Staff exodus leaves acute psychiatric wards unable to cope with patients’ complex needs

Violence, substance abuse and chronic staff shortages – two
major reports launched last week paint a dismal picture of life on
an acute psychiatric ward.

A study of 300 in-patient wards and 50 NHS trusts across England
by charity the Sainsbury Centre for Mental Health finds a general
over-reliance on agency staff.

Nearly half of wards lack a lead consultant psychiatrist while
13 per cent do not have a ward manager or senior nurse. And almost
a quarter of ward managers say their wards are unfit for use.

An audit of 265 mental health and disability wards by the Royal
College of Psychiatrists, released by the Healthcare Commission,
reveals high levels of violence, fuelled by substance misuse,
inadequate staffing and boredom.

A spokesperson for the Sainsbury Centre says the priority for
government over recent years has been to develop community-based
services. While this is to be welcomed, he argues, it has left
acute care behind.

One of the most telling statistics from the Sainsbury report is
the fact that a quarter of wards have lost staff members to a
community service over the past year.

According to the spokesperson staffing shortages are at the
heart of the problems facing acute wards, a view backed by Mental
Health Nurses Association professional officer Brian Rogers.

He believes staff have been attracted by the increasingly
sophisticated care being offered by community-based services and
feels in-patient care suffers from a perceived lack of status as a
result. “They do not feel as valued, that they have the same sort
of control over what happens in their environment as community
staff.”

These issues lead to recruitment problems and the increasing
reliance on agency staff, who are not around long enough to build
up a therapeutic relationship with patients. They will also be less
likely to cope in the potentially explosive situations arising on
acute wards, argues Rogers.

Of course, if staff levels are low, nurses will have less time
to spend with individual patients.

“There’s a lack of meaningful therapeutic activity for patients
on the wards and that can lead to people getting tense, bored and
irritated,” says Simon Lawton-Smith, senior policy adviser on
mental health for the King’s Fund.

The lack of activity is compounded by the growing number of
patients with complex needs, principally stemming from drug and
alcohol misuse, he says.

Lawton-Smith argues that the issues facing acute wards have been
clear for many years – it is time to look at what works. But he
warns against any temptation to believe that introducing compulsory
community-based treatment, as suggested in the latest draft Mental
Health Bill, will take pressure off acute wards.

International evidence suggests that as more people are treated
in the community the number of in-patient beds is reduced. But the
people who require those beds are the most ill and will make a
proportionately higher demand on resources, he says.

Also, community treatment orders, being a statutory requirement,
will inevitably draw resources away from other areas, he
adds.
According to Rethink spokesperson Paul Corry the only way to solve
the problems facing acute care is to restructure mental health
services. Corry talks about reclaiming the original meaning of the
word “asylum” as a non-hospital crisis centre people could use for
a few days at a time. Rethink has developed two such centres,
staffed by nurses, in conjunction with a helpline.
“The solution lies outside hospital in better preventive care,” he
says.

For some nothing less than a complete overhaul of the mental
health system can provide a solution.

Mental Health Foundation chief executive Andrew McCulloch
believes a greater range of different treatments and preventive
measures, including crisis intervention and therapeutic
communities, should be introduced. All the acute centres that are
unfit for use and where patients sit around waiting for something
to happen should eventually be closed down, he argues.

“It’s not about knocking staff,” he says. The model of
in-patient care is wrong and must be overhauled. “Trying to take an
incremental approach doesn’t work.”

• Sainsbury report at www.scmh.org.uk and Healthcare
  Commission audit from www.healthcarecommission.org.uk