Service Specification

The Crisis Centre was established in 1973 to provide personal, psychotherapeutic support to individuals, couples or families threatened by mental and social breakdown. Our goal is not simply to alleviate mental pain or to stop bizarre or disruptive behaviour, but to contain it and help people make sense of it. We believe an emotional crisis can be a turning point, an opportunity for growth and development.

1. As an early intervention service the Centre is particularly suited to those undergoing a first time emotional breakdown. The service offers a specialized alternative to hospitalisation with its emphasis on care in the community.

2. We provide an intensive care service based on our long-standing experience of working with people, many of whom have been diagnosed with schizophrenia, depression, borderline or adjustment personality disorder, anxiety or eating disorder, self-mutilation or other.

Some men and women have been referred to us because of our record of working successfully with individuals who have not responded to drugs and/or long periods of hospitalisation.

The Centre has had many placements by psychiatric and social services of individuals not able to benefit from a hospital environment, and otherwise too fragmented to be able to use a therapeutic community or group home. In this respect, the Crisis Centre has proven a unique facility working in a psychodynamic way with otherwise unmanageable individuals.

Between 1983 and 1985, our data showed that 31 % of each week was occupied by guests belonging to ethnic minority groups. They came from various religious and social-economic backgrounds. The age range was 15-60 and the female to male ratio was 6:4.

The Arbours Crisis Centre is registered under the Registered Homes Act 1984 and is a facility of the Arbours Association, a mental health charity founded in 1970. As part of the Arbours Association, it benefits from close links with the three residential long-stay Communities, the Psychotherapy consultation service, and the Training Programme of the Arbours Association. As a unit, however, the Crisis Centre is functionally separate. It is situated at 41 Weston Park, London N8 9SY in the area of Haringey, and it offers a specialized service to people in severe emotional distress. The Centre receives referrals from Psychiatrists, Psychotherapists, Psychoanalysts, General Practitioners, Social Services, Health Authorities, and the Probation Service, as well as direct requests for help from all areas of the UK and from abroad.

The Crisis Centre provides an immediate specialized response to acute emergencies through its crisis consultations whether at the Centre itself or, when indicated, at the caller's own home. The person(s) concerned are asked to meet with a team of therapists in order to assess the nature of the crisis and the kind of intervention that may be most useful. The team, consisting of a Resident Therapist, senior Psychotherapist and, when appropriate, an Arbours trainee Psychotherapist or other professional, serves as their primary source of support. The consultation offers clinical assessment and referral for individual, group, family or couple therapy or residential treatment.

The consultation may in itself become a focused crisis intervention or brief Psychotherapy which aims to help people quickly resume normal functioning and remain within their home environment.

The Crisis Centre can accommodate up to six residents at any one time. The period of care varies from a few days to several months. The six spaces are divided according to three categories:

1. A Short Stay: A few days to 4 weeks 2. A Medium Stay: 1- 4 months 3. A Long Stay: 4 - 12 months.

The length of stay reflects the degree of disturbance and need of the guest.

Three Psychotherapists live at the Centre, a substantial Edwardian house. They are assisted by a resource group of Psychotherapists, Psychiatrists, Psychologists, Nurses, Social Workers, Art and Movement Therapists and other professionals. The nine-strong Team Leader group operates an on-call rota covering the Centre on a 24 hour basis. A Nurse specialist is also on call at all times. There are close links with the GP practice in the area.

For the Resident Therapists, this house is their home. People who come to live at the Centre with them are their guests. Each guest has her/his own comfortably furnished room. There are communal rooms and a garden shared by all. A Financial Administrator and Clinical Assistant provide the administrative support to the Centre and its guests before, during and after their stay at the Centre. Together with the Resident Therapists, they negotiate for and on behalf of the guests with the Department of Social Security, Local and Health Authorities, employers, and insurance companies. They also liaise with other professionals such as Psychiatrists, Social Workers and General Practitioners.

Every guest participates in three different but connected systems of therapeutic intervention:

1. The Team: 3 or more meetings are held per week. In addition, family and/or couple meetings are organised when indicated.

2. The Group: 4 house meetings a week, plus art therapy and movement therapy once a week.

3. The Milieu: There are many opportunities for informal discussions with the resident therapists and with other guests who may suffer from the same problems.

Usually all the therapeutic work takes place at the Centre. If other professionals such as Psychiatrists or Social Workers are involved, they are invited to the Crisis Centre for meetings. However, when a guest is already in treatment before coming to the Centre, this may continue. We do our best to consult with the previous therapist and the resultant work may then be a collaborative effort.

A Care Plan is drafted at the beginning of each guest's stay which sets out our aims and what we hope to achieve as well as the number of Team Meetings necessary, and any other input such as Family or Couple Therapy in addition to the House Meetings, Art and Movement Therapy.

Ongoing monitoring of progress and planning of care takes place at the weekly clinical and administrative meetings.

Care is taken so that the guest's privacy, dignity, religious and cultural beliefs are respected and practical arrangements are made to accommodate them. During their stay guests determine how to spend their time outside meeting times. There is an evening meal arranged by the Resident Therapists and attended by everyone living in the house. Breakfast, lunch and refreshments are available to be taken at individually suitable times.

Guests are welcome to attend the social events of the whole Arbours network as well as participate in the day to day activities and events of the house. Theatre and cinema visits, concerts and various day trips as well as swimming and sports activities are organized by resident therapists and guests. Daily newspapers and various magazines are available in the lounge and guests are provided with opportunities for social and self-development.

Three Outcome Studies (1973-78, 1985-88, 1992-98) show that the most common outcome for guests is to return to their homes and resume their lives. Where further support is necessary, we can arrange for continued psychotherapy or residence at an Arbours long-stay therapeutic community. Since it was established in 1990, many former guests attend the Crisis Centre Support Group.

In all cases follow-up meetings are arranged and guests are sent two questionnaires to fill in so that we can get detailed feedback about their stay.

The work of the Crisis Centre has shown that individuals, couples or entire families can emerge from a period of emotional and mental breakdown with a greater degree of ego strength and heightened social functioning when given sufficient time, space and understanding.

The Crisis Centre Support Group is a service offered to clients while waiting to come to the Centre for a stay, or those leaving the Crisis Centre needing on-going support.

It has been developed to form a bridge between the supportive environment of the Centre and the outside community. The programme includes psychodynamic Group Meetings with an informal approach where social and practical problems may be identified and discussed, and an Art Therapy Group. Advice on accessing other resources, housing, employment and other support is provided. The meetings take place during twice weekly two hour sessions.

The programme is run by a Psychotherapist and an Art Therapist.

The Crisis Centre offers a comprehensive programme of placements to individuals training in Psychotherapy, Psychiatry, Social Work and other related areas.

All trainee Psychotherapists with the Arbours Association are expected to do a six-month placement at the Centre. In addition, many professionals from the United Kingdom and overseas have successfully completed placements at the Centre, and have contributed to the widening network of professionals interested in our work. Placements at the Centre are a recognised part of several social work CQSW training courses, as are placements for nursing students on the RGN Project 2000 Course.

The Crisis Centre recognizes the need for extensive and immediate support for all professionals working intensively with disturbed and disturbing individuals.

For the Centre's Resident Therapists there is weekly individual and group supervision as well as a commitment to at least three times a week Psychoanalytical Psychotherapy.

The Resident Therapists come from various professional backgrounds, including Psychology, Psychotherapy, Social Work, Medicine, Nursing and Art Therapy.

Team Leaders meet regularly as the management group to review the overall running and policies of the Centre.

The Arbours Crisis Centre draws on the experience of a number of therapeutic environments established in the 1950s and 1960s in Britain. In particular the Centre was influenced by the seminal work of Dr. Thomas Main at the Cassell Hospital, Dr. Maxwell Jones at the Henderson Hospital, Dr. Murray Jackson at the Maudsley Hospital as well as Dr. R.D. Laing at Kingsley Hall. All of these units used psychodynamic methods to help severely distressed and psychotic persons.

The Centre was also strongly influenced by pioneering projects in Crisis Intervention established by Dr. C. Murray Parkes at the London Hospital and Dr. R.D. Scott at the Napsbury Hospital. These and other efforts contributed to the recognition and acceptance of a community-based model of mental health provision.

In the United States the work of Dr. Loren Mosher, former chief of Schizophrenia Studies at the National Institute of Mental Health (the Soteria Project) and related projects in the United States, Italy and France have also provided a strong impetus to our work.

The Centre itself is a system of interrelated and interrelating therapeutic units consisting of the milieu, the group and the Team:

1 . The milieu is an active interpersonal environment comprising the Resident Therapists, Team Leaders, Consultants, several other professionals, trainee Psychotherapists, and fellow guests.

2. The house group consists of all the people who live in the Centre: guests and resident therapists. The house meetings are concerned with social relations. They draw on a variety of methods including role-playing to help the guests to integrate their experience at the Centre and move towards growth, responsibility and independence.

3. The Team consists of a guest, Resident Therapist, Team Leader, and, if appropriate, a trainee Psychotherapist. The team's primary task is to focus on a guest's internal reality: phantasies, dreams, memories, etc. By exploring the transference relationship that develops in the Team we seek to identify and ameliorate the symptoms that occur when these elements are in conflict with each other or with normal social mores and pressures. Thus, in the Team Meetings we work on the problems of the guests at the deepest level.

As internal reality is quite often unbearable for the majority of our guests, the work of the milieu and the group may be directed towards helping them enter and use the team space. In this sense the Centre as a system of interrelated units allows for intervention on multiple levels and, as such, is a uniquely intensive and thorough programme. Ultimately, the direct goal of the milieu, the group and the team is to enable the guests to resume their way - sometimes long interrupted - towards growth, independence and autonomy.