May 25, 2005
by Mike Andrews

Almost one third of mental health inpatient staff accept that they or colleagues have threatened to use medication or seclusion to control patients' behaviour, it has been revealed.

The findings were released yesterday in a national Healthcare Commission audit of violence on inpatient psychiatric and learning disability wards.

The audit also found that 78% of nurses, 41% of clinical staff and 36% of service users said that they have either been personally attacked, threatened or made to feel unsafe.

In addition, 35% of service users said staff 'winded them up'.

Almost half (45%) of mental health nurses said they had witnessed trouble on wards due to people drinking or taking drugs.

The audit, carried out for the commission by The Royal College of Psychiatrists' research unit, identified factors which the commission believes are contributing to a culture of violence on inpatient wards.

These include the unsafe design of wards, inadequate staffing, overcrowding, drug and alcohol abuse, high levels of boredom, and poor training in the prevention and management of violence.

For the audit, more than 6,500 anonymous questionnaires and 20,000 comments were received from staff, service users and ward visitors from 265 mental health and learning disability wards. The audit was carried out between December 2003 and March 2005.

The acute staffing problem within inpatient mental health services was reinforced today by a report by the Sainsbury Centre for Mental Health (SCMH)

It revealed that, on an average day, nearly half of 300 psychiatric wards in England surveyed lacked a lead consultant psychiatrist. Less than a quarter had a clinical psychologist, while 13% were without a ward manager or a senior nurse.

On an average day a ward of 16 beds had a combined shortfall of two full-time nurses and healthcare assistants, and used four full-time agency or bank staff.

In what has been a grim two days for everyone involved in mental health inpatient care, the audit and SCMH report expose, between them, a culture of violence, hostility and drug taking on inpatient wards.

Another mental health charity, Mind, also found last year that more than half of psychiatric inpatients had been verbally or physically threatened by other patients or staff.

Health Minister Rosie Winterton responded today by emphasising that since 1997 mental health services have witnessed a significant boost in the recruitment of key staff.

"The numbers of consultant psychiatrists and mental health nurses have increased by 45% and 21% respectively," she said.

Ms Winterton added that there are 74% more clinical psychologists, 125% more non-medical psychotherapists and 22% more art music and drama therapists.

"However, we are not complacent and in 2004 we published a National Mental Health Workforce Strategy which we are implementing in partnership with major stakeholders," she added.

The SCMH report - entitled Acute Care 2004 - covered 50 NHS trusts and was commissioned by the National Institute for Mental Health in England.

It called on the government to set national guidelines on appropriate staffing levels for acute psychiatric wards.

Ms Winterton said the government has developed an on-going programme of work to develop training for staff to prevent and de-escalate violence.

New National Institute for Mental Health guidelines on safer management of patients in psychiatric in-patient and A&E settings were released in February.

Snapshot of findings from The Healthcare Commission audit:
* 30% of nurses, 24% of clinical staff and 48% of service users felt staff threatened to use medication or seclusion to control service users' behaviour.
* 35% of service users said staff 'winded them up'
* 65% of service users were satisfied with their involvement in decisions about care and support. 29% were not.
* 45% of nurses said there had been trouble on wards due to people drinking or taking drugs
* 78% of nurses, 41% of clinical staff and 36% of service users said that they have either been personally attacked, threatened or made to feel unsafe.
* 23% of service users said they shared space with members of the opposite sex when they did not want to
* 75% of nurses and 79% of clinical staff said there was multi-disciplinary consensus on the clinical care of service users
* 86% of nurses and 82% of clinical staff thought that service users felt comfortable talking to staff
* 23% of service users said they shared space with members of the opposite sex when they did not want to
* 63% of service users said they did have enough time in private with family, friends or members of staff. 34% said they did not.
* 64% of service users said their complaints were taken seriously. 22% said they were not.

Read for yourself:
Healthcare Commission's audit on violence in psychiatric and learning disability inpatient wards and units (pdf)
Sainsbury Centre For Mental Health's Acute Care 2004 report (pdf)

See also:
Mental health comment
June 6, 2005: Our acute problem - To alleviate the culture of violence on inpatient psychiatric wards exposed by a Healthcare Commission audit, psychologists should have more of a role in care, argues Rufus May. There should also be more service user "consultants" helping manage wards and training of staff. But above all, says May, we need more non-medical residential alternatives to hospital care.
Feb 28, 2005: Mental health staff should understand how their behaviour can increase or decrease risks of violence, guidelines urge - but campaigners '"dismayed" that National Institute for Clinical Excellence does not recommend three-minute time limit for face-down restraint of patients
Sept 6, 2004: More than half of psychiatric inpatients verbally or physically threatened by other patients or staff, survey reports - but MIND's survey's validity likely to be questioned due to small sample

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