Cure sometimes, treat often, comfort always

Some 34 years ago, I moved to Manchester to start a new job as a commissioning nurse for the North West Regional Forensic Adolescent Service (Gardener Unit). It was the only NHS funded and managed forensic mental health service for young people. This service was based in a purpose built secure unit on what was once known as Prestwich Hospital. Prestwich Hospital was built as an asylum (in the true sense of the word) way back in 1851. By 1900, it had grown into the largest mental health hospital in Europe. 84 years later when I arrived, it was a much smaller hospital, largely made up of very specialised mental health services. These days it provides acute and community-based mental health services to many parts of Greater Manchester, the North West and beyond. 

The Gardener Unit was a relatively small medium secure unit. The latest data (2015) reveals that in England, there were 1,450 young people in secure settings at any one time. Over 300 of these young people were in secure mental health settings, the rest in what is termed welfare secure settings. However all these young people have clearly established (and often significant) mental health needs. Those young people in secure in-patient mental health units such as the Gardener Unit will present with the highest risk of harm to others. Typically these are young people who have committed a serious or grave crime. They are often vulnerable, have challenging behaviours, and self-harm. Secure settings such as the Gardener Unit have both high levels of physical security as well as high levels of procedural and relational security.  

My time there was a truly wonderful period in my career as a nurse, service manager and ultimately an academic. I worked there for 10 years before taking up my first University job at Manchester Metropolitan University, moving to the University of Salford 10 years later. Last week I was reminded of my time at Prestwich. I read the background to the public inquiry which began last week, into the contaminated blood scandal that affected many thousands of people. It is estimated that some 3000 people have died as a direct consequence of being given contaminated blood products.  Thousands of patients were given blood products infected with hepatitis and HIV during the 1970s and 1980s. One of these people was one of the first patients admitted to Gardener Unit. They were someone who had been given a contaminated blood product (Factor VIII) as part of their treatment for haemophilia. As a consequence of this they had developed HIV.

Back in 1984, little was known about HIV and AIDs. There was a societal climate of fear, discrimination and stigma associated with HIV and AIDs. This was mirrored in part by those staff working in the Gardener Unit. We were ignorant and sometimes this showed in our approaches to this young person. We simply didn’t know enough about the disease to use science and evidence-based knowledge in dispelling the myths and misunderstandings. Whilst this young person had committed a grave crime, the fact remained that they were simply an innocent victim, bewildered, and vulnerable. It didn’t help that their family, friends and home town was some 300 miles away from Manchester.

Fast forward to 2018, and we know a lot more about the prevention, and treatment of HIV and AIDs. The blood product risk has been eliminated and the greatest risk of contracting HIV today is through sexual relationships. NHS England, currently has a trial of the preventative medication PREP, (perhaps ironically, a pill with a similar shade of blue to Viagra). PREP is a pre-exposure prophylaxis, and is a daily pill that disables HIV before it can gain a stranglehold in the body. The pill is being made available to those at risk of contracting HIV, in the main young gay men. Trials suggest that it can cut the risk of becoming infected by up to 86%. Before the trial began, people buying the drug privately have been linked to the first ever fall in new infection rates in gay men.

However, there is no room for complacency. Here in Great Manchester, there are more than 5,000 people living with the disease (three times the national average). There are still some 300 new cases of HIV every year. The Greater Manchester Mayor, Andy Burnham has recently committed £1.3m to help stop the spread of HIV in the region. The city is set to join a growing global network of cities working together to stop the spread of the virus. It is a commitment only made possible through the devolution of funding and responsibility for managing the health and social care services to the region. 

I have often wondered what happened to all those young people who were the early patients at the Gardener Unit. I do know that working with troubled young people was as much a privilege as it was at times a challenge. I do also know that for me, working with such young people brought to life the words of Hippocrates ‘cure sometimes, treat often, comfort always’.