Street and the Eric Burden Community

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"STREET AND THE ERIC BURDEN COMMUNITY: WHY THEY LIVED AND WHY THEY DIED. ISSUES OF LEADERSHIP"

by Geoffrey Pullen

ABSTRACT

The first part of the paper is an edited transcript of the Peter van der Linden Lecture, “Leadership In The Garden”, given at the Association of Therapeutic Communities' Windsor Conference in 2003. It is a personal account of some aspects of two Therapeutic Communities, Street and the Eric Burden Community (EBC), where mentally ill people were treated in an NHS hospital setting. The author identifies four factors which he believes contributed towards their success: an open management culture, the communities’ leadership, the multidisciplinary team, and the presence of student nurses. He suggests that changes in each of these four areas contributed to the eventual closure of the EBC. In an afterword the author responds to some of the comments made about the original paper and discusses some of the challenges now facing the leadership of British Therapeutic Communities.



PETER VAN DER LINDEN LECTURE

Some will be familiar with the work of the Eric Burden Community as we presented and published a number of papers about it at Windsor and elsewhere over the years (most are listed in Pullen,1998b or Pullen,1999). Few, I suspect, will ever have heard of the Street Community, an experiment in running an acute admission ward as a formal therapeutic community which ran for about five years from 1976. I have been partly prompted to write about Street again because in the last five or six years before I retired I had to visit many acute admission wards in various parts of the country. (I took on the task of tracing and monitoring Oxfordshire patients receiving care outside of the County.) These were rarely happy experiences for me and I often felt an atmosphere of tension and threat and, even if nominally open, a culture of surveillance. All too often the patients did not seem to be engaged in any meaningful activity and I am afraid the nursing staff would usually be found in the ward office filling in various check lists, assessment forms, care plans etc.

During the time I worked at Street it was the only admission ward serving a population of about 150,000 from the city of Cambridge and the old County of Huntingdonshire. Its 40 mixed sex beds were in Kent House which opened in 1964, a typical two storey building of its period with numerous doors, large areas of glass and no concessions to the needs of “security”. The facilities on Street included a small suite where a mother could be admitted with her baby and, occasionally, her partner. The ward had been built with a seclusion room, the Blue Room, but we closed it in 1977 . Those of you who have only worked in British psychiatry in recent years may find it hard to believe that we had no access to secure facilities. If a mentally ill person from our sector needed treatment he or she came to Street whatever their presenting behaviour.

During the four years that I worked in Street we consciously introduced the therapeutic community model with all its traditional features including community meetings, small groups, activity groups, democratic processes etc. Many of the patients were floridly disturbed, but most only stayed for a very short period of time. In fact the average length of stay during a study carried out in 1978 was 16.8 days. A visitor to the ward then would have found a mixed group of up to 60 to 70 people, staff and residents, interacting in a typically vibrant TC way. Obviously from day to day the atmosphere was shaped by specific factors. A floridly manic patient will always energise a community, whereas the presence of a toddler brought out something quite different in all of us. The very heterogeneity of the group was often a strength in itself. We made no apologies for the fact that we were a psychiatric ward treating people with mental illnesses using the full range of conventional treatments, even including ECT for profound depression. We believed, however, that if for whatever reason you have to bring a group of people to live together you might as well make that living together a positive experience. I had been a Psychiatrist long enough to know something of the anti-therapeutic forces that can be unleashed in a psychiatric ward. I had previously worked on an acute admission ward attached to a London teaching hospital where the ward sister greeted me on my first day with the reassuring news that she would tell all the patients that they were not to talk to each other about their problems because she knew that I would see each of them at least once a week. Few will be surprised to learn of the outbreaks of wrist cutting and, later, jumping off the roof that occurred on that ward.

I believe that we demonstrated in a purely practical sense that running Street as a Therapeutic Community worked. We compared it with the two other acute admission wards at Fulbourn, both very good wards, which served virtually identical populations. We showed that although each sector generated almost exactly the same number of first admissions we managed to halve the length of stay of our patients compared to the other two wards without any increase in the number who had later to be readmitted. I might also add that during the four years I was at Street only one patient committed suicide whilst a patient on that ward and only two staff days were lost through injuries sustained at work (Pullen, 1982).

At Fulbourn I became convinced that therapeutic communities could and should be therapeutic also for the staff. In my opinion it is legitimate for staff who work in a Therapeutic Community to have some of their own therapeutic needs met by that opportunity. To deny the reality of such living-learning experiences is, in my opinion, as fatuous as the Sister who demanded that the patients living together on her ward did not interact. It is perhaps worth drawing attention to the fact that another study from Street showed that over two years the number of nursing days lost through sickness was only three quarters of that of the other Cambridge acute admission wards.

I would like to highlight four of the factors which I think contributed towards the success of the Street experiment: the first was undoubtedly the fact that since 1953 David Clark, initially as Physician Superintendent, had encouraged at Fulbourn an open management culture accepting of experimentation. David called the style of leadership he developed “Administrative Therapy” (Clark, 1964; Pullen & Clark,1983).

This leads me on to what I consider was the second important positive factor, the actual leadership of Street. Street originally had three Consultants, although one retired and was not replaced. All three of these Consultants had very extensive responsibilities away from Street where, of necessity, they spent comparatively little time. I would like here to pay tribute to Oliver Hodgson, one of those dedicated hard working clinicians who rarely have the time to speak at conferences or publish papers and whose contributions, therefore, tend to be forgotten. Oliver brought a warm open minded wisdom to the unit and contributed greatly to a sense of security felt by the rest of us who worked in the Community. The second pillar of the leadership was the ward Charge Nurse, Larry Nicholas. Although I think he would have been offended if I had said this to his face, I felt that he was the “mother” of the Community. Immodestly I include myself as the third pillar of the Community leadership bringing, I like to think, dynamism and ideology to the team. Whatever the truth of all that, my experience at Street convinced me of the importance and power of the Therapeutic Community concept of multiple leadership.

The third strength of Street in my opinion was the multi disciplinary team, a topic I intend to return to. The fourth factor I want to highlight were the student nurses, of whom up to 20 were attached to the ward at any one time. Fulbourn, like most Psychiatric hospitals of the time, had its own nurse training school, with training being largely carried out “on the job”. The high reputation of the hospital meant that it had no difficulty in attracting good quality students. The nursing school was also not afraid to take interesting men and women who had had some experience of life but few formal qualifications. This resulted in every ward, including Street, receiving a constant stream of bright, energetic young women and men, hormones at their peak, eager both to learn and to question. On Street we took full advantage of both the energy and the enthusiasm of the student nurses and fully integrated them into the Community. We were not afraid to give them responsibility and I cannot say that we were very often let down. As well as, I believe, a very professional approach to caring for those who were suffering, it was often fun to work on Street. Given that Fulbourn by then had a 25 year history of the Therapeutic Community approach I think that it was quite an achievement for the Street team to be able to provoke envious fantasies elsewhere in the hospital about the orgiastic behaviour of the staff. Mostly they were untrue.

In 1980 I moved to Oxford where for over 20 years I was Consultant to the Eric Burden Community at Littlemore Hospital. It was part of a network of services, the Young Adult Unit, which supported the hundred or so young men and women living in Oxfordshire who were identified as having the most disabling and often dangerous psychotic disorders. I think by any objective clinical, financial or managerial criteria it was a successful service. One outcome criterion that is particularly important for me is that during that twenty odd years only two of the members of the extended Community committed suicide, both tragedies, but statistically there “should” have been dozens. I am also proud of the fact that although most of the people when they came on to our case register had a history of assaultative behaviour, including rape, arson and murder, no member of the public was ever significantly hurt by one of them whilst I was their Consultant. Like Street, the residents and staff of EBC often had fun together.

However, there obviously were reasons why the unit was closed shortly after I retired. When I was asked to give this talk I was in two minds about trying to share my thoughts with the Conference. It was, however, the Peter van der Linden lecture, a reminder of the time when Windsor used to be called the UK/Netherlands Conference on Therapeutic Communities. For years I used to listen with wonder, and some envy, to accounts of the exciting, thriving Dutch Communities. Then they all seemed to have collapsed and I never really learnt why.

To return to the four factors which I identified as being so beneficial for the blossoming of Street. No one from Britain will need to be reminded that nursing is now a graduate profession, students usually following a largely academic university course. Interestingly, nursing has gone in completely the opposite direction from medicine where the more progressive schools such as Southampton have the medical students working on the wards from day one. When the Littlemore nursing school was closed that stream of enthusiastic young men and women with open minds dried up. Student nurses are now attached to wards on a sporadic part time basis with very clear instructions that they are to be treated as supernumerary not part of the workforce.

It seems to me that this has completely changed the nature of hospitals, both general and psychiatric. On the EBC we partially compensated for their loss by the employment of nursing assistants who, in return for receiving a pitiful salary, were given the title of Social Therapist and full team membership. Another consequence for us of the closure of our own nursing school was that we no longer had Staff Nurses returning to the EBC because they had enjoyed their time with us as student nurses. Increasingly we had to employ staff who wished to move to Oxford but who had no particular interest or knowledge of the therapeutic community in general or the EBC in particular. The Trust even indulged in the shameful raiding of third world countries for trained nursing staff.

As long as I can remember, “the multidisciplinary team” has officially been considered a “good thing,” and for once the received wisdom is correct. The therapeutic community concept of “role blurring” implicitly accepts the value of a team coming together from different professional and personal backgrounds. The true value, for example, of having a psychologist as a team member is not that they can carry out psychometric testing for you but rather that they enrich the unit by bringing their own unique theoretical and practical outlook.

David Kennard made a valuable contribution to the early development of EBC, but it is one of his successors, Jane Weekes, whose main attachment was to the EBC, who best illustrates what I mean. She not only contributed her technical expertise, helping, for example, to develop and publish an assessment process tailored to our patients’ needs, but was a full member of the team, enthusiastically sharing in even the most apparently mundane tasks. Her later successors, however, retreated to the Department of Psychology where, re-designated as Consultant Psychologists, they operated as “independent practitioners”. This development was part of a wider picture, both locally and nationally; at one stage in Oxford there were more Consultant Psychologists than there were Consultant Psychiatrists. The Department was later savagely cut. The result of this withdrawal of psychologists from the wards meant that for long periods the EBC staff team was denied the insights specific to that profession and the residents were denied access to their therapeutic skills.

On a personal note, I think that the profession I missed the most were psychiatric social workers. When I started my career in psychiatry most admission wards and other active units had a social worker seconded to it. They were not employed by the Health Authority and were usually semi-detached from their own Local Authority employers. This was an enviably independent position. I had the good fortune to work with a succession of bright, intelligent, radical young women and men who had joined what was then a fashionable profession for such talented people. I look back with pleasure to the various antics these accomplices and I got up to in rocking the boat! Sadly a decade or more ago social work became a generic profession and specialists were withdrawn from psychiatric hospitals. Social workers since then seem to have been overwhelmed with child protection work and latterly I only encountered them in their roles in helping to detain patients under the Mental Health Act. Nowadays social work seems to me to have become a deeply unattractive career, a sad loss.

The third of the so called support professions with a crucial role in therapeutic communities is occupational therapy. I always valued the skills of the OT and have co-written a number of papers with members of that profession. The OT attached to a ward who is willing and able to share their skills with the rest of the team can be invaluable. The problem for EBC in its later years was, as far as I know, a reflection of the insane national policy of not training enough occupational therapists, certainly in Oxford we suffered from chronic recruitment difficulties.

I similarly have always held in high regard the role of creative therapists and by 1989 EBC had the services of an art therapist, music therapist and a dance therapist. As management became increasingly rigid in Oxford, however, it became difficult to fund the employment of these therapists who seemed to have no place in the hierarchical management structures. During the last few years of the life of the EBC its multidisciplinary team had dwindled to nurses with a couple of secretaries and a couple of doctors, an impoverished and not particularly healthy situation.

The first reason I gave for the success of the Street community was that it operated within the benign managerial regime then to be found at Fulbourn. When the EBC started in 1980 at Littlemore in Oxford the situation was similar. Littlemore, like Fulbourn, had been a reforming open door hospital led by a charismatic physician superintendent, in Oxford’s case Bertram Mandlebrote (Mandlebrote, 1958). Although he did not retire until 1988, by 1974 he had given up the role of physician superintendent. When I arrived in Oxford the hospital was still managed by the traditional troika. The medical member was the chairman of the Division of Psychiatry, elected by the consultant body every two years. Seamus Killen, who like me had come from Fulbourn, took over as the senior nurse manager, whilst the triumvirate was completed by Ian Jardine, the hospital administrator.

Hospital administration is perhaps the least recognised of the professions that make up an effective multidisciplinary team. This profession now seems to be largely extinct within the NHS, although still valued in the private and voluntary sectors. Administrators like Ian saw their role as ensuring the effective running of the hospital in order to deliver the services identified as necessary by the clinicians. He, like many administrators of his generation, had an open door for patients who would often drop in to see him just to have a chat. Despite all the faults of the old asylums, when run in a humane and efficient manner they could be real communities, dare I say it, sometimes much more caring than the one outside to which patients are now discharged. I have never been greatly impressed by the care in the community which means living isolated in a tower block or sleeping rough under a railway arch. That is one of the reasons why the Eric Burden Community was conceptualised not simply as a ward based therapeutic community but as a network of relationships involving its members wherever they lived, the Young Adult Unit.

To return to the management of Littlemore Hospital, it had a long tradition of what is inelegantly called “bottom up” management. People at the grass roots, be they patients, clinicians or volunteers, were always supported and encouraged to develop innovative ideas. In 1985 all of the rehabilitation services in Oxford came together to create the Department of Rehabilitation and Continuing Community Care or DRC3. This department was chaired by John Hall, Head of the Trust’s Psychology Services, had its own Director of Nursing Services, Gerry Cooke, and its own senior administrator. It was managed by its weekly management meeting whose membership included all staff members whose seniority was roughly equivalent to that of a charge nurse or above. The consensus style of management was followed and considerable efforts were made to feed back to the staff and patients of the constituent units and to feed forward their views. In 1988 the Department of Health and Social Services invited DRC3 to become a National Demonstration Service in Rehabilitation. I think it is true to say that throughout its life DRC3 was held in high regard by its members. The rest of the hospital should, if nothing else, have respected the fact that it always delivered its services on time and to budget. Unfortunately this was not true for all Oxfordshire psychiatric services. The acute admission wards became demoralised by a string of suicides and their budgets were chronically overspent, mainly because of the excessive use of “specialling”. (Specialling is the system whereby an individual patient is constantly monitored by one or two or more nurses who do nothing else throughout their whole shift.) Interestingly, on Street ward we had had a policy forbidding the use of specialling.

In 1994 rehabilitation and general psychiatric services in Oxford were merged into a single Adult Mental Health Department. Unfortunately the undertaking to allow the rehabilitation services managerial autonomy as a sub department was immediately reneged upon. We for the first time found ourselves subject to an authoritarian and intrusive management with a determined effort to deny those of us working with the chronically mentally ill any separate identity. Our new chief nurse, an Assistant Director of Nursing Services, for example, forbade the Charge Nurses working on the wards for which I was Consultant to meet with me as a group. This placed me in a “Catch-22” situation. If I accepted this ruling we would lose our sense of being a team, if I encouraged the nurses to disobey they risked punishment. We partially circumvented the ban by setting up a more inclusive group. We increasingly found ourselves being regarded as low status staff looking after low status patients, our meagre budgets being plundered to bail out the more publicly visible services. Nevertheless morale remained high at the EBC which continued to develop and thrive.

Leadership can take many forms, hierarchical, sapiential and charismatic. In many ways I personally found the exercise of leadership easiest during the years when I progressed from a Nursing Assistant on a geriatric ward to a Senior Registrar at Street. During those years if someone followed a suggestion I made I could be reasonably confident that it was because of the strength of my arguments or at least the skill with which I put them. Once I became a Consultant there was always the possibility that people were simply following orders. Systems of multiple leadership, help to guard against this. I hope that it is also true that I have sometimes lived up to my belief in the value of devolving and sharing of power. Unfortunately I have learnt that the recipients of this power may then exercise it themselves in an authoritarian and even abusive manner. Of course, within the actual therapeutic community this behaviour can be identified and confronted by the rest of the community, but in the wider institution things are not so straightforward.

During the time I worked in Oxford I believe most of the Consultants were unusually ready to share their traditional powers, sometimes because of their beliefs in social psychiatric principles and sometimes, I must admit, because of their reluctance to take on the burdens of leadership. As the professional administrator has retreated to specialist areas such as finance it seems to me that throughout England and Wales that it is the nurse manager who has filled the vacuum. Of all the health care professions, nursing has the most pyramidal career structure with its numerous grades and ranks. This structure does of course offer opportunities to members of the nursing profession. The catch was always that the ambitious young nurse had to give up nursing at a very early stage and switch to a career in management (hopefully the introduction of Nurse Consultants will do something to rectify this situation). It is not clear to me why someone who has displayed talents in nursing, or for that matter medicine, should make a good administrator.

Another consequence of this changing style of management was the invention of the post of “ward manager”. The first holders I met (whilst I was working for the Health Advisory Service) had been trained as hospital administrators and took care of all the non-clinical aspects of ward management. More recently, however, I think ward sisters or charge nurses have simply been redesignated as the ward manager. They are told that they are the managers with hierarchical authority over everyone on the ward, but how they are to enforce this is never made clear. Similarly they are told that they manage the budget, but again, in my experience, they have no real authority or discretion on how the money is spent but are merely overwhelmed by trying to balance the books. These largely thankless tasks leave very little time for the Charge Nurse or Sister’s traditional role as the carrier of nursing wisdom and leadership.

In the spring of 1998 The Young Adult Unit, of which the EBC was part, suffered a serious blow when its satellite hostel, Thorncliffe House, was closed in order to help bail out the continual overspending of the acute admission wards, a decision made and ratified whilst I was away on holiday. Thorncliffe House was a small, clinically- and cost-effective unit but, being in the community, was out of sight to hospital based managers. It was this episode that brought home to me that I had become managerially powerless, I could rant and rave as much as I liked, but our management was much too macho by then to ever contemplate backing down. To the staff at Thorncliffe House, however, I was a senior Consultant, I had founded the Young Adult Unit, I was old enough to be their fathers, I must be powerful. Much of their anger during the process of its closure was directed at me rather than at the inaccessible and remote people who actually called the shots and, of course, had the powers to punish them.

Later other problems led to it being agreed that the Trust would benefit from having a more devolved management and so, at the start of 1999, I found myself appointed as the first Clinical Director of the Department of Rehabilitation and Forensic Services. I threw myself into this new role with renewed enthusiasm and I tried to undo some of the what I considered to be the pernicious developments of the previous five years. My priorities included setting up a financial structure whereby the tasks of units were linked to the resources they received. I attempted to devolve as much power as possible to a Rehabilitation Managers’ Group in the hope of reintroducing consensus management. Obviously not everyone welcomed everything I did and, with hindsight, from the start I think there was some unease within the nurse management hierarchy which had been left relatively intact.

Many of the difficulties experienced by employees of the Oxfordshire Mental Healthcare Trust in turn reflect the wider story of the NHS in the last decade or so. The new management culture was, of course, first introduced under a Conservative Government and the results are very well described in a book written by Dr. Peter Bruggen, “Who Cares, True Stories of the NHS Reforms” (1997). Peter Bruggen was a Consultant Psychiatrist who had worked at the Hill End Adolescent Unit (which I think at one time may have been a member of the ATC) and at the Tavistock Clinic before he retired in 1994. His experiences as a Medical Director of one of the new Trusts led him after his retirement to interview over a hundred NHS staff for his book. They painfully describe the new culture of bullying and incompetence establishing itself within the NHS. His book also touches on the concept of lying and deceit as a management skill. Later I was to see this for myself.

When the Labour party came back into power many people hoped that the NHS would return to the values upon which it had been founded. We have been disappointed. Non-British readers may not, however, be aware of some of the particular characteristics of New Labour. Most relevant for the NHS are firstly its “control freakery,” an overwhelmingly powerful drive to dictate and control everything from the centre. The second New Labour characteristic which has particular relevance to my story is the use of “spin”. For those who are not familiar with the term, this is the process by which all news and information has to be managed so as to meet the government’s propaganda needs. Related to the culture of spin is the elevation of being “on message” to the primary requirement for anyone who hopes to get on. There does not seem to be much room at Number 10 (Downing Street, the home of the British Prime Minister) for communalism, democratisation, permissiveness and reality confrontation.

Oxford’s “problems” had led to a requirement that a new Chief Executive had to be an external appointment and September 1999 the Acting Chief Executive was replaced. After an exhilarating few months as a Clinical Director when I had again experienced clinicians and managers working productively together, my life suddenly became altogether less pleasant as it was quickly made clear that my job in future was to implement directives from the top. It was also made clear that my opinions were of little interest. It seemed as if “New Labour” values had reached our Trust. My main role appeared to be to act as the visible target for the stress and anger of patients, their relatives and staff affected by these decisions. Much worse, however, was that it soon became clear that one of the main ways of dealing with the Trust’s financial difficulties was to be by exploiting the staff who worked for it. Some of the actions with which I was supposed to collude was simply abusive and, at least in one case, I am sure contrary to employment law. At the risk of sounding pompous, I believed that it was my responsibility to safeguard the well being of all members of our Department and when appropriate I lent my support to the Trust’s victims. I committed the mortal sin of being “off message”. By February 2000 I was sufficiently sickened by the whole system to resign; I was in fact not the first of the newly appointed Clinical Directors to resign nor the last. There was, of course, nothing unique about Oxford; David Clark describes at Fulbourn in the 1990’s, “the development of a mean, carping ,fault finding spirit.”(Clark, 1996)

Many of those who have written about leadership and the therapeutic community stress the primary responsibility of the leader to mediate between the community and the wider system and so to protect the community. In my very first Windsor paper, 22years ago, I wrote, “One ruthless autocrat upholding the status quo is more than a match for a hundred reforming democrats… The need to identify who has power over you should be obvious, and yet is always being forgotten. Everything else is pointless if you do not secure your external relationships. Bion discovered this, to his cost, in just six weeks in 1943. Why do we still so often forget the lesson?” (Pullen, 1985)

The EBC now entered a spiral of decline being chronically understaffed and increasingly shabby as it was starved of resources. The Chief Executive’s interest in the unit can perhaps be best demonstrated by the fact that in over two years she only visited the ward once. Clearly all this had a devastating effect upon the morale of the staff who, in truth, were not the most outstanding team I have ever worked with. A particularly nasty trick was the way that management would imply to relatives that the increasingly derelict state of EBC was due to staff incompetence and neglect. Again I found myself frequently the object of the staff’s frustration who could not, or would not, believe that I had no power in these matters. Interestingly the residents seem to have had much less difficulty in understanding my position, perhaps because they had had a lifetime of experience of dealing with a largely uncaring society and its agencies.

By this point in my career, like any senior consultant, I had developed a wide range of responsibilities, both locally and nationally, as well as remaining a consultant to a number of wards in addition to the EBC. Reasonably I would have hoped by then to have taken on a leadership role similar to that provided by Oliver Hodgson to Street. I think this would have been quite an attractive role, but where were Larry Nicholas and the younger me?

The coup de grace came when it was discovered that the EBC building, built in the 1960s, contained asbestos. With hindsight I think it was probable that a couple of middle managers were tipped off that our move out would be permanent but I believed what we were told and worked hard to find an alternative temporary home for the EBC. We identified two suitable buildings and for one of them, Rutland House, a former therapeutic community run by the Richmond Fellowship, we developed a workable proposal. For reasons to which I was not party, both of these proposals were vetoed and we were then informed that in a month’s time we would move to a refurbished psychogeriatric ward isolated in the part of Oxford which, amongst other things, had the most severe problems with drug abuse. (The Trust’s recent response to Oxford’s drug problems had been to close its excellent and renowned Department of Addictive Behaviours, DAB). I now believe that it was always intended to close EBC which, like the DAB, provided a service which has no place in the Government’s star system targets for hospitals - a high star rating brings various financial rewards, including performance bonuses.

As it turned out we remained in limbo for another three months due to administrative incompetence and did not move until March 2001. Our new home was a deeply unattractive building with painted bare brick walls, no garden and most importantly a layout without any centre or heart. Some of the residents understandably found the locality in which we were placed threatening and many missed, I believe, the sanctuary of the Littlemore campus. For those who do not know Oxford, Littlemore was in an outer suburb easily accessible to the centre but with enough grounds to provide gardens and a sense of space. Being at Littlemore also meant that if trouble occurred, either because of the behaviour of residents or that of intruders, help could quickly be summoned from the rest of the hospital. None of this was possible at the new site and as a consequence residents whose behaviour became disturbed had to be transferred back to acute admission wards or the intensive care unit. Doing this was wholly contrary to the ethos of the EBC and I felt a deep sense of betrayal towards residents who had to be shipped out.

Paradoxically in the last couple of months before I retired at Christmas 2001 I felt that things began to look up. We had the good fortune to appoint a new ward manager who seemed able to combine the onerous burdens of that post with the role of nurse leader. Some of the nursing team who had had problems moved on and were replaced by bright, enthusiastic, questioning young people who almost made me feel that I should stay on! However I left, and on the 17th August 2002 the Eric Burden Community was closed.

To be honest, I feel rather uncomfortable about having told this story, I feel as if I might have been simply self-indulgent. I defend my actions, at least to myself, by saying that perhaps I would have made a few less mistakes if I had been told the stories of some of the many therapeutic community closures that have occurred during the life of the ATC. Or perhaps not.

September, 2003



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