Vol 1 March 1995

Opening note

Dr Robert Hinshelwood,

Clinical Director & Consultant Psychotherapist

Welcome to the first issue of our newsletter. It will be produced on a half yearly basis to keep you up to date on new developments, both here at the Cassel and within the field of psychotherapy. I hope you find it useful and welcome any contributions you may have.

The hospital has been through a number of changes in the last few years, adapting to the conditions in the new NHS. As a result of our ability to meet these new conditions, the flow of referrals and admissions is better than at any time in recent years. In the last few months, we have seen: the opening of our adolescents' unit, one of few in the country able to meet the needs of 16-20 years olds; exceptional advancement of our unique research programmes; and accreditation by a leading university of one of our courses.

We are proud of the long tradition of experience that has been built up at the Cassel over nearly half a century, and the way in which we have begun to turn it to new projects.

In this newsletter you will read of various projects that are underway, completed or proposed. The numbers of patients and the kind of problems that we help are increasing and it is important to us that our developments are known about widely, are well understood, and can be of most benefit to those in need.

As we go into 1995 we are more optimistic now than we have been for a very long time about the future of our service and heartened that it is highly appreciated by patients and referrers.

Please do contact us about any of the services we offer or about any that you think we might be able to develop.


New Unit for Adolescents

At the end of last year, the Cassel opened a dedicated unit for adolescents. Providing in-patient treatment to young people between 16 and 20 years, the unit will help fill the gap in the current under provision of mental health services for this age group. According to the Unit's Consultant Psychotherapist, Dr Kevin Healy,

"Demand for specialist units like this is on the increase as adolescent problems escalate. All too frequently, adolescents who require treatment for mental illness are admitted to adult psychiatric wards or fail to receive treatment altogether."

The repercussions of not providing adequate health care for disturbed adolescents are severe, both in terms of human suffering and social and economic costs, he adds.

"Without appropriate treatment, these young people have little hope of ever enjoying productive and satisfying lives and many will display signs of mental abnormality in adulthood." (M. Laufer 1976 Adolescent Disturbance and Breakdown)

A variety of studies have demonstrated both the efficacy and cost effectiveness of psychotherapy. The Cassel's own follow-up study showed that 98% of patients are too disturbed upon admission to find employment; five years later, 90% have jobs.

Further studies have shown that psychotherapy, appropriatelyapplied, leads to a substantially improved quality of life for patients. Light and Bailey's "Child Mental Health Services" concluded that psychotherapy helps to strengthen families, teach self-help skills, prevent decades of wasted lives, increase productivity, reduce medical costs, minimise hospitalisation and reduce crime and social security costs.

Sister Maria Huk, Senior Nurse, talks about how the unit helps disturbed adolescents.

"The consequences of having to face the pressures of growing up, coupled with disruptive education and an unstable family life, make the young people that we treat here very vulnerable and generally despairing."

A Story of Despair

An example of a referral to the Unit is Mary, aged 17. She has a history of alleged sexual abuse from the age of 7 to 14. Mary could stand her ordeal no longer and alerted social services who took her into care when she was 15. She does not have any contact with her parents or siblings as she feels they are unsupportive and that they do not believe that she has been abused.

Mary has considerable emotional and behavioural difficulties. She is unable to express her sad and angry feelings and frequently harms herself, as well as expressing violence to others. Mary has had 19 social service placements in children's homes and foster carers within the last two years, most breaking down rapidly. Mary's current social worker is the only stable relationship in her life.Mary has come to the Cassel because she says she feels it is a chance for her to start to come to terms with her abuse and the anger she feels. The impact on her young life has been devastating and Mary wishes to start to think about her future which might involve a home and work.

Therapeutic Environment

At the Cassel, adolescents like Mary are treated and helped through psychoanalytical therapies that are specifically designed to help address their everyday living, relationships and related experiences, thus enabling the young person to manage and understand, and most importantly to work through their developmental problems.

The psychoanalytical experience is enhanced in an environment of psychosocial nursing and therapeutic community living combined with an individually planned programme of treatment. The unit programme complements the wider community structures and offers a variety of learning and living experiences such as sports, social skills, cooking supper for the community, gardening and evening outings such as going to the cinema, bowling or something similar.

This provides an opportunity to allow patients to form and develop their own identity and relationships. It is also a way to encourage responsibility for their actions in a containing, supportive, environment. In addition, adolescents are offered two individual and group psychotherapy sessions per week.


We offer an initial out-patient assessment and then a month in-patient assessment, invariably leading on to a six to twelve month period of continued treatment. This includes regular formal reviews, to which other workers are invited and in which adolescents are actively involved.

Where appropriate, the immediate family is included in their treatment and offered formal monthly meetings. Educational needs are also assessed which may lead to further education or remedial work.

For further information about adolescent services at the Cassel or referral and admission policies, please contact Dr Kevin Healy on 0181 237 2953.

New Balint Group for GPs

A Balint group for local GPs is being run by Cassel Consultant Psychotherapist, Dr Kevin Healy. The aim of the group is to foster psychodynamic understanding of the interaction between GPs and their patients. The group will meet weekly at the Cassel Hospital on a Friday from 1.30 pm to 2.45 pm. A nominal charge of £10.00 per session will be payable and PGEA is being sought.

Please contact Dr Kevin Healy on 0181 237 2953 if you would like to join the group or would like further information.


The Cassel has an active Hospital Appeal Fund whose appeal Director, Robin Briars, has achieved great success in raising significant funds towards research projects and to the re-build of our Day Unit and Families Unit. The Appeal goes back to the 80's when there was an attempt to completely close the Cassel. However, the local people and staff fought successfully and managed to get the decision rescinded. We then had to find a sum of £300,000 within nine months in order to survive. This we achieved and the Cassel's work continued uninterrupted.

Having got over that hurdle, we had to look at the future and decide how we could best plan the years ahead. It was clear that the accommodation for families was inadequate and that we needed research undertaken that would hopefully precipitate evidence and hard facts which proved the usefulness of the treatment we provide.

Since late 1990, more than £1 million has been raised, as well as some significant pledges towards the new building and funding of research.

Families Centre Appeal

That was how the Families Centre Appeal got started. The key to success lay in persuading medically orientated grant-giving Trusts to subscribe. By means of a mixture of major fund raising functions and a constant stream of research evidence and other information about the Cassel, we have acquired grants from more than seventy of them.

Initially, we had undertaken an evaluation of the Cassel's future within the internal market and we have now successfully gained planning permission.

The Families Centre Appeal will cover the costs of the rebuild of the Day Unit, including a school for children as well as the cost of rebuilding the Families Unit, which will feature purpose-built accommodation for families with full access for disabled people. So far, we have overcome all the potential problems which have included ensuring that the new building fits in with our existing historical mansion and avoiding disturbing the badger sets!

The best and latest news came at the end of last year when Riverside Mental Health Trust agreed to give the Cassel a large contribution towards the Day Unit which means that building can start in the near future.

Since this article was prepared, an additional grant has been received from Smith's Charity which means we are part way towards paying for the Families Unit.

The Hospital Appeal Fund

The Cassel's new Head of Research, Consultant Psychotherapist, Marco Chiesa and Robin Briars, have together been responsible for excellent presentations which have resulted in generous contributions from the Sir Jules Thorn Charitable Trust over three years as well as another large sum from the North Thames Regional Grants Committee.

These two major contributors and others pay for part of the cost of our Consultant Psychotherapist and the full cost of a Research Senior Registrar and part-time Research Psychologist as well as training and administrative support.


The progress of the new building and the Appeal funds will be featured in a future edition.


The Cassel Hospital has established a dedicated research and education department, headed by Dr Marco Chiesa, Consultant Psychiatrist in Psychotherapy.

Two major outcome studies are already underway. Further work to be undertaken by the department will include the improvement of the new Diploma in Psychosocial Nursing, recently accredited by Manchester University; the implementation of research studies to investigate the clinical work carried out at the Hospital; the establishment of one-day courses and workshops open to all mental health professionals on subjects such as treatment of borderline personality disorders, family management of multi-problem families with sexually and physically abused children, management of suicide/parasuicidal patients; and use of psychosocial nursing theory and techniques applied to various settings.

In addition, the Department will organise conferences aimed at enhancing the scientific status of the Hospital.

Our next newsletter will feature the Research Department's preliminary outcome results of their research studies.


The Diploma in Psychosocial Nursing - working alongside families and individuals in a therapeutic community

The Cassel's Certificate of Psychological and Family Centred Nursing, which has a long history at the Hospital, has received formal accreditation by the University of Manchester and is now offered to F grade nurses training at the Cassel as a Diploma in Psychosocial Nursing. It is believed that the Cassel is the only Hospital in the UK offering such a qualification.

The first group of Diploma students are already a few months into the course and for the remainder of the two year programme will work with a caseload of in-patient families and individuals, making links between the theory and practice of Psychosocial Nursing. Students are also supported in taking on significant managerial responsibilities in relation to the therapeutic community.

George Leach, Nurse Tutor says:

"For almost fifty years, the Cassel has evolved specialist training for the qualified nurses who come to work in this challenging setting. It's a great achievement for the Cassel to receive validation by one of the UK's top universities . The course has been designed to give nurses that train and work here at the Cassel effective interpersonal, group and organisational skills that are applicable to a wide range of settings in the mental health field."

For further information about the course, contact George Leach: 0181 237 2929.


A one day conference on


will be held on Friday 30th June 1995 from 9.30am - 5.45pm. Chaired by Bob Hinshelwood and Peter Fonagy.

Speakers will include

David Bell and Marco Chiesa, Consultant Psychotherapists at the Cassel Hospital, Bridget Dolan, Senior Research Fellow and Kingsley Norton, Consultant Psychotherapist from the Henderson Hospital.

Discussants will include Tony Bateman, Consultant Psychotherapist from St Ann's Hospital and Brian Martindale, Consultant Psychotherapist from Parkside Clinic.

The conference fee of £40.00, which includes lunch and refreshments will go towards the Cassel's Appeal Fund.

For an application form and full programme, please contact Vivien Tolfree on 0181 237 2902.

The Cassel Hospital is part of an NHS Trust which provides for in-patient and out-patient psychotherapy for whole families, single adults and adolescents. The majority of people we help suffer from severe personality disorders. They join our internationally known therapeutic community, which comprises a unique combination of intensive psychotherapy and psychosocial nursing.

Founded in 1919 by the benefactor Sir Ernest Cassel for psychological casualties of the First World War, the Hospital has built up a long-standing and international reputation for research and training in psychotherapy. Since the Second World War, under the direction of Dr Tom Main, the concept of treating personality disorders in a therapeutic community was developed and we now offer this service to all age ranges of patients who have proved largely resistant to other forms of psychiatric treatment available.

For further information about the Cassel's services contact:

Dr R. D. Hinshelwood, Clinical Director


Charlotte Way, Business Manager

The Cassel Hospital
1 Ham Common
TW10 7JF
Telephone: 0181 237 2929
Fax: 0181 237 2996

NEXT EDITION:Preliminary results of Research Studies