Macclesfield Young Person's Unit

Over the years I was in Care, I think the best facility I was in was Macclesfield Young Person's Unit. A Child Psychiatric Unit. I attended this particular institution in mid 1990.

The Y.P.U provided a regional specialist resource within the NHS. Since opening in 1970, it had been run on modified therapeutic community lines for young people of both sexes with emotional and/or conduct disorders between the ages of 13 and 18 under the consultancy of Dr Peter Wells. In the early days the unit was a residential seven day unit with places for 20 youngsters. 
In 1986, in spite of the rising referral rate, the service was pruned and the future of the YPU questioned. By 1990 there were 14 beds and the facility was open 5 days a week. Residents were left to make their own way home on a Friday and present themselves to the Unit on Monday morning ready to start school and therapy. Staff shortages did not impact on the care we received as we all mucked in to help out. At the time, we all just assumed it was part of the therapy side and we were, for the most part, unaware there were any staffing problems.

The unit provided an intensive in-patient experience comprising individual therapy, daily group therapy, weekly art therapy and psychodrama, programmes in social skills training, regular community meetings, and communal outwardbound-type activities. There was a school attached to the unit providing education for residential youngsters plus 20 additional day-pupils. Cost estimates varied and were upwards of £1,000 per week for an adolescent to stay on the unit.

In 1991 a follow-up study of 165 young people admitted to the unit over five years suggested that 60% showed subjective improvement and that this was maintained at two years. For this problematic group of youngsters the YPU  offered some potential for change.

Senior registrars from the North West Regional Training Scheme in Child and Adolescent Psychiatry had been electively placed at the YPU since 1972. This post tended to be held towards the end of training
by a trainee with particular interest in psychotherapy and a yen for an alternative training experience. It was regarded as a unique experience perhaps not fitting for all, but eminently suitable for training purposes.


The Young People's Unit in Macclesfield claimed to not admit psychotic youngsters, who accordingly were treated as out-patients or elsewhere. Their policy of treating the majority consumer group at the cost of excluding a very small minority (around 1-2% of referrals), which seemed an appropriate priority in
view of the demands, nevertheless invited critical comments; expensive units which operate an overt selection
policy tend to attract elitist or other perjorative labels. They are difficult to justify however unless they admit only those for whom the treatment is likely to prove effective. Follow- up studies suggest that the treatment of psychotic illness is even less effective than that of many conduct disorders.



There also seems to be a fairly universal opinion that psychotic adolescents should not be treated on adult wards. It stems partly from the supposed risk; however, the harm from exposing a vulnerable adolescent to a seriously disturbed or delinquent peer group can at times be very much greater. The risk of adolescents disturbing adult patients or the equanimity of adult ward staff can perhaps be justified in certain circumstances. 
Support for a more selective approach is given in a recent consumer survey in which the views were canvassed of discharged adolescents and their parents on the treatment given them on what they described as a 'general purpose adolescent unit'. Patients and relatives regarded as harmful the location of the unit in a psychiatric hospital, with its implications of mental illness. One of the conclusions in the paper is that a more selective approach should be 'dependent on a regional plan to establish units with different styles of regime suited to the treatment of different disorders.

Dr Wells did, in my opinion, an excellent job in the running of this facility. I presented to the facility every Monday morning, as required. Never feared going and remember often being happy during my weeks there.
This was one of only two institutions from which I never absconded.


The facility closed in 1992

Cited Ref: Royal College of Psychiatrists:
http://pb.rcpsych.org/content/10/9/231.full.pdf
http://pb.rcpsych.org/content/16/9/547.full.pdf+html