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HAPPINESS AS A TREATMENT CATALYST : The Bryn-y-Neuadd Health & Happiness Index

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Page 1: HAPPINESS AS A TREATMENT CATALYST : The Bryn-y-Neuadd Health & Happiness Index

HAPPINESS AS A TREATMENT CATALYST

The Bryn-y-Neuadd Health & Happiness Index MICHAEL CRAFT

Medical Superintendent, Bryn-y-Neuadd Hospital, Llanfairfechan, Gwynedd.

Bryn-y-Neuadd was built as a 520-bed subnormality hospital in North Wales. I t now runs as a unit for 303 in-patients, 102 day-patients. I t has a number of interesting features. Firstly, rather like Gheel in Belgium, the North Wales Guardianship group board- ing out with local families is increasing; secondly, to deal with these and other crises the domiciliary nursing programme offers a flying squad service to its local County of Gwynedd; thirdly, it has married quarters for its patients; fourthly, it is a back stop for a forensic psychiatric programme; fifthly, and most importantly, the position of the private beach and the hospital’s situation between mountains and sea make work a pleasure.

Purpose built, Bryn-y-Neuadd was opened in 1970. This article is concerned with one of its earlier failures. As part of an enthusiastic programme of patient assessment, a ten-point “Health and Happiness Scale” was devised. Since one of the ideals of the senior medical and nursing staff was that happiness and work for all were catalysts in treatment, these were the first two points of the new scale. It was hoped that, by testing residents, each ward could use the Scale to improve its own target.

THE BRYN-Y-NEUADD HEALTH AND HAPPINESS SCALE

Score up to 10 points on a self-rating basis counting 10 - perfection, 0 - no positive function.

Maximum score possible

1. 2. 3. 4. 5. 6.

7. 8 . 9.

10.

Satisfactory happiness Satisfactory work No mental suffering No physical suffering Satisfactory leisure Satisfactory food and fluid, ingestion and

Satisfactory sexual relationships Satisfactory sleep Satisfactory personal locomotion Satisfactory interpersonal communication

excretion

~

100 points

Whilst the scale was devised for residents and day- patients attending the hospital, we thought it could reasonably apply to most people in the community and, therefore, tried it upon our staff.

Staff scores By January, 1971, 140 patients and their 37

attendant staff had transferred to Bryn-y-Neuadd from the old subnormality hospital at Oakwood Park, which was then closed down. These 37 staff were mainly older retainers who had stayed on, some long past retiring age, in order to have the enjoyment of trans- fering to the new hospital and spending a year there to see what conditions would be like.

A new contingent of younger student nurses and other staff had also been taken on at Bryn-y-Neuadd but, since they had not taken part in earlier patient assessment schemes, they were not used for this test.

A cyclostyled sheet was prepared and issued to some 20 permanent staff members on a random basis round the wards who happened to be on duty that particular day. They returned them at the end of the day, scoring themselves on a self-rating basis, without the benefit of asking their wives’ opinions, which might have induced them to give a different reply. At the time the hospital staff were working on a long day basis, which may have had some influence on the results. There were also proportionately fewer staff then than now, 37 staff for 120 in-patients and 35 day- patients whereas, at the beginning of July, 1974, there were 181 nursing staff for 303 in-patients, 102 day- patients.

The average score for staff was 62 points, but, as this was a highly subjective rating there was no break- down into sub-scores, although we did look at certain sub patterns.

Patient scores 20 patients were also selected at random by choosing

from those who were taking lunch on four of the wards. Since this was a self-scoring test, there was a tendency for brighter subnormal patients (probably in the I.Q. range 50-75) to be chosen. Their average score was 78.

If it seems that the in-patients were considerably happier and healthier than the staff who nursed them it should at once be explained that many of the in-patients were, in later years, discharged to the North Wales Guardianship scheme of boarding out with local families and that also, in common with many other subnormality hospitals, a good half of them could quite well have been discharged many years before.

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Page 2: HAPPINESS AS A TREATMENT CATALYST : The Bryn-y-Neuadd Health & Happiness Index

Discussion On breaking down the results of the staff question-

naires, it seemed that whilst our elderly, former Oakwood Park nursing staff were reasonably happy with themselves and their new jobs, home and, possibly, wife troubles caused them a good deal of mental suffering. On personal enquiry it seemed that arthritis caused many a certain amount of physical pain and suffering. A number had indigestion, others may have had haemorrhoids resulting in lower scores on the food, ingestion/excretion scale; fluid intake at the new hospital (suitably sited near two welcoming public houses) and its voidance may have been beset with prostatic troubles. Sex was perhaps not as important for our elderly staff as the younger, although this matter was not pursued in detail by the researcher. Arthritis, mentioned before, may have caused certain difficulties in locomotion; communi- cation, possibly because our staff were a chatty lot, seemed to receive high scores from most.

Turning to our younger residents, most seemed to score highly on the happiness scale on arrival in the brand new, seaside hospital. They hugely enjoyed the big new workshops, the increased personal allow- ances just announced by the Government and the ability to spend this money in the shops right outside the hospital back door. All had parole, so there was no problem here.

I t was rare to find any of the patients of this psychiatric hospital complaining of mental suffering. Indeed, most modern subnormality hospitals are distinguished by the cheery faces of the residents. Physical suffering for this predominantly young group also seemed unusual, as were difficulties in food ingestion or excretion. The new kitchens and improvements in diet may have helped increase the score here. They were not concerned with prostatic difficulties; they all professed themselves able to sleep very well at night. Relationships with the opposite sex, were, indeed, a problem as, at that time, no female patients had been transferred from the Mid- Wales hospitals. Locomotion presented no difficulty; the only other sub-scale with a number of low scores was that concerned with interpersonal communication.

Conclusion We were all saddened by the results of our enquiry,

as it was obvious that our patients were a good deal happier than our staff. We decided, however, that coincidence and the selection of older staff only biassed the results. The test itself was also orientated towards a younger group and we, therefore, set about enjoying the new hospital, its superb site and the excitement of building it up.

Looking back I personally feel that we set staff expectations too high; perhaps ideals should be for saints, not for sinners. Since the mentally handicapped, by upbringing, do not expect too much out of life, they become very happy when they get more than they expected.

There may be a moral in this for all of us!

Castle Priory College

FOUR SHORT COURSES

Domiciliary and social work services for the mentally handicapped and their families.

February 3rd to 7th, 1975. NOS. 10135

The child with epilepsy. February 14th to 16th, 1975.

No. 10138

Group work in residential units for the handicapped. No. 10142 March 7th to 9th, 1975.

Course for unqualified remedial staff (O.T. aides). No. 10143 March 10th to 14th, 1975.

Further details from and applications to: The Principal, Castle Priory College, Wallingford, Berks. OX10 OHE.

Teaching and Training

The Journal of the National Association of Teachers of the Mentally Handicapped.

Deals with subjects of interest to Staffs of Special Schools and Adult Centres for the Mentally Handicapped and of similar Departments in Hospitals for the Subnormal, as well as to others who are concerned with the teaching and training of the mentally handicapped.

Annual Subscription (4 issues) 80p

Single copies 20p

Annual Subscription-Overseas €1.00

Subscription Secretary:

Mrs. E. Hughes, 1 Beechfield Avenue, Urmston, Manchester. M31 3RT.

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