Articles About The Centre

"One woman used to jump on my back when I went to answer the phone because she said I was keeping her from her boyfriends who were calling her. I would find myself chasing after the phone with her. We found her father had intercepted calls from boyfriends and that made her actions understandable. There's nothing very magical in what we do, although I think the house itself has a calming atmosphere. It provides a place for people to come during a particularly difficult time of their life and gives them time and space to begin to look at themselves in a different way."

Tom Ryan, the speaker, and Sally Berry were the first resident therapists at the Arbours crisis centre. (The temporary dwellings where the Israelites sheltered in the wilderness after the exodus from Egypt were called "arbours.") The centre was set up in 1973 to help people going through an acute emotional crisis.

"We wanted a place where people could go as an alternative to a mental hospital," says Dr Joseph Berke, director of the centre, "but where they could get psychotherapeutic help to understand the crisis they are going through." The ideas behind the centre are similar to those of R. D. Scott and his team at Napsbury Hospital, where the human approach is considered the most important therapeutic method of helping people overcome a crisis (see "Psychiatry at home," David Cohen, 2 March).
"We take individuals, couples or families -along with their babies, dogs and cats at a moment's notice. We can give them personal support, in the sense that two therapists actually live with the 'guests' who are there. This creates a very intense, immediate relationship, where people can reveal themselves and their problem more easily. It avoids the situation you get in hospital where because of staff changes, like night and day nurses, disturbances arise."
The centre tries to overcome problems like this which are associated with institutionalisation-for example, the people who come to the centre are not stigmatised as "patients" but are called "guests." This is because people who have been in mental hospital have a conception of themselves as patients and it colours their self-image.
Since the centre was set up, the phone 01-450 6896-has rung constantly. "When a person first calls the centre," says Berke", we assess whether it is a crisis in which we can reasonably intervene. Sometimes we can help by sessions over the phone. But we try to go to their home if possible, because the crisis usually involves the whole family. We also pay particular attention to who is making the initial call. If someone calls about himself, that is a good sign: much more positive. But a wife who calls up about a depressed husband may also be depressed and need help."
We also need to know if the problem is happening now, and is acute, or if the person has already had treatment. The more treatment they have had, the more difficult it is-a person will expect medication, for instance, or to obey 'orders.' In these circumstances, we might consider it more appropriate for them to go straight into one of our network of long-stay community houses. There, more emphasis is put on collective responsibility: in the crisis centre, people sometimes help with the meals, but it isn't expected."
The crisis centre is a house in a quiet, residential neighbourhood of north London. The day I went there, there was only one guest: a young man, with a tenuous hold on sanity, who had been there five weeks. He was sitting in the kitchen, drinking tea. "Every day, I have cups of tea, sit here and sometimes go for a walk along the road or sit in the park for a while," he said. "Sometimes I have meetings with my parents."

The therapists

The present living-in therapists, Iona and Bob Grant, have only been at the centre themselves since June. "In our short experience here," says Bob Grant, "the people who come here are often so regressed, it is difficult to structure their day for them. They just need time and space and caring. So we don't demand that they get up or go to bed at a certain time. If it's someone who has been in hospital, they expect a routine and it takes a while before they realise it is not going to happen."

Iona and Bob Grant are the fourth resident couple to live at the centre. The first Sally Berry and Tom Ryan-knew no more than the "guests" what to expect. We found that a potentially explosive situation had to be dealt with immediately and that we somehow had to make sense out of it. It's why we developed the idea of having a team leader outside the house involved coming in whenever necessary. It's a support system. When you are working with very distressed and disturbed people, you need to be able to talk to others outside. The kitchen became a major room where people congregated and drank tea and milk. If someone was not involving themselves in the house, it was a cause for concern.
"The most common situation where we were asked to intervene was acute depression and these were helped through being here and being involved in the relationships in the house. The way most people deal with depression is to go to the doctor and get a drug, and then get hooked. No one tries to find out why the person is in such despair.
"People usually contact us after some kind of incident: there's always an issue to focus on. The point would be to try to help people to explore, to get beyond the symptom they are presenting. We don't see a crisis in terms of one person, but as involving several members of the family."
One girl, for instance, had been anorexic for two to three, years. The therapists saw" the whole family and found that eating was an important family activity. One of the issues was the girl's autonomy, her breaking away from the family. They tried to change the focus from her anorexia and opened it up into the family relationships, helping the parents to realise it was not their fault. They saw the family weekly for a year and the girl started eating again.
Another adolescent girl was considered mad by her parents because she had run away from home, and ended up at Napsbury Hospital. Dr Scott decided that hospital wasn't the place for her, but that she needed a refuge, and referred her to the centre. "I thought there was something wrong with my brain," she says. "No one seemed to hear me when I spoke."
At the centre, she gained "independence from my parents for a short while" and found "a carefree attitude which sometimes pleased me and sometimes made me feel lonely and in the end I realised that I still depended on my parents." The centre's therapists saw her family several times and after four to five weeks the girl returned to her parents and school.
In another case, a man came to the centre after having been at a psychiatric hospital. He claimed he had seen a green man in the road and thought he had run over him. In hospital, he "saw" green hands coming at him through the window and became violent and smashed the glass. At the centre, it was found that he had written a long novel about creatures from outer space and his preoccupation with them had got out of control. He had become violent when he "saw" the green hands at the window, because he thought he was under attack. The hospital had drugged him, but no one had tried to find out what lay behind his actions. "Whatever their behaviour, violent or crazy," says Sally Berry, "We try to make sense of it to them. But sometimes they don't want to change or understand."

One family who came were crofters in Scotland. The wife had just had a baby and this proved to be a major crisis in the husband's life. He hacked off his finger to regain attention. Within hours he was having ECT treatment in Scotland. The couple and baby came to the centre. At first the husband was difficult to cope with as he regressed to childhood, but with the support of the resident therapists Andrea Sabbadini and Laura Forti he finally managed to discuss and accept the situation.


As Berke pointed out in his book, Butterfly Man, published by Hutchinson last year, "Our object is not just to stop the bizarre or disruptive behaviour, but to contain it within a network of sympathetic individuals . . . fortunately the neighbours have tended to be tolerant-especially when one young guest, a nurse from New Zealand who had freaked out, rang all the neighbours' doorbells and announced that an atomic bomb was about to go off."The staff, too, often have to cope with disturbed behaviour. "When I first lived here," says Sally Berry, "one of the women guests began to say that she was me. She would come into my room and get my clothes and come downstairs as me. She would answer the phone and say she was me. I began to find it difficult as she was absolutely convinced she was me, and it helped to talk it over with an outside member of the team. I managed to convince her in the end that I was clear who I was and she must try to find her own identity."
The centre's present therapist had only been resident one night before a bottle was thrown through their window: "It was a reaction to our being a couple, having a sex life. The guests behave to us as they would like to behave to their parents: they try to keep us apart, or tell one of us things and not the other."
In a follow-up study of the centre done by Ruthie Smith last year, 15 out of a group of 20 said that they found the therapists' support was adequate. ("I had no sense of being patronised or being condescended to." "I enjoyed ... being able to have honest, open conversations . . . at no time did I feel like a patient.") Many of those who had been in hospital described their experience there as "punitive"-locked wards, enforced seclusions, leather restraints, cold packs, excessive ECT and medication. They were particularly aware of the sense of freedom at the centre.
'A fragmented oddity'
Those who had been in hospital were more likely to describe themselves as mentally ill, considering they were "mad," crazy" "mentally ill and ready for a psycho ward," "a fragmented oddity," "suicidal," "frightened," "regressed," and generally "desperate" Most of these found Arbours' attitude to mental illness helpful. '
One girl I spoke to, Jane Johnson, had been in a psychiatric hospital twice, with breakdowns, before contacting the crisis centre. The first time, her father signed a form authorising ETC treatment "and that did not do me any good." The second time, she went into an expensive nursing home.
"I did not want ETC again, but they tried to sedate me. I realise this because a friend was visiting me and we asked for some tea and when I went to the door to collect it, the nurse wouldn't give the cups to me. I knew she wanted to hand them out herself.
"I was amazed at the effect it had on me, being at Arbours. I became a much happier human being, more independent. I realised it was important that I had to do some things myself. I was asking people to get me some tea, as if I was special."
At the time that Jane contacted the crisis centre, it was full. As she was in acute distress, Morton Schatzman, a director of Arbours and, like Berke, one of the cofounders, took her in to live with his family. He and his wife usually have young people staying in their house and occasionally take in rather desperate people, like Jane. "The idea of a psychiatrist taking people in distress into their home is not new," says Schatzman. "It provides them with a structured situation in which they live among a high proportion of sane people. A person with sane support is likely to do well."
Dr Schatzman's young children unwittingly act as a solid foundation of sanity. Listening to Peter, who came to the house labeled a "paranoid schizophrenic" and believed himself to be a servant of the Goddess of Destruction, they tell him he has "tapes in his head" and tease him. `You have to be a little bananas to live in this house, but Peter is big bananas," says one.
Even though the Schatzmans may help out in an emergency, the size of the crisis centre -it comfortably takes only three to four people-is proving insufficient to meet the demand. Larger accommodation is being looked for, but there are the inevitable financial problems. Arbours is a registered charity, and guests pay on a sliding scale but the centre-assisted by a resource group of psychiatrists, psychologists and social workers-costs over £300 a week to run.
Having somewhere to go to, at a time of crisis when the family can't cope, has helped a great number of people: statistics show that most of the guests at the centre returned home and carried on with their lives.
Perhaps its most important function, however, is to prevent people from embarking on a "career" as a mental patient. "One young woman who came to us had spend seven years in a mental hospital," said Dr Berke, "and had every kind of treatment. She had been recommended for lobotomy but had refused. She had outbursts of rage and depression and there was nowhere her to go. The parents asked us if we would accept her. It turned out that she , frightened that people couldn't understand her state of mind, her violence. I told her that she had to decide if she wanted to be a mental patient the rest of her life, or person. It was a hard time for her, but from the centre she went on to one of our long stay homes, and then to university."
Where the crisis centre helps is not with an immediate, explosive situation, with that far more important key decisions whether one is going to be a "mental patient or a "person."