Henderson Campaign: Letters

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Letters can be a powerful tool of persuasion. The letters below are examples of letters which have been written. They may give you an idea of what you might say yourself. It is always better to write in your own words in your own way; but it can be helpful to see how others have gone about it.

If you write a letter, please consider adding it here, as an inspiration to others.

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Contents

Example: AN OPEN LETTER TO THE GENERAL PUBLIC

This letter contains a lot of useful background material and statistics
SERVICES FACE CLOSURE DUE TO CHANGES IN COMMISSIONING: PATIENTS LOSE OUT
A Case in Point
Last year an internationally renowned service providing evidence-based, cost-effective treatment for patients for whom treatment was unavailable from local services, had 97% of target bed occupancy with a waiting list for admission. Now, bed occupancy is under 50%, with funded referrals reduced to a trickle. The Trust is considering closure of the service due to financial uncertainty.
Is this because there is suddenly no clinical need for the service or are other factors interfering with patient care? What has changed?
Between 1998 and 2006, the service was commissioned by the National Specialist Commissioning Advisory Group (NSCAG), :which, based on the success of this service, commissioned the establishment of two similar services, at a cost of over £25m. In April 2006, commissioning was devolved to PCTs. From 2006 to 2007 Specialist Commissioners had the agreement of 121 PCTs previously served by the provider to maintain the service by allocating the devolved money to a commissioning consortium. In April 2007, most PCTs chose not to put this devolved money into the consortium and a new gate-keeping process was put in place. Since then:
  • 50% of patients referred to the service have been refused funding (these are the ones that are known about; funding is meant to be in place before the referral is made).
  • Some patients have already had to wait six months for admission (despite beds being empty).
  • Others may have to wait for years for admission because their PCTs can only fund 2 patients at a time.
  • In some cases it appears that decisions are being made by PCTs that the referral was inappropriate, without an appropriate clinical assessment of the patient.
  • Waiting list targets cannot be kept as funding decisions are taking up to 132 days.
  • Some patients are being denied even an assessment with the service as this would make them aware that there is treatment available, which the PCTs would not then be able to fund.
Patient care is being directly affected by the commissioning process for those needing treatment and those currently admitted. The latter fear the Hospital is closing around them. These patients are people who have grown up in neglecting, rejecting or abusive families or care systems who need a stable, safe environment where they can feel that staff are not preoccupied with the state of the service or their own future, rather than feeling that their past is being repeated in treatment.


What are the consequences?
This service provides treatment for patients with personality disorders. What will happen to them if they can no longer access appropriate treament? A proportion of people with personality disorders engage in self harming or offending behaviours. Treatment can help some from degenerating into offending patterns or committing suicide, and can help others in rehabilitation after prison. Preventing these behaviors improves the lives of both those suffering from the diagnosis and society at large. Currently, there appears little bridging the commissioning of forensic and non-forensic services, yet much evidence that this is needed (see the Corston Report 2007, Home Office website). There is a need for more joined-up thinking.
NIMHE recognised the need for better services in their guidelines Personality Disorder: no longer a diagnosis of exclusion (2003, DH website). Essential new local outpatient and day patient services are being developed but clinicians providing those services still refer some patients who need a more intensive treatment to a residential service. Currently it is the commissioning system that is excluding patients with this diagnosis from receiving residential treatment, whether at the service described or the few others providing this treatment in the NHS. Two of the 5 have already closed their beds in the last 3 years.


Is this happening to other specialist services?
What is the Alternative?
The Health Reform for England (July 2006) incorporates the recommendations from the independent Review of Commissioning Arrangements for Specialised Services. Designated services would be commissioned by Specialist Commissioning Groups (SCGs) to provide specialist Regional treatments listed in the Act. The service above provides one of the treatments on the list, yet this recommendation is not being followed.
People suffering with personality disorder are yet again being denied access to services.
Henderson Hospital Services is once more facing closure.
Dr Diana Menzies
Consultant Psychiatrist in Psychotherapy
Clinical Lead, Henderson Hospital Services
diana.menzies@swlstg-tr.nhs.uk
020 8661 1611
November 2007



Example: LETTER TO A PARLIAMENTARY UNDERSECRETARY OF STATE (Minister)

A Question for Ara Darzi. BMJ (electronic) 30 November 2007
Prof. Sir Darzi's report, "Healthcare for London: A Framework for Action" was launched in July 2007. He is a practising surgeon
For list of other Health Ministers, including Ivan Lewis, click here
Decentralised commissioning may serve general services well but threatens the survival of small specialist mental health services. Would you intervene or allow them to close?
Specialist residential therapeutic community treatment for people with personality disorders is being decimated by changes in the commissioning of specialist services, despite being part of the guidance for service delivery in the NIMHE document Personality Disorder: no longer a diagnosis of exclusion (National Institute for Mental Health in England, NIMHE, 2003), and despite evidence of clinically significant improvement and a cost-offset to the nation of about 90% following treatment (1-5).
This funding crisis is essentially a consequence of devolvement of commissioning from National Specialist Commissioning Advisory Group (NSCAG) to Primary Care Trusts (PCTs). Some PCTs have decided to divert the money to develop local services for personality disorder, understandable when government guidelines recommend this development. However, those personality disordered clients who attend for residential treatment have a greater degree of personality pathology than those who attend day services (6), and referrals for residential treatment are still received from those areas that have local outpatient and day services. This demonstrates what has also been recognised, namely that a range of services and treatment approaches are needed to respond to the spectrum of complex needs of this client group. Furthermore, these are clients for whom intensive, residential treatment is suitable and beneficial (7) and who would be excluded from outpatient therapy due to the clinical risk of deterioration.
Cost-per-case funding was demonstrated in the early 1990s to contribute to deterioration in the service offered to personality disordered clients (8-11). Importantly, cost-per-case does not provide the host Trusts with the financial security that it needs to run the service. Closure is being discussed for the 3 remaining NHS residential services in England. Discussions with private and independent sector providers have not led to anything that would ensure the survival of treatment for the current client group.
When questioned, Ministers for Health say that decisions have to be made locally. Yet the independent Review of Commissioning Arrangements of Specialised Services (12) recognises that those services which are used only sparingly by PCTs need to be funded by collaborative commissioning arrangements, as indeed was suggested by NSCAG in its Final Report (13, 14). Otherwise the skills and experience gained over decades (two of the services predate the NHS) of treating people with personality disorders will be lost. This will add to the impoverishment of psychological treatments available to psychiatric patients (15). Not only will gaps emerge in developing a “seamless” service for people with personality disorders, but closure of these services will also be to the detriment of many who benefit indirectly through the training and consultation provided by the service (16).
While transitions in funding may destabilise many services, there is a strong argument to ensure that public monies invested to date in developing and providing specialist services are used properly, and that the effectiveness of policy and commissioning arrangements, alongside clinical service provision, are subject to rigorous and transparent, evidence-based evaluation.
Diana Menzies, Consultant Psychiatrist in Psychotherapy, Henderson Hospital Services.
References
1. Menzies D, Dolan B, Norton K (1993) Are short term savings worth long term costs? Funding treatment for personality disorders. Psychiatric Bulletin, 17, 517-519.
2. Dolan B, Warren F, Menzies D, Norton K. (1996) Cost-offset following specialist treatment of severe personality disorders. Psychiatric Bulletin, 20, 413-417.
3. Chiesa M, Fonagy P, Holmes J, Drahorad C, Harrison-Hall A, (2002) Health service use costs by personality disorder following specialist and nonspecialist treatment: a comparative study. Jounal of Personality Disorders, 16, 160-173.
4. Chiesa, M., Iacopani, E., & Morris, M. (1996) Changes in Health Service Utilization by Patients with Severe Personality Disorders before and after Inpatient Psychosocial Treatment. British Journal of Psychotherapy, 12, 501-512.
5. Davies S, Campling P (2003) Therapeutic Community Treatment of Personality Disorder: service use and mortality over 3 years follow-up. British Journal of Psychiatry 182 (suppl. 44), 24-27.
6. Lees, J. Evans, C., Manning, N. (2005) A cross-sectional snapshot of therapeutic community client members. Therapeutic Communities. 26, 3, 295-314
7. National Institute for Mental Health in England NIMHE. (2003). Personality Disorder: No longer a diagnosis of exclusion. London: Department of Health
8. Dolan, B. M., & Norton, K. (1990). Is there a need to safeguard specialist psychiatric units in the NHS? Henderson Hospital: A case in point. Psychiatric Bulletin, 14, 72-76.
9. Dolan, B. M., & Norton, K. (1991). The predicted impact of the NHS white paper on the use and funding of a specialist service for personality dis- ordered patients: A survey of clinicians' views. Psychiatric Bulletin, 15, 402-404.
10. Dolan, B. M., & Norton, K. (1992). One year after the NHS Bill: The extra-contractual referral system at Henderson Hospital. Psychiatric Bulletin, 16, 745-747.
11. Dolan, B., Evans, C., & Norton, K. (1994). Funding treatment of offender patients with severe personality disorder. Do financial considerations trump clinical need? Journal of Forensic Psychiatry, 5, 263-274.
12. www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/Commissioning/CommissioningSpecialisedSevices/fs/en
13. www.advisorybodies.doh.gov.uk/NSCAG
14. Pidd, F., & Benefield, N., National Severe Personality Disorder Service Report, NSCAG, August 2006
15. Frauenfelder, C. UK mental health charities call for more psychological treatments. BMJ, 2006;333:936 (4 November),
16. Drescher, U. Evaluation of the Henderson Outreach Service Team Module on working with people with enduring, complex and severe emotional and behavioural problems (Personality Disorder). May 2003. Internal Report.


Example: LETTER TO THE CHAIRMAN OF THE MENTAL HEALTH TRUST

For a list of all of the Trust Board members, click here

John Rafferty
Chairman, Southwest London and Saint Georges Mental Health Trust
Springfield Hospital
61 Glenburnie Road
London SW17 7DJ
Dear Mr. Rafferty,
Re: Henderson Hospital
I feel it is with immense sadness that there is a need to write this letter urging you to consider the future of the Henderson, given that its closure is a very real prospect.
I feel extremely passionate that the Henderson must survive and I urge you to consider the following points:
1. Financial outcomes: Although the cost of treatment per person seems very high, most people who go onto receive treatment at the Henderson have spent most of their lives in a revolving door pattern, frequently accessing and sometimes draining the resources of ill-equipped services such as A&E, primary and secondary care and acute mental health services. Indeed in the 18mths before I went to the Henderson I spent 11 months in a drug and alcohol programme that showed no efficacy in reducing my PD symptoms and 7 continuous months as an inpatient on an acute psychiatric ward interspersed with various trips to A&E after overdosing. In the 3 years since leaving the Henderson I have neither attended A&E nor needed to be admitted to a psychiatric unit and I firmly believe that the cost of my treatment was recouped in the first 12 mths since completing my year at the Henderson.
2. “Worthwhile’ Outcomes: How do you measure if a service is worthwhile? Is it all about how much money will be saved? What difference does a service like the Henderson make to people’s lives? In my case I believe the Henderson saved my life as I am sure that without this treatment, I would have continued with the destructive patterns that frequently resulted in serious self harm and suicide attempts. As a result I would likely be either dead or in hospital or prison. Instead I am preparing to go back into full-time work, looking towards a bright future rather than at a bleak past. Not only was my treatment life saving, it helped me work towards a future, with optimism and a sense of recovery, something I could not have been able to sustain or even conceptualize 5yrs ago. Many of my peers have gone on to educational opportunities, some completing degrees and professional training courses, others going back to work, and many putting something back into the mental health system through service user involvement. The most worthwhile outcomes for the majority of ex-residents include making significant improvements in social functioning, reductions in destructive behaviours and engagement in meaningful activity, these are not easily quantified by cost or financial saving but mean everything and more to those who achieve much after spending most of their lives socially excluded, disempowered, chronically distressed and labeled as ‘untreatable’.
3. The Henderson is a centre of excellence in terms of its knowledge base around Personality Disorder. Many of the newer pilot PD services are influenced in part by the Henderson and the model of treatment it delivers or by training and consultation from the outreach team. Many look to the Henderson as a source of inspiration and expertise and the loss of this centre of knowledge developed over the past 60 years could severely affect sustainability of new and existing services and dilute expertise. I have worked as an expert by experience with the Henderson for the past 2 years and have been continually amazed by the innovative involvement and empowerment of service users which is unrivalled by any other initiatives I have been involved with on local, regional and national levels.
4. Why can’t everyone be treated in the community? Why have residential treatments? It is true that some would benefit from treatment offered in the community, but there will always be some whose behaviours and symptoms are so severe that they could not be contained in a community setting. I was deemed too unsafe to live in the community prior to my time at the Henderson, hence my extended period on an acute ward and this scenario was all too familiar with other residents’ histories. I now live independently in my own flat, an inconceivable thought 5yrs ago. My argument is thus: there are pediatric departments in most hospital trusts, but there will always be need for a specialist hospital like Great Ormond Street, I believe the same to be true with Personality Disorder and the Henderson.
I implore you to find a solution that will secure a future for the Henderson that will allow more lives to be changed for the better. Please take time to read the attached testimonies which illustrate how the Henderson is also valued by those who care for people with PD.
Yours sincerely


  • A Sister’s story:
We are constantly hearing through the media that 1 in 4 people will be affected at some time in their lives by mental health problems, it makes be extremely sad and cross to think that they could even contemplate closing the Henderson. When my sister was diagnosed with BPD we thought ok so they have found the problem but is there a solution. We were so pleased when she was offered a place at the Henderson, and after spending a year there she finally came out the other side. I believe it truly saved her life. Before the Henderson I would call her up and pray that she would answer the phone and that when she did she would be ok, I can't tell you the sleepless nights and worry we all had during that time. She has since started a college course and is going to be a very successful young women. She is a changed person, she is more confident, happy and is managing her BPD so well. Without the Henderson I don't know where she would be today. Please please don't even think of shutting the Henderson down it saves lives.
  • A Mother’s story:
When my daughter became ill, it took two years to get a proper diagnosis. Before this diagnosis, we all went through an emotional rollercoaster, worrying every minute of every day that something terrible would happen to her, as no-one seemed to be able to help her. In the end she was referred to the Henderson. Before she went there, our thoughts were that a year was like a lifetime, and had many many doubts and worries about her being there.
However, after a month at the Henderson we all began to see the light. She steadily and painfully came to terms with BPD, and learned how to deal with many of her issues. The Henderson has taught her to take control of her life and to live it to the full.
We were so grateful to the Henderson, and cannot imagine what would have happened to her if she had not had the time there.
Please don't let it close down. It is the only hospital of it's kind - and there are so many other people out there who would benefit from it's being kept open.
It was my daughter's saviour. Please keep it open.
A very grateful mother
  • Ex-Resident’s story:
I was a resident at the Henderson for eight months, and being there quite simply kept me alive. I learnt to be patient with myself and others, instead of just thinking of myself as "a patient". This is part of learning to care for myself, to think of myself as a person worth saving, worth having hopes for the future, with something good in myself to give to others. I know that being at the Henderson has made a great and positive difference in the lives of many people I met there. It doesn't just save money, it saves lives. The Henderson provides an essential and dedicated service for people who have endured severe circumstances in their lives, and should receive funding to continue providing this service.


Example: LETTER TO A MEMBER OF PARLIAMENT

(Address)
5th January 2008
Dear,
Re: Closure of Henderson Hospital – Sutton, Surrey
I look forward to meeting you on at your . I hope you are able to assist in calling the Government to account regarding the current funding arrangements for health services which have in effect resulted in the planned closure of the Henderson Hospital which is a specialist mental health service that is renowned as a centre of excellence for the treatment of personality disorder throughout the world.
The Henderson Hospital opened its doors in 1947 to treat service men traumatised by the war and soon the benefits of group therapy were discovered. The Henderson Hospital currently treats both men and women with a diagnosis of personality disorder – in effect these are individuals with severe behavioural and emotional disturbance resulting from early trauma, usually characterised by severe neglect and abuse during their childhood. The Henderson has 29 beds and offers residential treatment for up to one year at a cost of £100,000 per bed per year.
Much of the work at the Henderson is about assisting individuals to achieve a position of integration within their psychic world. I often hear about joined up thinking from policy makers but my experience of the Government / DOH is anything but integrated and joined up. I experience it as madness that so much money is being pumped into some parts of mental health services (Forensic Psychiatry) and a centre of excellence is being chopped because it is not fashionable today.
I have worked as a mental health nurse for almost 30 years and it has been an honour to work at the Henderson Hospital in recent years. It is a very difficult and demanding working environment but I have felt very proud to have the opportunity to work within a treatment model that makes a real difference to people’s lives and that of their families.
In the Prime Ministers New Year message he spoke of wanting to pay tribute to the staff of the NHS, the relevance of the NHS in its sixtieth anniversary year and how the NHS remains a priority for 2008. I feel very angry as a tax payer and an NHS worker that the Henderson Hospital is identified for closure having survived its sixtieth anniversary in 2007. I do not experience any praise or admiration as Gordon Brown spoke of in his New Years message from the organisation that employs me. However, as is the case every year at the Henderson many ex-resident send Christmas Greetings. This year in particular is very painful receiving such greetings that are full of admiration for the place when it is about to close. I have never worked any where in the NHS that has impacted upon the lives of individuals in such a powerful way that they continue to send communications for many years after completing their treatment. The Henderson is about making a difference to peoples lived and breaking cycles of abuse and neglect, helping people recover from trauma and loss. There is a research base available regarding the benefits of treatment at the Henderson and the cost-offset in terms of reduction in use of services following treatment.
The decision to close the Henderson is short sighted and I believe a disgrace. In my humble opinion many of those who will now be denied this form of residential service are likely to continue to place demands on other services that are not well placed to respond effectively to the real needs of this client group and for some individuals the inevitable will happen which is behaviour escalating and them ending up in expensive secure mental health beds. I understand from a conference I recently attended that 50% of secure mental health beds are provided outside the NHS (I don’t know how accurate this information is).
I enclose some articles that I hope you will find helpful in understanding the position of the Henderson Hospital and why it is so important for the future of mental health that the service does not close.
Yours truly


Example: LETTER TO A MEMBER OF PARLIAMENT

Dear________
Re: Henderson Hospital
I am writing to you as a concerned member of your constituency about the Henderson Hospital which is a specialist centre serving the needs of people with enduring emotional and behavioural problems that are diagnosed with moderate to severe personality disorder. I wanted to ask if you would be willing to support the campaign to keep the hospital open. South West London and St Georges Mental Health Trust have taken the decision to close the Henderson Hospital in March next year on the grounds that it is no longer financially viable.
Henderson Hospital had been receiving money directly from the Department of Health through a central funding body the National Specialist Clinical Advisory Group (NSCAG). Under this scheme the unit was at full capacity and had a six month waiting list. However, with recent reforms in how the NHS pays for the services it runs the funding has now been devolved to individual PCTs. Commissioners of these PCTs are now refusing to fund referrals unless it is on a cost per case basis. While we still do receive a steady number of referrals from psychiatrist and CMHTs, these are being delayed due to complex and confusing gate keeping procedures for funding. Secondly PCTs have also been refusing to fund 75% of these referrals. Over the past year the six month waiting list disappeared and only 12 of the 29 beds remain occupied.
However its situation is not unique, there are only three Tier 4 (in-patient) services left in the NHS, Henderson Hospital (Sutton), Cassel (Richmond), and Main House (our sister hospital in Birmingham). All are facing similar financial crisis due to reforms in the funding process and are under threat of closure. It is quite concerning to read reports from the Sainsbury Centre stating that PCTs are directing funds away from mental health to underwrite overspend in general health. Also from the CEO Group that presented their report in July 2007 stated that in 2002/03 to 2005/06, London PCTs were spending less than their expected allocated funds for mental health, with some PCTs were spending less than 50% of their resource allocation. However accountability does not solely rest with local PCTs. The Responsible Commissioning policy (part of government Health Reforms for England 2007), state that the funding of specialist services should not be left to local PCTs but should be funded through specialist commissioning groups at either a regional or national level. It remains unclear whether these commissioning groups have been developed by the Department of Health.
There seems to be something clearly wrong with current funding arrangements and needs urgent attention. If the Henderson closes its expertise in training, consultation, and its unique treatment of a difficult client group will be noticeably absent. While these units are not cheap to run, they do save lives within a client group that tend to have a high suicide rate. Research has shown that the cost of treatment can be recouped within two years with a reduction in acute psychiatric admissions. At the other end there has been a concern and outrage from other mental health professionals and also former residents that the Henderson Hospital is being forced to close. It has been a place that has had a significant impact on their lives and helped them and others change.
I would like to thank you for taking the time to read this letter and hopeful that with your interest in the NHS you can present some of the key points to the health minister and ask him some of those important questions about funding, vulnerable service user and the continuing marginalisation of people with mental health, particularly of those with personality disorder. I have enclosed some of the recent news articles that have been released as well as some of the Hospital's literature.
Yours Sincerely


Example: LETTER TO A NATIONAL NEWSPAPER

Dear Sir
Your article about the family service at the Cassel Hospital (Guardian Society, 5 December 2007) exposes the threat to the survival of a small specialist mental health service, despite its highly valued work being within the Government’s stated aims. Sadly, this is not the only example; the Trust Board of S. W. London and St George’s Mental Health NHS Trust will decide tomorrow the fate of Henderson Hospital Services, a specialist residential therapeutic community (TC) treatment for people with personality disorders; it is likely that the decision will be to close it. This is despite residential treatment being part of the guidance for service delivery in the NIMHE document Personality Disorder: no longer a diagnosis of exclusion (National Institute for Mental Health in England, NIMHE, 2003), and despite evidence of clinically significant improvement and a cost-offset to the nation of about 90% following treatment.
This situation is unquestionably a consequence of devolvement of central commissioning to Primary Care Trusts (PCTs). When funded centrally, we had a waiting list for admission of people who had been assessed as suitable for treatment; now, only a year later, patients are being refused funding and more than half the beds lie empty. Some PCTs have decided to divert the money to develop local services for personality disorder, understandable when government guidelines recommend this development. However, research has shown that those personality disordered individuals who attend for residential treatment have a greater degree of personality pathology than those who attend day services, and referrals for residential treatment are still received from those areas that have local outpatient and day services. Without this tier of services these patients, who have typically suffered neglectful and/or abusive childhoods, whether emotional, physical or sexual, will continue to express their distress through various self or other harming behaviours. This flies in the face of Government policies for Social Inclusion, for child care such as “Every Child Matters” (many of the residents are parents) and for the treatment of offenders, for example the Corston Report. The unfortunate consequence is that some untreated patients will end up in secure services or prison at a time when the Government states it wants to address the exponential rise in the prison population.
Since the NIMHE guidelines were published in 2003, two of the five residential TCs in England have closed their beds and the remaining three face possible closure (the other two being Main House in Birmingham and the adult service provided by the Cassel. Discussions with private and independent sector providers have not led to anything that would ensure the survival of treatment for the current client group.
When questioned, Ministers for Health say that decisions have to be made locally. Yet the independent Review of Commissioning Arrangements of Specialised Services recognises that those services which are used only sparingly by PCTs need to be funded by collaborative commissioning arrangements. Funding patients on a cost-per-case basis does not provide the host Trusts with the financial security that they need to run the services and was demonstrated in the early 1990s to contribute to deterioration in the service offered to personality disordered clients. This was one reason why Henderson Hospital Services gained national central funding in 1997, with a remit to replicate its service at two further sites. Yet, one of these TCs closed its beds after only 4 years and the other is one of those under threat. Public monies invested to develop these services (over £25 million) through National Commissioning will have been wasted if they are allowed to close through a change in commissioning structure.
Closure of these services will result in the loss of skills and experience gained over decades (two of the services predate the NHS) of treating people with personality disorders. Most critically, it will add to the impoverishment of psychological treatments available to psychiatric patients. Not only will gaps emerge in developing a “seamless” service for people with personality disorders, but closure of these services will also be to the detriment of many who benefit indirectly through the training and consultation provided by the service. Ultimately, it will again be the most vulnerable in our society who ‘pay’ for the loss of these services.
Diana Menzies, Consultant Psychiatrist in Psychotherapy, Henderson Hospital Services.
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