"Problems at Cawley centre, Denmark Hill, London."

About: South London And Maudsley NHS Foundation Trust / Homeless mental health

(as the patient),

With regard to the Cawley Centre, I will start with the positive. The consultant who runs the centre and his second, are sincere about what they do. I think his second is a pleasant individual with a good attitude to patients.

Now for my critique.

I believe the approach of the Cawley Centre as a whole is severely broken. In my opinion the patient community has a myriad of problems and between one to one time with individual counsellors and group therapy, we are left to our own devices.

This has become a problem as patients, I feel often have difficulties relating to each other, some can be unreasonable.

I feel like this will inevitably lead to people being provoked and which can cause great upset and distress. The faulty logic assumes that a calm rational debate about it later will alleviate these behavioural problems.

I find the emotional reactions of many people, like myself are not thought out. For me, they happen spontaneously and are a conditioned response that has become unconscious.

I think talking to people later when they are calm does nothing but make them feel guilty and hopeless.

A reaction happens in a split second and once in an emotional state, I find it hard to respond.

It seems to me that some of the staff clearly aren't interested in what the patients think. I think the patients are often highly intelligent people, and the highly cultivated calm demeanor of staff with their placating body language gestures I find patronising and insulting. The patient may be acting like a five year old but they are not one. I feel as if talking to patients like me as such merely provokes further hostility.

I also believe the language in use by the professionals here is the worst kind of exported political correctness. They use the words "safe" or "unsafe" when referring to a situation that may cause distress to others. Such use of unnecessary simplification I think is insulting to the intellect of the patients.

We are all adults, though we may act otherwise from emotional issues. I think the Cawley Centre is demeaning to patients dignity. I want to be spoken to like a peer, not like I'm mentally deficient. I half expect to be asked to attend an afternoon of sponge painting.

I do not think the fairly poor social skills of some staff is hardly going to help rehabilitate the more pathologically antisocial patients.

In my opinion, there is also no realistic way that a patient could be protected from an outbreak of violence within the centre, which I think can be a possibility. When tempers flare some staff have demonstrated to me that they are woefully ineffectual at diffusing a situation. I think better people management skills are needed for the qualified staff who carry out behavioural therapies.

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Response from Su Glazier, Head of Improvement, Innovations and Involvement, South London and Maudsley NHS Foundation Trust

Dear aprilshowers33,

We appreciate you spending the time to share both the positive aspects and give us a critique of the service you are receiving. We value your feedback and are currently considering the specific issues you raise through your review. Once we have done this, we will post a more detailed response.

With best wishes,


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Response from Jill Lockett, Service Director, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust

Dear aprilshowers33,

Thank you for your comments about the Cawley Centre posted on Patient Opinion. I wanted to answer in detail to explain the rationale behind the way the Cawley Centre works in order to answer your criticisms.

The reason we encourage clients to be left alone in-between individual and group sessions is because social time is an important part of the therapy. Our clients will struggle with relating to each other, but this is at the core of their difficulties and one of the reasons why they have come to the Cawley Centre. People will sometimes get upset and feel distressed within these relationships and finding better ways to manage their feelings is the essence of therapy.

I understand your point that people’s reactions will often not be thought out and will be spontaneous. During your time with the Cawley Centre, we encourage you to develop reflection on these. We know that often, people cannot think when they are not calm which is why ‘in the moment’ might not be the best time to talk but our intention is certainly not to make you feel “guilty and hopeless”. We know that Cawley Centre clients in particular may find it difficult to respond when in an emotional state.

We consider that it is important for staff at the Cawley to contain their own feelings when dealing with difficult situations, which is perhaps why they come across to you as reacting differently than you might expect.

Finding an acceptable common language to use in the work of the Cawley Centre community is part of the process for all of us and I will pass your comments to the team. Staff make every attempt not to talk down to clients, but they do not always get it right so I’m sorry if you felt patronised.

I am not absolutely clear about what you mean by, ‘I do not think the fairly poor social skills of some staff is hardly going to help rehabilitate the more pathologically antisocial patients’, and I guess for me it would help to be given specific examples of what you do mean. However, the staff do constantly ask for feedback from the clients about how they feel they have handled certain situations, which is the way in which the Community on the Cawley learn and develop different ways of managing situations.

I hope you have not felt in danger of physical assault at the Cawley Centre. Our staff continuously assess the risk of violence for all our clients and it is an extremely rare occurrence. All of the staff have been trained in de-escalation techniques which they employ. We do realise that clients may expect staff to intervene more readily, but it is the policy of the Cawley Centre that physical restraint is not employed on the unit, due to the nature of our client group. This has been a policy that has been developed alongside clients with their input and involvement.

Thank you for your positive comments regarding two of our staff; I will of course pass these on to the individuals you specified.

If you have any further concerns and would like to discuss this issue further, Jann Oliver, Service Lead for the Cawley Centre will be happy to meet with you. Please phone 020 3228 2679 to arrange a time to meet with Jann.

With regards,


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