convalescent side of the house. Mr O'Connor said that bed occupancy had been 55 per cent in June, 60 per cent in July and August and 69 per cent in September, the busiest month for over five years. There had been well over 200 inquiries during the year from people who had not been to the house before. That had been translated into 40 confirmed bookings. Regular advertising in The Journal had contributed greatly to the level of interest, Mr O'Connor said. People who had been before also continued to support the house in good number.

Christmas opening

Mr O'Connor said that he had written to previous guests inviting them to come for Christmas and the New Year. The house would be open anyway because of the treatment unit. There could well be pharmacists or members of pharmacists' families who might otherwise be alone during the Christmas and New Year holiday period.
Other initiatives included the offering of weekend stress programmes. Planning for this was well advanced. Up to four programmes could be offered in any one year.
As to expansion of the treatment facilities, Mr O'Connor said that he had thoughts on the subject rather than plans. The level of referrals indicated that additional facilities might be needed in the relatively short term. It would not be appropriate to expand the facilities at Birdsgrove House. The unit worked well because of its size.
Concluding, Mr O'Connor said that many of the staff at Birdsgrove House had worked at the house for many years and had coped with the transition extraordinarily well. They were really pleased about the way things were turning out.
He was delighted with the level of support he had from them, the treatment team and from the Council and staff of the Society generally.

Grateful guests record their pleasure

There does not seem, from The Journal's perspective, to have been any diminution in the pleasure that pharmacists and their families derive from convalescence at Birdsgrove House. Grateful guests tell us about it from time to time. Mr and Mrs Grace-Dutton from Long Buckby, Northampton, wrote to us in August to say that they had been overwhelmed by the kindness, professionalism and warmth of the welcome they had been given. They stayed for 10 days and said that the profession could be justly proud of Birdsgrove House. In September, Mr David Judson of Pelsall, Walsall, wrote to say: "We had five days of superb food, excellent staff and glorious weather. Nothing was too much trouble."

Phoebe Pinder-Houghton: hoping for more use of the house by younger members

A guest at the house when The Journal visited was Mrs Phoebe Pinder-Houghton, who had been several times before. One thing that she missed was always having someone on hand for the convalescence guests. Previously, there had been someone on duty all day and into the evening. Now, the duty nurse finished at 4pm.
Mrs Pinder-Houghton was, however, otherwise unstinting in her praise of the house. "You are spoilt and looked after in every way possible," she said.
She was concerned that the house did not attract younger members for convalescence. "Young pharmacists must be ill in the same way as older members and be in need of peace and quiet to recover," she said. She urged more of them to make use of the facility. "You can be as busy or as quiet as you want," she said.