Five recommendations to improve safety on inpatient wards
13/03/2023
Anyone who has endured a mental health crisis will tell you what a frightening, bewildering experience it can be. It is often one of the most distressing events in someone’s life. With this in mind, people who find themselves in a mental health hospital should expect to be kept safe, cared for with respect and dignity, and given appropriate treatment that helps them to recover. But sadly, this is too often not the case.
Rethink Mental Illness has been campaigning on longstanding issues around the safety of people in mental health hospitals for years, but recent exposés by BBC Panorama and Channel 4’s Dispatches are stark reminders of the shocking levels of abuse and neglect which can take place.
These investigations echo what people have been telling Rethink Mental Illness and our partner charity, Mental Health UK, in recent months. We’ve heard distressing stories of poor care in unsafe environments, often as the result of a lack of empathy and compassion from some staff, alongside harmful practices such as the overuse of restraint and seclusion. Many say this fundamentally stems from the imbalance of power between the patient and the system.
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There is physical safety, things like self harm or from other service users. But there’s also the psychological aspect to it. One of the things I found difficult is there were instances where people kicked off, restraint issues, things like that. The tension and fear that there would be violence, all the time. It wears you down.
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The shocking cases of abuse and neglect in Essex and Manchester have bolstered our fight for better care and show that change must happen urgently to save lives. In this blog, we will outline our work in this area and provide recommendations for change. Improving safety on inpatient wards will require systematic change. The government recently announced an independent rapid review which will look at whether data and information is being used effectively to identify patient safety issues. While we fully support this review, on its own, it will not be enough to save lives. We would like to see a set of actions that will be taken to ensure that this data is responded to and where there are failings, that rapid action is taken to improve patient safety.
1 - Improve the mental health workforce
Experts by experience tell us time and time again that the low levels of staff, overworked staff and staff without appropriate qualifications and training, have led to unsafe and ineffective care. The government must ensure there are clear recommendations to improve this as part of the NHS workforce plan, with funding for the mental health workforce. This should include a mental health inpatient workforce plan which features peer support and the commissioning of the voluntary sector to deliver services on wards.
2 - Prioritise reforming the Mental Health Act
The government must also prioritise and properly resource the reform of the Mental Health Act. The reformed act should be guided by the principles of giving patients choice and autonomy, the use of least restriction, a focus on therapeutic benefit and ensuring people are treated as individuals. We believe this will go some way in addressing the power imbalance that currently exists between patient and practitioner.
3 - Address the continuing rise in out-of-area placements
We know that out of area placements can be very distressing for patients, and it is important that patients are able to receive care close to their homes and communities. However, out of area placements continue to rise in certain areas and the NHS Long Term Plan has failed to reach its target in eliminating them. The NHS must continue to focus on this issue and look at ways to incentivise the reduction of these placements so that people can be treated safely near their families and home.
4 - Work collaboratively with experts by experience
The Care Quality Commission (CQC) will continue to play a key role in independently assessing hospitals and ensuring best practice. To improve inspection practices, the CQC must ensure greater involvement of experts by experience, and their families and carers, as well as independent mental health advocates in inspections. The CQC must also actively engage with patients and their carers to weed out safety issues. The CQC must also strengthen its collaboration with local safeguarding boards in regard to inspections of hospitals. Concerns raised about a hospital or units are a critical source of information for inspectors and can help in the monitoring of patient safety.
5 - A change in attitude from policy makers
Finally, a change in attitude by policy makers is much needed. The government must focus on relational security - building better relationships between staff and patients - as much as physical security, such as ward design, and procedural security, such as safeguarding procedures. The DHSC, NHS England, and CQC must continue to speak with and work alongside experts by experience, and their families and carers, to understand what safety means to them and how to improve it.
Continuing reports of failures in mental health hospitals paint a bleak picture, but we must remember that there is good practice happening across the country, and that change is possible. Rethink Mental Illness is committed to continuing to work with experts by experience, their families/carers, mental health charities and the government to ensure that patients receive the best possible care and that their safety is prioritised.
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There were also some good things - some of the female nurses were exceptional and it was only due to their particular care, that I was overall, safe.
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