Dalton Ward is a 13-bedded high dependency rehabilitation service for females with severe and enduring mental health disorders and challenging behaviour. The hospital provides a campus style complex in spacious grounds, just outside Darlington, with modern facilities and recreational spaces.

Referrals and admissions

• Females aged 18 or over
• Informal patients or those detained under the Mental Health Act
• Females who present with complex and challenging behaviours related to complex mental health disorders
• Individuals who may have a history of failed or di­fficult placements and would benefit from a period of rehabilitation in a patient-centred, recovery-focused environment
• Females whose care needs require a bespoke treatment pathway
• Patients with treatment-resistant mental health disorders
• Females with poor activities of daily living skills (ADLS), who require further rehabilitation in order to progress to more independent community settings

We use a recovery-based model of care which recognises the seven principles of recovery:

• Hope
• A secure base
• A sense of self
• Supportive relationships
• Empowerment and inclusion
• Coping strategies
• Purpose

Our service is patient-centred, multidisciplinary, comprehensive, collaborative, and focuses on achieving realistic goals and ensuring an e­ffective pathway to the community.

Linden Ward is a 15-bedded unit, which offers a comprehensive specialist rehabilitation and recovery-focused service designed to treat males with complex mental health needs and challenging behaviours. There is also an established care pathway to a community house, under the care of the same responsible clinician.

Referrals and admissions

• Males aged 18 and over
• Primary diagnosis of a severe and enduring mental illness
• Co-morbid presentations e.g. personality disorder, substance misuse issues, mobility problems and epilepsy
• Continuing diffi­culties in other areas such as complex and challenging behaviours, behaviours that involve risk of harm to self or others, life skills problems, self-care, vulnerability and social or relationship problems
• Patients transferring from prison, medium or low secure services, where there is a lack of diagnostic clarity, and who need a holistic assessment or bespoke care
• Patients who have successfully, or partially, completed treatment in secure services but who may need relapse prevention or further rehabilitation, before returning to the community or moving to supported living
• Patients who require care and treatment in a calm and therapeutic environment following repeated episodes of acute illness, including patients who have required treatment in a psychiatric intensive care unit (PICU) and an acute inpatient environment
• Patients who have mainstream treatment needs but are subject to particular geographical restrictions such that treatment cannot be provided in their home area
• Detained and informal patients including forensic sections

Linden Ward is led and overseen by a consultant rehabilitation psychiatrist working with a dedicated multidisciplinary team including a clinical psychologist, a social worker, an occupational therapist, registered mental health nurses and support workers.

Hazelwood Ward offers a specialist rehabilitation and recovery service for females with a diagnosis of emotionally unstable personality disorder. The hospital provides a campus style complex in spacious grounds, just outside of Darlington, with modern facilities and recreational spaces.

Referrals and admissions

• Females aged 18 and above
• Detained and informal admissions
• Formal diagnosis of personality disorder as classified by DSM IV (or ICD 10) or those patients presenting with personality traits who do not attract a full diagnosis of personality disorder
• Co-morbidity with other disorders such as mood disorder, post-traumatic stress disorder (PTSD) and/or substance misuse
• A history of trauma/abuse
• History of and potentially continuing substance misuse problems
• A high incidence of risk to self, such as self-harm and/or suicide intent
• May have previous involvement in the Criminal Justice System or currently detained in prison
• Multiple (revolving door) crisis admissions to local acute services or protracted lengths of stay within local acute services (potentially lasting months or years)

This specialist service is designed to specifically address the complex needs of people with personality disorders and provides a recovery-focused programme. A non-restrictive, positive risk-taking approach is followed in the delivery of care on Hazelwood, with patients being supported in practising, strengthening and generating coping strategies and skills learnt during their stay at the hospital.

Thoburn Ward is a 22-bedded, mixed-gender, open acute unit providing treatment for patients who have a primary diagnosis of mental disorder or mental illness. There may also be co-morbid mental disorders such as substance misuse or an eating disorder.

Oak Ward is our female-only 12-bedded open acute unit, providing care and treatment for women requiring support in an acute setting for complex mental health needs and / or personality disorders. There may also be co-morbid issues such as substance abuse.

Oak Ward’s milieu is DBT-informed, which is why Oak is able to actively support individuals who may be at the challenging end of the acute range as well as those diagnosed with a personality disorder.

The aim of our services is to act as an extension to NHS care pathways during times of fluctuating capacity and flow, allowing many patients to receive care and treatment closer to home. This will provide continuity of care and the minimum disruption to patients and their loved ones.

Patients receiving acute treatment may be either admitted informally or if necessary, detained under the Mental Health Act. An admission for acute treatment must be confirmed as being the least restrictive option for patients, in order for them to receive the necessary treatment with the safest management of risks to themselves or others.

Lengths of stay vary, and are dependent upon individual need and response to treatment.

The ward endeavours to utilise the Recovery Framework and works collaboratively to support patients through the period of crisis. We also work with patients and their families to assess and identify health, social and support needs. We continually liaise with local NHS services to ensure that there is the effective transition of care on discharge or transfer.

Referrals and admissions

Acute patients can be referred from anywhere within the UK (England and Wales if detained), and are funded by the NHS when there are no beds available in the patient’s local area. As such, Thoburn and Oak are referred to as an ‘out of area placement’.

Individuals are normally referred to the service via the crisis team, liaison mental health team or bed management team, from the local mental health NHS trust. They will be assessed following the receipt of appropriate faxed/emailed clinical information. This must include:

• The reason for requesting admission (diagnosis if available)
• Current treatment
• Clinical risk assessment (current and historical)
• Patients’ thoughts with regards to admission
• Mental Health Act status
• GP/physical health details and details of previous contact with services

It should also include contingency planning if the patient was to become too unwell to be managed in an acute ward.

A multidisciplinary team discussion in regard to the appropriateness of admission and ability to meet identified care needs also takes place (for less complex cases it is acceptable for the nurse in charge to agree admission). The referrers will be notified within one hour of the receipt of the faxed information and the outcome of the referral. It will be the responsibility of the referrers to arrange appropriate transport for the patient to be admitted to the ward.

The services would be suitable for:

• Males and females aged 18 and above (female-only for Oak Ward)
• Either informal or detained under the Mental Health Act
• Rapid assessment and admission, 24 hours per day, 7 days per week
• Those who fail to engage with local mental health teams and require a period of stabilisation
• Have a primary diagnosis of mental illness or personality disorder (Oak Ward), there may also be co-morbid mental disorders such and substance misuse

The overall clinical model of care on our PICU wards is centred on the rapid reduction of acute symptoms whilst promoting self-management and recovery.  We aim to provide a least restrictive environment, empowering individuals to make decisions and be at the forefront of their care pathway and treatments.

The patients who are admitted to our PICUs have typically exceeded, exhausted or been unsuccessful to benefit from local resources.  Our skilled, multidisciplinary PICU teams have experience in safely managing complex patients in an acute phase of mental illness, who often demonstrate challenging behaviours, along with co-existing issues such as substance misuse.

When the team agrees the patient no longer meets the criteria for a PICU service, they will be considered ready for discharge to a less restrictive environment.  In order to effect a smooth transition, we believe it is essential to commence planning for discharge as soon as possible.

Birch Ward (male) and Chester Ward (female)

Both wards were purposely built in 2019 to meet National Association for Psychiatric Intensive Care Unit (NAPICU) standards, offering bright and spacious environments with dedicated therapy and activity space as well as outdoor garden areas.  Each ward has access to seclusion facilities (if necessary), enhanced care suites and consultation rooms.   

Each ward is 12-bedded, providing safe, single-sex en-suite accommodation. Our PICUs are consultant-led and supported by an experienced multidisciplinary team. We aim to provide high quality, effective care to adults, who meet the following criteria:

• Patients admitted to the PICU should exhibit mental state or clinical behaviour which seriously compromises their physical or psychological wellbeing or that of others
• Are experiencing an acute mental health crisis which cannot be managed in a less secure environment
• Consideration will also be made as to whether their behaviours could be safely managed and treated on a general acute ward facility
• The behaviour that determines the need for admission to the PICU will be as a result of an acute mental health condition, or an acute exacerbation of an existing mental disorder which is expected to respond to treatment approaches available at the PICU in a relatively short period of time
• All patients will be detained under the Mental Health Act (1983)

Referrals and admissions process

Referrals are accepted on the authorisation of the responsible funding authority and in accordance with NHS commission guidelines.  Referral to the PICU would be from a wide range of services, including:

• Acute psychiatric inpatient units
• High dependency units
• Following assessment at 136 suites
• Police stations, courts and prisons
• Directly from the community

Once our triage nurse has received the appropriate information, every effort will be made to provide confirmation on whether a patient is accepted within 1 hour.