By Hannah Jackson and Clare Hardwick Bridging the Gap: A Self-Evaluation By Service-Users of A Post-Therapy Transitional Group By Hannah Jackson and Clare Hardwick

Introduction ‘’............ abrupt endings in therapy can adversely affect Service Users” -National Institute for Health and Care Excellence 2009 The Acorn Graduate Group = “nice idea for ex-clients to get together and chat” or “a genuine, positive support in aiding transition from full-time inpatient care to living well in the community”???

Hannah's Personal Experiences of Leaving a Unit Without a Transitional Group 1st experience of inpatient care and therapy was a 2 year detention in secure services. I was discharged straight from secure services to a new home with a new team of CPNs and support from a new CMHT and had no contact with the hospital again. Despite my desperation to leave hospital I did struggle with going from lots of containment and being around people 24/7 to weekly input from my CPNs who I hadn’t established trusting relationships or any rapport with. Didn’t have any purpose or direction in life and I felt alone and had no sense of belonging. My life was empty and I had nothing to help me help myself and encourage me to fight emotional challenges and self harming urges. I quickly deteriorated and began self-harming and jumping from crisis to crisis. I had over 10 hospitalisations in 2 years before going to Acorn. “My life was empty and there was nothing to help me keep myself stable, nobody to answer to and no reason to fight my emotional challenges and urges.”

Aims and Objectives of Graduate Group. Come to………………… Be with those who know you well Focus your mind Talk in ‘DBT’ Language with those who understand Tell us about your month and we’ll listen and give feedback Set your goals for the next month “Turn up, tune in and tell the truth”

Benefits of Attending Graduate Group A continuation of the programme post discharge which covers: Continued accountability and boundaries of behaviours. Continued goal setting and discussion of goals.   A safe place to discuss difficulties in an environment where: People understand you and your difficulties and your journey through the programme and therapy. People know each other well and meaningful and relevant discussion, advice and challenging can take place. You Can continue to use DBT language and other terminology from the programme without having to explain it. “Acorn is a unique experience and those who have not gone through it cannot understand the programme and the therapy that you’ve done so it can be good to have a space in which there are people who know what you have been through and what you’ve learnt”

Difficulties of Attending Graduate Group ‘hard and painful’ to go back and see the staff members that you had built up important therapeutic attachments with whilst on the Programme. “I discovered that building a healthy, therapeutic attachment with my main ‘care givers’ was a vital and integral part of the therapy I underwent” “Difficult to negotiate what that relationship is now” the girls and staff on Acorn became like my family, I've never been in a family environment, I miss that’ “Even after a few Grad Groups it can be emotionally challenging as it can evoke memories and you can miss the environment and it can leave you a bit sad”. Expensive and a Big Commitment “I have to spend 2 nights away from home and travel a long way, paying expenses, in order to attend one group. I would attend more often it is was nearer”

How Does Graduate Group Help With the Transition? Going from an intensive therapeutic environment like Acorn to being back in the community is a big step. But the following were identified as being helpful with the transition.   A continuation of meaningful relationships that were developed on the programme which helps people not feel as alone with coping with the transition. Helps reduce feelings of abandonment, although this still can be present. A reminder of what skills you have learnt and a space which helps you put that into practice in the community “It has made me feel not so alone.”

What Additional Challenges We Would Face Without Graduate Group “no one who understands my aims and goals” “Would have felt abandoned” ”Be lonely and Isolated” “No Accountability! Would have definitely engaged in more behaviours”

Clare’s Experiences Of leaving Acorn with A Transitional Group Was very nervous, been discharged before from a long-term residential placement and almost immediately relapsed. Had no reason not to self-harm, and didn’t understand my behaviour! Was leaving Acorn going to be the same? Whilst at Acorn I was prepared for discharge well. I left with a good leave plan that me and my Mental Health Team understood. I now understood the impact of my behaviour on others. I left Acorn with the knowledge that I did not need to use self-defeating behaviours. I now had new choices to make. I left with good, solid, positive friendships that I knew would help me when I struggled. On Acorn I learnt to communicate more effectively my levels of distress - and I therefore found was able to use these friendships and my Mental Health Team in a more effective and healthy way. Also had Graduate Group to go back to help with accountability. I know for sure that without Graduate Group I would have engaged in many more self harming behaviours. The thought of going back to the group and having to tell my friends how i am doing keeps me working hard. I feel proud to tell them I am doing well! I have never been proud of myself before. Been left 10 months. Have maintained living in my flat. No hospital admissions. This 10 month period is the longest that I have spent out of hospital for 7 years. Have engaged in few self-defeating behaviours. Am working well with my mental health team! Am still utilising Grad Group. RESULT!

Conclusion The Acorn Graduate Group = “nice idea for ex-clients to get together and chat” or “a genuine, positive support in aiding transition from full-time inpatient care to living well in the community”..... From the evidence we received despite certain difficulties in attending graduate group it is an appreciated space which on the whole members feel helps with the transition from the unit to the community. Members feel it also reduces the likelihood of relapse by providing a safe, familiar and supportive space in order to manage the transition and on going recovery in the community.