Comment: Neither safe nor sound

Behaviour considered utterly unacceptable outside institutions can be condoned or even considered normal inside. Judging by new figures on sexual and physical violence, there may be cases where mental health and learning difficulty wards have fallen into this way of thinking – or, more to the point, not thinking.

Last week a Community Care investigation revealed more than 300 allegations of sexual assaults on mental health wards in a three-year period, somewhat higher than official figures released by the National Patient Safety Agency. But even the NPSA figures included 11 alleged rapes carried out by members of staff.

Equally disturbing are the NHS Security Management Service’s new findings that there were 43,097 attacks on staff last year in mental health and learning difficulty wards, averaging 120 physical assaults a day. Neither set of figures gives any grounds for confidence that sexual and physical violence in the mental health and learning difficulty systems are being taken seriously, yet here are some of the most vulnerable people of all.

While it is true that most mixed sex wards have been closed, the rule is often limited to sleeping arrangements and even then may be breached if the only spare bed is in a ward supposedly earmarked for the opposite sex. Monitoring by nursing staff can be slipshod and is often left to inexperienced juniors with little knowledge of what to expect. Specialist training is erratic and the illegal drug culture on many wards is fuelling the violence that staff are ill-equipped to resist. Complaints procedures, where more than nominal, are frequently a dead end and senior managers are likely to be in denial.

Better training for nurses on the management of violence and aggression, effective complaints procedures and vigilant external monitoring of wards are part of the answer. More experienced staff on the front line, fewer of them from agencies, would help.
But the best remedy for the evils of institutions is that, wherever possible, the institutions cease to exist. Most of the old-fashioned long-stay hospitals have mercifully gone, but new institutions such as NHS “campuses” have risen in their place. Where group care is necessary, it must be small-scale and close to the communities of the people cared for. Only then will full accountability be achieved.

Additional reading
‘Stress on services’ behind wave of assaults on mental health staff