What is Doorways?
The Doorways project is investigating whether increasing the access to therapeutic activities on acute inpatient psychiatric wards improves ward atmosphere. Naturally, increasing the access that service users have to these therapy groups raises a number of interesting questions, many of which are the focus of our research.
At the heart of this project is the central question - what are the effects of increasing the amount of these therapies that the ward delivers to service users?
We are carrying out a detailed investigation of the ward atmosphere before and after the increase in therapeutic activities, to explore how this change is perceived by patients and staff alike.
In addition, we will explore the sustainability of the positive effects of these changes (particularly on staff morale and service user satisfaction) as well as monitoring any possible negative effects.
Doorways has already been a great
success across seven acute inpatient wards located within the boroughs of
Southwark and Croydon, which between them serve a catchment areas with a
population of approximately 250,000. The project is now being expanded
across the surrounding boroughs of
The study will run for a period of 24 months, during which there will be five periods of data collection. At each data collection time, two wards will be assigned at random to receive an intervention of a new program of therapeutic activities.
"I have learnt so much from working with staff and patients on the wards. It’s been great to see the benefits of increasing therapeutic activities and to appreciate what good work is already happening on the wards."
Dr Rumina Taylor, Clinical Psychologist and Staff Trainer
Our clinical psychologist trains ward staff to deliver a range of therapeutic interventions on the ward. These require varying degrees of nursing staff input. Staff on the wards will have an opportunity to select the interventions most suited to their service user group, and those which most compliment their current program of ward activities.
Each ward will receive training in four core groups, and in two of five possible optional groups. These are as follows:
Social Cognition and Interaction Training
Cognitive Remediation Therapy
Emotional Coping Skills
Self-Esteem & Coping with Stigma
- VOICE – Service user measure of ward satisfaction (as developed in LIAISE).
- VOTE – Staff measure of ward satisfaction (as developed in LIAISE)
- Clinical service outcomes: Readmission rates, length of stay & Mental Health Act detention.
(a) Patient assessments
- Use of available therapeutic activities.
- Symptoms: PANSS scores, Global Assessment of Functioning.
- NOSIE: Behaviour scale measuring social and disruptive behaviours over a short time frame.
- Service Satisfaction Scale - Residential.
(b) Staff assessments
- VOCALISE- Barriers to change assessment (developed as part of LIAISE).
- Maslach Burnout Inventory (Maslach, Jackson and Leiter, 1996) to measure burn out and positive attributes of the work place.
- Index of Work Satisfaction Questionnaire.
- Good Milieu Index (Rossberg and Friis, 2003).
(c) General ward assessments:
- Length of stay on inpatient wards during the study period.
- Ward Atmosphere Scale (35).
- Routine incident reporting from electronic records.
- Therapeutic program guide based on activities available.
- Movement of ward staff measured as length of stay, number of new staff and their ward origin.
(d) Economic measure
- CITRINE: health economic measure, developed as part of the Perceive project.
For further information, please contact:
Dr Emese Csipke, Project Co-ordinator on 0207 848 5001 or fill the contact form here
Dr Rumina Taylor
Dr Charlie Heriot-Maitland
Dr Stephen Livingstone