Assaults on mental health and learning difficulties staff: special report

The NHS and police this week pledged to get tough on service users who assault health and social care staff. More prosecutions and tougher sentences for perpetrators are promised.

Health minister Rosie Winterton, said: “It is crucial that we work with the police to crack down on all forms of unacceptable behaviour.”

Staff working in NHS mental health and learning difficulty services suffer 120 physical assaults a day, the most recent official figures collected by the NHS Security Management Service show. The total adds up to more than 40,000 staff in mental health and learning difficulty services facing physical attacks during 2004-5.

This week’s agreement by the NHS Security Management Service and the Association of Chief Police Officers commits both the police and the NHS to investigating every reported incident of violence and abuse and to put pressure on the courts and crown prosecution service to implement tougher sentencing.

Sick leave
Two nurses based at Millview Hospital in Hove, East Sussex might have benefited from the new tougher regime.

Both were punched in the face by patient Joel Eneke in separate incidents in June 2005 and forced to take sick leave because of their injuries.

Their attacker was brought to justice in June when he appeared at Brighton Magistrates Court and was given a two year conditional discharge but only because the NHS pursued a private criminal prosecution.

The police, despite obtaining a statement from one of the nurses, had decided to take no further action stating: “due to the suspect’s detention under the Mental Health Act we are unable to interview him and progress these matters”.

However protecting staff who deal with vulnerable service users is a complex issue.

Mind chief executive Paul Farmer has said that NHS staff have a right to carry out their jobs in safety but there was a major difference between Friday night alcohol-fuelled violence in accident and emergency wards and incidents resulting from psychosis.

Apart from this week’s get tough pledge other activities to protect staff are underway. The NHS Security Management Service is responsible for developing policy on how to make the health service safer and its remit includes establishing the legal protection unit.

Prosecuting offenders
The unit gives advice to health bodies on prosecuting offenders and it also considers private prosecutions against offenders if the police and or crown prosecution service have decided against it.

Since it was set up, the unit has successfully prosecuted five individuals for attacks on staff in mental health and learning difficulty services and it is currently dealing with another five cases, two of which involve multiple incidents.

Preventing and managing violence is also crucial. As well as establishing the unit, the NHS Security Management Service also piloted anti-violence training in mental health and learning difficulty settings last year, which was developed following the death of David ‘Rocky’ Bennett.

Bennett, a 38-year-old schizophrenic who died in 1998 after he was restrained, face done for 25 minutes, by at least four nurses at Norvic clinic in Norwich.

Over 500 NHS trainers have attended seminars organised by the NHS Security Management Service on a new training syllabus that has 10 learning outcomes, including how to recognise how an individual’s life and behavior relate to aggression, an understating of risk assessment implementing prevention strategies.

Social workers
Joe Delaney is a project manager for the prevention of violence and aggression at South Essex Partnership Trust, one of the trusts piloting the training. Since April, the trust has trained more than 100 staff, including social workers and nurses.

He says that universities to do not necessarily prepare people, such as nurses and social workers, for how to deal with conflict at work.

A mental health nurse, who did not wish to be named, agreed, saying he had just a day’s training in breakaway techniques as a student, which meant he did not feel sufficiently skilled to deal with violent incidents.

“I wouldn’t say that being attacked is part of the job, but I would say that the chances of it happening are pretty high.

This needs to be looked at with regards to staffing. It is not always possible to have a best possible skill, gender and age mix coupled with thought disordered, psychotic patients,” he says.