Information Scotland

The Journal of the Chartered Institute of Library and Information Professionals in Scotland

April 2004 Volume 2 (2)

Patients’ Library

A library that changes lives

Gerry Maclean describes how her work in a secure hospital is really making a difference to patients.

For many, the image of the State Hospital at Carstairs is the high perimeter fence and the ring of lights usually seen from the windows of passing trains. As a Special Health Board within NHS Scotland the hospital provides care and treatment in conditions of special security for individuals with mental disorder who, because of their dangerous, violent or criminal propensities, cannot be cared for in any other setting. It is a national service for Scotland and Northern Ireland. There are usually about 240 patients, mainly men.

I moved from Librarian at Anniesland College to the hospital in 1998, attracted by the challenge of a job split between a well-established service for staff and a newly established service for patients. For staff, the library had historically been a medical library, specifically psychiatry. For patients, the library then consisted of a small collection of books and audio-tapes, situated in the Community Centre, a building in the centre of the campus, housing space for community events such as film shows, the shop for patients and a tea-bar. Now the staff library is the core of a newly-created Learning Centre with LearnDirect Scotland branding. The patients’ library is also part of a LearnDirect Scotland branded learning centre (though this is distributed among a range of locations) and was a runner-up in the 2002 Libraries Change Lives award.Naturally enough, when I took up post here, I looked to others in the library/information world to give me a steer into the role. There was considerable support from the health information side, but no direct parallel for the patients’ service. I assumed that there would be most similarities between a library service in prisons and here, by the nature of the closed environment and I did find individuals here and in the Prison Libraries Group of CILIP who were generous with their time and experience. As so often happens, the initial apparent uniqueness “weakness/threat” of the service became a “strength/opportunity” to open up new ways forward. In fact, I found ideas for the various user needs from a much wider range of library/information sectors, such as public and school/ education libraries.

The library serves both men and women from aged 18 upwards with a wide range of literacy levels, social and educational backgrounds and life experiences. A group of patients have learning disabilities. There are many indicators of social exclusion among patients and a range of diversity issues, but also the whole gamut of recreational, leisure and lifelong learning interests you would expect to find in the general population. Patients come to the hospital from other NHS hospitals, from the prison service and direct from courts. The library contributes to patients’ rehabilitation by becoming involved with them in the admission ward, in the continuing care wards, and at the stage where they are assessed to be nearing the point where they no longer need the conditions of special security provided here.

The range of users meant that an obvious first step was expanding the stock. This now includes books, audio-tapes, videos, PlayStation games, DVDs and music CDs, to meet personal preferences, literacies and concentration levels. Flexible shelving allows rearrangement so that the Centre can be used for a wide range of activities. Most patients have access to the Centre at least once a week, and can combine using the library with visiting the bank and the shop, having a cup of tea and perhaps going to the hairdresser. Three patients have jobs as library assistants, working on a rota which can usually provide a service seven days a week, in morning and afternoon sessions. We advertise the jobs as they arise, and interview for them, as part of the rehabilitation process. Being a library assistant allows patients the opportunity to demonstrate their progress, for example, in taking on more responsibility and in using their social, communication and organisational skills. One library assistant completed three NC Library and Information Studies modules before moving out of the hospital and another library assistant is working through his first module.

Inspired by public library book groups led me to try it here. It quickly became apparent that because of concentration levels, the usual approach of reading a book beforehand and discussing it in the group was impractical. Instead, we had self-contained meetings, when we read a short story or some poetry and discussed it, or group members, staff and visitors talked about favourite books as a way to encourage reader development. To be more inclusive, we also welcomed non-readers and less confident readers, and we read everything aloud. In the supportive environment, more group members began to take a turn at the reading with obvious self-esteem and literacy benefits. This activity can contribute to the overall picture of a patient’s progress. There are currently two book groups, each meeting weekly. One group is self-directing and able to undertake longer-term projects. In the past they have read short novels (eg Animal Farm, Kes), looked at various short stories and poetry, read a few plays (eg Death of a Salesman, Twelfth Night, because, as one group member put it, he’d never been allowed to do Shakespeare at school ) and tried their hands at writing poetry, doing story-boards and creating characters. My role is to facilitate the group. Most recently, this group decided they wanted to read something by Des Dillon (who another visitor had recommended). I have organised a visit from Des Dillon to take place in April, under the Live Literature Scotland scheme.

Meanwhile, the other group have opted to keep each session self-contained. Sometimes patients move from one group to the other, reflecting how well things are going for them at that point.

The library offers opportunities to help break the cycle of deprivation which low expectation and low self-esteem contribute to. For example, the library assistant who despite his learning disabilities had worked his way through three NC modules in Library and Information Studies and had a real flair and interest in the routines which underpin library operations. We devised ways to make the knowledge in the open learning packs more accessible for him. I would have no hesitation in providing a reference for him, since he would show real interest and commitment (not to mention good time-keeping and attendance) in a supported, supervised position.

Another way in which patients can become involved in the library is through the Library Users Group to which each ward may appoint a representative. As well a providing a voice for the library on the ward, these reps are also a communication channel, to let us know unmet need. They are also instrumental in writing the newsletter which usually goes out after each meeting. The reps are part of the decision-making process about stock selection, and can help with routines, such as processing.

Apart from these ongoing activities, we have been able to tap into other support, to widen more horizons through enjoyable activities. We have had support from the Writers in Scotland/Live Literature Scotland scheme, in particular, a well-established and fruitful relationship with storytellers David Campbell and Claire Mulholland. In one-off or a series of visits they have worked with patients. SLIC provided funding for a series of workshops on creative writing, and at the moment we have support from the Scottish Arts Council to fund a visiting creative writer/dramatist who is working with patients on a performance. This (by their choice) reflects the experience of patients on their journey through the hospital, and links work done by the creative writing group with the skills developed during the drama workshop group.

While the hub of the service is the physical collection in the Community Centre, we have tried other ways to reach out to patients or to provide a more focused service. I put a collection into the Education Department, to underpin the support that the library can give to learning in the hospital. The library, with the Education Department and other areas of learning in the hospital constitute a distributed ‘learning centre’ with LearnDirect Scotland branding. We have bought learning software and laptops. These, for example, can be taken onto the admission ward, whose patients do not have access to the general activities around the hospital. We can also offer BBC Webwise course, and short courses focused on introducing IT to those with severe and enduring mental illness. We are trying to bring IT awareness and skills within the reach of more patients, who may then take up more formal training and education.

Of course, there are many frustrations in trying to develop a service within the constraints of special security. Maintaining a safe environment for patients, staff and visitors must be everyone’s responsibility. But along with the frustrations are very real positives. The CommuniC8 team – myself and two PARS staff , one nurse and one rehabilitation worker – have a close working relationship. There are opportunities for partnership working with other professions, towards the common goal of patient benefit. And I have had the opportunity to rethink my own attitudes towards mental ill health – one in four of us will suffer from mental health issues – and about the devastating impact of severe and enduring mental illness. Finally, it has reaffirmed that while there are no magic wands, libraries can, and do, make a difference.

Gerry Maclean is Librarian at the State Hospital, Carstairs, Lanark (Gerry.Maclean@tsh.scot.nhs.uk).

Information Scotland Vol. 2 (2) April 2004

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Last updated: 10 May 2004