Mental health leaders must take an “it could happen here” approach to rooting out “toxic and closed” work cultures, in the wake of abuse exposed last week by Panorama.
That was the message from NHS England national mental health director Claire Murdoch in a letter to mental health, learning disability and autism provider leaders last week, after an undercover reporter revealed abuse of patients at the Edenfield Centre hospital, Greater Manchester.
Panorama filmed staff assaulting, inappropriately restraining and secluding and verbally abusing and humiliating patients at the medium-secure hospital run by Greater Manchester Mental Health NHS Foundation Trust.
Greater Manchester Police and nurses’ regulator the Nursing and Midwifery Council have begun investigations into the abuse, and the trust has suspended staff and commissioned an independent review of the service.
‘Hearbreaking and shameful’ footage
Murdoch described the programme’s footage as “heartbreaking and shameful”, but said that leaders needed to proceed on the basis that such abuse could be happening elsewhere, and take immediate actions to review their safeguarding systems.
Panorama was tipped off about the Edenfield Centre by a member of staff, prompting whistleblowing charity Protect to say that this illustrated failings in the health service’s “speak up” policy to empower staff to raise concerns.
Murdoch said mental health providers should review speak up arrangements, adding that abuse was prevented by, among other things, leaders and senior clinicians who had an open door and created “a safe environment for people to speak up about poor care”.
She urged leaders to ask themselves whether they were sufficiently visible, and heard enough from all staff on their wards, including healthcare assistants, cleaners and porters.
Paramount importance of patient voice
Murdoch also stressed the paramount importance of hearing from patients and their families, highlighting that those at Edenfield had reported the abuse they had experienced.
She said organisations needed to consider introducing peer-led support to enable patients to have their voices heard.
“In your own organisations you must ask how you are not only hearing the patient voice, but how you are acting on it,” she told leaders.
When people and families tell us things are not right as leaders, we must take action.”
In the light of the “role inappropriate use of restrictive interventions played in the unsafe treatment of patients” at Edenfield, she said leaders would need to “double down” on efforts to reduce levels of restraint.
This should include reviewing the use of segregation and seclusion on their wards and plans to remove patients from these settings.
They should also review arrangements for advocacy, complaints and patient care and treatment reviews, she added.
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Murdoch said NHS England would bring forward the rollout of a programme to improve the quality of inpatient mental healthcare, which she hoped would tackle the root causes of unsafe care.
She urged leaders to feed back on how the programme should be developed by emailing its head, Liz Durrant.
‘Act now to tackle toxic and closed cultures’
Murdoch added: “Clearly, there is positive work already in train across many parts of the country, but
we must act now to ramp up that action to prevent the formation or perpetuation of toxic and closed cultures, and tackle unacceptable practices; the mindset that ‘it could happen here’ must be front and centre of each organisation’s response to what we collectively witnessed.
“We must prioritise listening to the people we serve and their families and taking effective action when they tell us something isn’t right.”
In response to the letter, the NHS Confederation’s mental health network, which represents sector providers, said it welcomed NHS England’s response to the Panorama programme.
Leaders ‘doing everything in their power’ to prevent abuse
“Such abuse, lack of care and basic respect for patients must never be tolerated anywhere,” said network chief executive Sean Duggan.
“Leaders will be taking a forensic look at the policies and processes they have in place across the services they manage to ensure that patients, family members and staff are listened to and truly heard when they raise concerns about care provision.
“They will also be doing everything in their power to ensure that this kind of practice never happens again, patients and their families have the right to expect safe care delivered to the highest of standards.”
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The fundamental issue is with the values and ethics of those trusted to oversee and care for society’s most vulnerable. It’s a deep rooted issue in all state services be it the NHS or Local Authorities. Too many people in management roles that are ill equipped and lack the skills needed to ensure that human rights are protected and promoted, and decision making anti-oppressive. It creates a toxic culture of complicity whereby anybody with the right values is ostracized for trying to do the right thing. There may be policies and procedures in place, but many (not all) are breaking these everyday in practice. After several years as a social worker it left me disturbed to the core and I walked away. There needs to be a way for staff on the ground to turn to somebody to report concerns and those be taken seriously and investigated – and I don’t mean simply just going to the managers manager, they’re often complicit.
Yes this is correct, but it also is a direct ramification of the government’s lack of knowledge and funding around mental health. Mental health should be treated just as physical health is, with a holistic and person centered approach. Staff are also massively underpaid, people who work in supermarkets are paid more and they deal with challenging and volatile situations on a daily basis.
There is. You report to police. These are criminal offences not just civil ones. If frontline staff did this then more prosecutions of individuals- including management who choose to obstruct police or pervert the course of justice – would happen. As would the escalation of prosecution of Trusts.
No mention of the importance of Independent Advocacy. Detained patients have a legal right to have an IMHA under the Mental Health Act to enable people to speak up and be listened to, it also acts as an additional safeguard for people who are experiencing abuse or inappropriate care and treatment. Even in the most supportive and therapeutic setting, detained patients can still have an Independent Mental Health Advocate, they are independent from all health and social care services and they’re for the patient through their mental health recovery. Family and friends of loved ones detained in hospital, also need to know they can contact independent organisations if they are worried and need to discuss their concerns or ‘gut feelings’ that something isn’t quite right. Our heart goes out to all affected by the abuse at Edenfield.
We have left some links to free tools and resources to help patients and their loved ones understand more about their rights and treatment.
https://advocacyfocus.org.uk/mental-health-self-help-toolkits/
https://advocacyfocus.org.uk/services/advocacy-for-informal-patients-with-autism/
Apologies Leanne, the letter does mention advocacy, I just didn’t reference that in the story. I’ve added in a line now. Thanks for sharing the resources.
This documentary has left me beside myself. My son is in a high secure mental health hospital and for the last 6 months I’ve had so many issues . He’s been there over 6 years and it was OK, but now they are short staffed , leaving wards lockdowned from 2.15 pm until staff turn up for the shift the following day. They have rights to , then management are putting staff on wards that don’t work on them leaving the patients vulnerable. My son has a lot of mental health problems exacerbated by lack of trust ,so non regular staff don’t know his behaviours/ triggers ..how is that right how can they support him . Then you have jumped up obnoxious staff who think they are above you…Which makes communication no existent . Fortunately for my son I will keep fighting but there are a lot of patients that have nobody . Its a very scary world
Perhaps we can also look at the possible corrolation between the continuing neglect and abuse of people and the decisions made by Chief Executives of NHS Trusts also. Our service had a CQC inspection where the Trust Board was briefed beforehand on the “parameters” of the inspection. For the week of that inspection our Trust instructed managers to remove some staff from inpatient duties with those “better able to articulate our principles and vision”. Direct quote. Knowing some of your staff are not quite up to the standards you say you are committed to, removing them from public scrutiny but continuing to employ them anyway says everything about the smoke and mirrors that CQC are also willfully colluding with. Fine though the rhetoric is on hearing the patient voice and acting on it, I have no doubt that the indignities, neglect and abuse experienced by patients daily will continue. While the priority of ward and service managers is cost driven patient welfare is never going to be the main priority. Supposedly open wards with locked doors, informal patients not allowed off the ward unless given permission by staff, lack of privacy, pretence at having single sex wards, ward routines dictated by “medication time” are as much a contributory factor as staff whose first recourse in a patient contact is denigration and abuse. As an aside, if transparency matters it should be made clear that the NHS England National Mental Health Director does not sit as a neutral observer of mental health services but is also a Chief Executive of a large NHS Trust too.
Thanks Samuel, it’s really important to mention and thanks for adding it in.
I have worked in Health and Social care settings in a variety of positions, for the past 11 years I have been qualified as a social worker and now work in a forensic mental health unit. I joined as the head of Social Work and immediately looked at the nature and quality of training in the organisation, especially in relation to safeguarding. In my mind, as a social worker and designated safeguarding lead I have a professional and personal obligation to ensure the safety and wellbeing of the patients in my care.
I now undertake the safeguarding training at all levels within the organisation, whether this is for new staff undertaking their induction training, annual refresher training for nurses or to highly qualified and experienced consultant psychiatrists. I oversee all investigations, when needed, and have advocated most strongly for an open culture of questioning practice and looking at all incidents, irrespective of the perceived severity, with a critically reflective approach to ensure that a toxic culture, such as we see here and at previous incidents (for example Winterbourne View) never becomes instilled.
Leanne’s comment regarding Advocacy is so true. I actually approached the county’s advocacy service when we commissioned a new hospital and asked them to be part of this. They were amazed as they “usually have to push to get into see the detained patients”, which I found completely shocking. This is a legal right for the detained patient and, even if this were not the case, all patients within our organisation would have this support.
I am pleased to say that we have a very good reputation, we constantly hold ourselves up to external scrutiny and will continue to do so. I will never allow a toxic culture to develop here, an ethos echoed by the whole of the clinical management team.
The whole, MH service is rotten to the core. Trust after trust exposed. Nothing ever done. It’s been the same for decades/ centuries.
Janice I agree with you, it is impossible to work in and challenge a work culture that is toxic. But from what I witnessed in a home for residents with mental health needs and learning disabilities; advocates can also get sucked into accepting poor practice and living conditions. The other warning is that this awful institution used to be a run by the NHS but was ‘improved’ by being privatised. So be careful about how changes are made for these patients as the only benefit may be the neo-liberals making huge profits from caring for the most vulnerable in our society. Hey pay minimum wages and minimal training for people who in the right culture may have the capacity to be good carers.
Here is an example of a toxic and closed work culture. My daughter is currently under the ‘care’ of a London CMHT. She made a serious allegation about her male social worker which we were told would be investigated as a complaint. By his direct line manager. When I said this was unacceptable and hardly neutral we were sent a letter signed by the Head of Service which reprimanded us for undermining the professionalism of the investigator. We were also told not to contact him directly about her care during his investigation and were directed to a manager in another team. The unsubtle implication is that we are “difficult” and the social worker and his manager need a buffer from us. They could be right and we could be wrong but turning a query over the independence of an investigator immediately into a confrontation is not an example of an open culture. Defensive practice is not conducive to learning nor is it an open door to a safe environment to report and discuss concerns. It shouldn’t matter but I happen to work as a social worker in the neighbouring borough. If a fellow social worker is treated with suspicion and hostility l dread to think what is meted out to others. The allegation/complaint? Never got investigated as the social worker left before it “could be organised”.
There needs to be information readily available to patients and their carers with a diagnosis of Autism so they can access reasonable adjustments and request a CTR, care treatment review independently from the hospital as the wards are not equipped to support and accommodate people with a diagnosis of Autism.
I was held at a metal health unit in Prestwich unsure If it was at this exact one but have a strong feeling it was. I wasn’t verbally or physically abused as such but was tauntwd by staff told me pacing due to anxiety will make my voluntary section and involuntary one. My partner rang my doctor’s there amwas no records of me being there and was not allowed to leave premises even though it was voluntary. I ended up asking to see paper work I was the allowed to leave premises I didn’t go back in I waited for family to come and then told them I was leaving and again asked for paper work which I did not receive. I believe I was held unlawfully