Understanding the Borders Specialist Dementia Unit (BSDU)
The Borders Specialist Dementia Unit (BSDU) is the modern, dedicated inpatient service for older adults with dementia at Borders General Hospital (BGH) in Melrose. This unit is managed by NHS Borders and is specifically designed to support patients over the age of 69 presenting with complex needs and episodes of significant distress. It is a critical part of the wider mental health provision for older adults in the Scottish Borders region.
Previously, BGH's dementia care was split between different wards, including Melburn Lodge and Cauldshiels Ward. However, a significant service redesign led to the creation of the BSDU, consolidating specialist expertise and resources into a single, cohesive unit. This change, which was implemented following recommendations for service modernisation, aimed to provide a more streamlined and higher quality of person-centred care.
The purpose and function of the BSDU
The primary function of the BSDU is not long-term residential care but rather a period of specialised assessment and treatment. Patients admitted are those whose symptoms cannot be managed in a less intensive community setting. The goal of the multidisciplinary team is to support the individual to manage their symptoms of stress and distress, and ultimately, to plan for their safe and effective discharge. The unit offers 24-hour care in a secure and therapeutic environment that promotes physical and mental well-being.
Services and Multidisciplinary Team
Care within the BSDU is based on a person-centred framework, with a belief that every individual has the right to privacy, dignity, and respect. This approach is delivered by a dedicated multidisciplinary team (MDT) working collaboratively to create a tailored treatment plan for each patient.
Key services and team members include:
- Psychiatric assessment: Comprehensive evaluation of a patient's mental state.
- Physical health monitoring: Ongoing monitoring to ensure all physical health needs are addressed.
- Person-centred care planning: Developing individualised care strategies based on the person's unique history, preferences, and needs.
- Treatment planning: Creating specific treatment goals and pathways.
- Discharge planning and support: Preparing for a smooth transition from hospital back to a community setting or other appropriate accommodation.
- Carer's support: Providing guidance and assistance to the patient's family and carers.
- Activity Coordination: Organised therapeutic activities to engage patients, led by a dedicated activity coordinator.
The multidisciplinary team
Weekly MDT rounds are attended by a variety of specialists to review and discuss patient progress and discharge goals. The team can include:
- Consultant Psychiatrist
- Junior Doctors/relevant medical staff
- Charge Nurses
- Staff Nurses
- Health Care Support Workers
- Activity Coordinator
- Physiotherapists (when required)
- Occupational Therapists (when required)
- Social Workers (once allocated/if appropriate)
The Physical Environment and Facilities
The BSDU is designed with the specific needs of dementia patients in mind, creating a calm and secure setting. Key features include:
- Bedrooms: All are single rooms with en-suite facilities (toilet and washing sink), offering privacy and dignity.
- Shared Spaces: Two sitting room/servery areas provide communal spaces for patients to socialise or relax.
- Quiet and Sensory Rooms: A quiet room offers a peaceful escape, and a sensory room (in development) provides therapeutic stimulation.
- Outdoor Space: A secure, dementia-friendly garden allows patients safe access to fresh air and the outdoors.
Comparison of Past and Present Units
The redesign of NHS Borders' older adult mental health inpatient service created a more focused and effective approach to dementia care. The following table highlights the key differences between the past wards and the current BSDU.
| Feature | Former Wards (e.g., Melburn Lodge, Cauldshiels) | Borders Specialist Dementia Unit (BSDU) |
|---|---|---|
| Function | Separated roles: Melburn for complex care, Cauldshiels for assessment. | Integrated function: Combined assessment and treatment unit. |
| Capacity | Variable, e.g., Melburn 16 beds, Cauldshiels 14 beds at different times. | Single, consistent 12-bedded unit. |
| Remit | Initially included continuing care for dementia patients. | Purely for specialist assessment and treatment, with focus on discharge. |
| Consolidation | Staff and patient groups split across different wards. | Single, highly-skilled specialist staff group within one unit. |
Navigating Admission and Discharge
Most admissions to the BSDU are informal, meaning the patient can generally choose to leave. However, in situations where a patient's illness impairs their insight and they pose a risk to themselves or others, admission may fall under the Mental Health (Care and Treatment) (Scotland) Act 2003. A doctor assesses the patient's capacity and risk level in such cases.
Discharge planning is a central part of the BSDU's process. It begins at admission and involves the patient, their family, and the MDT. The goal is to ensure a smooth and safe transition back to the community or into more suitable long-term accommodation, with a clear plan for ongoing support.
Conclusion: The Evolving Face of Dementia Care
The Borders Specialist Dementia Unit represents a significant and positive evolution in dementia care for the Scottish Borders. By centralising specialist expertise and focusing on person-centred assessment and treatment within a dedicated, modern facility, NHS Borders can provide a higher standard of care for older adults experiencing acute periods of distress. For families and carers, understanding the role and function of the BSDU is the first step towards accessing the right support.
For more detailed information on the unit and its services, please refer to the official NHS Borders website on the Borders Specialist Dementia Unit (BSDU).
