Concerns stoked over scale of sexual abuse in single-sex mental health wards

A patient safety watchdog has revealed a worryingly high incidence of sexual assault in mental health wards in England and Wales. However, as Sally Gillen reports, figures uncovered by Community Care show the scale of the problem is likely to be much bigger

The revelation last week that there have been 122 sexual incidents on mental health wards in England and Wales from November 2003 to September 2005, including 11 alleged rapes by staff, was shocking.

Figures contained in the first mental health services report by watchdog the National Patient Safety Agency gave an insight into levels of abuse in in-patient settings.

More shocking still was an investigation by Community Care that uncovered more than 300 allegations of sexual assault made by patients on wards in England alone from 2003 to 2006, indicating that the NPSA may just have scratched the surface of the problem (Official figures on mental health sexual assault claims do not add up).

The NPSA report admits that the true figure is likely to be higher because allegations are under-reported. It also makes the point that a high number of allegations in particular trusts could be due to higher levels of reporting rather than more incidents.

Assaults are committed by patients and staff, according to the NPSA report and Community Care’s research. Our figures show that 224 allegations were by patients against patients.

Arguably, the government has failed to limit this figure by the way in which it has allowed single-sex wards to be defined.

Despite its readiness to trumpet the fact that 99 per cent of wards are single sex, on closer inspection it is using a questionable definition of what constitutes such an environment.

Mental health trusts are required only to provide single-sex sleeping and bathing areas in wards to satisfy the government’s requirements. Day areas can remain mixed.

Many in the sector believe the government requirements are not stringent enough to safeguard patients. They argue that much more could be done to separate male and female patients, thus reducing the number of alleged assaults.

Even with separate areas for sleeping and bathing, it is not uncommon for men to be given beds on a women’s ward if male provision is over capacity, and women have often reported that bathrooms are not secure, says Sophie Corlett (pictured left), policy director at charity Mind.

Health minister Rosie Winterton defended the government’s requirements when she was questioned during a parliamentary debate on the NPSA report on its day of publication, arguing that having areas that could be used by men and women made a ward a “normal setting”.

Mental Health Foundation head of policy Moira Fraser agrees that this is a valid reason, especially when people may be detained for many months. However, she adds that it should be optional as, while there may be people who want to be on a mixed ward, others do not. Mental health charities claim that many female in-patients in psychiatric wards have been victims of some sort of abuse in their lives, and being forced into a closed environment with men may hamper their recovery and prove even more damaging if they are assaulted again.

Among the key messages and recommendations of the NPSA report is that mental health units should be reconfigured to provide single-sex wards only. It also says that wards must not be pressurised into admitting patients of the opposite sex into single-sex areas when there is high demand for beds. Neither of these points was addressed by Winterton.

Mental health tsar Louis Appleby has now asked all mental health trusts to review their procedures on patient safety. Some mental health organisations, such as Mind, which highlighted the dangers in its Wardwatch campaign in 2004, may wonder why this has taken so long.

It could be seen as another example of the lower priority given to adult protection compared with child protection.

“If this had happened on a children’s ward there would have been a national outcry,” says Corlett. “It appears that people have not taken on board the fact that these sorts of things are happening in in-patient settings.

“Somebody senior needs to be saying this is an absolutely disgraceful state of affairs. This is not the same as mistakes over medication or falls. This is not about accidents happening.”

The disparity between Community Care’s statistics and those gathered by the NPSA inevitably raises questions about the rigour of the system. Margaret Edwards, head of strategy at charity Sane, says: “We do have concerns about the robustness of the system for collecting information (see The Reporting System, below), especially as the delay in publishing the NPSA report was attributed to the need to validate the data received.” She believes there should be an annual audit of incidents of sexual abuse on mental health wards.

The NPSA does not inspect services but campaigners argue that its findings should be used to regulate them.

Corlett says: “I can see a world in which the NPSA has a place because no-blame learning is useful. But it would be good if we could see what comes out feeding into what the Healthcare Commission does in terms of inspection.”

Certainly the way in which allegations are dealt with is crucial to tackling abuse, both by patients and staff, and many patients often complain that they are not believed when they report assaults.

In April, the NPSA launched an online service for patients and the public to lodge complaints. But three months after its launch it has dealt with just 37 complaints and it does not know how many relate to sexual assaults on mental health wards.

Our research indicates that, over time, the potential number of people using the complaints system may prove more shocking than the findings unveiled by the government last week.

No allegations made
Trusts that told Community Care they had dealt with no recorded allegations of abuse:
Doncaster and South Humber Healthcare NHS Trust
Pennine Care NHS Trust 
Somerset Partnership NHS and Social Care Trust 
Selby and York Primary Care Trust 
Hertfordshire Partnership NHS Trust 
Craven, Harrogate and Rural District Primary Care Trust 
Worcestershire Mental Health Partnership NHS Trust 
North Warwickshire Primary Care Trust

Trusts that had recorded no allegations made by patients against staff: 
Cambridge City and South Cambridgeshire Primary Care Trusts 
Morecambe Bay Primary Care Trust 
Shropshire County Primary Care Trust 
Bedfordshire and Luton Mental Health and Social Care Trust 
Suffolk Mental Health Partnership Trust 
South Essex Partnership NHS Foundation Trust 
West London Mental Health NHS Trust

Trusts that had recorded no allegations made by patients against patients: 
North Cumbria NHS Trust 
Nottinghamshire Healthcare NHS Trust 
Hampshire Partnership NHS Trust 
Surrey and Borders Partnership NHS Trust 
Dudley, Beacon and Castle Primary Care Trust

NPSA figures
A breakdown of the 122 incidents recorded in the NPSA report:
19 allegations of rape; 20 consensual sex; 13 exposure; 18 sexual advances; 26 touching; and 26 other incidents.

Our figures
Community Care asked mental health trusts in England: