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Violence and overcrowding characterise many mental health wards in England

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a959 (Published 23 July 2008) Cite this as: BMJ 2008;337:a959
  1. Andrew Cole
  1. 1London

    A comprehensive survey of England’s mental health wards has identified high levels of violence, overcrowding, and impersonal care, and 11 of the 69 trusts surveyed failed to meet minimum standards.

    The health watchdog the Healthcare Commission also found that many detained patients are leaving the wards without permission and putting themselves or others at risk. During a six month period patients were recorded leaving the ward on 2745 occasions for an average of three days.

    The commission examined in detail the performance of 554 mental health wards in England that provide almost 10 000 beds for patients between the ages of 18 and 65.

    Overall it scored eight trusts as excellent, 20 as good, 30 as fair, and 11 as weak (meaning that they fell below minimum standards). The commission has almost completed follow-up visits to all the trusts rated as weak, and action plans are now being implemented.

    It also found that the best performers were more likely to be smaller units and that those scoring poorly were more likely to be larger and serving an urban and deprived population.

    Overall the bed occupancy rate was 87%. But the rate was over 90% in 29 trusts and over 100% in eight trusts. The highest bed occupancy rate was Walsall Teaching Primary Care Trust, which had 106%.

    The report’s authors express concern at the high levels of violence in some wards. The latest audit showed that 45% of nurses and 15% of patients were physically assaulted in 2006-7 and that only two thirds of staff had received training in preventing or handling violence.

    And despite patients’ vulnerability to sexual aggression or violence, only 59% of the care records the commission looked at showed an assessment of patients’ risk of sexual vulnerability.

    The commission also expressed concern at a lack of personalised care in many wards. Four in 10 care plans sampled did not record the patient’s views, while 16% did not have a one to one session between the patient and a nurse at any time during the patient’s first week on the ward. Ethnic minority patients were particularly poorly treated in these two areas.

    Anna Walker, the commission’s chief executive, emphasised that the in-depth survey had highlighted some excellent care from some organisations. But there were also issues of significant concern, she said. “There are cases where people are not always getting the personalised, safe, high quality care that they need. This is happening at a time of crisis in their lives, and it cannot be ignored.”

    The 11 trusts rated as weak overall are Wolverhampton City Primary Care Trust, North East London Mental Health Trust, West London Mental Health Trust, Leicestershire Partnership Trust, Lancashire Care Trust, Northumberland, Tyne and Wear Trust, Birmingham and Solihull Mental Health Trust, North Yorkshire and York Primary Care Trust, Avon and Wiltshire Mental Health Partnership Trust, Manchester Mental Health and Social Care Trust, and Sheffield Care Trust.

    Notes

    Cite this as: BMJ 2008;337:a959

    Footnotes

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