leaders to end violence on psychiatric wards, says psychiatrist
by Angela Hussain
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.
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.
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.
health services must give ward managers the authority to manage
their wards effectively and must ensure that they have the resources
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.
National Director for Mental Health, Louis Appleby, said the situation
"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,"
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.
against service users goes unrecorded
Louise Pembroke, mental health campaigner and survivor activist,
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.
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
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.
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.
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"
in 40 years
Peter Campbell, mental health activist, trainer and writer in mental
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.
have been using them for 40 years and the basic service they offer
has changed very little and not improved much.
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.
am not convinced that the current initiatives to improve acute ward
care are really doing enough to encourage such a fundamental review.
will make services worse
Allan House, professor of liaison psychiatry, University of Leeds
February 24, 2008
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.
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.
Lorraine Johnstone, Consultant Clinical Forensic Psychologist and
Honorary Research Fellow, Rowanbank Clinic, Glasgow, Scotland
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
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