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

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.

Dr Paul Lelliot, of the Royal College of Psychiatrists’ research and training unit, made the call after a violence audit of 211 psychiatric units in England and Wales found 46% of nurses on psychiatric wards for adults of working age had been assaulted by patients. This went up to 64 per cent for nurses in wards for older people.

Some nurses described serious injury such as fractures, dislocations and black eyes.

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

At the audit’s launch on Wednesday Dr Lelliot urged trusts and private organisations to give ward managers the go-ahead and resources to implement change.

“Good leadership is the single most important ingredient for quality and safety,” he said.

“Mental health services must give ward managers the authority to manage their wards effectively and must ensure that they have the resources they need.”

The national audit of violence in mental health services was conducted for the Healthcare Commission by the Royal College of Psychiatrists.

It revealed no marked improvement since a similar 2005 audit. This reported that 78% of nurses, 41% of clinical staff and 36% of patients had been personally attacked, threatened or made to feel unsafe.

There are around 30,000 in-patients in mental health units in NHS and independent organisations in England and Wales.

The audit examined 211 units at 69 of those organisations.

This audit says the impact of violence on staff and patients can be “constant and intolerable”.

But it highlighted improvements in the way violence is now being managed, particularly in providing effective alarm systems, reporting incidents and having an appropriate mix of staff skills.

But it said ward physical environments, activities for patients, training and staffing levels remain poor.

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.

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