Appoint good leaders to end violence on psychiatric wards, says psychiatrist

February 14, 2008
by Angela Hussain

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Appointing good leaders with the freedom to implement change is vital to ending the “intolerable” level of violence on psychiatric wards, a leading psychiatrist has said.

Patients are also victims of the well-documented violent and untherapeutic culture in many psychiatric wards. A fifth of working-age patients have been attacked. For older patients, the figure was 6%.

A fifth of clinical staff, such as psychologists and psychiarists, working with older people said they were attacked, with the figure dropping to 13% of those working with working age people.

Last month Mental Health Act commissioners said psychiatric wards were "tougher, scarier places” than they were 10 years ago

The National Director for Mental Health, Louis Appleby, said the situation is improving.:

"I don't for a minute pretend we've got there yet, with wards the tranquil, therapeutic places they need to be in every part of the county, but I do think we're heading in the right direction," he said.

Read also:
Feb 1, 2008: Psychiatric wards are “frightening and dangerous” - Mental Health Act commissioners say they are also "tougher, scarier places” than they were 10 years ago.

See also:
Wards

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Violence against service users goes unrecorded

Comment from: Louise Pembroke, mental health campaigner and survivor activist, London
Date: February 14, 2008

Psychiatric wards are violent places because the culture breeds violence. A lot of violence is also committed against service users and that goes mostly unrecorded. If that violence is perpetrated by staff then service users feel reticent to report it in the belief that they will not be believed.

The Kerr/Haslam abuse is an example of how health services and professionals cover up abuse of service users, don't take people seriously, and then how there is little legal redress. Whereas if a patient assualts a health worker, if that person has a psychiatric history they are much more likely to have a one-way ticket to a secure unit for a much longer length of time than a prison sentence.

I'll never report the sexual harrassment I experienced because I know the process would put my mental health on trial.

Outside of health services, users are already subject to high levels of harassment and difficulties with being taken seriously as Mind's report, Another Assualt, shows.

Consider the 'everyday' violence which service users are subject to such as close observation and forced adminstration of medication. If I had to endure someone gawping at me all day including on the loo, I'd feel violent. Then forced adminstration of medication, especially when injected, IS assault.

Again, if someone were trying to ram a needle into my backside I would hit out. Acute units are horrible places for both service users and service providers. They are cramped with no privacy and little to do and are like pressure cookers.

Even visiting someone I feel claustraphobic and want to run out. Nurses are expected to just observe, document and dish out drugs which is a waste of their skills. Then psychological therapies are restricted to CBT. You wouldn't wish inpatient services on anyone - both service users and providers. This needs more than "'leadership" or even resources, it needs a complete shift in culture and with very different training, and no, I'm not referring to the current wishy washy gravy train of "recovery"

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No change in 40 years

Comment from: Peter Campbell, mental health activist, trainer and writer in mental health, London
Date: February 14, 2008

I doubt whether good leadership alone will be enough to end violence on acute wards. What I feel is needed is a wide and open debate about what acute wards are trying to achieve.

I have been using them for 40 years and the basic service they offer has changed very little and not improved much.

Until we actually examine the core response (or lack of it) to crisis provided by acute wards, I do not see how we can change a culture that feeds violence.

I am not convinced that the current initiatives to improve acute ward care are really doing enough to encourage such a fundamental review.

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Privatisation will make services worse

From: Allan House, professor of liaison psychiatry, University of Leeds
Date: February 24, 2008

Both the article and its responses downplay the importance of the polictical context within which psychiatry is practiced. Psychiatric wards are often overcrowded and badly designed - PFI (private finance initiative) will make that worse not better.

A country obsessed with neoliberal market-based solutions to everything is never goiung to provide good care to people who don't fit in, can't work and can't (usually) work the system. Creeping privatisation will make that worse not better.

Let's not just get at each others' throats (although there are plenty of serious points made here) but work together to highlight some of these wider threats.

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Risk factors for violence

From: Lorraine Johnstone, Consultant Clinical Forensic Psychologist and Honorary Research Fellow, Rowanbank Clinic, Glasgow, Scotland
Date: April 25, 2008

I have been involved in research studies designed to examine institutional factors for violence risk. Based on a systematic review and then a qualitative research study we identify approximately 20 risk factors for violence. Good leadership was a key facet of the organisational domain. We have now developed a structured professional judgement tool called PRISM to facilitate objective assessment of the risk factors. It might tie in well with this research. We have piloted it in Scotland and Barbados. I'd be pleased to provide additional information.

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