"Toilet Facilities in Mental Health Rehabilitation Ward"

About: Lanarkshire Community Services / Adult Mental Health Services

(as a friend),

Today I visited my friend in an NHS Lanarkshire mental health rehabilitation unit. I have visited many times before, and although the facility is relatively new and modern it definitely has never felt like anything other than a ward. It is very clinical in appearance (well at least the ground floor is - I have never seen the bedrooms upstairs).

A rehab facility as far as I am led to believe is where people go to enable them to take steps towards returning back to a more independent and fulfilling life after a hospital admission for acute mental ill-health. To my mind it should also be about building back up peoples confidence, self-esteem and self-worth. These vital components to recovery are often overlooked with preference being given to the more "practical skills" which of course are also important.

Today I asked if I could use the toilet (which I had done before).

To the left hand side of the narrow corridor which runs from one end of the rehab unit to the other - are 3 identical doors. Identical unisex toilets with one exception - one has a "staff toilet" sign on the door.

I was told yes I could use the toilet and I automatically reached for the toilet door which was closest to me which was not the one marked for staff. As I went to open the door (which was locked) the staff member screwed their face up, shook their head with a look of disdain and said "don't use that one - it's for patients" and unlocked the staff toilet for me to use. Meantime my friend a "patient" witnessed this interaction. (She also told me that staff frequently lock the toilet doors and people need to ask to use the toilet? ? Dignity.....)

I was duly shuffled into the "staff" toilet which as far as I could see was exactly the same as the "patients" toilet I had used the previous week.

When I left the toilet and ultimately said goodbye to my friend it took me a while to figure out in my head why this interaction had disturbed me so much. I then realised that it was because an act like this, as unintentional as it was - was most definitely a simple and effective unconscious reinforcement of stigma.

It says "you are different to me".

As a friend who I have discussed this with tonight said to me I was "subconsciously recruited to 'othering'" where I wasn't a "patient", so I was automatically of the "others"

On an open ward area like this, why not have public toilets which are cleaned and well maintained and which can be communal. And yes....I can hear you shouting "risk assessment" - but as I said the toilets were EXACTLY the same so where is the additional "risk"? I also agree that staff have a right to private personal space away from public view as would happen in any other workplace. So if staff toilets are required - why not have them in a completely separate area?

It says a lot about how service design respects or doesn't respect people whether staff, patients or public.

This is probably more accidental than by design, but it absolutely reinforces stigma and power inequalities. Such a simple - most likely subconscious action, indirectly causing such stigma.

Going back to my point about confidence, self-esteem etc, take a moment to think about how this may impact someone who has possibly already spent some of their life due to stigma in society thinking "why can't I be like them" and/or" why am I different".

And interestingly - I currently am a patient of mental health services in NHS Lanarkshire - albeit a different service. I also work in mental health services so which toilet do I use? ? ?

I don't blame, or hold the person responsible that I interacted with today as this is a problem much bigger than people. This is perhaps more about institutional stigma, and I hope it has given people who are responsible for service and facility design some food for thought.

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Response from Iain MacKenzie, Service Manager, Forensic Rehab and Recovery and Custody Health Care, NHS Lanarkshire

Dear Dazzle

As Service Manager for the Rehabilitation Service, I firstly wish to apologise if your perception of the staff’s response to your request to use the toilet facility led you to believe that there is an issue with organisational stigma. I would like to thank you for your thoughtful and considered comments. I have today raised this with the Senior Charge nurse. I can confirm at this point that other than for cleaning purposes the patient toilets will be open.

The rehabilitation unit does have a focus on recovery and as you rightly say, practical skill enhancement is a component part of this process. But building confidence, self-esteem and self worth are equally as important. The service has recently been reviewed by the Mental Welfare Commission and I would encourage you to have a look at their report which can be found on their website. There have been other reviews which have examined patient experiences of the service which I would be happy to share with you.

If there are other aspects of the service that you want to discuss please contact my secretary on 01555 777480.

Kind regards

Iain Mackenzie

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful

Update posted by Dazzle (a friend)

Hi Iain

Thank you for replying. Just to confirm that as stated in my original post - to me this isn't about one persons attitude or deliberate act of stigma or discrimination. The post was to highlight that quite often stigma and discrimination can happen unintentionally and indirectly. The post was to encourage NHS Lanarkshire and also other health boards to consider this when looking at the design of such services and buildings. Sadly health and social care settings have been identified by See Me Scotland as one of three main areas where stigma and discrimination is still very prominent. And sometimes this happens unintentionally perhaps through things as simple as what I have highlighted. I would be interested to know if there is any particular reason why all toilets in the same corridor are not indeed communal toilets? Again I suspect that there was no intention of causing stigma - but I also would be interested to hear if you can see how this could indirectly give out the message that "I'm different to you" ?

I have previously viewed the MWC inspection report and was pleased to see that it highlighted the excellent garden facility that you have. It is indeed a lovely space and far better than the very limited outdoor space available in the adult acute in-patient wards across Lanarkshire. I recently visited both acute inpatient wards and a rehabilitation ward in Angus and was blown away by the facilities available to people on the ward and their visitors. It would be great if the Trusts shared such examples of good practice. As a wise friend of mine says "None of us are as wise as all of us".

Again to clarify - this post was not about one persons response. It was about thinking about small things that can make a difference when services and buildings are being designed.

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