Organization and management of an in-patient treatment unit for adolescents.

Brookside is a second or third tier treatment unit for disturbed adolescents. Most youngsters admitted have been already "treated" by the usual disciplinary measures, simple behavioural techniques, medication and work of different types with them and their families, which have been found to be ineffective. An outline of the philosophy of treatment developed in the unit is described in the paper--a philosophy aimed at dealing with the source of the disturbance and applicable to any type of adolescent problem. A small minority of referrals from our catchment area, the NETRHA has been found unsuitable for this type of work. This unsuitability is not based on the type of problem, but on our assessment of the potential capacities of the individual. Inevitably, in the in-patient setting, the disturbance of the patients affect the staff, and individual and group patient pathology is reflected in staff stress and staff disturbance. Whilst the philosophy of treatment is aimed at benefiting the patient, it is through the understanding and management of staff difficulties, which became of primary concern in the unit, that the pathology of the patients can be unravelled, understood and dealt with. Paradoxically, attempting to care directly for the patients can lead to impossible difficulties, whilst caring for the philosophy of treatment and the staff leads to a solution of most of the problems, and development of both staff and patients. Total patient care is built into the philosophy and management of the unit. Staying with the problem and working as a team has resulted in successful treatment of youngsters considered to have intractable problems whilst periods of poor staff support and difficulties of working together, have led to failures in treatment. The basis of this philosophy was first introduced to the author during his training years at the Northgate Clinic, London NW9.