Soft, neatly folded blankets hang invitingly over the backs of the modern but comfy armchairs in the Gellinudd Recovery Centre’s communal living room. In the en suite bedrooms, there are white waffle slippers and dressing gowns embroidered with the centre’s tree symbol.
Staff and guests – those who stay are not termed patients – join forces to cook, clean and tend the fruit and veg they then sit down to eat together at Gellinudd, which is the UK’s first inpatient mental health centre to be designed by service users and their carers. “If you’re a psychiatrist you’ll still be expected to be in the kitchen chopping vegetables alongside everyone else,” says the centre’s director, Alison Guyatt.
Over three years, via consultation meetings attended by up to 50 people and annual general meetings attracting as many as 300, service users and carers who are also members of the Welsh charity Hafal, which runs the centre, have influenced everything from the policies and procedures to the decor, facilities and recovery-focused activities on offer.
“They’re the experts,” says Guyatt. “They can say how it feels to be on the receiving end of care, how anxious you would be, what your concerns would be. They have such powerful stories to tell.” The lack of privacy and dignity in hospital settings, together with old and decrepit buildings that provide little access to fresh air, were common themes among those who gave input. “A lot of them feel very clinical, rather than homely and welcoming,” Guyatt says.
Ensuring a different atmosphere at Gellinudd, which opened in April 2017, was therefore critical. Members met the architects in the earliest stages, and Guyatt arranged for furniture makers to bring chairs, tables and beds to consultation events to be tested.
Hafal believes co-produced, recovery-focused services improve outcomes for patients and reduce costs. It has estimated that Gellinudd, which was developed with Big Lottery funding of £1m and £500,000 from the Welsh government’s Invest to Save scheme, will generate year-on-year NHS savings of £300,000 in Wales.
Could the model be copied elsewhere in the UK? Commissioners are increasingly interested in co-production, according to Grazina Berry, director of performance, quality and innovation at the Richmond Fellowship, a voluntary sector mental health support provider that involves its users in shaping services. But the resources to make it happen are not necessarily available.
“We’re seeing many more opportunities coming up which directly ask for co-produced innovations,” Berry says. “But the money to match that isn’t always there because funding is reducing. We as a provider can say we’ll implement a whole range of innovative services. But to prove they work we want to evaluate them, and evaluation costs money.” Berry has no doubt that services designed with users bring better outcomes: “They give power to the people who understand recovery the most.”
At the National Survivor User Network (NSUN), a charity which helps mental health service users shape policy and services, managing director Sarah Yiannoullou believes the extent to which service users are listened to remains patchy. “There are some really good examples where the rhetoric is starting to become the reality, but it’s not consistent,” she says.
“I think we’re still in a system where the medical model is dominant and there’s this culture that the professional still knows best. The problem for the voluntary sector is that quite often what you say works and helps is regarded as anecdotal or dismissed as not credible.”
But it is crucial service users are listened to: “Meaningful, effective involvement can transform people’s lives, improve the quality and efficiency of services and develop the resilience of communities,” says Yiannoullou. “If commissioners and clinicians really listen to us, respect us and treat us as equals then our experience of services will improve.”
Designed by patients: the mental health centre saving the NHS £300,000 a year
